World Health Assembly

WHA38/1985/REC/1

WORLD HEALTH ORGANIZATION

THIKTY-EIGHTH WORLD HEALTH ASSEMBLY

GENEVA, 6 -20 MAY 1985

RESOLUTIONS AND DECISIONS ANNEXES

GENEVA 1985 ABBREVIATIONS

The following abbreviations are used in WHO documentation:

ACABQ - Advisory Committee on OAU - Organization of African Unity Administrative and Budgetary OECD - Organisation for Economic Questions Co- operation and Development ACC - Administrative Committee on PARO - Pan American Health Organization Coordination PASE - Pan American Sanitary Bureau ACIR - Advisory Committee on Medical SIDA - Swedish International Development Research Authority AGFUND - Arab Gulf Programme for United UNCTAD - United Nations Conference on Trade Nations Development Organizations and Development ASEAN - Association of South-East Asian UNDP - United Nations Development Nations Programme CIDA - Canadian International Development UNDRO - Office of the United Nations Agency Disaster Relief Coordinator CIOMS - Council for International UNEP - United Nations Environment Organizations of Medical Sciences Programme DANIDA - Danish International Development UNESCO - United Nations Educational, Agency Scientific and Cultural ЕСА - Economic Commission for Africa Organization EСE - Economic Commission for Europe UNFDAC - United Nations Fund for Drug Abuse ECLAC - Economic Commission for Latin Control America and the Caribbean UNFPA - United Nations Fund for Population ECWA - Economic Commission for Western Activities Asia UNHCR - Office of the United Nations High ESCAP - Economic and Social Commission for Commissioner for Refugees Asia and the Pacific UNICEF - United Nations Children's Fund FAO - Food and Agriculture Organization UNIDO - United Nations Industrial of the United Nations Development Organization IAEА - International Atomic Energy Agency UNITAR - United Nations Institute for IARC - International Agency for Research Training and Research on Cancer UNRWA - United Nations Relief and Works IBRD - International Bank for Agency for Palestine Refugees Reconstruction and Development in the Near East (World Bank) UNSCEAR - United Nations Scientific Committee ICAO - International Civil Aviation on the Effects of Atomic Organization Radiation 'FAD - International Fund for USAID - United States Agency for Agricultural Development International Development ILO - International Labour Organisation WFP - World Food Programme (Office) WHO - World Health Organization IMO - International Maritime Organization WIPO - World Intellectual Property ‚TU - International Telecommunication Organization Union WMO - World Meteorological Organization NORAD - Norwegian Agency for International Development

The designations employed and the presentation of the material in this volume do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Where the designation "country or area" appears in the headings of tables, it covers countries, territories, cities or areas. PREFACE

The Thirty -eighth World Health Assembly was held at the Palais des Nations, Geneva, from 6 to 20 May 1985, in accordance with the decision of the Executive Board at its seventy -fourth session. Its proceedings are published in three volumes, containing, in addition to other relevant material:

Resolutions and decisions,1 and list of participants - document WHA38 /1985 /REC /1

Verbatim records of plenary meetings, and committee reports - document WHA38 /1985/REC/2

Summary records of committees - document WHA38 /1985/REC/3

1 The resolutions, which are reproduced in the order in which they were adopted, have been cross -referenced to the relevant sections of the WHO Handbook of Resolutions and Decisions, and are grouped in the table of contents under the appropriate subject headings. This is to ensure continuity with the Handbook, Volumes I and II of which contain most of the resolutions adopted by the Health Assembly and the Executive Board between 1948 and 1984. A list of the dates of sessions, indicating resolution symbols and the volumes in which the resolutions and decisions were first published, is given in Volume II of the Handbook (page XIII).

Index to resolutions and decisions: page 177

coNтENтs

Page

Preface iii

Agenda ix

RESOLUTIONS AND DECISIONS

PRO GRAMME

Strategies for health for all

WHА38.16 Additional support to national strategies for health for all in the least developed among developing countries 12

WHA38.20 Implementation of strategies for health for all by the year 2000 . 15

WHA38.21 Maintenance of national health budgets at a level compatible with

attainment of the objective of health for all by the year 2000 . . 15

WHА38.31 Collaboration with nongovernmental organizations in implementing the Global Strategy for Health for All 25

Technical cooperation

WHА38.23 Technical cooperation among developing countries in support of the goal of health for all 17

WHA38.2б Health and medical assistance to Lebanon 19

WHА38.28 Liberation struggle in southern Africa: assistance to the front- line States, Lesotho and Swaziland 22

WHA38.29 Emergency health, medical and social assistance to drought -, famine- and other disaster -affected countries in Africa 22

WHO's general programme development and management

Decision 9 Report of the Director -General on the work of WHO in 1984 30

General health protection and promotion

WHA38.19 Prevention of hearing impairment and deafness 14

Protection and promotion of the health of specific population groups

WHА38.22 Maturity before childbearing and promotion of responsible parenthood 16

Diagnostic, therapeutic and rehabilitative technology

WHA38.18 Prevention of disability and rehabilitation of the disabled 13

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Disease prevention and control

WHA38.24 Malaria control 18

WHA38.30 Prevention and control of chronic noncommunicable diseases 23

PROGRAMME BUDGET

Policy and guiding principles

WHA38.11 Regional programme budget policies 8

Consideration and approval

WHA38.4 Report on casual income, budgetary exchange rates and other

adjustments to the proposed programme budget for 1986 -1987 . . . . 2

WHA38.32 Appropriation resolution for the financial period 1986 -1987 26

GOVERNING BODIES

World Health Assembly

Decision 1 Composition of the Committee on Credentials 28

Decision 2 Composition of the Committee on Nominations 28

Decision 3 Election of officers of the Thirty-eighth World Health Assembly . . 28

Decision 4 Election of officers of the main committees 28

Decision 5 Establishment of the General Committee 29

Decision 6 Adoption of the agenda 29

Decision 7 Appointment of the General Chairman of the Technical Discussions at the Thirty-eighth World Health Assembly 29

Decision 8 Verification of credentials 29

Decision 14 Place of future Health Assemblies 31

Decision 15 Selection of the country in which the Thirty-ninth World Health Assembly will be held 31

Executive Board

WHA38.14 Number of members of the Executive Board 10

Decision 10 Election of Members entitled to designate a person to serve on the Executive Board 30

Decision 13 Reports of the Executive Board on its seventy -fourth and seventy - fifth sessions 31

REGIONAL MATTERS

Delineation of and assignments to regions

WHA38.1 Assignment of Israel to the European Region 1

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FINANCIAL AND ADMINISTRATIVE MATTERS

Financial matters

WHA38.2 Interim financial report for the year 1984 1

WHA38.3 Status of collection of assessed contributions and status of advances to the Working Capital Fund 1

WHA38.5 Assessment of Saint Christopher and Nevis 2

WHA38.6 Assessment of Brunei Darussalam 3

WHA38.7 Scale of assessments for the financial period 1986 -1987 3

WHA38.8 Review of the Working Capital Fund 6

WHA38.9 Real Estate Fund 8

WHA38.13 Members in arrears in the payment of their contributions to an extent which may invoke Article 7 of the Constitution 10

Staff matters

WHA38.10 Salaries and allowances for ungraded posts and the Director -General . 8

WHA38.12 Recruitment of international staff in WHO 9

Decision 11 Annual report of the United Nations Joint Staff Pension Board for 1983 31

Decision 12 Appointment of representatives to the WHO Staff Pension Committee . . 31

EXTERNAL COORDINATION FOR HEALTH AND SOCIAL DEVELOPMENT

United Nations system

WHА38.15 Health conditions of the Arab population in the occupied Arab territories, including Palestine 11

WHA38.17 Repercussions on health of economic and political sanctions between States 13

WHА38.25 Health assistance to refugees and displaced persons in Cyprus . . . 19

WHА38.27 Women, health and development 20

ANNEXES

1. Report on casual income, budgetary exchange rates and other adjustments to the proposed programme budget for 1986 -1987 35

2. Contributions of Members and Associate Members to the programme budget for the financial period 1986 -1987 40

3. Guidelines for preparing a regional programme budget policy 44

4. Number of members of the Executive Board 95

5. Emergency health and medical assistance to drought -stricken and famine -affected countries in Africa 98

6. Report of the Director -General on the work of WHO in 1984 and progress report on the Global Strategy for Health for All by the Year 2000 107 Page

MEMBERSHIP OF THE HEALTH ASSEMBLY

List of delegates and other participants 131

Representatives of the Executive Board 174

Officers of the Health Assembly and membership of its committees 175

Index to resolutions and decisions 177 AGENDA1

PLENARY MEETINGS

1. Opening of the session

2. Appointment of the Committee on Credentials

3. Election of the Committee on Nominations

4. Election of the President and the five Vice -Presidents

5. Election of the Chairman of Committee A

6. Election of the Chairman of Committee В

7. Establishment of the General Committee

8. Adoption of the agenda and allocation of items to the main committees

9. [deleted)

10. Review and approval of the reports of the Executive Board on its seventy-fourth and seventy-fifth sessions

11. Review of the report of the Director- General on the work of WHO in 1984

12. Assignment of Israel to the European Region

13. Election of Members entitled to designate a person to serve on the Executive Board

14. Presentation of the Léon Bernard Foundation Medal and Prize

15. Presentation of the Dr A. T. Shousha Foundation Medal and Prize

16. Presentation of the Jacques Parisot Foundation Medal

17. Presentation of the Child Health Foundation Medal and Prize

18. Presentation of the Sasakawa Health Prize

19. Approval of reports of main committees

20. Closure of the Thirty-eighth World Health Assembly

COMMITTEE A

21. Election of Vice -Chairmen and Rapporteur

22. Proposed programme budget for the financial period 1986 -1987

22.1 General policy matters 22.2 Programme policy matters 22.3 Financial policy matters

1 The agenda was adopted, as amended, at the third plenary meeting. THIRTY -EIGHTH WORLD HEALTH ASSEMBLY

COMMITTEE B

23. Election of Vice -Chairmen and Rapporteur

24. Review of the financial position of the Organization

24.1 Interim financial report on the accounts of WHO for 1984 and comments thereon of the Committee of the Executive Board to Consider Certain Financial Matters prior to the Health Assembly 24.2 Status of collection of assessed contributions and status of advances to the Working Capital Fund 24.3 Members in arrears in the payment of their contributions to an extent which may invoke Article 7 of the Constitution 24.4 Report on casual income, budgetary exchange rates and other adjustments to the proposed programme budget for 1986 -1987

25. [deleted]

26. Scale of assessments

26.1 Assessment of new Members and Associate Members 26.2 Scale of assessments for the financial period 1986 -1987

27. Working Capital Fund

27.1 [deleted] 27.2 [deleted] 27.3 Review of the Working Capital Fund

28. Real Estate Fund

29. Salaries and allowances for ungraded posts and the Director -General

30. Recruitment of international staff in WHO: biennial report

31. Number of members of the Executive Board

32. Health conditions of the Arab population in the occupied Arab territories, including Palestine

33. Collaboration within the United Nations system

33.1 General matters 33.2 Women, health and development 33.3 Health assistance to refugees and displaced persons in Cyprus 33.4 Health and medical assistance to Lebanon 33.5 Liberation struggle in southern Africa: assistance to the front -line States, Lesotho and Swaziland 33.6 Emergency health and medical assistance to drought-stricken and famine -affected countries in Africa

34. United Nations Joint Staff Pension Fund

34.1 Annual report of the United Nations Joint Staff Pension Board for 1983 34.2 Appointment of representatives to the WHO Staff Pension Committee

-х- RESOLUTIONS

WHA38.1 Assignment of Israel to the European Region

The Thirty -eighth World Health Assembly,

Having considered the request from the Government of Israel for the inclusion of that country in the European Region;

RESOLVES that Israel shall form part of the European Region.

Hbk Res., Vol. II (1985), 4.1.3 (Eleventh plenary meeting, 13 May 1985)

WHA38.2 Interim financial report for the year 1984

The Thirty- eighth World Health Assembly,

Having examined the interim financial report for the year 1984;1

Having noted the report of the Committee of the Executive Board to Consider Certain Financial Matters prior to the Thirty- eighth World Health Assembly;2

ACCEPTS the Director- General's interim financial report for the year 1984.

Hbk Res., Vol. II (1985), 6.1.10.3 (Eleventh plenary meeting, 13 May 1985 - Committee B, first report)

WHA38.3 Status of collection of assessed contributions and status of advances to the Working Capital Fund

The Thirty- eighth World Health Assembly

1. NOTES the status, as at 7 May 1985, of the collection of assessed contributions and of advances to the Working Capital Fund, as reported by the Director- General;3

2. CALLS THE ATTENTION of Members to the importance of paying their annual instalments as early as possible in the year in which they are due, in order that the approved programme can be carried out as planned;

3. URGES Members in arrears to make special efforts to liquidate their arrears during 1985;

4. REQUESTS the Director -General to communicate this resolution to Members in arrears and to draw their attention to the fact that continued delay in payment could have serious financial implications for the Organization.

Hbk Res., Vol. II (1985), 6.1.2.4 (Eleventh plenary meeting, 13 May 1985 - Committee B, first report)

1 Document А38/5 and Corr.1. 2 Document А38/23. Document А38/6.

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WHA38.4 Report on casual income, budgetary exchange rates and other adjustments to the proposed programme budget for 1986 -19871

The Thirty-eighth World Health Assembly,

Having considered the recommendation of the Executive Board on the use of casual income to reduce adverse effects of currency fluctuations on the programme budget for the financial period 1986 -1987;

1. AUTHORIZES the Director -General, notwithstanding the provisions of Financial Regulation 4.1 and the terms of the Appropriation Resolution for the financial period 1986 -1987, to charge against available casual income the net additional costs to the Organization under the regular programme budget resulting from differences between the WHO budgetary rate of exchange and the United Nations /WHO accounting rates of exchange with respect to the US dollar /Swiss franc relationship prevailing during this financial period, provided that such charges against casual income shall not exceed US$ 20 000 000 in 1986 -1987;

2. REQUESTS the Director-General, notwithstanding the provisions of Financial Regulation 4.1 and the terms of the Appropriation Resolution for the financial period 1986 -1987, to transfer to casual income the net savings under the regular programme budget resulting from differences between the WHO budgetary rate of exchange and the United Nations /WHO accounting rates of exchange with respect to the US dollar /Swiss franc relationship prevailing during this financial period, provided that, having regard to inflationary trends and other factors which may affect the implementation of the regular programme budget, such transfers to casual income need not exceed US$ 20 000 000 in 1986 -1987;

3. FURTHER REQUESTS the Director -General to report such charges or transfers in the financial report for the financial period 1986 -1987;

4. STRESSES the importance of Members' paying their contributions to the Organization's budget in accordance with Financial Regulations 5.3 and 5.6, that is, not later than the first day of the year to which they relate, in order that the approved programme may be carried out as planned.

Hbk Res., Vol. II (1985), 2.3 (Eleventh plenary meeting, 13 May 1985 - Committee B, first report)

WHA38.5 Assessment of Saint Christopher and Nevis

The Thirty- eighth World Health Assembly,

Noting that Saint Christopher and Nevis, a Member of the United Nations, became a Member of the World Health Organization by depositing with the Secretary -General of the United Nations a formal instrument of acceptance of the WHO Constitution on 3 December 1984;

Noting that the United Nations General Assembly, in resolution 39/247, established the assessment of Saint Christopher and Nevis at the rate of 0.01% for the years 1983 to 1985;

Recalling the principle established in resolution WHA8.5, and confirmed in resolution WHA24.12, that the latest available United Nations scale of assessments should be used as a basis for determining the scale of assessments to be used by WHO;

Recalling further that the Twenty-sixth World Health Assembly, in resolution WHA26.21, affirmed its belief that the scale of assessments in WHO should follow as closely as possible that of the United Nations;

1 See Annex 1. RESOLUTIONS AND DECISIONS 3

DECIDES:

(1) that Saint Christopher and Nevis shall be assessed at the rate of 0.01% for the financial period 1984 -1985 and future financial periods;

(2) that Saint Christopher and Nevis' assessment relating to the year 1984 shall be reduced to one -ninth of 0.01%.

Hbk Res., Vol. II (1985), 6.1.2.2 (Eleventh plenary meeting, 13 May 1985 - Committee B, first report)

WHA38.6 Assessment of Brunei Darussalam

The Thirty -eighth World Health Assembly,

Noting that Brunei Darussalam, a Member of the United Nations, became a Member of the World Health Organization by depositing with the Secretary -General of the United Nations a formal instrument of acceptance of the WHO Constitution on 25 March 1985;

Noting that the United Nations General Assembly, in resolution 39/247, established the assessment of Brunei Darussalam at the rate of 0.03% for the years 1983 to 1985;

DECIDES:

(1) that Brunei Darussalam shall be assessed at the rate of 0.03% for the second year of the financial period 1984 -1985 aid future financial periods;

(2) that Brunei Darussalam's assessment relating to the year 1985 shall be reduced to one -third of 0.03 %.

Hbk Res., Vol. II (1985), 6.1.2.2 (Eleventh plenary meeting, 13 May 1985 - Committee B, first report)

WHA38.7 Scale of assessments for the financial period 1986 -19871

The Thirty- eighth World Health Assembly

1. DECIDES that the scale of assessments for 1986 -1987 shall, subject to the provisions of paragraph 2 below, be as follows:

Member Assessment

(percentage)

Afghanistan 0.01 Albania 0.01 Algeria 0.13 Angola 0.01 Antigua and Barbuda 0.01 Argentina 0.70 Australia 1.54 Austria 0.74

1 See Annex 2. 4 THIRTY -EIGHTH WORLD HEALTH ASSEMBLY

Member Assessment

(percentage)

Bahamas 0.01 Bahrain 0.01 Bangladesh 0.03 Barbados 0.01 Belgium 1.26 Benin 0.01 Bhutan 0.01 Bolivia 0.01 Botswana 0.01 Brazil 1.36 Brunei Darussalam 0.03 Bulgaria 0.18 Burkina Faso 0.01 Burma 0.01 Burundi 0.01 Byelorussian Soviet Socialist Republic 0.35 Cameroon 0.01 Canada 3.02 Cape Verde 0.01 Central African Republic 0.01 Chad 0.01 Chile 0.07 China 0.86 Colombia 0.11 Comoros 0.01 Congo 0.01 Cook Islands 0.01 Costa Rica 0.02 Cuba 0.09 Cyprus 0.01 Czechoslovakia 0.74 Democratic Kampuchea 0.01 Democratic People's Republic of Korea 0.05 Democratic Yemen 0.01 Denmark 0.74 Djibouti 0.01 Dominica 0.01 Dominican Republic 0.03 Ecuador 0.02 Egypt 0.07 El Salvador 0.01 Equatorial Guinea 0.01 Ethiopia 0.01 Fiji 0.01 Finland 0.47 France 6.39 Gabon 0.02 Gambia 0.01 German Democratic Republic 1.36 Germany, Federal Republic of 8.38 Ghana 0.02 Greece 0.39 Grenada 0.01 Guatemala 0.02 Guinea 0.01 Guinea- Bissau 0.01 Guyana 0.01 Haiti 0.01 Honduras 0.01 Hungary 0.22 RESOLUTIONS AND DECISIONS 5

Member Assessment

(percentage)

Iceland 0.03 India 0.35 Indonesia 0.13 Iran (Islamic Republic of) 0.57 Iraq 0.12 Ireland 0.18 Israel 0.22 Italy 3.67 Ivory Coast 0.03 Jamaica 0.02 Japan 10.13 Jordan 0.01 Kenya 0.01 Kiribati 0.01 Kuwait 0.24 Lao People's Democratic Republic 0.01 Lebanon 0.02 Lesotho 0.01 Liberia 0.01 Libyan Arab Jamahiriya 0.25 Luxembourg 0.06 Madagascar 0.01 Malawi 0.01 Malaysia 0.09 Maldives 0.01 Mali 0.01 Malta 0.01 Mauritania 0.01 Mauritius 0.01 Mexico 0.86 Monaco 0.01 Mongolia 0.01 Morocco 0.05 Mozambique 0.01 Namibia 0.01 Nepal 0.01 Netherlands 1.75 New Zealand 0.25 Nicaragua 0.01 Niger 0.01 Nigeria 0.19 Norway 0.50 Oman 0.01 Pakistan 0.06 Panama 0.02 Papua New Guinea 0.01 Paraguay 0.01 Peru 0.07 Philippines 0.09 Poland 0.71 Portugal 0.18 Qatar 0.03 Republic of Korea 0.18 Romania 0.19 Rwanda 0.01 Saint Christopher and Nevis 0.01 Saint Lucia 0.01 Saint Vincent and the Grenadines 0.01 Samoa 0.01 San Marino 0.01 Sao Tome and Principe 0.01 6 THIRTY -EIGHTH WORLD HEALTH ASSEMBLY

Member Assessment

(percentage)

Saudi Arabia 0.84 Senegal 0.01 Seychelles 0.01 Sierra Leone 0.01 Singapore 0.09 Solomon Islands 0.01 Somalia 0.01 South Africa 0.40 Spain 1.89 Sri Lanka 0.01 Sudan 0.01 Suriname 0.01 Swaziland 0.01 Sweden 1.29 Switzerland 1.08 Syrian Arab Republic 0.03 Thailand 0.08 Togo 0.01 Tonga 0.01 Trinidad and Tobago 0.03 Tunisia 0.03 Turkey 0.31 Uganda 0.01 Ukrainian Soviet Socialist Republic 1.29 Union of Soviet Socialist Republics 10.34 United Arab Emirates 0.16 United Kingdom of Great Britain and Northern Ireland 4.58 United Republic of Tanzania 0.01 United States of America 25.00 Uruguay 0.04 Vanuatu 0.01 Venezuela 0.54 Viet Nam 0.02 Yemen 0.01 Yugoslavia 0.45 Zaire 0.01 Zambia 0.01 Zimbabwe 0.02

2. REQUESTS the Director-General, in the event that assessments are fixed provisionally or definitively by the present Health Assembly for any new Members, to adjust the scale as set forth in paragraph 1.

Hbk Res., Vol. II (1985), 6.1.2.1 (Eleventh plenary meeting, 13 May 1985 - Committee В, first report)

WHA38.8 Review of the Working Capital Fund

The Thirty- eighth World Health Assembly,

Having considered the recommendations of the Executive Board on the Working Capital Fund ;I A 1. DECIDES that

(1) Part I of the Working Capital Fund, composed of advances assessed on Members and Associate Members, shall be established in the amount of US$ 5 132 750, to which

1 See document ЕB75 /1985 /REC /1, resolution EВ75.R11 and Annex 4. RESOLUTIONS AND DECISIONS 7

shall be added the assessments of any Members or Associate Members joining the Organization after 30 September 1984;

(2) the advances to the Working Capital Fund shall be assessed on the basis of the scale of assessments adopted by the Thirty- eighth World Health Assembly for the financial period 1986 -1987, adjusted to the nearest US$ 10;

(3) any additional advances shall be due and payable on 1 January 1986;

(4) any credits due to Members and Associate Members shall be refunded on 1 January 1986 by applying these credits to any contributions outstanding on that date or to the 1986 assessments;

2. REQUESTS the Members and Associate Members concerned to provide in their national budgets for payment of the additional advances on the due date;

1. DECIDES that Part II of the Working Capital Fund shall remain established at US$ 6 000 000;

2. DECIDES also that Part II of the Working Capital Fund shall continue to be financed by appropriations by the Health Assembly from casual income as recommended by the Executive Board after considering the report of the Director -General; such appropriations shall be voted separately from the appropriations for the relevant financial period;

1. AUTHORIZES the Director -General to advance from the Working Capital Fund:

(1) such funds as may be required to finance the appropriations pending receipt of contributions from Members and Associate Members; sums so advanced shall be reimbursed to the Working Capital Fund as contributions become available;

(2) such sums as may be required during a calendar year to meet unforeseen or extraordinary expenses, and to increase the relevant appropriation sections accordingly, provided that not more than US$ 250 000 are used for such purposes, except that with the prior concurrence of the Executive Board a total of US$ 2 000 000 may be used;

(3) such sums as may be required for the provision of emergency supplies to Members and Associate Members on a reimbursable basis; sums so advanced shall be reimbursed to the Working Capital Fund when payments are received; provided that the total amount so withdrawn shall not exceed uS$ 200 000 at any one time, and provided further that the credit extended to any one Member or Associate Member shall not exceed US$ 50 000 at any one time;

2. REQUESTS the Director-General to report annually to the Health Assembly:

(1) all advances made under the authority vested in him to meet unforeseen or extraordinary expenses and the circumstances relating thereto, and to make provision in the estimates for the reimbursement of the Working Capital Fund, except when such advances are recoverable from other sources;

(2) all advances made under the authority of paragraph C.1(3) for the provision of emergency supplies to Members and Associate Members, together with the status of reimbursement by those concerned;

1. REQUESTS Members and Associate Members to make every effort to pay their contributions on the dates on which they are due, in order to preclude the need to increase the amount of the Working Capital Fund;

2. REQUESTS the Director -General to continue his efforts to secure early payment of Members' and Associate Members' assessed contributions; 8 THIRTY -EIGHTH WORLD HEALTH ASSEMBLY

REQUESTS the Director -General to submit a report on the Working Capital Fund to the Executive Board and the Health Assembly when he considers it warranted.

Hbk Res., Vol. II (1985), 6.1.3 (Eleventh plenary meeting, 13 May 1985 - Committee B, first report)

WHA38.9 Real Estate Fund

The Thirty- eighth World Health Assembly,

Having considered resolution EВ75.R12 and the report of the Director-Genera 11 on the status of projects financed from the Real Estate Fund and the estimated requirements of the Fund for the period 1 June 1985 to 31 May 1986;

Recognizing that certain estimates must necessarily remain provisional because of the fluctuation of exchange rates;

AUTHORIZES the financing from the Real Estate Fund of the expenditures summarized in part III of the Director -General's report, at the estimated cost of US$ 190 000.

Hbk Res., Vol. II (1985), 6.1.7 (Eleventh plenary meeting, 13 May 1985 - Committee B, first report)

WHA38.10 Salaries and allowances for ungraded posts and the Director -General

The Thirty- eighth World Health Assembly,

Noting the recommendations of the Executive Board with regard to remuneration of staff in the ungraded posts and of the Director- General;2

1. CONCURS with the recommendations of the Board; and, in consequence,

2. ESTABLISHES the salary for the posts of Assistant Directors -General and Regional Directors at US$ 107 089 per annum before staff assessment, resulting in a modified net salary of US$ 59 203 (dependency rate) or US$ 53 866 (single rate);

3. ESTABLISHES the salary for the post of Deputy Director -General at US$ 123 197 per annum before staff assessment, resulting in a modified net salary of US$ 65 320 (dependency rate) or US$ 58 918 (single rate);

4. ESTABLISHES the salary for the Director -General at US$ 159 115 per annum before staff assessment, resulting in a modified net salary of US$ 78 430 (dependency rate) or US$ 69 334 (single rate);

5. NOTES that, concurrent with the changes of the salary schedules for these officials, appropriate reduction will be made of the post adjustment rates applicable to these posts;

6. DECIDES that these adjustments in remuneration shall be effective from 1 January 1985.

Hbk Res., Vol. II (1985), 6.2.4.1; 6.2.10 (Eleventh plenary meeting, 13 May 1985 - Committee В, first report)

WHA38.11 Regional programme budget policies3

The Thirty- eighth World Health Assembly,

Recalling numerous Health Assembly resolutions concerning programme budget policy, WHO's international health work through coordination and technical cooperation, and the functions

1 Document EB75 /1985 /REС /1, Annex 5.

2 See document ЕВ75 /1985 /REC /1, resolution EB75.R10 and Annex 3.

See Annex 3. RESOLUTIONS AND DECISIONS 9

and related structures of WHO, and in particular resolutions WHA29.48, WHA30.23, WHA33.17 and WHA34.24;

Having considered resolution EB75.R7 on regional programme budget policies;

1. STRONGLY SUPPORTS the preparation of such policies by the regional committees as requested by the Executive Board;

2. URGES Member States to assume their responsibilities for the preparation and implementation of such policies;

З. ENDORSES the Board's decision to monitor their preparation, as well as to monitor and evaluate their implementation in conjunction with the biennial budget reviews, and to report to the Health Assembly thereon;

4. DECIDES to monitor and evaluate their implementation in the light of the Executive Board's reports thereon;

5. REQUESTS the Director -General to provide full support to Member States and to the Health Assembly, regional committees and Executive Board, for the preparation, implementation, monitoring and evaluation of the regional programme budget policies.

Hbk Res., Vol. II (1985), 2.1 (Twelfth plenary meeting, 14 May 1985 - Committee A, first report)

WHA38.12 Recruitment of international staff in WHO

The Thirty -eighth World Health Assembly,

Noting the report' and proposals of the Director -General and the views of the Executive Board2 with regard to the recruitment of international staff in WHO;

Recalling earlier resolutions of the Health Assembly and the Executive Board on the same subject, and in particular resolution WHA36.19;

Noting the progress made between October 1982 and October 1984 in the geographical representativeness of the staff and in the proportion of women on the staff of WHO;

Noting also the special efforts made by the Director -General to increase significantly the proportion of women staff members;

1. DECIDES to maintain the target of 40% of all vacancies arising in professional and higher -graded posts subject to geographical distribution during the period ending October 1986 for the appointment of nationals of unrepresented and under -represented countries;

2. DECIDES to raise to 30% the target set for the proportion of all professional and higher -graded posts in established offices to be occupied by women;

3. REITERATES again the urgent request to Member States to assist the Director -General in his efforts to increase the number of women on the staff by proposing a much higher proportion of well -qualified and experienced women candidates;

4. CALLS UPON the Director -General and the Regional Directors to pursue energetically their efforts to continue to improve both the geographical representativeness of the staff and the proportion of posts occupied by women;

5. REQUESTS the Director -General to report on the recruitment of international staff in WHO to the Executive Board and the Health Assembly in 1987.

Hbk Res., Vol. II (1985), 6.2.2 (Twelfth plenary meeting, 14 May 1985 - Committee B, second report)

1 See document EB75 /1985 /REС /1, Annex 2.

2 Document EB75/1985/REC/2, summary records of the Board's twenty -fourth and twenty -fifth meetings, pp. 331 -339, 343 -346. 10 THIRTY -EIGHTH WORLD HEALTH ASSEMBLY

WHA38.13 Members in arrears in the payment of their contributions to an extent which may invoke Article 7 of the Constitution

The Thirty- eighth World Health Assembly,

Having considered the report of the Committee of the Executive Board to Consider Certain Financial Matters prior to the Thirty- eighth World Health Assembly on Members in arrears to an extent which may invoke the provisions of Article 7 of the Constitution ;1

Recalling resolution WHA37.7 stating that in future years the Health Assembly should decide to suspend the voting rights of Members subject to Article 7 of the Constitution as a matter of course, unless in a particular case there were exceptional circumstances justifying the retention of the right to vote which had been communicated by the Member concerned;

Having noted that Burundi, Comoros, Guinea- Bissau, Mauritania, Romania, Saint Lucia and Zaire are in arrears to such an extent that it is necessary for the Health Assembly to consider, in accordance with Article 7 of the Constitution, whether or not the voting privileges of these Members should be suspended;

Having noted that Guinea- Bissau and Zaire have indicated that arrangements for the transfer of funds are being made;

Having noted that Burundi and Comoros have conveyed the nature of difficulties they are experiencing in making payment;

Being of the opinion that Mauritania and Saint Lucia are experiencing difficulties similar to those of Burundi and Comoros;

Having noted that the indebtedness of Romania dates from 1981 and that no written communications have been received from Romania by the Director -General since the closure of the Thirty -seventh World Health Assembly in May 1984;

1. EXPRESSES serious concern at the number of Members in recent years which have been subject to Article 7 of the Constitution;

2. DECIDES not to suspend the voting privileges of Burundi, Comoros, Guinea -Bissau, Mauritania, Romania, Saint Lucia and Zaire;

3. URGES these Members to intensify efforts in order to regularize their position;

4. REQUESTS the Director -General to communicate this resolution to the Members concerned.

Hbk Res., Vol. II (1985), 6.1.2.4 (Twelfth plenary meeting, 14 May 1985 - Committee B, second report)

WHA38.14 Number of members of the Executive Board2

The Thirty- eighth World Health Assembly,

Having considered resolution EB75.R4 of the Executive Board and resolution WPR /RC35.R10 of the thirty -fifth session of the Regional Committee for the Western Pacific;

Recognizing the need to increase the number of Members from the Western Pacific Region entitled to designate a person to serve on the Executive Board from the current three to four, taking into account the recent increase in the number of Members in the Region and the size of its population;

1 Document А38/24. 2 See Annex 4. RESOLUTIONS AND DECISIONS 11

REQUESTS the Director-General to propose for the consideration of the Thirty -ninth World Health Assembly draft amendments to the Constitution in order to increase the membership of the Executive Board from 31 to 32, so that the number of Members of the Western Pacific Region entitled to designate a person to serve on the Executive Board be increased to four, and to transmit such draft amendments to Members at least six months in advance of their consideration, in accordance with the provision of Article 73 of the Constitution.

Hbk Res., Vol. II (1985), 3.2.1; 5.1 (Twelfth plenary meeting, 14 May 1985 - Committee B, second report)

WHA38.15 Health conditions of the Arab population in the occupied Arab territories, including Palestine

The Thirty- eighth World Health Assembly,

Mindful of the basic principle established in the WHO Constitution, which affirms that the health of all peoples is fundamental to the attainment of peace and security;

Aware of its responsibility for ensuring proper health conditions for all peoples who suffer from exceptional situations, including foreign occupation and especially settler colonialism;

Affirming the principle that the acquisition of territories by force is inadmissible and that any occupation of territories by force has serious repercussions on the health and psychosocial conditions of the people under occupation, including mental and physical health, and that this can be rectified only by the complete and immediate termination of the occupation;

Considering that the States parties to the Geneva Convention of 12 August 1949 pledged themselves, under Article One thereof, not only to respect the Convention but also to ensure that it was respected in all circumstances;

Recalling United Nations General Assembly resolutions 39/49, 39/95 and 39/169 as well as all other United Nations resolutions relative to the questions of Palestine and the Middle East;

Mindful of the struggle that the Palestinian people, led by the Palestine Liberation Organization, their sole legitimate representative, have waged for their rights to self -determination, to return to their homeland and to establish their independent State in Palestine;

Reiterating the support for this struggle expressed in many resolutions of the United Nations and other international institutions and organizations that call for the immediate and unconditional withdrawal of Israel from the occupied Arab territories, including Palestine;

Taking note of the report of the Special Committee of Experts;1

Considering the right of the peoples to organize for themselves, and through their institutions, the provision of their own health and social services;

1. REAFFIRMS resolutions WHA37.26, WHA36.27 and previous relevant resolutions of the Health Assembly;

2. CONDEMNS Israel for its continuing occupation of Arab territories, its arbitrary practices against the Arab population, and its continuing establishment of Israeli settlements in the occupied Arab territories, including Palestine and the Golan; and for its illegal exploitation of the natural wealth and resources of the Arab inhabitants in those territories, especially the appropriation of water resources and their diversion for the purpose of occupation and settlement, all of which have devastating and long -term effects on the mental and physical health conditions of the population under occupation;

1 Document A38/10. 12 THIRTY- EIGHTH WORLD HEALTH ASSEMBLY

3. CONDEMNS Israel for its policy aiming at making the population of the occupied Arab territories, including Palestine and the Golan, dependent on the Israeli health system, by hindering the normal development of the Arab health institutions, as part of Israel's overall plan of annexation of those territories;

4. CONDEMNS Israel for continuously raising obstacles to the implementation of resolution WHA36.27, sub -paragraph 8(2), which requests the establishment of three health centres in the occupied Arab territories, including Palestine, under the direct supervision of WHO;

5. DEMANDS an immediate end to occupation, violence and repression, and to the establishment of new settlements; also demands that those settlements already established be dismantled, in order to enable the Palestinian people to exercise its inalienable national rights, as a prerequisite to the establishment of a social and health system that would be able to ensure health for all by the year 2000;

6. THÀNKS the Director -General for his efforts to implement sub -paragraph 8(2) of resolution WHА36.27 and requests that he pursue these efforts until the full implementation of this resolution and submit a report to the Thirty -ninth World Health Assembly;

7. REAFFIRMS the right of the Palestinian people to have its own institutions which provide medical and social services, and requests the Director -General:

(1) to collaborate and coordinate further with the Arab States concerned and with the Palestine Liberation Organization regarding the provision of the necessary assistance to the Palestinian people;

(2) to help the Palestinian people and their health institutions to promote primary health care inside and outside the occupied Palestinian territories, by developing sufficient health and social services, and by the training of additional health personnel, in order to reach health for all by the year 2000;

(3) to monitor the health conditions of the Arab population in the occupied Arab territories, including Palestine, and report regularly to the Health Assembly;

8. THANKS the Special Committee of Experts for its report and requests it to continue its task with respect to all the implications of occupation and the policies of the occupying Israeli authorities and their various practices which adversely affect the physical and psychological health of the Arab inhabitants in the occupied Arab territories, including Palestine, and to report to the Thirty-ninth World Health Assembly, in coordination with the Arab States concerned and the Palestine Liberation Organization.

Hbk Res., Vol. II (1985), 7.1.4.4 (Fourteenth plenary meeting, 16 May 1985 - Committee B, third report)

WHА38.16 Additional support to national strategies for health for all in the least developed among developing countries

The Thirty -eighth World Health Assembly,

Realizing that the deteriorating health situation in the least developed among developing countries stands in flagrant contradiction to the Global Strategy for Health for All adopted unanimously by WHO's Member States;

REQUESTS the Director -General:

(1) to mobilize new financial and technical resources to support national strategies for health for all in the least developed among developing countries within the existing Special Account for Assistance to the Least Developed among Developing Countries in the Voluntary Fund for Health Promotion;

(2) to prepare a report for further consideration by the Executive Board and the Health Assembly on possible actions which can support these countries in strengthening their health infrastructures and thereby enhance their capacities to attract and absorb RESOLUTIONS AND DECISIONS 13

significant quantities of new health resources, including the establishment of a special trust health fund to assist them, the strengthening of existing special funds, and /or other actions in this respect.

Hbk Res., Vol. II (1985), 1.1 (Fourteenth plenary meeting, 16 May 1985 - Committee B, third report)

WHA38.17 Repercussions on health of economic and political sanctions between States

The Thirty-eighth World Health Assembly,

Bearing in mind the principle set out in the WHO Constitution that the health of all peoples is fundamental to the attainment of peace and security;

Reaffirming that resolution 2625 (XXV) of the United Nations General Assembly concerning friendly relations and cooperation among States remains fully applicable to the solution of the problems facing countries;

Recalling resolution 39/210 of the United Nations General Assembly deploring the fact that some developed countries continue to apply economic measures that have the purpose of exerting political coercion on the sovereign decisions of developing countries, and reaffirming that developed countries should refrain from threatening or applying trade restrictions, blockades, embargoes and other sanctions;

Bearing in mind that the efforts of Member States to improve the health of their peoples may be seriously affected by the application of coercive economic, commercial or political measures by other countries;

1. REITERATES the basic principles regarding the happiness, harmonious relations and security of all peoples, as set out in the WHO Constitution;

2. EXPRESSES its concern that political or economic differences between countries may give rise to actions that obstruct the attainment of the fundamental aims of WHO and prejudice the development of the health programmes of any Member State;

3. DEPLORES the application by any country of measures of this kind against any other country or countries;

4. URGES all Member States to refrain from adopting measures of this kind and to put an end to those currently in force;

5. REQUESTS Member States to maintain and increase their collaboration with countries affected in this way;

6. REQUESTS the Director -General to keep the worldwide situation in this respect under constant review and to take the necessary steps to ensure that. WHO collaborates in preventing and offsetting the unfavourable effects on health.

Hbk Res., Vol. II (1985), 7.1.1 (Fourteenth plenary meeting, 16 May 1985 - Committee B, third report)

WHA38.18 Prevention of disability and rehabilitation of the disabled

The Thirty -eighth World Health Assembly,

Recalling resolutions WНА19.37 and WHA29.68;

Noting the great medical, economic, social and psychological impact caused by disability to millions of people throughout the world;

Stressing the importance of the United Nations Decade of Disabled Persons, as underlined in United Nations General Assembly resolution 39/26 concerning the Decade; 14 THIRTY -EIGHTH WORLD HEALTH ASSEMBLY

Stressing the need to integrate fully activities for the prevention of disability and rehabilitation of the disabled within the framework of the strategies for health for all by the year 2000;

1. CALLS ON Member States:

(1) to emphasize the prevention of disability by achieving the goals of the Expanded Programme on Immunization and by strengthening environmental, occupational and other health programmes;

(2) to increase opportunities for the participation of disabled persons in social, cultural, religious, recreational and community life, and in decision- making at all levels;

(3) to expand education, training and job opportunities for disabled persons;

(4) to facilitate the increased acceptance of disabled persons through communication and education programmes for the general population;

(5) to increase public awareness and education so as to prevent disabling accidents at home, at work, and on the road;

(6) to remove all barriers, whether relating to architecture, transportation, communications or legal considerations, in order to permit disabled persons to participate fully and enjoy equality of opportunity;

2. REQUESTS the Director -General:

(1) to intensify his efforts to publicize the Decade and the goals of the World Programme of Action concerning Disabled Persons;

(2) to support government efforts to prevent disabling diseases and conditions, giving special priority to achieving the goals of the Expanded Programme on Immunization by 1990, in view of the short-term impact on the reduction of disability to be expected merely from the decrease in poliomyelitis and the potential for eventual elimination of this disease, and to support governments in improving environmental, occupational and other health programmes;

(3) within existing resources, or with voluntary contributions, to support governments in expanding community -based rehabilitation services and self -help programmes involving disabled persons and their families;

(4) to ensure that WHO, at both headquarters and regional offices, removes barriers in order to permit full participation and provide equal opportunities for all, including the disabled;

(5) to ensure that WHO's programmes for prevention of disability and rehabilitation of the disabled are integrated fully with the implementation of the strategies for health for all by the year 2000;

(6) to intensify WHO's collaboration and coordination with other concerned agencies and voluntary bodies in programmes aimed at prevention of disability and rehabilitation of the disabled.

Hbk Res., Vol. II (1985), 1.15.5 (Fourteenth plenary meeting, 16 May 1985 - Committee В, third report)

WHA38.19 Prevention of hearing impairment and deafness

The Thirty- eighth World Health Assembly,

Recognizing that the attainment of health for all requires increased activity for the prevention of hearing impairment, which affects at least 8% of the population in every country, and of deafness, which is estimated to afflict 70 million people in the world; RESOLUTIONS AND DECISIONS 15

Recognizing also that in developing countries most of the hearing impairment, which occurs in excessive prevalence in some communities, results from causes that can be prevented at the primary health care level, and that much of the deafness is reversible or remediable;

Aware of the international action being taken to limit the misuse of ototoxic agents and to reduce noise -induced occupational deafness;

Aware also of the rapid advance of technology in otolaryngology and audiology and of the development in some countries of mass treatment programmes using techniques appropriate for the control of hearing impairment and deafness;

Welcoming the readiness of the international nongovernmental organizations to coordinate their activities in support of global, regional and national programmes for the prevention of hearing impairment aid deafness;

REQUESTS the Director -General, in collaboration with governments and appropriate nongovernmental organizations, to assess the extent, causes and consequences of hearing impairment and deafness in all countries, and to make proposals to the Thirty -ninth World Health Assembly for strengthening measures of prevention aid treatment within existing programmes of health and development.

Hbk Res., Vol. II (1985), 1.11 (Fourteenth plenary meeting, 16 May 1985 - Committee A, second report)

WHA38.20 Implementation of strategies for health for all by the year 2000

The Thirty- eighth World Health Assembly,

Bearing in mind the serious adverse implications of the continuing economic crisis afflicting many countries for international development, cooperation, national development policies, the achievement of balanced economic and social development, and the availability of international and national resources for health;

Recalling that the Member States of WHO have unanimously adopted a long -term common policy and strategy for achieving the goal of health for all by the year 2000;

Considering that the present critical economic situation in many countries is a serious constraint to the achievement of this goal;

Emphasizing the importance arid urgency of devising effective measures to overcome this constraint and to ensure the achievement of the goal of health for all by the year 2000;

REQUESTS the Director -General;

(1) to prepare a report on the repercussions of the world economic situation on the national, regional and global efforts undertaken by Member States in order to achieve the goal of health for all by the year 2000, including recommendations on ways and means of achieving that goal, for submission to the Executive Board at its seventy -seventh session arid to the Thirty -ninth World Health Assembly;

(2) to transmit his report to the Secretary -General of the United Nations for circulation to all its Member States.

Hbk Res., Vol. II (1985), 1.1 (Fifteenth plenary meeting, 17 May 1985 - Committee A, third report)

WHA38.21 Maintenance of national health budgets at a level compatible with attainment of the objective of health for all by the year 2000

The Thirty- eighth World Health Assembly,

Conscious of the enormous differences in levels of health between the developed and the developing countries, which lack the human, material and financial resources needed to cope with their substantial health problems and to build up their national health services; 16 THIRTY- EIGHTH WORLD HEALTH ASSEMBLY

Bearing in mind the economic crisis affecting the developing countries;

Considering, furthermore, that policies for economic recovery practised by many countries may affect the health services and thus bring in their train pernicious consequences for socioeconomic development;

Reaffirming resolutions WHA30.43, WHA34.36 and WHA35.23 on the policy, strategy and plan of action for attaining the objective of health for all by the year 2000;

Recalling resolution WHA33.17, in which the Health Assembly decided to concentrate the Organization's activities on the support of strategies designed to achieve that objective;

1. URGES Member States to maintain, or even increase as far as possible, the percentage of national budgetary expenditures devoted to health;

2. REQUESTS the Director -General:

(1) in collaboration with other international organizations and institutions, to support Member States in this action;

(2) to report to a forthcoming Health Assembly on the results of the steps taken in application of this resolution.

Hbk Res., Vol. II (1985), 1.1 (Fifteenth plenary meeting, 17 May 1985 - Committee A, third report)

WHA38.22 Maturity before childbearing and promotion of responsible parenthood

The Thirty- eighth World Health Assembly,

Recalling resolutions WHA31.55 and WHA32.42 on the long -term programme on maternal and child health;

Recognizing the disastrous worldwide health, educational, economic and social consequences of premature pregnancy in adolescents, and in particular the high risks of maternal morbidity and mortality, as well as low birth -weight with consequent infant mortality and physical or mental handicap which may persist throughout life;

Recognizing that these effects are compounded where poverty, illiteracy, adverse environmental conditions or undernutrition prevail, and where for many reasons prenatal care is not available or sought;

Aware that a large and increasing proportion of the populations of many Member States is adolescent and that trained health workers and resources, especially in rural areas, are too limited to ensure the provision of adequate health services for all;

1. URGES all Member States to act immediately:

(1) to promote healthy families through the provision of adequate information and guidance to adolescents for responsible parenthood;

(2) to promote the delay of childbearing until both prospective parents, and especially the mother, have reached maturity in adulthood;

(3) to ensure that their populations are aware of the need for both prospective parents to be fully grown, adequately nourished, and disease -free before conception;

(4) to ensure that health, education and social service providers are enabled to provide sound, culturally acceptable information and guidance;

2. REQUESTS the Director-General:

(1) to encourage collaborative action-oriented research on both biomedical and culturally relevant social factors contributing to the prevention of pregnancy before RESOLUTIONS AND DECISIONS 17

the couple are biologically and socially mature, and on the adverse consequences of pregnancy and childbirth in adolescence;

(2) to increase the Organization's collaboration with Member States and their relevant governmental and nongovernmental agencies in providing primary health care with the emphasis on health promotion and preventive care for adolescents, including family life education, antenatal, delivery and postnatal care, and supporting family services, as an urgent step in the implementation of the 1978 Declaration of Alma -Ata.

Hbk Res., Vol. II (1985), 1.12.1 (Fifteenth plenary meeting, 17 May 1985 - Committee A, third report)

WHА38.23 Technical cooperation among developing countries in support of the goal of health for all

The Thirty- eighth World Health Assembly,

Recalling resolutions WHA28.75, WHA28.76, WHA29.48, WHA30.30, WHА30.43, WHA31.41, WHА32.27 and WHA34.36, the importance of technical and economic cooperation among developing countries (TCDC /ECDC) as a fundamental element of national, regional and global strategies, and the need to stengthen the WHO programme to promote TCDC /ECDC and provide support to developing countries for the establishment and implementation of that form of cooperation;

Reaffirming resolutions WHA35.24, WHА37.16 and WHA37.17, especially in view of the concrete activities initiated during 1984 in implementing the medium-term programme (1984 -1989) and the initial plan of action (1984 -1985) adopted by the Eighth Meeting of Ministers of Health of the Non -Aligned and other Developing Countries and welcomed by the Thirty -seventh World Health Assembly;

Noting with satisfaction from his introduction to the proposed programme budget for the financial period 1986 -1987 that the Director -General intends to initiate action to build up critical masses of health - for -all leaders, and considering the need for the preparation of a comprehensive strategy for leadership development through a variety of actions;

Expressing appreciation of the concrete action taken by the developing countries in the implementation of their medium -term programme (1984 -1989) and initial plan of action (1984 -1985) in support of the goal of health for all by the year 2000, and particularly the initiation of the process of building up critical masses of health-for -all leaders through international and national colloquia on leadership development for health for all and TCDC and other complementary activities;

Recognizing that the international and national colloquia on leadership development for health for all and TCDC organized in Brioni, Yugoslavia, in 1984 and programmed for 1985 and 1986 in Cuba, Thailand, the United Republic of Tanzania, and Yugoslavia, are concrete efforts for the building -up of critical masses of health -for -all leaders;

1. WELCOMES and strongly supports the priority given by the Director -General, in his introduction to the proposed programme budget for the financial period 1986 -1987, to the objective of building up critical masses of health - for -all leaders;

2. CALLS UPON all Member States, especially developed countries, and international organizations and bilateral, multilateral, nongovernmental and voluntary agencies, to concentrate their technical and financial cooperation on programmes, actions and activities relating to TCDC /ECDC;

3. REQUESTS the Director -General:

(1) to establish and /or strengthen specific focal points for the promotion and support of TCDC /ECDC in the regional offices of WHO, in accordance with resolution WHA32.27, and to strengthen the capacity of WHO programme coordinators at the country level, in order 18 THIRTY- EIGHTH WORLD HEALTH ASSEMBLY

to secure the most effective catalytic action and support of WHO at all levels to countries carrying out TCDC programmes and activities to implement strategies for health for all by the year 2000;

(2) to report to the Executive Board and to the Health Assembly, in even -numbered years, on the progress made in the catalytic and supportive action of WHO for TCDC /ECDC;

4. REQUESTS the Executive Board to give particular importance to the promotion and support of TCDC /ECDC in preparing the Eighth General Programme of Work covering a specific period and when reviewing programme budget proposals.

Hbk Res., Vol. II (1985), 1.2.2.1 (Fifteenth plenary meeting, 17 May 1985 - Committee A, third report)

WНАЭ8.24 Malaria control

The Thirty- eighth World Health Assembly,

Recalling resolutions WHA28.87, W1А29.73 and WНАЭ1.45;

Noting that the problems caused by the spread of malaria in many developing countries in tropical and subtropical zones are adversely affecting health and socioeconomic development in these countries;

Recognizing that coordinated efforts are necessary to prevent further deterioration of the situation;

Bearing in mind that control of malaria is essential in the context of the implementation of the Global Strategy for Health for All by the Year 2000;

Realizing that malaria control programmes are extremely complex and that full and active community involvement is essential in order to achieve the desired objectives;

Taking note of the report of the WHO Study Group on Malaria Control as Part of Primary Health Care;1

1. RECOMMENDS that malaria control should be developed as an integral part of national primary health care systems;

2. URGES the Members States concerned:

(1) to undertake an immediate review and appraisal of the malaria situation and of existing control strategies, in terms of their effectiveness, efficiency, and prospects of achieving and maintaining their objectives, as a basis for planning the necessary modifications to maximize their contribution to the objective of health for all;

(2) in compliance with the targets of the Seventh General Programme of Work, to plan antimalaria activities utilizing appropriate technologies in order to prevent the deterioration of the malaria problem in the immediate future and to ensure sustained progress in control;

(3) to mobilize adequate national resources for malaria control and applied research on malaria;

3. REQUESTS the Director -General to continue his efforts, in coordination with other international agencies, to provide technical support and to assist in the mobilization of adequate resources at national and international levels for malaria control in endemic countries, giving particular attention to the development and strengthening of intercountry technical arid operational collaboration, with emphasis on research for the development of effective methods and means for the prevention and control of malaria, especially the development of vaccines.

Hbk Res., vol. II (1985), 1.16.3.1 (Fifteenth plenary meeting, 17 May 1985 - Committee A, third report)

1 WHO Technical Report Series, No. 712, 1984. RESOLUTIONS AND DECISIONS 19

WHA38.25 Health assistance to refugees and displaced persons in Cyprus

The Thirty- eighth World Health Assembly,

Mindful of the principle that the health of all peoples is fundamental to the attainment of peace and security;

Recalling resolutions WHA28.47, WHA29.44, WНА30.26, WHA31.25, WHA32.18, WHA33.22, WHA34.20, WHA35.18, WHА36.22 and WHA37.24;

Noting all relevant United Nations General Assembly and Security Council resolutions on Cyprus;

Considering that the continuing health problems of the refugees and displaced persons in Cyprus call for further assistance;

1. NOTES with satisfaction the information provided by the Director-Generan on health assistance to refugees and displaced persons in Cyprus;

2. EXPRESSES its appreciation for all the efforts of the Coordinator of United Nations Humanitarian Assistance in Cyprus to obtain the funds necessary for the Organization's action to meet the health needs of the population of Cyprus;

3. REQUESTS the Director -General to continue and intensify health assistance to refugees and displaced persons in Cyprus, in addition to any assistance made available within the framework of the efforts of the Coordinator of United Nations Humanitarian Assistance in Cyprus, and to report to the Thirty -ninth World Health Assembly on such assistance.

Hbk Res., Vol. II (1985), 7.1.4.5. (Fifteenth plenary meeting, 17 May 1985 - Committee B, fourth report)

WHA38.26 Health and medical assistance to Lebanon

The Thirty- eighth World Health Assembly,

Recalling resolutions W1A29.40, WHA30.27, WHА31.26, WHA32.19, WHA33.23, WHA34.21, WHA35.19, WHA36.23 aid WHA37.25 on health and medical assistance to Lebanon;

Taking note of United Nations General Assembly resolutions 33/146 of 20 December 1978, 34/135 of 14 December 1979, 35/85 of 5 December 1980, 36/205 of 16 December 1981, 37/163 of 17 December 1982, 38/220 of 20 December 1983 and 39/197 of 17 December 1984 on international assistance for the reconstruction and development of Lebanon, calling on the specialized agencies, organs and other bodies of the United Nations to expand aid intensify programmes of assistance within the framework of the needs of Lebanon;

Having examined the Director -General's report2 on the action taken by WHO, in cooperation with other international bodies, for emergency health aid medical assistance to Lebanon in 1983 -1984 and the first quarter of 1985;

Aware that the tragic situation that has arisen from the latest events requires urgent assistance and relief to the persons displaced from their homes and regions;

Noting the health and medical assistance provided by the Organization to Lebanon during 1984 -1985;

1. EXPRESSES its appreciation to the Director -General for his continuous efforts to mobilize health and medical assistance for Lebanon;

1 Document А38/13. 2 Document А38/14. 20 THIRTY -EIGHTH WORLD HEALTH ASSEMBLY

2. EXPRESSES also its appreciation to all the international agencies, organs and bodies of the United Nations, and to all governmental and nongovernmental organizations, for their cooperation with WHO in this regard;

3. CONSIDERS that the growing health and medical problems in Lebanon, which have recently reached a critical level, constitute a source of great concern and necessitate thereby a continuation and a substantial expansion of programmes of health and medical assistance to Lebanon;

4. REQUESTS the Director-General to continue and to expand substantially the Organization's programmes of health, medical aid relief assistance to Lebanon and to allocate for this purpose, as far as possible, funds from the regular budget and other financial resources;

5. CALLS UPON the specialized agencies, organs and bodies of the United Nations, and on all governmental and nongovernmental organizations, to intensify their cooperation with WHO in this field, and in particular to put into operation the recommendations of the report on the reconstruction of the health services of Lebanon;

6. CALLS ALSO UPON Member States to increase their technical and financial support for relief operations and the reconstruction of the health services of Lebanon in consultation with the Ministry of Health and Social Affairs in Lebanon;

7. REQUESTS the Director-General to report to the Thirty -ninth World Health Assembly on the implementation of this resolution.

Hbk Res., Vol. II (1985), 1.2.2.3 (Fifteenth plenary meeting, 17 May 1985 - Committee B, fourth report)

WHA38.27 Women, health and development

The Thirty- eighth World Health Assembly,

Taking note of the report of the Director-Genera 11- and of the views of the Executive Board on the health situation of women and their role in health and development, and particularly in the implementation of the Global Strategy for Health for All by the Year 2000;

Noting the close relationship between equal rights for men and women and the participation of women in health activities and in the promotion of health for all, particularly as decision- makers;

Recalling previous resolutions of the Health Assembly on the role of women and, in particular, resolutions WHA28.40, WHA29.43 and WHA36.21;

Recognizing the great importance of the forthcoming World Conference to Review and Appraise the Achievements of the United Nations Decade for Women: Equality, Development and Peace;

Concerned at the slow progress made by a number of countries in realizing the objectives of the United Nations Decade for Women, which are formulated in the reports of the World Conference of the International Women's Year, Mexico City (1975), aid the World Conference of the United Nations Decade for Women, Copenhagen (1980), and recalling the report of the International Conference on Population, Mexico City (1984), particularly with regard to women's physical and mental health and also with regard to their social security and the safeguarding of their rights;

Concerned at the very high maternal mortality rates in many countries and at the frequency and severity of the repercussions on women's physical and mental health of certain practices, particularly during pregnancy or childbirth but also during puberty or childhood;

Concerned at the adverse effects on women's physical and mental health, and the risks for their children, of inadequate conditions of domestic work or paid employment;

1 World Health Organization. Women, health and development. Geneva, 1985 (WHO Offset Publication No. 90). RESOLUTIONS AND DECISIONS 21

Concerned at the frequency of nutritional anaemia in many countries, especially among pregnant women;

Concerned at the close spacing of pregnancies, particularly in the developing countries, and aware of the importance of adequate spacing of pregnancies as part of an appropriate family planning policy integrated within the general economic and social development programme of each country;

Bearing in mind with anxiety the prevalence in some countries of adolescent marriages and pregnancies;

Concerned at the increasing incidence and impact of family violence on women and children;

Aware that in some countries the general public does not know enough about the nature of the risk to the health or even the life of women presented by such factors as deficient or inadequate diet, lack of hygiene, excessive workloads, and pregnancy prior to full physical maturity and corresponding mental development - risks that may also have repercussions on the health of the children;

Recalling the correlation between the education of mothers and the reduction of child mortality levels;

1. THANKS the Director -General for his report;

2. CALLS UPON Member States to show greater concern, within the context of national activities and international cooperation, for the protection of women's physical and mental health, particularly as regards the nutrition of women, the health of pregnant women and young mothers and conditions of work; to assist women to carry out their functions as providers of primary health care; to strengthen their efforts to provide women with greater opportunities to pursue activities in the context of the realization of the objectives of the strategies for health for all; and to take an active part in the World Conference to Review and Appraise the Achievements of the United Nations Decade for Women;

3. REQUESTS the Executive Board to monitor developments in the field of women, health and development;

4. REQUESTS the Director -General:

(1) to ensure the Organization's active participation in the World Conference and to present to it a report on the role of women in health and development, on the principal risks threatening women, and on the possibilities of guarding against those risks;

(2) to continue to pay close attention to cooperation with, and to provide expertise to, Member States in their activities both for promoting women's physical and mental health - including information and education of the public - and for intensifying the participation of women, particularly as decision- makers, in health and socioeconomic development, and to assist Member States to evaluate the effect of health development programmes and social services on the situation of women and on the protection and promotion of their physical and mental health;

(3) to strengthen coordination with the other United Nations agencies that pay special attention to the economic role of women;

(4) to evaluate the contribution made by WHO's programmes to the promotion and protection of women's physical and mental health and the effects of these programmes on the participation of women in health activities;

(5) to report periodically to the Executive Board and the Health Assembly on the progress achieved in this field.

Hbk Res., Vol. II (1985), 7.1.3.7 (Fifteenth plenary meeting, 17 May 1985 - Committee B, fourth report) 22 THIRTY -EIGHTH WORLD HEALTH ASSEMBLY

WHA38.28 Liberation struggle in southern Africa: Assistance to the front-line States, Lesotho and Swaziland

The Thirty-eighth World Health Assembly,

Considering that the front -line States and Lesotho continue to suffer from the consequences of armed banditry, political and economic destabilization by the South African racist regime which hamper their economic and social development;

Considering that the front -line States and Lesotho have to accept enormous sacrifices to rehabilitate and develop their health infrastructure which has suffered as a result of military destabilization planned, directed aid carried out by the South African racist regime;

Considering also resolutions AFR /RC31 /R12 and AFR /RC32 /R9 of the Regional Committee for Africa, which call for a special programme of health cooperation with the People's Republic of Angola;

Bearing in mind that the consequences of these destabilization activities still force the countries concerned to divert large amounts of financial and technical resources from their national health programmes to defence and reconstruction;

1. THANKS the Director-General for his report;l

2. RESOLVES that WHO shall:

(1) continue to take appropriate and timely measures to help the front -line States, Lesotho and Swaziland solve the acute health problems of the Namibian and South African refugees;

(2) continue to provide countries which are or have been targets of destabilization by South Africa with health assistance, health personnel, pharmaceutical products and financial assistance for their national health programmes and for such special health programmes as are necessary, as a consequence of the destabilization activities, for the rehabilitation of their damaged health infrastructures;

3. CALLS UPON the Member States, according to their capabilities, to continue to provide adequate health assistance to the front -line States (Angola, Botswana, Mozambique, United Republic of Tanzania, Zambia and Zimbabwe) and Lesotho and Swaziland;

4. REQUESTS the Director -General:

(1) to make use, when necessary, of funds from the Director -General's Development Programme to help the countries concerned to overcome the problems arising both from the presence of the Namibian and South African refugees and from destabilization activities, as well as for the rehabilitation of their damaged health infrastructures;

(2) to report to the Thirty-ninth World Health Assembly on the progress made in the implementation of this resolution.

Hbk Res., Vol. II (1985), 1.2.2.2 (Fifteenth plenary meeting, 17 May 1985 - Committee B, fourth report)

WHA38.29 Emergency health, medical and social assistance to drought-, famine- and other disaster- affected countries in Africa

The Thirty -eighth World Health Assembly,

Deeply concerned with the serious economic crisis in the African continent, affecting a large number of countries which are faced with drought, food scarcity, problems of refugees, returnees, displaced persons and retardation in the development process;

1 Document А38/15. RESOLUTIONS AND DECISIONS 23

Recalling United Nations General Assembly resolutions 38/199 and 38/200, aid particularly taking into account resolution 39/29 and the Declaration on the Critical Economic Situation in Africa;

Further recalling Health Assembly resolutions WHA36.29 and WHA37.29 and Executive Board resolution EB75.R14;

Expressing the non- aligned and other developing countries' as well as the international community's solidarity and deep sympathy with the crisis- affected people of Africa, and recalling that the ministerial level meeting of non- aligned countries held in New Delhi in April 1985 called for intensified efforts and generous response to the emergency needs and requirements of medium- and long -term development programmes;

Taking into account the Director -General's report' on the African crisis situation and noting with satisfaction the action taken by WHO in its humanitarian response to the serious health aspects of the crisis in Africa;

Emphasizing the necessity of an integrated response linking emergency measures with the long -term development perspective for effectively dealing with the situation;

1. CALLS UPON the international community, including bilateral donors, United Nations organs and organizations, specialized agencies and nongovernmental organizations and others, to pursue its relief efforts vigorously to deal with the crisis in a coordinated and concerted manner, taking fully into account the imperative need to link these initiatives and efforts with the long -term development perspective;

2. REQUESTS Member States and the affected countries to do all they can to facilitate and coordinate all relief, rehabilitation and development efforts;

3. URGES the Director -General and the Regional Directors concerned to continue their unrelenting efforts to cooperate with the governments of the affected African Member States to respond to the health consequences of the crisis as an integral part of the regional and global strategies for health for all, particularly taking into account the need to intensify WHO's technical cooperation at the country level to enable the Member States to enhance their disaster preparedness, including measures to prevent and manage malnutrition, anaemia and outbreak of epidemics;

4. REQUESTS the Director -General:

(1) to review the situation in collaboration with the countries concerned and take appropriate measures to mobilize additional resources for assistance to these countries;

(2) to report on the action taken to the Thirty -ninth World Health Assembly.

Hbk Res., Vol. II (1985), 1.2.2.3 (Fifteenth plenary meeting, 17 May 1985 - Committee B, fourth report)

WHA38.30 Prevention and control of chronic noncommunicable diseases

The Thirty- eighth World Health Assembly,

Recalling resolutions WHA29.49 and WHA36.32, which led to the rapid development of a long -term programme to control cardiovascular diseases, with special emphasis on research into prevention, etiology, early detection, treatment and rehabilitation;

I See Annex 5. 24 THIRTY -EIGHTH WORLD HEALTH ASSEMBLY

Mindful of the Director -General's progress report on the Global Strategy for Health for All by the Year 2000,1 in which he underlines the growing importance of chronic noncommunicable diseases, notably those of the cardiovascular system, cancers and diabetes mellitus, as major factors adversely affecting life expectancy and health in general in both developed and developing countries;

Bearing in mind that information is accumulating that points to a number of features common to several noncommunicable diseases, such as their origins in and aggravation by tobacco smoking and other life style factors including unbalanced nutrition;

Taking also into account the proposals regarding the application of existing knowledge in national health services made by the WHO Expert Committee on Community Prevention and Control of Cardiovascular Diseases,2 in the report to the twenty - fourth session of the UNICEF /WHO Joint Committee on Health Policy on the prevention of rheumatic fever and rheumatic heart disease,3 and by the WHO Study Group on Diabetes Mellitus,2 together with the recommendations of the WHO Meeting on Reappraisal of the Present Situation in Prevention and Control of Lung Cancer;4

1. APPRECIATES the Organization's increasing efforts to coordinate scientific activities in the prevention aid control of chronic noncommunicable diseases, and welcomes the results attained thus far;

2. CALLS on Member States:

(1) to assess the importance of noncommunicable diseases in their countries;

(2) where the problem is of high priority, to promote and introduce community studies with a view to arriving at population -centred measures to prevent and control cardiovascular diseases, lung cancer, diabetes mellitus, chronic respiratory and other noncommunicable diseases, and, where these measures are already being applied, to exchange information on their operation and on the training of relevant personnel;

(3) to offer other Member States opportunities for training and further education in the community control of noncommunicable diseases as an integral part of existing health services, and to make information available on the national criteria applied in defining persons at risk, early detection, therapy and rehabilitation;

(4) to make use of the latest findings in chronic noncommunicable disease control with the aim of devising, testing and introducing into existing health services models for the integrated control of several chronic conditions;

3. REQUESTS the Executive Board to consider the inclusion in the Eighth General Programme of Work, as a continuation and intensification of the Seventh General Programme of Work, of research and development aimed at the combined prevention and control of several noncommunicable diseases within health systems based on primary health care;

4. REQUESTS the Director -General, in view of the overriding importance of noncommunicable diseases in several countries in the implementation of their strategies for health for all by the year 2000:

(1) to intensify measures to promote the prevention of cardiovascular diseases, as an example for other noncommunicable diseases;

(2) to foster and support community studies aimed at the joint control of a number of risk- related noncommunicable diseases;

(3) to encourage particularly the coordination within WHO of programmes aimed at influencing risk factors closely related to individual life-styles;

1 See Annex 6. 2 Reports being published in the WHO Technical Report Series. Document JC24 /UNICEF -WHO /83.4(d).

§ Bulletin of the World Health Organization, 60(6): 809 -819 (1982). RESOLUTIONS AND DECISIONS 25

(4) to ensure the availability of resources for the exchange of study protocols and experience among Member States involved in this initiative;

(5) to encourage and sponsor workshops in Member States so that information about the practical implementation of control programmes can be quickly exchanged.

Hbk Res., Vol. II (1985), 1.16.15; (Sixteenth plenary meeting, 20 May 1985 - 1.16.16; 1.16.17 Committee A, fourth report)

WHА38.31 Collaboration with nongovernmental organizations in implementing the Global Strategy for Health for All

The Thirty- eighth World Health Assembly,

Recalling resolution WHA34.36, and reaffirming commitment to the implementation of the Global Strategy for Health for All by the Year 2000 through the solemnly agreed, combined efforts of governments, people and WHO;

Mindful that the attainment of the goal of health for all by the year 2000 is an integral part of international social and economic development as well as a direct contribution to world peace;

Emphasizing the crucial need for a real partnership between governments, nongovernmental organizations and WHO in order to achieve the goal of health for all by the year 2000;

Recognizing the commitment of nongovernmental organizations and the extent of the resources which they can mobilize for the achievement of strategies for health for all;

Taking into account the conclusions and recommendations of the Technical Discussions held during the Thirty- eighth World Health Assembly on collaboration with nongovernmental organizations in implementing the Global Strategy for Health for All;

1. APPEALS to all nongovernmental organizations to support the strategies for health for all, and calls for their involvement and the increased use of national and international resources towards this end;

2. CALLS on the national nongovernmental organizations:

(1) to commit themselves in practice to the implementation of the strategies for health for all by the year 2000;

(2) to establish close collaboration with governments, in a spirit of partnership, for the implementation of national health -for -all policies and programmes;

(3) to encourage and support in all ways self -care and self-help groups at the community level for the effective implementation of primary health care;

(4) to establish appropriate national coordinating mechanisms, such as national councils of nongovernmental organizations, to provide a focal point for nongovernmental activities in health and health -related fields;

3. URGES international nongovernmental organizations:

(1) to take appropriate measures to further the collaboration between national nongovernmental organizations and Member States in the implementation of health -for -all strategies;

(2) to collaborate with WHO and other international organizations in providing support and cooperation in health -for -all activities;

(3) to coordinate their activities to ensure mutual support and cooperation in health matters; 26 THIRTY- EIGHTH WORLD HEALTH ASSEMBLY

4. CALLS on Member States:

(1) to promote, foster and support the partnership approach by involving nongovernmental organizations in policy formulation and the planning, implementation, and evaluation of the national health - for -all strategies;

(2) to encourage and support the establishment of self -help and self -care nongovernmental groups at the community level, giving particular emphasis to women's groups, in order to implement primary health care approaches effectively;

(3) to stimulate the active involvement of youth and student organizations, since these represent the generation that will be responsible for the world's health in the year 2000;

(4) to encourage and support the establishment of nongovernmental coordinating or other appropriate mechanisms at the national level to facilitate mutual dialogue and close consultation on health matters;

(5) to utilize the expertise and experience of nongovernmental organizations through consultation, and for this purpose prepare inventories of their resources, skills and collaborative health activities with governments;

(6) to facilitate the mobilization of adequate resources for the work of national nongovernmental organizations in the field of health;

5. REQUESTS the regional committees to consider ways and means of strengthening the involvement of national and regional nongovernmental organizations in the implementation of national and regional strategies for health for all;

6. REQUESTS the Executive Board to review the existing framework of WHO's collaboration with organizations in the nongovernmental sector, together with the existing rules and procedures, with a view to strengthening it and making it more effective;

7. REQUESTS the Director -General:

(1) to pursue his efforts to promote the involvement of international nongovernmental organizations in the Global Strategy for Health for All;

(2) to promote and support partnership activities of Member States, WHO and nongovernmental organizations for the implementation of strategies for health for all;

(3) to review periodically the progress made in promoting and fostering collaboration between governments and nongovernmental organizations.

Hbk Res., Vol. II (1985), 1.1; 7.2 (Sixteenth plenary meeting, 20 May 1985 - Committee A, fourth report)

WHA38.32 Appropriation resolution for the financial period 1986 -19871

The Thirty- eighth World Health Assembly

RESOLVES to appropriate for the financial period 1986 -1987 an amount of US$ 605 327 400 as follows:

1 For Committee B's report to Committee A on this subject, see document WHA38 /1985/REС/2. RESOLUTIONS AND DECISIONS 27

Appropriation Amount section Purpose of appropriation US $

1. Direction, coordination and management 62 812 700 2. Health system infrastructure 179 084 500 З. Health science and technology: health promotion and care 101 123 300 4. Health science and technology: disease prevention and control 84 480 400 5. Programme support 115 799 100

Effective working budget 543 300 000

6. Transfer to Tax Equalization Fund 52 000 000 7. Undistributed reserve 10 027 400

Total 605 327 400

B. Amounts not exceeding the appropriations voted under paragraph A shall be available for the payment of obligations incurred during the financial period 1 January 1986 - 31 December 1987 in accordance with the provisions of the Financial Regulations. Notwithstanding the provisions of the present paragraph, the Director -General shall limit the obligations to be incurred during the financial period 1986 -1987 to sections 1-6.

C. Notwithstanding the provisions of Financial Regulation 4.5, the Director -General is authorized to make transfers between those appropriation sections that constitute the effective working budget up to an amount not exceeding 10% of the amount appropriated for the section from which the transfer is made, this percentage being established in respect of section 1 exclusive of the provision made for the Director -General's and Regional Directors' Development Programme (US$ 10 334 000). The Director -General is also authorized to apply amounts not exceeding the provision for the Director -General's and Regional Directors' Development Programme to those sections of the effective working budget under which tie programme expenditure will be incurred. All such transfers shall be reported in the financial report for the financial period 1986 -1987. Any other transfers required shall be made and reported in accordance with the provisions of Financial Regulation 4.5.

D. The appropriations voted under paragraph A shall be financed by assessments on Members after deduction of the following:

Us $

(i) reimbursement of programme support costs by the United Nations Development Programme in the estimated amount of 5 000 000 (ii) casual income in the amount of 56 790 000

61 790 000 thus resulting in assessments on Members of US$ 543 537 400. In establishing the amounts of contributions to be paid by individual Members, their assessments shall be reduced further by the amount standing to their credit in the Tax Equalization Fund, except that the credits of those Members that require staff members of WHO to pay taxes on their WHO emoluments shall be reduced by the estimated amounts of such tax reimbursements to be made by the Organization.

Hbk Res., Vol. II (1985), 2.3 (Sixteenth plenary meeting, 20 May 1985 - Committee A, fifth report) DECISIONS

(1) Composition of the Committee on Credentials

The Thirty- eighth World Health Assembly appointed a Committee on Credentials consisting of delegates of the following 12 Member States: Austria; Botswana; Czechoslovakia; Ivory Coast; Mexico; Norway; Oman; Papua New Guinea; Sri Lanka; Trinidad and Tobago; Tunisia; and Zaire.

(First plenary meeting, 6 May 1985)

(2) Composition of the Committee on Nominations

The Thirty- eighth World Health Assembly elected a Committee on Nominations consisting of delegates of the following 24 Member States: Angola; Argentina; Bahrain; Barbados; Brazil; China; Egypt; Finland; France; Gambia; Guinea; Jordan; Maldives; Nigeria; Pakistan; Poland; Solomon Islands; Suriname; Thailand; Togo; Union of Soviet Socialist Republics; United Kingdom of Great Britain and Northern Ireland; United Republic of Tanzania; and United States of America.

(First plenary meeting, 6 May 1985)

(3) Election of officers of the Thirty- eighth World Health Assembly

The Thirty-eighth World Health Assembly, after considering the recommendations of the Committee on Nominations, elected the following officers:

President: Dr S. Surjaningrat (Indonesia)

Vice -Presidents:

Dr E. Nakamura (Japan), Dr W. Chinchón (Chile), Dr Aleya Ayoub (Egypt), Dr Barbro Westerholm (Sweden), Mr D. S. Katopola (Malawi)

(Second plenary meeting, 6 May 1985)

(4) Election of officers of the main committees

The Thirty- eighth World Health Assembly, after considering the recommendations of the Committee on Nominations, elected the following officers of the main committees:

COMMITTEE A: Chairman, Dr D. G. Makuto (Zimbabwe) COMMITTEE B: Chairman, Mr R. Rochon (Canada)

(Second plenary meeting, 6 May 1985)

-28- RESOLUTIONS AND DECISIONS 29

The main committees subsequently elected the following officers:

COMMITTEE A: Vice -Chairmen, Dr J. van Linden (Netherlands) and Dr A. Al -Saif (Kuwait);

Rapporteur, Mr J. F. Rubio (Peru)

COMMITTEE B: Vice -Chairmen, Dr B. P. Kean (Australia) and Dr M. M. Pal (Pakistan);

Rapporteur, Dr Zsuzsanna Jakab (Hungary)

(First meeting of Committee A and first meeting of Committee B, 7 May 1985)

(5) Establishment of the General Committee

The Thirty- eighth World Health Assembly, after considering the recommendations of the Committee on Nominations, elected the delegates of the following 16 countries as members of the General Committee: Burma; Cameroon; China; Cuba; Ethiopia; France; Iraq; Jamaica; Jordan; Morocco; Nigeria; Senegal; Sudan; Union of Soviet Socialist Republics; United Kingdom of Great Britain and Northern Ireland; and United States of America.

(Second plenary meeting, 6 May 1985)

(6) Adoption of the agenda

The Thirty- eighth World Health Assembly adopted the provisional agenda prepared by the Executive Board at its seventy -fifth session with the deletion of two items and two sub -items and the amendment of the title of one item.

(Third plenary meeting, 7 May 1985)

(7) Appointment of the General Chairman of the Technical Discussions at the Thirty- eighth World Health Assembly

The Thirty- eighth World Health Assembly appointed Dr Maureen M. Law as General Chairman of the Technical Discussions to be held at the Health Assembly, in place of Mr M. Viravaidya, who was unable to take up his appointment1 owing to sudden illness.

(Third plenary meeting, 7 May 1985)

(8) Verification of credentials

The Thirty -eighth World Health Assembly recognized the validity of the credentials of the following delegations:

1 Decision EB74(9). 30 THIRTY- EIGHTH WORLD HEALTH ASSEMBLY

Members

Afghanistan; Albania; Algeria; Angola; Antigua and Barbuda; Argentina; Australia; Austria; Bahamas; Bahrain; Bangladesh; Barbados; Belgium; Benin; Bhutan; Bolivia; Botswana; Brazil; Brunei Darussalam; Bulgaria; Burkina Faso; Burma; Burundi; Cameroon; Canada; Cape Verde; Central African Republic; Chad; Chile; China; Colombia; Comoros; Congo; Cook Islands; Costa Rica; Cuba; Cyprus; Czechoslovakia; Democratic Kampuchea; Democratic People's Republic of Korea; Democratic Yemen; Denmark; Djibouti; Dominican Republic; Ecuador; Egypt; El Salvador; Equatorial Guinea; Ethiopia; Fiji; Finland; France; Gabon; Gambia; German Democratic Republic; Germany, Federal Republic of; Ghana; Greece; Grenada;1 Guatemala; Guinea; Guinea-Bissau; Guyana; Haiti; Honduras; Hungary; Iceland; India; Indonesia; Iran (Islamic Republic of); Iraq; Ireland; Israel; Italy; Ivory Coast; Jamaica; Japan; Jordan; Kenya; Kiribati; Kuwait; Lao People's Democratic Republic; Lebanon; Lesotho; Liberia; Libyan Arab Jamahiriya; Luxembourg; Madagascar; Malawi; Malaysia; Maldives; Mali; Malta; Mauritania; Mauritius; Mexico; Monaco; Mongolia; Morocco; Mozambique; Nepal; Netherlands; New Zealand; Nicaragua; Niger; Nigeria; Norway; Oman; Pakistan; Panama; Papua New Guinea; Paraguay; Peru; Philippines; Poland; Portugal; Qatar; Republic of Korea; Romania; Rwanda; Samoa; San Marino; Sao Tome and Principe; Saudi Arabia; Senegal; Seychelles; Sierra Leone; Singapore; Solomon Islands; Somalia; Spain; Sri Lanka; Sudan; Suriname; Swaziland; Sweden; Switzerland; Syrian Arab Republic; Thailand; Togo; Tonga; Trinidad and Tobago; Tunisia; Turkey; Uganda; Union of Soviet Socialist Republics; United Arab Emirates; United Kingdom of Great Britain and Northern Ireland; United Republic of Tanzania; United States of America; Uruguay; Vanuatu; Venezuela; Viet Nam; Yemen; Yugoslavia; Zaire; Zambia; and Zimbabwe.

Associate Member:

Namibia1

(Fifth and eleventh plenary meetings, 8 and 13 May 1985)

(9) Report of the Director -General on the work of WHO in 1984

The Thirty- eighth World Health Assembly, after reviewing the Director -General's report on the work of the Organization in 1984,2 noted with satisfaction the manner in which the Organization's programme for this year had been implemented.

(Tenth plenary meeting, 10 May 1985)

(10) Election of Members entitled to designate a person to serve on the Executive Board

The Thirty-eighth World Health Assembly, after considering the recommendations of the General Committee, and in accordance with Rule 104 of the Rules of Procedure, elected Ecuador for a period of two years in place of the United States of America, which was entitled by the election at the Thirty-seventh World Health Assembly4 to designate a person to serve on the Executive Board for a period of three years, but which had surrendered that right before the expiration of the term for which it was elected. The Health Assembly further elected the following as Members entitled to designate a person to serve on the Executive Board: Australia; Canada; Cuba; Cyprus; Democratic Yemen; Germany, Federal Republic of; Indonesia; Lesotho; Malta; Poland; and Tonga.

(Thirteenth plenary meeting, 15 May 1985)

1 Credentials provisonally accepted. 2 See Annex 6.

For report of the General Committee, see document WHA38 /1985/REC/2. 4 Decision WHA37(11). RESOLUTIONS AND DECISIONS 31

(11) Annual report of the United Nations Joint Staff Pension Board for 1983

The Thirty- eighth World Health Assembly noted the status of the operation of the Joint Staff Pension Fund, as indicated by the annual report of the United Nations Joint Staff Pension Board for the year 1983 and as reported by the Director- General.l

(Fifteenth plenary meeting, 17 May 1985)

(12) Appointment of representatives to the WHO Staff Pension Committee

The Thirty- eighth World Health Assembly appointed Dr J. J. A. Reid, in a personal capacity, as member of the WHO Staff Pension Committee, and the member of the Executive Board designated by the Government of Democratic Yemen as alternate member of the Committee, the appointments being for a period of three years.

(Fifteenth plenary meeting, 17 May 1985)

(13) Reports of the Executive Board on its seventy -fourth and seventy -fifth sessions2

The Thirty -eighth World Health Assembly, after reviewing the Executive Board's reports on its seventy- fourth3 and seventy- fifth4 sessions, approved the reports; commended the Board on the work it had performed; and expressed its appreciation of the dedication with which the Board had carried out the tasks entrusted to it. It requested the President to convey the thanks of the Health Assembly in particular to those members of the Board who would be completing their terms of office immediately after the closure of the Assembly.

(Sixteenth plenary meeting, 20 May 1985)

(14) Place of future Health Assemblies

The Thirty- eighth World Health Assembly, after considering the Executive Board's recommendation,5 concluded that it was in the interest of all Member States to maintain the practice of holding Health Assemblies at the site of the headquarters of the Organization, which it believed to be beneficial in terms of efficiency and effectiveness. It requested the Director -General to bring those views to the attention of any Member State proposing to invite the Health Assembly to hold a session away from the site of headquarters.

(Sixteenth plenary meeting, 20 May 1985)

(15) Selection of the country in which the Thirty -ninth World Health Assembly will be held

The Thirty-eighth World Health Assembly, in accordance with Article 14 of the Constitution, decided that the Thirty -ninth World Health Assembly would be held in Switzerland.

(Sixteenth plenary meeting, 20 May 1985)

1 Document А38/17.

2 See document А38/2. 3 Document ЕB74 /1984 /RЕС /1. 4 Documents EВ75 /1985 /RЕС /1 and EB75/1985/RE0/2.

§ Decision ЕВ75(12).

ANNEXES

ANNEX 1

REPORT ON CASUAL INCOME, BUDGETARY EXCHANGE RATES AND OTHER ADJUSTMENTS TO THE PROPOSED PROGRAMME BUDGET FOR 1986 -19871

[А38/25 - 7 May 1985]

Report of the Committee of the Executive Board to Consider Certain Financial Matters prior to the Health Assembly

1. At its seventy -fifth session (January 1985), in resolution EB75.R16,2 the Executive Board established a Committee consisting of Dr J. M. Borgoño, Mr A. Grfmsson, Dr R. Hapsara and Professor J. Roux to consider, inter alia, the amount of casual income available to help finance the proposed 1986 -1987 programme budget and the budgetary rates of exchange and to report thereon on behalf of the Board to the Thirty- eighth World Health Assembly. The Committee met on 6 May 1985 under the chairmanship of Professor Roux.

2. The Committee had before it a report by the Director- General3 on casual income available at 31 December 1984 as reflected in document А38/5 (Interim financial report for the year 1984). The Committee noted that the balance available was US$ 56 791 706 and that the Director -General recommended that an amount of US$ 56 700 000 be appropriated to help finance the regular budget for 1986 -1987. The Committee concurs with the Director- General's proposal to increase the amount of casual income to be included in the draft Appropriation Resolution proposed in resolution EB75.R6 by US$ 200 000, and therefore recommends to the Thirty- eighth World Health Assembly that it appropriate US$ 56 700 000 from casual income to help finance the proposed programme budget for 1986 -1987.

3. The Committee also reviewed a report by the Director -General on the possible adjustment of budgetary exchange rates in the light of currency exchange developments up to April 1985. The report (see Appendix) was prepared in the light of the discussions at the Executive Board's seventy -fifth session in January 1985.

4. Noting the currency developments during the first four months of 1985, the Committee agreed that the budgetary rate of exchange for the Swiss franc should be maintained at 2.50 Swiss francs to one US dollar, but that adjustments had to be made in the budgetary exchange rates of the major regional office currencies. However, some members of the Committee considered that the size of the adjustments proposed by the Director -General could expose the regional programmes to financial difficulties in 1986 -1987. Bearing in mind that the regional programmes did not enjoy the same kind of protection as the global and interregional component of the budget, aid with a view to ensuring adequate budget provisions for the regional programmes, a majority of the members of the Committee proposed that the budgetary exchange rates of the major regional office currencies be adjusted as shown in the following table:

1 See resolution WHA38.4. 2 Document ЕB75 /1985 /REС /1, p. 13.

Document EB75 /CFI /3.

- 35 - 36 THIRTY -EIGHTH WORLD HEALTH ASSEMBLY

Rate of exchange per Budgetary rate of exchange US dollar used Major regional in Accounting rate per US dollar proposed to be proposed office currency preparation of of exchange for used for 1986 -1987 by the: programme budget for May 1985 1986 -1987 Director -General Committee

CFA franc 380 475 430 410 Danish krone 8.10 11.00 10.00 9.50 Indian rupee 10.00 12.13 11.50 10.50 Philippine peso 14.00 17.66 16.00 15.30

The adjusted budgetary rates of exchange as recommended by the majority of the members of the Committee for the above -mentioned major regional office currencies and the US dollar would result in a saving of US$ 5 100 000 for 1986 -1987, as compared to a saving of US$ 7 500 000 resulting from the budgetary exchange rates proposed by the Director -General.

5. In addition, the Committee was informed that the postponement by the United Nations General Assembly of an increase of one class of post adjustment in New York in December 1984 had had the effect of delaying post adjustment changes in other duty stations. As a result, the Director -General proposes to reduce the provision for post adjustment at global and at regional levels by the amount of estimated savings, namely, an amount of US$ 3 200 000. The Committee concurred with the Director-General's recommendation, the effect of which was a further reduction in the proposed effective working budget and in the assessments of Members for 1986 -1987.

6. If the above proposals should be approved, the draft Appropriation Resolution for the financial period 1986 -1987 would need to be revised to reflect the changes resulting from using adjusted budgetary rates of exchange between the US dollar and four of the major regional office currencies and from the delay in increases in post adjustments at global and regional levels. The revised Appropriation Resolution would also reflect the proposed increase of US$ 200 000 in casual income to help finance the regular budget for 1986 -1987.

7. The Committee noted that the effect of the adjustments as proposed by the Director -General would have resulted in an effective working budget of US$ 543 300 000, representing an increase over the 1984 -1985 approved budget of US$ 23 200 000, or 4.46 %, and an increase in the assessment of Members of US$ 21 000 000, or 4.56 %. The adjustments proposed by the Committee can be summarized as follows:

Us $ Effective working budget as recommended in resolution EB75.R6 554 000 000

Less: reduction for adjustment in budgetary rates of exchange for four major regional office currencies 5 100 000

548 900 000

Less: adjustment for delay in application of post adjustment increase 3 200 000

Effective working budget as revised 545 700 000

representing an increase over the 1984 -1985 approved budget of US$ 25 600 000, or 4.92 %, and an increase in contributions by Members for the effective working budget of US$ 23 400 000, or 5.08 %. This compares with the original programme budget proposal endorsed by the Executive Board at its seventy-fifth session in January 1985, which would have resulted in an increase in the budget level for 1986 -1987 of 6.52% and an increase in assessments on Members of 6.92 %. ANNEX 1 37

Appendix

POSSIBLE ADJUSTMENT OF BUDGETARY EXCHANGE RATES IN THE LIGHT OF CURRENCY EXCHANGE DEVELOPMENTS UP TO APRIL 1985

[ЕВ75 /CFI /4 - 23 April 1985]

Report by the Director-General

Introduction

1. When the Executive Board at its seventy -fifth session (January 1985) examined the proposed programme budget for 1986 -1987, it was noted that the budgetary rates of exchange used between the US dollar and several major regional office currencies differed significantly from current market rates of exchange. Consequently it was agreed that the issue of budgetary rates of exchange for 1986 -1987 would be reviewed by the Director -General and a report submitted to the Committee of the Executive Board to Consider Certain Financial Matters prior to the Thirty- eighth World Health Assembly, for such recommendations as the Committee might wish to make to the Health Assembly on behalf of the Board. This review would take into account currency exchange developments up to April 1985.

US dollar /Swiss franc budgetary exchange rate

2. In accordance with the agreed methodology, the rate of exchange used in preparing the proposed programme budget for 1986 -1987 for expenditure to be incurred in Swiss francs was 2.50 Swiss francs to one US dollar, which corresponded to the United Nations /WHO accounting rate of exchange for October 1984, when the estimates were finalized. At the time of the seventy -fifth session of the Executive Board in January 1985, the accounting rate of exchange was 2.58 Swiss francs to one US dollar. For February and March this rate increased to 2.67 and 2.83 Swiss francs per US dollar respectively. However, for April it decreased to 2.64 Swiss francs to one US dollar. These increases /decreases were a reflection of significant currency fluctuations occurring up to the time of preparation of this report. Thus, during one recent four -week period, the market rate of exchange between the Swiss franc and the US dollar went from a high of 2.94 to a low of 2.57 Swiss francs per US dollar. Considering that (i) a budgetary rate of exchange which has been determined in accordance with an agreed methodology should be changed only in the most exceptional circumstances, (ii) the difference between the present United Nations /WHO accounting rate of exchange and the budgetary rate of exchange for 1986 -1987 in respect of the US dollar /Swiss franc relationship is rather modest, (iii) any net savings under the regular programme budget which might result from differences between the WHO budgetary rate of exchange and the United Nations /WHO accounting rates of exchange with respect to the US dollar /Swiss franc relationship in 1986 and 1987 would be transferred to casual income, and (iv) currency exchange rates continue to be highly volatile and unpredictable, the Director-General recommends that the budgetary rate of exchange for the proposed programme budget for 1986 -1987 should be maintained at 2.50 Swiss francs to one US dollar.

Budgetary exchange rates of major regional office currencies

3. Except in the case of the Regional Office for the Americas, the currency of which is the US dollar, the rates of exchange used in preparing the 1986 -1987 budget estimates for expenditures to be incurred in the major regional office currencies took account of the relevant United Nations /WHO accounting rates of exchange as well as exchange rate developments aid trends up to the time when the estimates were finalized. In accordance with the established timetable, regional programme budget proposals, based on such rates of exchange, were reviewed by the respective regional committees during the autumn of 1984. Following their endorsement by the regional committees they were submitted to the Director -General for consolidation in his proposed programme budget for 1986 -1987.

4. During the period following the finalization of the regional budget estimates for 1986 -1987, that is, during the latter half of 1984, the value of the US dollar increased considerably in relation to the major regional office currencies. At the time of the Executive Board's review of the proposed programme budget for 1986 -1987, in January 1985, the differences between the then prevailing rates of exchange aid those originally used in preparing the 1986 -1987 regional budget proposals for expenditures to be incurred in several 38 THIRTY -EIGHTH WORLD HEALTH ASSEMBLY major regional office currencies were deemed significant enough to warrant further review prior to the Thirty- eighth World Health Assembly.

5. During the period following the Board's January 1985 session the value of the US dollar in relation to a number of currencies, including several of the major regional office currencies, has continued to fluctuate considerably and occasionally with extreme volatility. Thus the relevant rates of exchange have at one time moved sharply in one direction, reflecting an increase in the value of the US dollar, only subsequently to move equally sharply in the opposite direction, reflecting a decrease in the value of the US dollar. At the time of preparation of this report the rates of exchange between the US dollar and several regional office currencies continue to fluctuate. Notwithstanding the uncertainty of this situation it would appear that the differences between current rates of exchange and those originally used for the US dollar in relation to four of the major regional office currencies in the preparation of the relevant budget estimates remain significant enough to justify an adjustment. Accordingly, it is proposed that the 1986 -1987 budgetary rates of exchange between the US dollar and the currencies of the regional offices for Africa, Europe, South -East Asia and the Western Pacific be adjusted upward as set out in the table below:

Rate of exchange per US dollar Budgetary rate of exchange Major regional used in preparation of per US dollar now proposed office currency proposed programme budget for to be used for 1986 -1987 1986 -1987

CFA franc 380 430

Danish krone 8.10 10.00

Indian rupee 10.00 11.50

Philippine peso 14.00 16.00

6. The adjustments proposed above give recognition to the fact that present exchange rates between the currencies in question and the US dollar are significantly higher than those prevailing in the summer of 1984, when the relevant budget estimates were finalized; they also take account of the volatility and unpredictability of the international monetary situation. Because of this last factor, and since regional office currencies do not enjoy the same measure of protection from the adverse effects of exchange rate fluctuations as the Swiss franc under the casual income facility, the budgetary rates of exchange now proposed provide for a small margin of safety and operational flexibility in relation to the accounting rates of exchange for the month of April 1985. With regard to the currency of the Regional Office for the Eastern Mediterranean, no adjustment in the budgetary rate of exchange between the US dollar and the Egyptian pound is being proposed, since the accounting rate of exchange remains unchanged from that originally used as the budgetary rate for the 1986 -1987 budget estimates, i.e., 0.8217 Egyptian pound to one US dollar.

Budgetary impact of proposals

7. The upward adjustments of the budgetary rates of exchange between the above -mentioned major regional office currencies and the US dollar would result in a saving of US$ 7 500 000. The total effect of these proposals would be to reduce the level of the proposed effective working budget for 1986 -1987 from US$ 554 000 000 to US$ 546 500 000.

8. It will be recalled that the effective working budget of US$ 554 000 000 for 1986 -1987 recommended by the Executive Board represented a total increase of 6.52% over the effective working budget for 1984 -1985, and would entail an increase of 6.92% in assessments for the effective working budget 1986 -1987 over those for 1984 -1985. The combined effect of adjusting the above-mentioned regional budgetary rates of exchange and endorsing the separate recommendation' to use an additional amount of US$ 200 000 of available casual income to help finance the regular budget for 1986 -1987 would be to reduce the increase in the level of the effective working budget for 1986 -1987 over 1984 -1985 from 6.52% to 5.08 %, and to reduce the increase in the assessments for the effective working budget from 6.92% to 5.25 %.

1 Document ЕB75 /CFI /3. ANNEX 1 39

Cinc lus ion

9. If the above -mentioned proposals should be approved, it would be necessary to revise the draft Appropriation Resolution for the financial period 1986 -1987 recommended by the Executive Board in resolution EВ75.R61 in order to reflect (i) the change in the proposed effective working budget for 1986 -1987 that would result from using adjusted budgetary rates of exchange between the US dollar and four of the major regional office currencies, and (ii) the proposed increase of US$ 200 000 in the amount of available casual income to be used to help finance the regular budget for 1986 -1987.

1 Document ЕB75 /1985 /REС /1, p. 5. ANNEX 2

CONTRIBUTIONS OF MEMBERS AND ASSOCIATE MEMBERS TO THE PROGRAMME BUDGET FOR THE FINANCIAL PERIOD 1986 -19871

[А38 /INF.DOC. /18 - 20 May 1985]

For the information of Members and Associate Members, the following table shows the contributions assessed in respect of the programme budget for the financial period 1986 -1987. The calculations are based on the decisions taken by the Thirty -eighth World Health Assembly in the Appropriation Resolution,2 and on the scale of assessments for the financial period 1986 -1987.1

1 See resolution WHA38.7. 2 Resolution WHA38.32.

- 40 - ANNEX 2 41

Credit from Members and Gross Net Payable Payable Percentage Tax Equalization 1п Associate Members assessments contributions in Fund 1986 1987

US $ Us $ us $ us $ us $ Afghanistan 0. 01 54 350 5 200 49 150 24 575 24 575 Albania 0. 01 54 350 5 200 49 150 24 575 24 575 Algeria 0.13 706 600 67 600 639 000 319 500 319 500 Angola 0. 01 54 350 5 200 49 150 24 575 24 575 Antigua and Barbuda 0. 01 54 350 5 200 49 150 24 575 24 575 Argentina 0.70 ¥ 804 760 364 000 3 440 760 1 720 380 1 720 380 Australia 1. 54 8 370 480 800 800 7 569 680 3 784 840 ¥ 784 840 Austria 0.74 4 022 180 384 800 3 637 380 1 818 690 1 818 690 Bahamas 0.01 54 350 5 200 49 150 24 575 24 575 Bahrain 0. 01 54 350 5 200 49 150 24 575 24 575 Bangladesh 0.О3 163 070 15 600 147 470 73 735 73 735 Barbados 0. 01 54 350 5 200 49 150 24 575 24 575 Belgium 6 1.26 848 570 655 200 6 193 370 3 096 685 3 096 685 Benin 0. 01 54 350 5 200 49 150 24 575 24 575 Bhutan 0.01 54 350 5 200 49 150 24 575 24 575 Bolivia 0. 01 54 350 5 200 49 150 24 575 24 575 Botswana 0. 01 54 350 5 200 49 150 24 575 24 575 Brazil 7 1.36 392 110 707 200 6 684 910 3 342 455 3 342 455 Brunei Darussalam 0.О3 163 070 15 600 147 470 73 735 73 735 Bulgaria 0.18 978 370 93 600 884 770 442 385 442 385 Burkina Faso 0.01 54 350 5 200 49 150 24 575 24 575 Burma 0.01 54 350 5 200 49 150 24 575 24 575 Burundi 0. 01 54 350 5 200 49 150 24 575 24 575 Byelorussian Soviet Socialist Republic 0.35 1 902 380 182 000 1 720 380 860 190 860 190 Cameroon 0. 01 54 350 5 200 49 150 24 575 24 575 Canada 414 3.02 16 830 1 544 400 14 870 430 7 435 215 7 435 215 Cape Verde 0.01 54 350 5 200 49 150 24 575 24 575 Central African Republic 0.01 54 350 5 200 49 150 24 575 24 575 Chad 0.01 54 350 5 200 49 150 24 575 24 575 Chile 0.07 380 480 36 400 344 080 172 040 172 040 China 0.86 4 674 420 447 200 4 227 220 2 113 610 2 113 610 Colombia 0.11 597 890 57 200 540 690 270 345 270 345 Comoros 0.01 54 350 5 200 49 150 24 575 24 575 Congo 0.01 54 350 11 200 ¡¥ 150 21 575 21 575 Cook Islands 0.01 54 350 5 200 49 150 24 575 24 575 Costa Rica 0. 02 108 710 10 400 98 310 49 155 49 155 Cuba 0.09 489 190 46 800 442 390 221 195 221 195 Cyprus 0.01 54 350 5 200 49 150 24 575 24 575 Czechoslovakia 0.74 4 022 180 384 800 3 637 380 1 818 690 1 818 690 Democratic Kampuchea 0.01 54 350 5 200 49 150 24 575 24 575 Democratic People's Republic of Korea 0. 05 271 770 26 000 245 770 122 885 122 885 Democratic Yemen 0.01 54 350 (17 800) 72 150 36 075 36 075 Denmark 0. 74 4 022 180 384 800 3 637 380 1 818 690 1 818 690 Djibouti 0.01 54 350 5 200 49 150 24 575 24 575 Dominica 0.01 54 350 5 200 49 150 24 575 24 575 Dominican Republic 0.03 163 070 15 600 147 470 73 735 73 735 Есua.r 0.02 108 710 10 400 98 310 49 155 49 155 Egypt 0.07 380 480 36 400 344 080 172 040 172 040 El Salvador 0.01 54 350 5 200 49 150 24 575 24 575 Equatorial Guinea 0.01 54 350 5 200 49 150 24 575 24 575 Ethiopia 0.01 54 350 5 200 49 150 24 575 24 575 Fiji 0.01 54 350 5 200 49 150 24 575 24 575 Finland 0.47 2 554 630 244 400 2 310 230 1 155 115 1 155 115 France 6.39 34 732 040 2 735 800 Э1 996 240 15 998 120 15 998 120 Gabon 0.02 108 710 10 400 98 310 49 155 49 155 Gambia 0.01 54 350 5 200 49 150 24 575 24 575 German Democratic Republic 1.36 7 392 110 707 200 6 684 910 ¥ 342 455 3 342 455 Germany, Federal Republic of 8.38 45 548 430 4 357 600 41 190 830 20 595 415 20 595 415 Ghana 0.02 108 710 10 400 98 310 49 155 49 155 Greece 0.39 2 119 800 202 800 1 917 000 958 500 958 500 Grenada 0.01 54 350 5 200 49 150 24 575 24 575 Guatemala 0.02 108 710 10 400 98 310 49 155 49 155 Guinea 0. 01 54 350 5 200 49 150 24 575 24 575 Guinea -Bissau 0.01 54 350 5 200 49 150 24 575 24 575 Guyana 0. 01 54 350 5 200 49 150 24 575 24 575 Haiti 0.01 54 350 5 200 49 150 24 575 24 575 Honduras 0. 01 54 350 5 200 49 150 24 575 24 575 Hungary 0.22 1 195 790 114 400 1 081 390 540 695 540 695 Iceland 0.03 163 070 15 600 147 470 73 735 73 735 India 0.35 1 902 380 182 000 1 720 380 860 190 860 190 Indonesia 0.13 706 600 67 600 639 000 319 500 319 500 Iran (Islamic Republic of) 0.57 3 098 170 296 400 2 801 770 1 400 885 1 400 885 Iraq 0.12 652 250 62 400 589 850 294 925 294 925 Ireland 0.18 978 370 93 600 884 770 442 385 442 385 Israel 0.22 1 195 790 114 400 1 081 390 540 695 540 695 Italy 3.67 19 947 830 1 908 400 18 039 430 9 019 715 9 019 715 Ivory Coast 0.03 163 070 15 600 147 470 73 735 73 735 Jamaica 0.02 108 710 10 400 98 310 49 155 49 155 Japan 10.13 55 060 330 5 267 600 49 792 730 24 896 365 24 896 365 42 THIRTY-EIGHTH WORLD HEALTH ASSEMBLY

Credit from Payable Members and Gross Net Payable Percentage Tax Equalization Associate Members assessments contributions 1п 1п Fund 1986 1987

US US b US $ Us $ Us $ Jordan 0.01 54 Э50 5 200 49 150 24 575 24 575 Kenya 0.01 54 350 5 200 49 150 24 575 24 575 Kiribati 0.01 54 350 5 200 49 150 24 575 24 575 Kuwait 0.24 1 304 490 124 80Ф 1 179 690 589 845 589 845 Lao People's Democratic Republic 0.01 54 350 5 200 49 150 24 575 24 575 Lebanon 0.02 108 710 10 400 98 310 49 155 49 155 Lesotho 0.01 54 350 5 200 49 150 24 575 24 575 Liberia 0.01 54 350 5 200 49 150 24 575 24 575 Libyan Arab Jamahiriya 0.25 1 358 850 130 000 1 228 850 614 425 614 425 Luxembourg 0.06 326 130 Э1 200 294 930 147 465 147 465 Madagascar 0.01 54 350 5 200 49 150 24 575 24 575 Malawi 0.01 54 350 5 200 49 150 24 575 24 575 Malaysia 0.09 489 190 46 800 442 390 221 195 221 195 Maldives 0.01 54 350 5 200 49 150 24 575 24 575 Mali 0.01 54 350 5 200 49 150 24 575 24 575 Malta 0.01 54 350 5 200 49 150 24 575 24 575 Mauritania 0.01 54 350 5 200 49 150 24 575 24 575 Mauritius 0.01 54 Э50 5 200 49 150 24 575 24 575 Mexico 0.86 4 674 420 447 200 4 227 220 2 113 610 2 113 610 Monaco 0.01 54 350 5 200 49 150 24 575 24 575 Mongolia 0.01 54 350 5 200 49 150 24 575 24 575 Morocco 0.05 271 770 26 000 245 770 122 885 122 885 Mozambique 0.01 54 350 5 200 49 150 24 575 24 575 Namibia9 0.01 54 350 5 200 49 150 24 575 24 575 Nepal 0.01 54 350 5 200 49 150 24 575 24 575 Netherlands 1.75 9 511 910 910 000 8 601 910 4 300 955 4 ¥¤¤ 955 New Zealand 0.25 1 358 850 130 000 1 228 850 614 425 ´¡ 425 Nicaragua 0.01 54 350 5 200 49 150 24 575 24 575 Niger 0.01 54 350 5 200 49 150 24 575 24 575 Nigeria 0.19 1 032 720 98 800 933 920 466 960 466 960 Norway 0.50 2 717 690 260 000 2 457 690 1 228 845 1 228 845 Oman 0.01 54 Э50 5 200 49 150 24 575 24 575 Pakistan 0.06 326 130 31 200 294 930 147 465 147 465 Panama 0.02 108 710 10 400 98 Э10 49 155 49 155 Papua New Guinea 0.01 54 350 5 200 49 150 24 575 24 575 Paraguay 0.01 54 350 5 200 49 150 24 575 24 575 Peru 0.07 380 480 36 400 ¥¡¡ 080 172 040 172 040 Philippines 0.09 489 190 46 800 442 ¥£¤ 221 195 221 195 Poland 0.71 3 859 120 Э69 200 3 489 920 1 744 960 1 744 960 Portugal 0.18 978 370 93 ³¤¤ 884 770 442 385 422 385 Qatar 0.03 163 070 15 ³¤¤ 147 470 73 735 73 735 Republic of Korea 0.18 978 Э70 93 600 884 770 442 385 442 385 Romania 0.19 1 032 720 98 800 933 920 466 960 466 960 Rwanda 0.01 54 350 5 200 49 150 24 575 24 575 Saint Christopher and Nevis 0.01 54 350 5 200 49 150 24 575 24 575 Saint Lucia 0.01 54 350 5 200 49 150 24 575 24 575 Saint Vincent and the Grenadines 0.01 54 350 5 200 49 150 24 575 24 575 Samoa 0.01 54 350 5 200 49 150 24 575 24 575 San Marino 0.01 54 350 5 200 49 150 24 575 24 575 Sao Tome and Principe 0.01 54 350 5 200 49 150 24 575 24 575 Saudi Arabia 0.84 4 565 720 436 800 4 128 920 2 064 460 2 064 460 Senegal 0.01 54 350 5 200 49 150 24 575 24 575 Seychelles 0.01 54 350 5 200 49 150 24 575 24 575 Sierra Leone 0.01 54 350 5 200 49 150 24 575 24 575 Singapore 0.09 489 190 46 800 442 390 221 195 221 195 Solomon Islande 0.01 54 350 5 200 49 150 24 575 24 575 Somalia 0.01 54 350 5 200 49 150 24 575 24 575 South Africa 0.40 2 174 180 208 000 1 966 180 983 090 983 090 Spain 1.89 10 272 860 982 800 9 290 060 4 645 030 4 645 030 Sri Lanka 0.01 54 Э50 5 200 49 150 24 575 24 575 Sudan 0.01 54 350 5 200 49 150 24 575 24 575 Suriname 0.01 54 350 5 200 49 150 24 575 24 575 Swaziland 0.01 54 350 5 200 49 150 24 575 24 575 Sweden 1.29 7 011 640 670 800 ³ 340 840 3 170 420 ¥ 170 420 Switzerland 1.08 5 870 ±¤ 561 600 5 308 610 2 654 305 2 654 305 Syrian Arab Republic 0.03 163 070 15 600 147 470 73 7Э5 73 735 Thailand 0.08 434 830 41 600 393 230 196 615 196 615 Togo 0.01 54 350 5 200 49 150 24 575 24 575 Tonga 0.01 54 350 5 200 49 150 24 575 24 575 Trinidad and Tobago 0.03 163 070 15 600 147 470 73 735 73 7Э5 Tunisia 0.03 163 070 15 600 147 470 73 735 73 735 Turkey 0.31 1 684 970 161 200 1 523 770 761 885 761 885 Uganda 0.01 54 Э50 5 200 49 150 24 575 24 575 Ukrainian Soviet Socialist Republic 1.29 7 011 640 670 800 6 340 840 3 170 420 3 170 420 Union of Soviet Socialist Republics 10.34 56 201 760 5 Э76 800 50 824 960 25 412 480 25 412 480 United Arab Emirates 0.16 869 660 83 200 786 460 393 230 393 230 United Kingdom of Great Britain and Northern Ireland 4.58 24 894 020 2 381 600 22 512 420 11 256 210 11 256 210 United Republic of Tanzania 0.01 54 350 (4 800) 59 150 29 575 29 575 ANNEX 2 43

Credit from Payable Payable and Gross Net Percentage Tax Equalization in in Associate Members assessments contributions Fund 1986 1987

i Us$ Us$ Us$ Us$ Us$ United States of America 25.00 135 884 350 10 289 000 125 595 350 62 797 675 62 797 675 Uruguay 0.04 217 420 20 800 196 620 98 310 98 310 Vanuatu 0.01 54 350 5 200 49 150 24 575 24 575 Venezuela 0.54 2 935 110 280 800 2 654 310 1 327 155 1 327 155 Viet Nam 0.02 108 710 10 400 98 310 49 155 49 155 Yemen 0.01 54 350 5 200 49 150 24 575 24 575 Yugoslavia 0.45 2 445 920 234 000 2 211 920 1 105 960 1 105 960 Zaire 0.01 54 350 5 200 49 150 24 575 24 575 Zambia 0.01 54 350 5 200 49 150 24 575 24 575 Zimbabwe 0.02 108 710 10 400 98 310 49 155 49 155

TOTAL 100.00 543 537 400 48 649 000 494 888 400 247 444 200 247 444 200

Associate Member. ANNEX 3

GUIDELINES FOR PREPARING A REGIONAL PROGRAMME BUDGET POLICY'

[А38/INF.DOC./1 - 20 March 1985]

These guidelines constitute a frame of reference for regional committees in establishing regional programme budget policies in accordance with resolutions EB75.R72 and WHA38.11.3

CONTENTS

Page

Executive summary 45

Introduction 50

Issues' 52

Support to national strategies for health for all 52 Promotion of the national health strategy 55

Developing the health system through support to national health programmes . . . 56 Strengthening national capacities to prepare and implement national health -for -all strategies and related programmes 59 Transfer of validated information and facilitation of its absorption 60 Research and development for health for all 62 Optimal use of resources 63 Criteria for deciding on the form of WHO cooperation 65 Intercountry and regional activities 67 Training 69 Use of and limitations on provision of supplies and equipment 71 Use of consultants 71 Meetings 71

Process in countries 72

Mechanisms in countries 73

Regional office 74

Staffing policy 75 Budgetary and financial implications 76 Regional committee 77 Monitoring and evaluation 77 Timetable 78

Appendix 80

See resolution WHA38.11. 2 Document ЕB75 /1985 /REC /1, p. 6.

Page 8 of this volume.

- 44 - ANNEX 3 45

EXECUTIVE SUMMARY

I. The aim of a regional programme budget policy is to enable Member States to make the best possible use of WHO's resources for health development in their country, and in particular for their policy and strategy for health for all by the year 2000.

II. The mainstay of the programme budget policy is the process whereby countries make the most of WHO's resources - in the country, in other countries, in collaborating centres, at the regional level, in other regions and at the global level. The funds allocated in the regional programme budgets for cooperation with Member States are meant to ensure access to all of these as necessary. These resources have to be used to give rise to the self -sustaining growth of socially and economically relevant nationall health strategies and related programmes managed by the countries themselves, and to lead to the mobilization and most rational use of national resources for health to that end, as well as, in developing countries, to the mobilization and most rational use of external resources to the same end. To be effective, these endeavours have to be consistent with the policies, strategies and related programmes that Member States have decided upon collectively in WHO. Adherence to collective policy implies the kind of self -discipline required to focus the Organization's resources on activities that are vital for attaining the goal of health for all by the year 2000.

III. To adapt collective international policy to individual national needs, and to define national policies, strategies and programmes accordingly, requires a process of research and development (R &D) and of exposure to the findings of others' R &D. WHO is uniquely placed by its Constitution to cooperate with its Member States in such R &D, and in ensuring this exchange of information and experience. It can do so on condition that its Member States engage in the necessary communications with it. These R &D findings, like all endeavours in WHO, will only be of value if they, the process that gave rise to them and the results of their application are systematically monitored and evaluated and fearlessly reported on with a view to improving shortcomings and making up for deficiencies, as well as sharing experiences with other Member States.

IV. By its Constitution, WHO is made up of all its Member States collectively, cooperating to promote and protect the health of all peoples. Cooperation among parts that make up the whole implies a very intimate partnership between Member States and their Organization. Thus, cooperation that combines disciplined adherence to collective policy, experimentation in adaptively applying that policy to national circumstances, and free exchange of information and experience throughout the Organization, is fundamental to the regional programme budget policy. That policy will give visibility to Member States' loyalty to collective policies. As part of this loyalty they will understand that the Organization's resources are the collective property of its Member States and that in consequence the level of resources invested in a Member State in any biennium does not automatically become its everlasting right.

V. There is nothing really "new" in the regional programme budget policy: it is rather a systematic consolidation of policies that have been approved by WHO's governing bodies, such as the global and regional strategies for health for all by the year 2000, the Seventh General Programme of Work, resolutions of the governing bodies, and the global programme budget policy, together with the new managerial arrangements for ensuring optimal use of WHO's resources in direct support of Member States.

VI. As part of their intimate partnership relations, WHO and its Member States will cooperate in developing and implementing national strategies for health for all along the lines described in the global and regional strategies. This will include the investment of resources in reviewing and in developing national health systems based on primary health care, incidentally strengthening national capacities to do so. It will also include the

1 Wherever the word "national" is used in these guidelines it implies the country level as opposed to the international level; it does not necessarily imply the central level within the country. 46 THIRTY -EIGHTH WORLD HEALTH ASSEMBLY transfer of validated information and the facilitation of its absorption including training, as well as the joint pursuit of R &D, and support in generating and mobilizing resources. WHO will provide international services as well as direct financial cooperation in conformity with defined criteria. Intercountry activities will also be jointly agreed upon in the light of defined criteria, as will the facilitation of technical cooperation among developing countries (TCDC). The monitoring and evaluating of national strategies as part of the managerial process for national health development will be prominent in WHO's cooperative activities with its Member States.

VII. Resources will be invested in the promotion of national health strategies, including the formulation of well -articulated policy and strategy statements for the consideration of governments and socioeconomic planners, and the preparation of promotional material for the public, including the use of the mass media. Support will be given to the establishment of intersectoral mechanisms and the preparation of convincing inputs to national social and economic development plans as well as to major economic development projects. Measures will be taken to enlist professional health workers, citizens' groups and national nongovernmental organizations, including the possibility of providing appropriate incentives.

VIII. Major emphasis will be given to developing national health systems through support to national health programmes. To define and implement their strategy and its component programmes, Member States will find it necessary to apply a systematic managerial process for national health development and WHO will invest heavily in supporting them in this. Both in considering national programme priorities and WHO's involvement in their formulation and execution, Member States will find it practical to make use of WHO's General Programme of Work, proceeding systematically through it as a "checklist" from which to select the main kinds of issues, targets and objectives, programmes and activities to implement the national strategy; priorities will certainly cover the essential elements of primary health care. WHO's involvement in the formulation and implementation of national health programmes will be decided on through joint government /WHO application of this scanning process, using, defined criteria. Care will be taken to ensure a single infrastructure for the delivery of programmes, and to that end use will be made of the classes of programmes defined in the Seventh General Programme of Work - namely, direction, coordination and management; health system infrastructure; health science and technology; and programme support. In most countries, particular attention will have to be paid to the development and organization of a health system infrastructure based on primary health care. National science arid technology programmes will be identified in which WHO's resources could be usefully invested. Support programmes too should not be forgotten, particularly health information support. The exchange of information between WHO and its Member States as well as among those Member States will always be kept in mind.

IX. There will be no further independently managed "WHO projects" but only WHO cooperation in national programmes for whose execution the national authorities will be responsible. Existing WHO projects will be carefully reviewed with a view to phasing them out as quickly as possible, or, if appropriate, phasing them into national programmes.

X. To strengthen national capacities to prepare and implement national strategies for health - for -all and related programmes, Member States will identify those national structures, institutions and individuals that are potentially capable of making a useful contribution and being strengthened in the process. Cooperative activities will then be undertaken that both further the strategies and programmes arid at the same time strengthen the national capacities to do so. WHO will advocate, at top policy -making level, health development as an essential factor in socioeconomic development and will invest in strengthening as necessary ministries of health or equivalent health authorities. However, the Organization, by agreement with its Member States, will diversify its investments in countries by using where appropriate its constitutional right to have direct access to other relevant government departments and institutions, as well as nongovernmental organizations, strengthening them through the process of joint action.

XI. WHO will transfer to its Member States the wide variety of validated information required by them on all aspects of health, and will facilitate the absorption of such information by them. To this end, it will allocate adequate resources to build up the Organization's information systems and at the same time to support countries in building up ANNEX ¹ 47 their information systems so that they have the capacity both to absorb information from WHO and to contribute information to the Organization for exchange with other Member States. The use of appropriate information will be central to all cooperative ventures between WHO and its Member States.

XII. There are too many variables and too many other unknown factors within these variables to have a universally applicable model of a health system. What is known has to be adapted to local circumstances, and what is not known has to be elucidated. In both cases the process of research and development (R &D) is required. In the course of applying the managerial process for national health development, as well as proceeding systematically through WHO's General Programme of Work, dialogues between Member States and WHO will give due consideration to defining the country's needs for health research and development and for joint government /WHO investment of resources in such R &D. Attention will be given to the prompt dissemination of useful research findings to all who need them, and to the identification of problems for which more extensive worldwide research is required.

XIII. All the activities referred to above involve the investment of resources - knowledge, information, people, material, money. Optimal use has to be made of both national and international resources, since these are finite, and resources for health are usually scarce. WHO's resources have to be invested primarily in spearheading development; they are much too limited to permit it to share national recurring expenditures. These must devolve on the government; less developed countries may be able to obtain the support of other external partners. It is the government's responsibility to induce these partners to support national health activities that are consistent both with the national health policy and strategy and with the international health policies and strategies decided upon collectively under the auspices of WHO. Such combined efforts of national and international action should result in enlightened investment and use of resources.

XIV. A systematic approach will have to be adopted to ensure the preferential allocation of resources to priority activities in the national health strategy, such as through programme budgeting_ and related cost -effectiveness and cost -efficiency estimates of alternative ways of reaching the same objective. Having defined resource needs, it is necessary to define realistic ways of financing them, first of all with the resources available or potentially available in the country, and only afterwards in the case of developing countries turning to external sources. This is a government responsibility, but WHO will cooperate in this endeavour with those Member States that so desire. However, before contemplating additional resources, it is wise to make sure that the most is being made of existing ones. Sustained financing of the health system, whether through existing or additional resources, can be achieved in a variety of ways, and working out the optimal ways or combinations of them is another important R &D undertaking.

XV. The use of all resources has to be accounted for, not only to demonstrate that they have been spent according to agreed financial regulations, but also that they have been spent for the purpose for which they were invested. This implies setting up national programme monitoring and evaluation processes which include national accounting control and auditing procedures. WHO too, in addition to existing auditing practices, is setting up a process of monitoring the use of its resources through financial audit in policy and programme terms, namely identifying precisely how expenditures were decided upon aid what has actually been achieved once they have been incurred.

XVI. The form WHO cooperation will take will be decided upon using defined criteria. From a financial accounting viewpoint, WHO involvement in national programmes will take the form of either the provision of international services or direct financial cooperation. In most instances in developing countries a combination of both forms will take place, the balance between the two depending on the country situation and the national capacity to handle and account for WHO's resources through direct financial cooperation. WHO will cooperate with Member States with a view to developing such capacities. International services will include the provision by WHO of the conventional kind of technical support services. Direct financial cooperation will involve the sharing between the government and WHO of budgetary costs for carefully designed national programme activities aimed at attaining defined health objectives, targets and outputs. 48 THIRTY -EIGHTH WORLD HEALTH ASSEMBLY

XVII. Defined criteria will be used for the use of resources for intercountry and regional activities. WHO's intercountry activities have to be distinguished from technical cooperation among developing countries (TCDC). WHO's role in TCDC will be mainly catalytic and supportive, financing being mainly the responsibility of the governments concerned.

XVIII. Socially motivated and technically competent people are the most precious resource for health development. Heavy investments therefore have to be made in the training of health workers, and the pattern of that training will have to keep up with the changing pattern of the Organization's policies and the consequent relationships with its Member States. Particular emphasis will be given to the training of health workers in their own country in accordance with defined national health manpower policies and plans and in the light of critical needs that are part of defined national programmes. This will have the additional effect of strengthening national training institutions. The latter may also be effectively used for intercountry training which meets the criteria for intercountry and TCDC activities referred to above. WHO will provide its own training courses only in response to specific national needs emerging from joint government /WHO programme reviews. Similarly, WHO will set up intercountry training courses only on condition that they meet the criteria for intercountry activities referred to above. Fellowships will be granted in conformity with the policy on fellowships decided on by the Executive Board in resolution EB71.R6. Once a fellowship has been determined as the most appropriate means of training, Member States will use an adequate selection mechanism and will consult WHO in the process of selection. The use of fellowships and other training activities will be monitored and evaluated periodically.

XIX. WHO's resources for the provision of supplies and equipment will be highly selective and severely limited in accordance with defined criteria. Defined criteria will also be used with respect to the use of consultants. Greater use will be made of national staff of the country concerned in the execution of collaborative activities, and all consultants will have to be well versed in WHO's policies concerning the issues for consultation and will have to work together with the national health workers. All consultants will be carefully selected and adequately briefed. Clear criteria will also be adhered to with respect to meetings organized by WHO.

XX. The process in countries for carrying out the above will follow that decided upon by the World Health Assembly in resolution WHA30.23 concerning the development of programme budgeting and management of WHO's resources at country level. Joint government /WHO review will identify the essential needs for the development of the national strategy for health for all by proceeding systematically through the global and regional strategies for health for all. National health programme support needs will be determined by proceeding systematically through the WHO General Programme of Work. For each area of collaboration the kinds of information needed by the country as well as the needs for international services and direct financial cooperation will be identified. Ongoing WHO- supported activities in the country will be monitored and evaluated jointly by the government and WHO. As part of the joint government /WHO review process, areas will be identified where national resources could profit from being rationalized and for which additional national resources would have to be mobilized, optimal ways of using these resources being defined. Care will be taken to apply the criteria for determining the organizational level for the implementation of programme activities. Opportunities for facilitating technical cooperation among countries will also be seized.

XXI. Governments and WHO will thus engage in a continuing, joint process of programme budgeting. The regional committee will be provided with information on the proposed investment of WHO's resources in the country in terms of the programmes of the WHO General Programme of Work. Governments will also provide the regional committee with a succinct account of the use of WHO's resources in the country during the previous year or biennium. Moreover, they will explain why WHO's resources were not used for certain important parts of the national health strategy.

XXII. To carry out the above joint policy and programme reviews and programme budgeting process, an appropriate government /WHO coordinating mechanism will be established, the nature of which will depend on the situation in each country and the level of WHO resources being invested in it. Whatever the mechanism, wherever WHO programme coordinators exist they will exercise defined functions aimed at providing the government with information and ANNEX 3 49

explanations concerning the policies of the governing bodies of WHO; supporting the government in the planning and further management of national health programmes; collaborating with the government in identifying those national programmes in which WHO could profitably have more specific functions; and helping the government to identify and coordinate available or potentially available external resources for the implementation of approved national health programmes. An appropriate information system will be set up in WHO programme coordinators' offices to permit them to carry out their functions properly.

XXIII. Once the regional director has approved the programme budget proposals for the country, the question at the regional level will be how these are to be provided promptly, efficiently and effectively. To this end, an appropriate country support review mechanism will be established in the regional office to ensure a coordinated response from WHO to the total needs of each country. Its purposes will be to support the joint government /WHO mechanism; review programme proposals to the regional director; ensure a coherent response to countries' technical, administrative and financial needs; help ensure that intercountry and regional activities are relevant to countries in conformity with the defined criteria; and support the monitoring of the use of WHO's resources through financial audit in policy and programme terms. For such country support review mechanisms to be effective they will have to be managed by senior staff designated by the regional director, and supported by multidisciplinary teams.

XXIV. The regional director will keep the organization of the regional office under review, ensuring a "best fit" of requirements to provide well -coordinated support to national health strategies and programmes, to carry out the regional strategy for health for all and to implement the WHO General Programme of Work, always bringing to bear on countries the information and programme activities most appropriate to the situation. The information systems in the regional office will be updated or redesigned as necessary. The regional director will prepare the programme budget proposals for 1988 -1989 and subsequent financial periods in accordance with the new programme budget policy.

XXV. Staffing and recruiting polices in the region, along with staff profiles and training needs, will be reviewed in the light of the new regional programme budget policy, and the necessary changes will be introduced as soon as possible. The budgetary and the financial implications of the new policy will also be considered, it being realized that these will relate not so much to the overall level of WHO budgetary and financial resources in the region as to how the resources are used within the region, as well as to their distribution among Member States. These implications will be reflected in the distributive allocation of resources in the regional programme budget proposals for 1988 -1989 and future financial periods.

XXVI. As requested by the Executive Board in resolution EB75.R7, each regional committee will use these guidelines as a frame of reference in establishing the regional programme budget policy. It will monitor the further elaboration of the policy aid will ensure that the 1988 -1989 and subsequent regional programme budget proposals are prepared in line with it, establishing any necessary mechanisms to this end. In reviewing programme budget proposals, the regional committee, in compliance with resolution WHA33.17, will consider the proposals for each Member State in the region with a view to ensuring that they reflect the regional programme budget policy. This will include the consideration of each Member State's account of the use or non -use of WHO's resources in the country during the preceding period.

XXVII. The implementation of the regional programme budget policy will be monitored and evaluated, the main vehicle for doing so being the review of the programme budget proposals and of the use of WHO's resources in giving effect to these proposals once they have been approved by the Health Assembly. Monitoring and evaluation will be carried out successively by the regional committee, the Executive Board and the World Health Assembly. The Director -General and the regional directors will support them in doing so. 50 THIRTY- EIGHTH WORLD HEALTH ASSEMBLY

INTRODUCTION

1. The aim of a regional programme budget policy is to enable Member States to make the best possible use of WHO's resources for health development in their country, and in particular for their policy and strategy for health for all by the year 2000.1,2

2. The mainstay of the programme budget policy is the process whereby countries do make the most of whatever resources WHO has to offer - political, moral, human, technical, material and financial, no matter where these resources reside - in the country, in other countries, in collaborating centres, at the regional level, in other regions and at the global level. The funds allocated in the regional programme budgets for cooperation with Member States are meant to ensure access to all of these as necessary. These resources have to be used most effectively so that they do give rise to the self -sustaining growth of socially aid economically relevant national health strategies and to related programmes managed by the country itself; and that they do lead to the mobilization and most rational use of national resources for health to that end, as well as, in developing countries, to the mobilization and most rational use of external resources to the same end. These endeavours are most likely to bring nearer the goal of health for all if they are consistent with the policies, strategies and related programmes that Member States have decided upon collectively in WHO, for in this way individual Member States derive benefit from the collective wisdom and experience of all Member States.

3. All this is a far cry from bureaucratic dispensation of funds, submission and approval of requests for isolated projects or unplanned equipment, supplies and fellowships, or ad hoc manifestations of magnanimity. It implies a process of constructive dialogue between Member States and their Organization in a spirit of democratic cooperation - but cooperation within a policy framework that has been agreed by Member States collectively. Adherence to collective policy implies discipline, which is often associated with sacrifice. In the event this is a positive kind of discipline that implies no sacrifice: on the contrary, it implies the beneficial action of focusing the Organization's resources on activities that are vital for the most daring enterprise WHO's Member States have ever undertaken - the attainment of health for all by the year 2000, first and foremost through national strategies to that end. By corollary this means eliminating activities that are not vital to that end.

4. Are there uniform rules for achieving the above? No and yes. No, there are no universally applicable formulae that can be applied mechanically to reach the above goal. Yes, there are collectively agreed policies, strategies, programmes and principles whose application in specific national circumstances requires wise experimentation, learning not only from one's own doing but also from the experience of others. In short, to adapt collective international policy to individual national needs, aid define national policies, strategies and programmes accordingly, requires a process of research and development (R&D) and of exposure to the findings of others' R&D. WHO is uniquely placed by its Constitution to cooperate with its Member States in such R&D, and in ensuring this exchange of information and experience. It can do that on condition that its Member States engage in the necessary communications with it. These R&D findings will only be of real value if they, the process that gave rise to them and the results of their application are systematically monitored and evaluated and fearlessly reported on with a view to improving shortcomings and making up for deficiencies, as well as sharing experiences with other Member States. Indeed, this applies to all endeavours undertaken by the Organization and its Member States.

5. The above manifests the kind of positive discipline that, if adhered to with open -mindedness and inquisitive probing as a joint enjoyable venture of WHO and its Member States, should go a long way towards making it possible for each and every Member State - less developed and more developed - to derive greatest benefit from the Organization as a whole. That whole, which is made up of all Member States collectively, was established for the purpose of cooperation among Member States to promote and protect the health of all peoples as the Constitution of the Organization clearly states. Cooperation among parts that make up the whole surely implies a very intimate partnership between Member States and their Organization - partnership in policy, in technical programmes, and in related financial

1 Resolution WHA30.43.

2 [At regional level, reference to be made to the relevant resolution of the regional committee.] ANNEX 3 51

provisions. Moreover, national institutions and experts officially serving WHO are as much part of the Organization's system as are members of the Secretariat. Cooperation that combines disciplined adherence to collective policy, experimentation in adaptively applying that policy to national circumstances, and free exchange of information and experience throughout the Organization, is fundamental to the regional programme budget policy. Moreover, that policy will help Member States not only to use WHO as they have decided collectively, but also to give visibility to their loyalty to collective policies, particularly the policy and strategy of health for all by the year 2000 - no small matter in these days of growing criticism of international organizations. As part of this loyalty, they will understand that the Organization's resources are the collective property of its Member States and that in consequence the level of resources invested in a Member State in any biennium does not automatically become its everlasting right.

6. This having been said, there is nothing really "new" in the policy that follows. It is rather a bringing together in a systematic way of relevant policies that have been approved by WHO's governing bodies and appear in the globall and regional2 strategies for health for all by the year 2000, the Seventh General Programme of Work,3 and Health Assembly, Executive Board and regional committee resolutions, together with the new managerial arrangements for ensuring that WHO's cooperation with its Member States4 is as effective and efficient as is humanly possible.

7. It goes without saying that the global programme budget policy will have to be brought to bear on any regional programme budget policy. The objectives of the global programme budget for 1986 -1987 have been defined as follows:5

(1) To strengthen national capacities to prepare and implement national strategies for health for all by the year 2000 with emphasis on sound health infrastructure development.

(2) To focus technical cooperation on activities that support the mainstream of well -defined national strategies for health for all or on the development of such strategies where they do not exist.

(3) To build up critical masses of health -for -all leaders in countries; in WHO, in bilateral and multilateral agencies, and in nongovernmental and voluntary organizations.

(4) To promote the spectrum of research and development required for the further preparation and implementation of national strategies for health for all.

(5) To ensure that valid information required to prepare and carry out national strategies for health for all is made available to all in need according to their need, and to facilitate its absorption by them.

(6) To foster the coordinated and optimal use of resources by governments, bilateral and multilateral agencies and nongovernmental and voluntary organizations for the preparation and implementation of the national health -for -all strategies of developing countries.

These objectives will therefore be borne in mind throughout the preparation of the regional programme budget policy.

8. The regional programme budget policy will specify the issues to be considered, the process in countries for addressing these issues, and the related mechanisms for applying the

1 Global Strategy for Health for All by the Year 2000. Geneva, World Health Organization, 1981 ( Health for All" Series, No. 3).

2 [Reference to be made to the regional strategy for health for all by the year 2000.] 3 Seventh General Programme of Work covering the period 1984 -1989. Geneva, World

Health Organization, 1982 ( "Health for All" Series, No. 8). 4 See Appendix.

5 Proposed programme budget for the financial period 1986 -1987 (document РВ/86 -87), Geneva, World Health Organization, 1984, pp. XXV -XXVI. 52 THIRTY -EIGHTH WORLD HEALTH ASSEMBLY process. This will be followed by consideration of adaptations required in the functions and structures of the regional office, staffing policy in the region, budgetary and financial implications, and the role of the regional committee. The monitoring and evaluation of the policy will be outlined. Finally a timetable for preparation, implementation, monitoring and evaluation of the strategy will be included.

9. The proposed regional programme budget for the financial period 1988 -1989 will be prepared in accordance with this regional programme budget policy, as will subsequent regional programme budget proposals.

ISSUES

10. The regional programme budget policy will include the following issues:

(1) Support to national strategies for health for all

(2) Promotion of the national health strategy

(3) Developing the health system through support to national health programmes

(4) Strengthening national capacities to prepare aid implement national health - for -all strategies and related programmes

(5) Transfer of validated information and facilitation of its absorption

(6) Research and development for health for all

(7) Optimal use of resources for health - for -all strategies and related programmes

(8) Criteria for deciding on WHO international services and direct financial cooperation

(9) Intercountry and regional activities

(10) Training

(11) Use of and limitations on provision of supplies and equipment

(12) Use of consultants

(13) Meetings

Support to national strategies for health for all

11. WHO's regional programme budget will be used extensively and intensively to support national strategies for health for all. To identify the main activities and corresponding resources required of WHO to do that, it is necessary to recapitulate the main policy bases and main thrusts of a national strategy for health for all for which resources are required.

12. The main policy bases are:

(1) the recognition of health for all by the year 2000 as a priority social goal;

(2) equitable distribution of resources for health leading to universal accessibility to primary health care and its supporting services;

(3) government responsibility for the health of its people;

(4) community involvement in health development;

(5) the use of health technology that is appropriate for the country concerned;

(6) the involvement in health development of all sectors concerned, and not only the health sector;

(7) the mutually supportive influence of health and socioeconomic development leading to genuine human development; ANNEX 3 53

(8) national, community and individual self -reliance in health matters.

13. Resources will be required for all or some of the main thrusts of a national strategy for health for all appearing in paragraphs 14 -20 below, depending on each country's particularities.

14. Countries will review further their health systems with a view to reshaping them as necessary in order to:

(1) encompass the entire population;

(2) include appropriate components from the health and related sectors;

(3) provide the essential elements of primary health care at the first point of contact between individuals and the health system;

(4) ensure the support of the other levels of the system to primary health care;

(5) exercise central coordination of all parts of the system.

15. To develop such systems countries will take further steps to:

(1) identify and set in motion the activities required in the health and related sectors and make sure they are well coordinated;

(2) devise ways of involving people and communities in primary health care and plan accordingly;

(3) set up a referral system to support primary health care;

(4) organize a countrywide logistic system;

(5) plan, train and develop health manpower in response to people's needs as the backbone of the health infrastructure;

(6) establish suitable health care facilities;

(7) select health technology that is technically, socially and economically appropriate for the country, and ensure that it is properly used;

(8) foster control of the system in ways that are commensurate with the country's political, social and administrative practices.

16. To promote and support the development of such health systems countries will take further steps to

(1) ensure political commitment to the strategy of the government as a whole;

(2) ensure economic support to the strategy;

(3) make efforts to win over the health and related professions;

(4) disseminate information to different groups of people in order to mobilize political, financial, managerial, technical and popular support;

(5) establish and apply a managerial process for national health development, making use of health systems research;

(6) focus biomedical, behavioural and health systems research on solving problems related to the strategy.

17. To carry out the strategy all available human, material aid financial resources will be generated and /or mobilized.

18. Activities that could benefit from cooperation with other countries will be identified and the necessary action taken to ensure such cooperation. 54 THIRTY- EIGHTH WORLD HEALTH ASSEMBLY

19. The strategy will be monitored and evaluated, using at least the twelve indicators agreed upon globally in WHO.1

20. The following specific lines of action will be undertaken in countries in conformity with the regional strategy for health for all:

(1)

(2)

(3)

[e.g., in the European Region the targets would be included here in a suitable manner, such as by presenting the Region's 38 targets and annexing the document; or merely by referring to the targets with or without annexing the document.]

21. The regional programme budget - first and foremost through WHO's resources in each country, but also supplemented as necessary by intercountry and regional resources, calling on global and other resources as necessary - will support the above national action in the ways that follow. Through dialogue between each Member State and the Organization, agreement will be reached on priorities for WHO's actual involvement in that country, as well as the nature and scope of such involvement, following the articulation of realistic plans and prospects for the national health strategy.

22. WHO's direct support to national strategies for health for all will bring the Organization into intimate partnership relationships with its Member States and will include the following:

(1) Cooperation in the review of the country's health system with a view to reshaping it as necessary as outlined in paragraph 14 above

(2) Cooperation in developing the health system as outlined in paragraph 15 above and described in paragraphs 25 -34 below

(3) Cooperation in promoting the development of the health system as outlined in paragraph 16 above and described in paragraphs 23 -24 below

(4) Cooperation in strengthening national capacities to prepare and implement strategies, as described in paragraphs 37 -40 below

(5) Cooperation in transferring validated information and facilitating its absorption, as described in paragraphs 41 -45 below

(6) Cooperation in R&D as described in paragraphs 46 -49 below

(7) Cooperation in generating and /or mobilizing all available resources, as mentioned in paragraph 17 above and described in paragraphs 50 -58 below

(8) Cooperation in training as described in paragraphs 78 -84 below

(9) Provision of international services as listed in paragraph 61 below, e.g., internationally recruited staff, consultants (see paragraphs 86 -87 below), fellowships (see paragraphs 83 -84 below), supplies and equipment (see paragraph 85 below) and meetings abroad (see paragraph 88 below)

(10) Direct financial cooperation in conformity with the criteria presented in paragraphs 62 -69 below

1 Global Strategy for Health for All by the Year 2000. Geneva, World Health

Organization, 1981 ( "Health for All" Series, No. 3), pp. 74 -76. ANNEX 3 55

(11) Cooperation in identifying activities that could benefit from intercountry collaboration under the auspices of WHO as mentioned in paragraph 18 above, in conformity with the criteria presented in paragraph 70 below

(12) Facilitating of technical cooperation among developing countries (TCDC) as well as among developed countries and between developing and developed countries as described in paragraphs 73 -74 below

(13) Cooperation in monitoring and evaluating the national strategy, with particular emphasis on strengthening the national capacity to do so.l

Promotion of the national health strategy

23. Technical and managerial action alone, no matter how well carried out, will not ensure recognition for the national strategy for health for all. It has to be "sold "; and to do that requires the expenditure of resources. It has to be sold to different kinds of people representing different kinds of interest. First of all the government as a whole has to be convinced if it is to give its political blessing; without that the road to health for all will be even more uphill than it is. At the same time, economic planners have to be convinced that health is essential for development; otherwise the strategy will have no chance of competing with other demands on the national economy. The whole concept of health for all by the year 2000 has been misunderstood by large bodies of professional health workers; they have to be won over by getting them to understand what it is all about and to realize that they have a highly positive and important role to play. Last but not least, the public at large - as individuals, families, communities, and in different professional and social associations - have to be properly informed so that they are in a position to become intelligently involved in the health -for -all movement and capable of ensuring the social control of the health system.

24. The following is an illustrative list of activities on which countries could beneficially spend resources to ensure the above and call on WHO to collaborate:

(1) Submission of well -conceived and articulated policy statements to government to demonstrate the political popularity that can result from action aimed at attaining health for all citizens by the year 2000

(2) Presentation of a synopsis of the strategy for consideration and endorsement by the government

(3) Presentation of promotional material to public bodies, such as political parties, religious groups, trade unions, nongovernmental organizations, as well as to influential individuals

(4) Use of the mass media to get across to the public the message of the strategy and their part in it

(5) Establishment of mechanisms for joint action of the ministry of health or equivalent body and other ministries, and provision of appropriate encouragement and support for such action

(6) Submission of convincing inputs to the national social and economic development plan

(7) Promulgation of legislation required to develop or implement the strategy

1 To this end, use will be made of Health programme evaluation: Guiding principles for its application in the managerial process for national health development, Geneva, World Health Organization, 1981 ( "Health for All" Series, No. 6); Development of indicators for monitoring progress towards health for all by the year 2000, Geneva, World Health Organization, 1981 ("Health for All" Series, No. 4); "Common framework and format for monitoring progress in implementing the strategies for health for all by the year 2000" (WHO document DGO /82.1, Geneva, 1982); and "Evaluating the strategies for health for all by the year 2000 - Common framework and format" (WHO document DGO /84.1, Geneva, 1984). The two latter documents may be updated in the light of experience, in which case the latest version will be used. 56 THIRTY- EIGHTH WORLD HEALTH ASSEMBLY

(8) Presenting material to economic planners to explain how health contributes to productivity, and involving these planners as economic advisers for the development of the strategy

(9) Submitting proposals for health protection in major economic development projects, and for the health care of the communities involved

(10) Organizing gatherings of professional health workers, and in particular doctors and nurses (for example through their professional organizations), to explain the policy of health for all and the strategy for giving effect to it, and the roles of leadership, education, guidance and supervision they ought to be assuming - using appropriate audiovisual material accompanied by informative brochures

(11) Encouraging health workers to become involved in the practice of primary health care in communities, for example through appropriate remuneration and career structures

(12) Preparing suitable learning material for schools of medicine, nursing, public health and other health sciences, aid providing incentives to use that material

(13) Motivating citizens' groups and national nongovernmental organizations to lend their support to the strategy.

Developing the health system through support to national health programmes

25. A national strategy for health for all usually includes specific programmes, namely organized aggregates of activities directed towards the attainment of defined objectives and targets that are consistent with those of the strategy. Each programme should set out clearly the requirements in health workers, physical facilities, technology, equipment and supplies, information and intercommunication, methods of monitoring and evaluation, ways of ensuring correlation between its various elements and related programmes, a timetable of activities, and the expected costs as well as ways of covering them.

26. To define and implement their strategy and component programmes, Member States will find it necessary to apply a systematic managerial process for national health development.1 Ideally such a process should include the following:

(1) Formulating policies aid defining priorities

(2) Translating policies into a strategy with clearly stated objectives and targets

(3) Preferential allocation of resources to implement the strategy

(4) A plan of action to implement the strategy

(5) Preparation of detailed programmes as outlined in paragraph 25 above

(6) Delivery of the programmes through the health infrastructure and applying of sound day -to -day managerial procedures to this end

(7) Monitoring and evaluating strategies and programmes, and introducing modifications to them in the light of the findings

(8) Ensuring information support for all the above.

27. WHO will pay particular attention to the use of its resources for cooperation with Member States in establishing and applying such a managerial process. In considering both national programme priorities and WHO's involvement in their formulation and execution,

1 Managerial process for national health development: Guiding principles for use in support of strategies for health for all by the year 2000. Geneva, World Health Organization, 1981 ( "Health for All" Series, No. 5). ANNEX 3 57

Member States will find it practical to make use of WHO's General Programme of Work,1 proceeding systematically through it as a "checklist" from which to select the main kinds of issues, targets and objectives, programmes and activities to implement the national strategy. The priority programmes that emerge from such a process will depend on the country situation, but they will certainly cover the essential elements of primary health care.2 Decisions concerning WHO's involvement in the formulation and implementation of national health programmes will be taken through joint government /WHO application of this scanning process.

28. The following set of criteria will be used to decide on WHO involvement in national programmes, it being understood that not all the criteria need apply simultaneously, but that a reasonable number of them should:

(1) The problem is clearly defined.

(2) The underlying problem is of major importance to the country in view of its high social relevance in terms of its effect on people's health and particularly the health of underprivileged and high -risk groups; its incidence, prevalence, distribution and severity; or its adverse social and economic implications.

(3) The programme is an important part of the national strategy for health for all, having been identified as such through a systematic managerial process as described in paragraph 26 above.

(4) There is a demonstrable potential for solution.

(5) WHO's involvement has been clearly indicated in the national or regional strategy.

(6) WHO is better equipped than other external partners to support the country with respect to the issue, in view of its constitutional mandate and the knowledge and experience it can bring to bear.

(7) WHO's involvement could have a significant impact on the promotion of health and improvement of the quality of life.

(8) WHO's involvement will promote the establishment and self -sustaining growth of the programme throughout the country.

(9) The country will be able to maintain the programme in terms of financial resources and human resources that are either currently available or could become available if appropriate training was provided.

(10) WHO's involvement will help developing countries to rationalize and mobilize their resources for health as well as to mobilize external resources and use them rationally.

29. The danger is always present of establishing separate infrastructures for each programme, or perpetuating those that already exist. To overcome this, in keeping with the strategy for health for all aid in the interests of effectiveness, efficiency and economy, WHO's current General Programme of Work classifies programmes under four main headings:

(1) Direction, coordination and management [of WHO's policies and programmes]

(2) Health system infrastructure

(3) Health science and technology

(4) Programme support.

1 The current one will be found in Seventh General Programme of Work covering the 1984 -1989. period Geneva, World Health Organization, 1982 ( "Health for All" Series, No. 8). 2 Declaration of Alma -Ata, Article VII. See Alma -Ata 1978: Primary health care. Geneva, World Health Organization, 1978, reprinted 1983 ( "Health for All' Series, No. 1), p. 4. 58 THIRTY -EIGHTH WORLD HEALTH ASSEMBLY

30. Health systems infrastructure programmes aim at establishing comprehensive health systems based on primary health care and the related political, administrative and social adjustments, including a high degree of community involvement. They deal with: the establishment, progressive strengthening, organization and operational management of health system infrastructures, including the relevant manpower, through the systematic application of a well -defined managerial process and related health systems research, and on the basis of the most valid available information; the delivery of well -defined countrywide health programmes; the absorption and application of appropriate technologies that form part of those programmes; and social control of the health system and the technology used in it.

31. Health science and technology programmes, being an association of methods, techniques, equipment and supplies (together with the research required to develop them), constitute the content of a health system. Health science and technology programmes deal with: the identification of technologies that are already appropriate for delivery by the health system infrastructure; the research required to adapt or develop technologies that are not yet appropriate for delivery; the search for social and behavioural alternatives to technical measures; and the related aspects of social control of health science and technology.

32. The joint government /WHO scanning of the General Programme of Work, using the criteria in paragraph 28 above, will lead to identifying the national programmes in which WHO's resources would be usefully invested. In most countries it will be necessary to pay particular attention to the investment of resources in the development and organization of a health system infrastructure based on primary health care - either to establish or strengthen one or, in some countries, to put order into the multiplicity of institutions and convert them into a system. So it will be necessary to invest in assessing the health situation and trends, in setting up or reinforcing and applying the managerial process referred to above, in organizing the system so that it is capable of delivering health technology appropriate to the country, in ensuring the availability of socially and technically relevant health manpower, and in inducing people's involvement through the right kind of information and education so that they become competent to contribute to and control the country's health system. Essential to all of this is the establishment, continued updating and constant use of a supportive national health information system. A glance at the criteria in paragraph 28 above will reveal how extensive WHO's involvement in these matters ought to be, and therefore how extensively its resources should be invested in them and used wisely and with discipline to ensure effectiveness and efficiency.

33. This does not mean neglecting the health science and technology programmes; these too have to be dealt with in the perspective of the health and socioeconomic situation in each country. As mentioned in the Introduction, there are no universally applicable rules but rather general principles whose adaptation to any particular set of circumstances has to be researched and developed. This applies to health infrastructure programmes too. Hence the importance of research promotion and development - the first health science and technology programme in the Seventh General Programme of Work. Hence also the importance of health systems research in applying the managerial process for national health development. This kind of research will be useful for assessing the appropriateness of any health technology for the country and for arriving at the optimal organization of the health system infrastructure for delivering programmes that use technology that is appropriate.

34. National science and technology programmes in which WHO's resources would be usefully invested include those concerned with health protection and promotion in general or of specific groups; promotion of mental and environmental health; diagnostic, therapeutic and rehabilitation technology; and disease prevention and control. Support programmes too should not be forgotten, particularly health information support. Moreover, WHO's medium-term programmes should be scanned to identify relevant cooperative activities within programmes that the Organization might have to offer.

35. There will be no further independently managed "WHO projects" but only WHO cooperation in national programmes for whose execution the national authorities will be responsible. Any existing WHO projects will be carefully reviewed with a view to phasing them out as quickly as possible or, if appropriate, phasing them into national programmes. If the government agrees, WHO will make every effort to phase into national programmes those projects financed by other agencies for which it is executing agency, e.g., projects financed by UNDP, UNEP, or UNFPA. This will require negotiations both with the government and the other agency concerned. ANNEX ¹ 59

36. Cooperation in implementing WHO's General Programme of Work will include the highly important but sorely neglected function of exchange of information between WHO and its Member States and among Member States. This will be dealt with in paragraphs 41 -45 below.

Strengthening national capacities to prepare and implement national health - for -all strategies and related programmes

37. The importance of Member States managing their own health strategies and programmes has already been emphasized. Not all Member States have equal capacity to do this; that capacity has to be strengthened. In the era of WHO- managed projects in countries, reference was made to "national counterparts ". The aim will now be to have the national structures, institutions and individuals responsible - WHO's structures, institutions, information systems and staff being the "counterparts ". Such counterparts will only be useful if they have resources that are deficient in the country - knowledge, information, know -how, experience, powers of persuasion, and to some extent financial resources. Some or all of these as necessary will be shared with Member States, the latter assuming not only formal responsibility for the activities concerned but also operational responsibility, and thus learning and gaining experience by doing. To that end, the necessary resources will have to be invested - both national and WHO.

38. Member States will identify those national structures, institutions and individuals that are potentially capable of contributing usefully to the national health strategy and programmes. (Some such institutions have been termed "national health development centres ".) The list might include:

(1) The ministry or department of health, or equivalent authority

(2) Social security authorities or departments

(3) Ministries or departments of education, agriculture, planning or development, finance, environment, housing, public works, communications and the like

(4) Interministerial mechanisms

(5) National consensus groups on various health matters, similar to WHO's expert committees at the international level

(6) Universities, including schools or faculties of medicine, nursing, pharmacy or other health sciences, as well as schools and faculties of social, economic and behavioural sciences and postgraduate schools or faculties, for example of public or community health

(7) Other schools for professional or non- professional health workers

(8) Research and other academic institutions, for example for biomedical and health systems research, social and economic studies, and management

(9) Nongovernmental and voluntary organizations active in the health and related fields

(10) Individuals, such as experts in relevant fields and educational, civic, social and religious leaders

(11) Communities and their leaders, for example seen as community laboratories for self- determined patterns of primary health care.

39. WHO will use its powers of persuasion at top policy -making level to advocate health development as an essential factor in social and economic development. It will invest in strengthening, as necessary, ministries of health or equivalent health authorities so that they become the directing and coordinating authority on national health work as urged by the World Health Assembly.' Ways of doing so are to be found in the Global Strategy for Health for All, the Seventh General Programme of Work, and a number of regional documents.2

1 Resolution WHA33.17, para. 2(1). 2 [At regional level, the latter will be cited.] 60 THIRTY -EIGHTH WORLD HEALTH ASSEMBLY

However, the Organization, by agreement with its Member States, will diversify its investments in countries by using where appropriate its constitutional right to have direct access to other relevant government departments, as well as to governmental and nongovernmental health organizations,1 strengthening these through the process of joint action.

40. The following illustrates the kind of cooperative activities that will be engaged in with a view to developing and implementing the national health strategy and related programmes and at the same time strengthening the capacities of the national structures, organizations, institutions, and individuals involved:

(1) Development and application of the managerial process for national health development, including monitoring and evaluation of the national strategy for health for all

(2) Training

(3) Research and development

(4) Epidemiological studies

(5) Health situation and trend assessment

(6) Management studies

(7) Information collation, analysis, synthesis and dissemination

(8) Financial cooperation.

Transfer of validated information and facilitation of its absorption

41. One of the main functions of WHO is to provide information to its Member States on all aspects of health. For this information to be useful it has to be assessed and validated, objective and balanced. The Organization generates, collates and disseminates a vast amount of information, not all of it equally useful to all Member States, and much of it highly specific information that is required by different kinds of people in Member States. So the identification of relevant information for the national health strategy and programmes is a highly important activity that should permeate many other activities. Thus, during the application of the managerial process for national health development, it is necessary to identify aid use information not only emanating from the country itself, but also available from WHO. The joint scanning of the General Programme of Work mentioned in paragraphs 27 and 32 above has therefore another important function - that of identifying information available to WHO that could be useful for the national strategy and its diverse programmes. Such information is a highly precious resource that has to be used more often. Even if additional involvement of WHO in the national programmes concerned is not required, the provision of relevant, objective, validated information should be considered as a major contribution by the Organization.

42. The following kinds of information may be required by countries from WHO:

(1) The Organization's policies and strategies, programmes and principles, managerial arrangements and procedures

(2) Resolutions of its governing bodies and reports on their debates

(3) Regional and global reports by Member States on the monitoring and evaluation of the strategies for health for all

(4) Relevant, sensitive and consistent programme information relating to programme planning, implementation, monitoring and evaluation; the experience of other countries; scientific and technical information whether or not generated by WHO, including bibliographical references to the relevant world literature; technical and managerial guidelines

1 Constitution of the World Health Organization, Article 33. ANNEX 3 61

(5) Expert committee, study group and scientific group reports, as well as other WHO scientific and technical publications and documents

(6) Findings of research and R &D

(7) Training and learning material

(8) Popularized information on health matters

(9) Lists of relevant collaborating institutions throughout the world and of other sources of information and expertise

(10) Potential sources of external technical cooperation and financing from the international community

(11) Reports of Member States to the governing bodies

(12) Reports of the Director -General to the Executive Board and Health Assembly

(13) Reports of the regional directors to the regional committees

(14) Regional and global programme budget information.

43. WHO will allocate adequate resources to build up information systems capable of making available to Member States the above kinds of information, and at the same time to support countries in building up their information systems so that they have the capacity both to absorb information from WHO and to contribute information to the Organization. Some, but not all, of the information will be held in the offices of the WHO programme coordinators; these offices will have reference to the source of information not held by them and will have access to these sources through the regional office. The regional office too will have references to the sources of information not stored by it and will have access to the information held at other regional offices and at the global level. The global level will take active measures to ensure that the regional level is informed about the availability of the information it holds and will selectively disseminate that information by mutual agreement. Moreover, the global level will have access to information held in the regions. All this is not for the glory of the Secretariat, but to ensure that Member States do in fact get the information they require and that none of the organizational levels is overloaded with information that it may need only rarely, or not at all. Indeed, a leading criterion for evaluating the work of WHO at all levels will be the relevance, response rate, and quality of the information it provides to Member States.

44. For information to be useful it has to be used. The use of appropriate information will thus be central to all cooperative ventures between WHO and its Member States. This means seeking all possible avenues for transferring the required information. They will include insistence on clarifying what is the most appropriate information for any joint activity and persistence in using it. This relates not only to joint planning and operational activities but also to workshops, seminars and other learning happenings. Moreover, it may be useful to appoint focal points or networks within countries to ensure that the information reaches the individuals, institutions and programmes that require it. It will be a highly legitimate use of WHO's human, material and financial resources to cooperate in setting up and sustaining such focal points and networks.

45. But the ultimate responsibility of Member States for WHO requires an information flow in the other direction too. So in the joint scanning of the General Programme of Work, information will be identified from the country's programmes and experience that might usefully be absorbed by WHO's information system for exchange with other Member States. Such information could include, for example, successful research and development in the country on the organization of health systems based on primary health care or on the delivery of a new technology for prevention and control of disease, which could be adapted to provide solutions in other countries. Thus the value of the relationship between WHO and any particular Member State is to be measured not only by what that country can get out of WHO, but also what the country can put into the cooperative system. 62 THIRTY -EIGHTH WORLD HEALTH ASSEMBLY

Research and development for health for all

46. As stated in the Introduction, there are no universally applicable models of a health system, even if the goal for which the system was set up is identical. There are too many variables - political, social, cultural, economic, epidemiological, managerial, scientific and technological - and too many unknown factors within those variables, for uniformity to be possible. What is known has to be adapted to local circumstances; what is not known has to be elucidated. In both cases the process of research and development (R &D) is required; put simply, that means generating knowledge and working out the most appropriate ways of applying it for a useful purpose.

47. When Member States adopted the Global Strategy for Health for All, they undertook to review the scope and content of their activities in the fields of biomedical, behavioural and health systems research with a view to focusing them on problems requiring solution as part of their own strategies for health for all. This implies developing an R &D strategy to support the national health strategy. To do that will require new attitudes and new ways of thinking on the part of national and international health workers, as well as their appropriate training. Lest it be considered that research is a luxury of the affluent, it should be pointed out that its successful pursuit and the application of its findings are often the source of affluence. Dialogues between Member States and WHO will therefore give due consideration to defining the country's needs in health research and development. In so doing, account will have to be taken of the potential applicability of the R &D findings to the country as a whole and not merely to that part of it under investigation. There are at least two interconnected ways of defining the R &D needs: one is in the course of applying the managerial process for national health development, and the other is in the course of proceeding systematically through WHO's General Programme of Work as mentioned above.

48. In both cases, as each issue arises, questions such as the following have to be asked:

(1) Is the problem clear? If not, studies have to be undertaken in order to clarify it.

(2) Does the knowledge exist for solving the problem? If not, biomedical or social and behavioural research - or both - have to be pursued in order to generate that knowledge.

(3) Does the technology exist for solving the problem? If not, developmental activities have to be undertaken to devise the technology.

(4) Is the technology appropriate for the country concerned or for different areas, communities and social groups in the country? To determine that, the technology has to be assessed in terms of its scientific soundness, its social and cultural acceptability and its economic feasibility.

(5) Is the technology potentially appropriate but not effective, or not being adequately or properly used? In response to that, operational research to adapt the technology or modify the health system infrastructure is required.

(6) Are there social and behavioural alternatives or additions to the technical measures that would solve the problem or contribute to its solution? To reply to this question requires social and behavioural research.

(7) Are there social, cultural or economic obstacles to applying the technology? When such obstacles are suspected, socio- anthropological and economic research is indicated.

(8) Are there adequate numbers of health workers for the work to be performed, and are they socially motivated for their responsibilities and technically capable of fulfilling them? Health manpower research and development will be required to respond to these questions and to introduce any necessary improvements in the situation.

(9) Is the health system infrastructure sufficiently developed and adequately organized to deliver programmes using appropriate technology and induce the social and behavioural measures required? Health systems research can help to answer that.

(10) What are the most suitable ways of financing the health system? To answer that rationally will require economic and social research in addition to political insight. ANNEX 3 63

49. In practice, various combinations of the above kinds of research are required. It is clear that a mine of opportunities presents itself for potentially fruitful joint government /WHO investment of resources in R &D. The following illustrates the kinds of activity that will be considered for such investment:

(1) Formulation of a health research strategy, including ways of determining priorities

(2) Establishment or strengthening of promotional, coordinative and supportive mechanisms for health research, such as health research councils or health research sections in general scientific research councils

(3) Setting up of mechanisms to bring together health research workers, health planners and socioeconomic planners

(4) Clinical research on issues of importance for the provision of medical care in the country, such as testing new diagnostic procedures or promising new drugs

(5) Community research, such as: epidemiological studies, intervention trials for new drugs and vaccines, communicable disease control through primary health care, development of low-cost technology for drinking -water supply, investigation of the effects of behaviour on feeling healthy, and prevention and control of coronary heart disease or of the chronic disorders prevalent in the country, to mention a few examples

(6) Participation in global research activities, for example on human reproduction or on endemic tropical diseases

(7) Training of young research workers by involving them in research

(8) Establishment of a career structure for health research workers and provision of incentives, particularly to those entering sorely needed but highly neglected areas, ensuring that a balance is maintained between research and service

(9) Prompt dissemination of useful research findings to all who need them

(10) Identifying problems on which more extensive, possibly worldwide, research is required, such as to develop a new or more effective vaccine, pesticide or drug.

Optimal use of resources

50. All the activities referred to above involve the investment of resources - knowledge, information, people, material, money. Since resources are finite, and resources for health usually scarce, optimal use has to be made of them. This applies to the country's resources, to WHO's, and to those of other partners outside the country. In many instances in the preceding sections no distinction has been made between the use of resources by countries on the one hand and by WHO on the other. This derives from WHO's international position as the intimate partner of Member States with respect to health development, from which it follows that its cooperation is so close that it is sometimes hard to distinguish qualitatively between WHO's share and that of the country concerned. It has to be realized, however, that such intimacy may touch on the raw nerves of the country's social and economic system and that it is therefore the government's prerogative to decide on its limits.

51. Quantitatively the situation is different. WHO's resources have to be invested primarily in spearheading development; they are much too limited to permit it to share the recurring expenditures of administering the health services, such as costs of staff, maintenance of institutions, and provision of drugs. Such expenditure must devolve on the government; less developed countries may be able to obtain the support of other external partners, such as bilateral or multilateral agencies and nongovernmental and voluntary organizations. It is the government's responsibility to induce these partners to support national health activities that are consistent both with the national health policy and strategy and with the international health policies aid strategies decided upon collectively under the auspices of WHO. That is what is meant by "enlightened external support ". Such support can provide valuable supplements to national health development efforts as well as to the current administration of the health system. WHO will cooperate with its Member States - the less affluent and the more affluent - in ensuring that such relationships between countries in the field of health are indeed "enlightened ". Combined national and international action will in this way result in enlightened investment and use of resources. 64 THIRTY- EIGHTH WORLD HEALTH ASSEMBLY

52. It is a truism to state that in order to implement strategies for health for all and programmes related it is necessary to identify, find and use the resources required. But the best ways of doing so are not obvious. Reference was made in paragraph 26 above, in connection with the managerial process for national health development, to the preferential allocation of resources to activities that form part of the national health strategy as well as to a plan of action to implement the strategy. How are these resource needs to be identified? A systematic approach to that task is called programme budgeting, which implies formulating priority programme activities to attain defined objectives and allocating budgets to those activities. To do that, it is first necessary to analyse the economic carrying capacity of the country and the distribution of resources between health and other competing concerns, as well as the distribution among the various concerns within the health system. It is also necessary to study the cost -effectiveness and cost -efficiency of alternative ways of reaching the same objective. Guiding principles for programme budgeting are to be found in a WHO document entitled "Programme budgeting as a part of the managerial process for national health development (MPNHD): Guiding principles ".1

53. Having defined resource needs it is then necessary to define realistic ways of financing them, first of all with the resources available or potentially available in the country and only afterwards, in the case of developing countries, turning to external sources. This again is a government responsibility, but WHO will certainly cooperate in such an endeavour with those Member States that so desire. Before contemplating additional national resources it is wise to make sure that the most is being made of existing ones. This applies to countries at all levels of economic development; for those with the least resources it is the most urgent. Thus, making sure that the technology being used is really appropriate for the country and is being applied properly, ensuring coordinated action among the different components of the health system, and reducing slack to a minimum through improved management of the health system infrastructure and the programmes it is delivering, can all contribute to releasing resources for additional high priority activities.

54. Sustained financing of the health system, whether through existing or additional resources, can be achieved in a variety of ways. They include (to mention only the main ones) central, regional or local taxation, community contributions, social security systems, health insurance schemes, employers' contributions, fees -for -service, revolving funds, and other forms of cost sharing and cost recovery. The blend of costs and means of financing will vary between countries, and sometimes between different states or localities within a country. Working out the optimal ways or combinations of them is another important R &D undertaking. Guiding principles for financing health systems are to be found in a WHO publication entitled Planning the finances of the health sector: A manual for developing countries.2

55. When the health authorities of developing countries decide to have recourse to external sources of funds for health, they will first have to list and analyse the use of such funds as are already available in the country with a view to making optimal use of these. They will then have to identify those activities for which it can realistically be expected to attract additional external funds. To do so they will have to present to potential partners convincing justifications, demonstrating how these funds will be used to support essential components of the national health strategy that are consistent with international collective health policy. They will also have to demonstrate how they are using their own resources, and other external resources already available, for activities essential to the strategy. All this may be termed "country resource utilization review"; it is an inseparable part of a managerial process for national health development.

56. The use of all resources has to be accounted for; national and WHO resources for health are no exception. This is an essential part of the discipline first referred to in the Introduction. However, it is not enough to demonstrate that resources have been spent according to agreed financial regulations, it is necessary to show that they have been spent for the purpose for which they were invested. This means that if countries are to ensure the optimal use of both internal and external resources, they will have to set up national programme monitoring and evaluation processes which include national accounting control and auditing procedures that provide sound evidence of internal and external resources being

1 WHO document MPNHD /84.2, Geneva, 1984.

2 Mach, E.P. & Abel- Smith, B. Planning the finances of the health sector: A manual for developing countries. Geneva, World Health Organization, 1983. ANNEX 3 65

effectively and efficiently used for the purpose intended. The demonstration of proper use of resources is the best guarantor of continued and increased availability of resources for health.

57. WHO too, in addition to its existing auditing practices, is setting up a process for monitoring the use of its resources through financial audit in policy and programme terms, namely: identifying precisely how expenditures were decided upon, what has actually been achieved once they have been incurred, and how they relate to the national, regional and global strategies for health for all. Thus, the process will clarify how, by whom, and on the basis of what policy decisions expenditures were planned and decided upon and »¼½« the decisions were taken. It will trace the progress of implementation in relation to expenditures incurred, and will assess the efficiency with which resources were used. The Organization will cooperate with its Member States in monitoring the use of WHO's resources in this way. Since WHO's resources will be intimately interwoven with those of its Member States, the existence of similar auditing processes within Member States will lighten the joint task. The setting up of such internal processes by Member States will therefore be useful not only for helping them to make optimal use of their own resources but also for monitoring the use of their Organization's resources.

58. While governments retain full responsibility for making optimal use of resources in their country, it is possible to sum up the ways in which WHO will cooperate with them in doing so. They include:

(1) Analysis of national health resources situation and trends in the light of the country's economic carrying capacity

(2) Programme budgeting of national health resources to ensure preferential allocation to priority activities

(3) Costing of health strategies and programmes, and related cost -effectiveness and cost -efficiency studies

(4) R &D on optimal ways of financing the health system

(5) Country resource utilization reviews as part of the managerial process for national health development

(6) Preparation of convincing proposals for attracting external funds for the national health strategies and programmes of developing countries

(7) Ensuring that WHO's resources are used to spearhead developmental action for health

(8) Setting up national systems for financial monitoring and evaluation in policy and programme terms, including the assessment of both the effectiveness and efficiency of the use of resources

(9) Cooperation in applying WHO's process of financial audit in policy and programme terms.

Criteria for deciding on the form of WHO cooperation

59. Whatever the nature of WHO's direct cooperation with Member States, the regional programme budget policy calls for sufficient flexibility in WHO's internal programme budgeting procedures. These have to be consistent with standards of international accountability for the use of the contributions of Member States, and to permit maximum interface and mínimum interference with properly designed national programme budgeting procedures, as part of the overall managerial process for national health development. From a financial accounting viewpoint, WHO involvement in national programmes can take two forms:

(1) Provision of international services and related technical support to national programmes

(2) Direct financial cooperation in the national programmes. 66 THIRTY- EIGHTH WORLD HEALTH ASSEMBLY

60. In most instances in developing countries a combination of both forms will take place, the balance between the two depending on the country situation and the national capacity to handle and account for WHO's resources through direct financial cooperation. WHO will cooperate with Member States with a view to developing such capacity. However, where national fiscal policy precludes direct financial cooperation, the Organization will have to administer certain activities financially on behalf of the health authorities of the country concerned.

61. International services include the provision by WHO of the conventional kind of technical support services - internationally recruited staff, consultants, meetings, equipment and supplies, training including fellowships, attendance at international meetings, etc., which can be accounted for by the Organization in the first instance.

62. Direct financial cooperation involves the sharing between the government and WHO of the budgetary costs of carefully designed national programme activities aimed at attaining defined health objectives, targets and outputs. In accounting for such cooperation it is unnecessary to identify WHO's financial share with particular objects of expenditure, as under what have conventionally been called "local cost subsidies ", for example paying for supplies and equipment bought locally or meeting part of the salary of national staff. "Direct financial cooperation" is an expression of partnership with countries in that it implies WHO's cooperation in agreed national health programme activities. It is in no sense a "give away" of money, since WHO and the government will share their vital interest in the progress and performance of the specific activities agreed upon, in keeping with their intimate partnership relationship forged by disciplined adherence to collective policy.

63. Moreover, accountability is required to show that the funds have been used for the intended national programme purpose, and, ultimately, that the programme can be monitored and evaluated in terms of performance. Cooperation will thus be accompanied by monitoring of the use of the money in terms of measurement of outputs aid attainment of targets and objectives: for example, with respect to R &D, an assessment of the outcomes and their usefulness for national health development programmes. To give other examples: Were immunization targets reached? Were the planned numbers of trainees actually trained and were they absorbed usefully into the health system? In view of the novelty of this approach, and in order to dissipate misunderstandings, it is worthwhile describing it in more detail. The following are some particularly relevant examples.

64. Governments might ask for WHO support in policy promotion, in the form of information and the participation of staff in a consultative capacity. But to promote policy it would be useful to strengthen national institutions. An agreement would be worked out between the government and WHO on the form that cooperation for policy promotion should take, and the costs would be shared. Most of the promotion would be undertaken by the country, but some would be undertaken by WHO both to facilitate the initiation of the effort and to attract additional resources to it from inside and outside the country.

65. Cooperation in the managerial process for national health development might be similar to the promotion of policy. It could involve the setting up or the strengthening of a national health development centre or a network of centres, for example in planning, social and economic analysis and information system support. It could also involve training within the country - WHO providing training material, taking part in the training of trainers and ensuring direct financial cooperation for a few years to set the process in motion and make sure that it gets firmly established.

66. The transfer of technology and information is one of the weakest areas in WHO's programme. The Organization is producing a great deal of useful technology and information but in comparison is doing much less to ensure their penetration and absorption. Therefore, joint schemes could be established with countries to work out programmes of information transfer, incorporating libraries, information systems, workshops and training courses, WHO's contribution being the technology and information to be transferred and a share of the overall costs in the countries concerned.

67. R &D could take place jointly in a multiple variety of areas, involving government ministries, universities and other academic and research institutions, WHO providing expertise, methodology, the experience of other countries and other information, and participating in the overall costs. Examples have been given in paragraphs 46 -49 above. In all cases the information and experience generated would be fed back to WHO's information system for use as required in other countries. ANNEX 3 67

68. National training activities, as part of a national health manpower development strategy, lend themselves admirably to direct financial cooperation. Thus, training in national institutions (both academic and other), non -institutional or on- the -job training such as in primary health care in communities, and specific workshops decided on through joint government /WHO programme reviews, could all benefit from WHO support through provision of training and learning material, training of trainers, participation of staff and consultants in ongoing training and, in addition, direct financial cooperation until the activities become nationally self -sustaining and the related institutions firmly established.

69. Direct financial cooperation can be useful for launching national programmes, e.g., for launching primary health care on a countrywide basis, or starting in certain communities and progressively extending the experience gained by them to other communities and eventually to the whole country. By virtue of their involvement in applying WHO collective policy, such communities and the national programme they are implementing become part of the Organization's system. Also, a government might decide to initiate a number of primary health care elements jointly depending on the local situation, e.g., water and sanitation using locally appropriate technology, maternal and child health including family planning, immunization, diarrhoeal disease control, and essential drugs. WHO, in addition to providing information required, and possibly collaborating in programme planning and in related R&D and training, could also cooperate financially by providing seed money. This could be provided on a diminishing scale over a period of years until the country can take over financially; or to initiate the programme in additional areas until the whole country is covered. Moreover, such seed money can act as an encouragement to bilateral and multilateral agencies to provide "enlightened" support for the further development of such programmes once they have been launched.

Intercountry and regional activities

70. Thus far consideration has been given almost exclusively to the use of WHO's resources in individual Member States. But it may also be useful to use these resources for intercountry activities. To decide on that, the following criteria will be applied (compare with criteria for activities at the country level in paragraph 28 above):

(1) Similar needs have been identified by a number of countries in the region following a rational process of programming or a common awareness of joint problems.

(2) The activity will be useful for eventual application by countries.

(3) The pursuit of the activity as a cooperative effort of a number of countries in the same region is likely to contribute significantly to attaining the programme objective.

(4) For reasons of economy the intercountry framework is useful for pooling selective national resources, for example for the provision of highly skilled technical services to countries.

(5) Cooperating countries, whether developing countries cooperating among themselves (TCDC /ECDC), developed countries so doing, or developed countries cooperating with developing countries, have requested WHO to facilitate such cooperation.

71. The above criteria, taken from the Seventh General Programme of Work,1 will be applied as part of the government /WHO dialogue concerning the use of WHO's resources in the country, and in particular when scanning jointly the General Programme of Work as described in previous sections. Also, WHO's medium -term programmes will be scanned to identify the precise intercountry activities that will be available if the need has become apparent for the participation in such activities of the country concerned.

72. The following kinds of issue lend themselves well to intercountry activities:

(1) Advocacy of the policy and strategies for health for all and related leadership development

(2) Training and sharing of training facilities

1 Seventh General Programme of Work covering the period 1984 -1989. Geneva, World

Health Organization, 1982 ( "Health for All" Series, No. 8), pp. 34 -35, para. 70. 68 THIRTY -EIGHTH WORLD HEALTH ASSEMBLY

(3) R&D, for example for generating appropriate technology and identifying various useful ways of applying it through the health infrastructure, as well as for exchange of methodology

(4) Exchange of information and experience

(5) Joint programme activities along common borders, for example for the control of malaria or onchocerciasis

(6) Specific issues identified as priorities for intercountry action by the regional committee.

73. WHO's intercountry activities have to be distinguished from technical cooperation among developing countries (TCDC) although often the distinction has not been made. The characteristics of TCDC are that political cooperation among the countries concerned, or at least the absence of political antagonism, is a prerequisite. Cooperation results from voluntary agreements between governments and joint activities aim at strengthening the self -reliance of the countries or group of countries concerned with respect to the subjects of collaboration and in the interest of promoting active socioeconomic development. These might include, in addition to the issues mentioned above for intercountry activities, such matters as information on institutions in the countries concerned that are able to provide the services required; transfer of technology; joint planning and purchasing of equipment and supplies, such as drugs; quality control of vaccines and drugs; and provision of specialized medical care. All this may apply equally to cooperation between developing and developed countries, as well as among developed countries.

74. WHO's role in TCDC will be mainly catalytic and supportive. The financing of TCDC will be mainly the responsibility of the governments concerned; otherwise there is a risk of destroying the very self -reliance that TCDC aims at generating. Member States will be entitled, however, to make use of the WHO country allocation as seed money to plan and initiate the process, but the bulk of the funds will have to come from the countries themselves, with the possible support of bilateral and multilateral development agencies. WHO is ready to cooperate with governments that so wish to obtain such support, if the TCDC proposals seem promising.

75. WHO also has resources at the regional level. These are meant to support Member States collectively through the work of the regional committee and its subcommittees and by ensuring appropriate cooperation with individual Member States in line with regional and global policy. The following criteria will apply for deciding on regional activities:

(1) The activity directly supports the work of the regional committee or one of its subcommittees.

(2) The activity encompasses regional planning, management, monitoring aid evaluation.

(3) The activity ensures regional coordination.

(4) The activity facilitates TCDC.

(5) The activity supports direct cooperation between WHO and a Member State at the national level.

(6) The activity supports approved intercountry activities.

(7) The activity is an essential regional component of an interregional or global activity.

(8) For reasons of economy the regional framework is useful for pooling highly selective international resources, for example for the provision of highly skilled technical services to countries.

76. Support from regional -level resources will include the following:

(1) Enlisting top-level political support for the national and regional strategies

(2) Supporting the implementation and monitoring of the strategies ANNEX 3 69

(3) Promoting intersectoral and international action in the region

(4) Facilitating information exchange and technical cooperation among countries of the region

(5) Supporting country and intercountry research and development

(6) Supporting country and intercountry training

(7) Coordinating multidisciplinary technical support to countries

(8) Identifying needs for, and possible sources of, external resources for health strategies in developing countries, with greatest attention to development of the health system infrastructure in accordance with the defined priorities articulated in the national policies and strategies for health for all

(9) Setting up appropriate information systems to carry out the above.

77. The regional level will draw on the global level as necessary for global political support for health -for -all strategies, coordination of information and resources transfer, promotion of ideas and research, and specialized technical support, as well as financial cooperation in highly selective innovative activities from which useful experience might be gained for Member States throughout the world.

Training

78. The most precious resources for health development are human beings, on condition that they are socially motivated and technically competent to carry out the tasks devolving on them. To satisfy that condition requires heavy investment. Training of health workers is one of WHO's time-honoured priority preoccupations, but the pattern of that training has to keep up with the changing pattern of the Organization's policies and consequent relationships with its Member States. In the past, overriding priority was given to fellowships abroad. This has resulted in the existence of tens of thousands of health workers throughout the world who were trained in this way. But what might have been highly relevant in the past is not necessarily so in the context of the Organization's latest policies and related functions. Now the emphasis must be on training that is highly relevant to each country's strategy for health for all and that at the same time strengthens the national capacity to generate itself the kinds of health workers it requires. Hence priority will now be given to training within the country itself whenever possible, and to the concomitant strengthening of the national training institutions concerned.

79. It also has to be remembered that fellowships abroad require the spending of WHO's hard currency outside the country of origin of the trainee, whereas training in the country implies the infusion of additional resources into the country. Moreover, the latter makes it possible to train more people in more relevant and cost -effective ways than by sending them abroad to study in systems, technologies and settings that may be quite inapplicable to their country. Where fellowships abroad are still indicated, care will be taken to ensure that they take place in a country whose conditions are comparable with those of the fellow's country, with the exception of a limited number of fellowships in highly specialized subjects.

80. Training in countries with WHO's involvement will take place selectively in accordance with defined national health manpower policies and plans and in the light of critical needs that are part of defined national programmes. In addition to, and also as part of, cooperation with Member States in formulating relevant national health manpower policies and plans, the following are some of the forms that such cooperation will take in the country:

(1) Cooperation in training leaders for health for all from diverse walks of life

(2) Cooperation in training trainers

(3) Cooperation in training all categories of health workers and of workers in related sectors in primary health care and community health in general

(4) Cooperation in training non -professional primary health care workers on the job in the community 70 THIRTY -EIGHTH WORLD HEALTH ASSEMBLY

(5) Cooperation in training non -professional primary health care workers from other communities in communities with more experience

(6) Cooperation in other on- the -job training

(7) Cooperation in national seminars and workshops

(8) Cooperation in reshaping the curricula of training institutions

(9) Provision of health learning material and cooperation in adapting it to local needs

(10) Direct financial cooperation in training institutions

(11) Making available information on training facilities.

81. National training institutions may also be effectively used for intercountry training which meets the criteria and purpose of intercountry and TCDC activities (indicated in paragraphs 70 and 73 above), taking into account the suitability and acceptability of the institutions to the other countries involved. WHO will help to identify and bring into contact such institutions, thus creating training networks.

82. In the past, WHO ran a considerable number of its own training courses. In the light of the new policy, the Organization may provide critically needed training courses in countries in response to specific national needs emerging from joint government /WHO programme reviews (see paragraph 27 above), particularly as a prelude to important developmental or operational activities, such as the introduction or updating of a managerial process for national health development, monitoring and evaluating strategies for health for all, and training of managers, for example for the national immunization, diarrhoeal disease control and essential drugs programmes. WHO may sometimes set up intercountry training courses on condition that they meet the criteria for intercountry activities (see paragraph 70 above) as well as the kind of criteria for national training courses mentioned in this paragraph.

83. Fellowships will be granted in conformity with resolution EB71.R6 of the Executive Board, entitled "Policy on fellowships ". The following criteria will be adhered to:

(1) A fellowship is the most relevant and cost -effective training option.

(2) A fellowship is the most appropriate means of contributing to the attainment of the objectives of the national health manpower policy and plan.

(3) A fellowship is the most appropriate means of contributing to the attainment of the objective of a specific national health programme that forms an essential part of the health strategy.

(4) The institution abroad is capable of providing training that is highly relevant to the conditions of the fellow's country.

(5) Appropriate employment is assured to the fellow in the subject of study on return to the home country.

84. For the purpose of selecting WHO fellowship candidates once a fellowship has been determined as the most appropriate means of training, Member States will use an adequate selection mechanism, such as a properly constituted selection committee composed of representatives of the national health administration, the appropriate national body concerned with the education of health personnel, and the appropriate professional group (if applicable), and will consult WHO in the process of selection. The use of fellowships and other training activities will be monitored and evaluated periodically in terms of impact of health manpower development an national health development.1

1 Resolution EB71.R6 [and any regional committee resolution on training policy, including fellowships]. ANNEX 3 71

Use of and limitations on provision of supplies and equipment

85. WHO's role of technical cooperation rather than technical assistance implies a highly selective use of WHO's resources for the provision of supplies and equipment, and severe limitations on such use. The following criteria will be adhered to when contemplating the use of resources to this end:

(1) The supplies or equipment are essential technical components for implementing a well -defined national programme in which WHO has become involved following a government /WHO dialogue in which the criteria appearing in paragraph 28 above have been applied, and the government concerned is itself committed to the purchase of supplies or equipment for the same programme.

(2) The purchase by WHO is not a substitute in the long term for purchase by governments.

(3) The purchase, if and when required, has been included in the joint planning of WHO's involvement in the national programme, and not added as an afterthought or as a way of using up unused funds towards the end of the biennial financial period.

(4) Subsequent use of specifically planned supplies or equipment provided by WHO must be accounted for in terms of their essential nature for the development of the programme concerned.

Use of consultants

86. WHO's international services include the provision of expert advice and on-the -job sharing of information, experience and know -how through the use in countries of WHO staff in a consultative capacity and other consultants. Before considering the use of external consultants, optimal use will be made of national staff of the country concerned in the execution of collaborative activities, in order to ensure the relevance of technical contributions to such activities, and at the same time build up national capacity through learning-by- doing. If there is a need for external consultants the following criteria will apply to their use:

(1) Consultants must be well versed in WHO's policies concerning the issues for consultation.

(2) Consultants must work together with the national health workers concerned in reviewing, applying and adapting as necessary the knowledge, information and technology identified collectively in WHO as being potentially appropriate.

(3) WHO staff in addition must have a proper understanding of WHO's overall policy framework and of the place the issues for consultation occupy within that framework.

87. To meet the above criteria, consultants to countries - both external consultants and WHO staff acting in a consultative capacity - will be carefully selected and adequately briefed.

Meetings

88. Meetings are a popular WHO activity. If well prepared and properly managed they can provide an efficient and effective means of bringing together expertise, exchanging information and experience, and reaching consensus decisions for health development work. If not, they can be a huge waste of time and money. The following criteria will be adhered to with respect to meetings:

(1) WHO's resources will be used for intercountry and regional meetings only if they meet the criteria for intercountry and regional activities indicated in paragraphs 70 and 75 above respectively.

(2) Such meetings should form an essential part of a carefully thought out WHO medium -term programme.

(3) To ensure optimal value, meetings will have clear purposes and expected outcomes, will be properly structured, and will be based on working documents that will lead to practical results. 72 THIRTY- EIGHTH WORLD HEALTH ASSEMBLY

(4) Participants will be nominated /selected who can contribute to the proceedings and related programme development; they should include those from sectors other than the health sector where relevant.

(5) Detailed information and specific criteria for selection of participants in each meeting will be sent to countries at the beginning of each financial biennium.

PROCESS IN COUNTRIES

89. Having described the issues addressed by the regional programme budget policy, it is useful to outline the process for carrying it out, beginning with country level. This is in accord with the agreed approach to the development of programme budgeting and management of WHO's resources at country level.1,2

90. Having considered the country's epidemiological, environmental and socioeconomic conditions, the first step is for government health officials and the WHO counterpart to review the essential needs for the development of the national strategy for health for all (paragraphs 11 -24 above) by proceeding systematically through the WHO global and regional strategies for health for all. If there are areas of fundamental weakness, these will be areas for highest priority in terms of the resources of WHO.

91. With regard to individual national health programme needs (paragraphs 25 -36 above) these should be determined by proceeding systematically through the WHO General Programme of Work, taking into account the essential criteria for health system infrastructure programmes, and health science and technology programmes.

92. Priorities within the collaborative programme will result from careful analysis of countries' needs in support of their strategies for health for all, translating these needs into WHO's response under the WHO programmes concerned; such priorities will also result from careful selection of the approaches to be used, individually or in combination as appropriate, for each programme, with a view to ensuring that all programmes do in fact support the progressive development by countries of comprehensive health systems based on primary health care.

93. For each area of collaboration, it is necessary to identify the kinds of information needed by the country (paragraphs 41 -45 above) as well as the needs for international services and direct financial cooperation (paragraphs 59 -69 above).

94. In considering future directions for WHO collaboration, it is necessary for the government and WHO jointly to monitor and evaluate ongoing WHO- supported activities in the country in order to assess their relevance and effectiveness for national health - for -all strategy development and for the development of health programmes that form part of the strategy. Use will be made of the results of financial audit in policy and programme terms (paragraphs 56 -57 above). This will also lead to the identification of activities in which WHO's involvement should come to an end, either because they are no more of relevance to the country or now have low priority, or they are too inefficient to warrant continuation and there is little hope of rendering them reasonably efficient.

95. As part of the joint government /WHO review process, areas will be identified for which national resources could profit from being rationalized and for which additional national resources would have to be mobilized (paragraphs 52 -54 above). Optimal ways of using these resources will then be defined. This may be followed in developing countries by performing the same kind of diagnosis and remedial action with respect to external resources (paragraph 55 above).

96. Care will be taken to apply the criteria for determining the organizational level for implementation of programme activities, that is, at country level (paragraph 28), intercountry level (paragraph 70), or regional level (paragraph 75). Opportunities for facilitating technical cooperation among countries will also be seized (paragraphs 73 -74 above).

1 Resolution WHA30.23.

2 [At regional level, reference to be made to the relevant resolution of the regional committee.] ANNEX ¹ 73

97. Governments and WHO will thus engage in a continuing, joint process of programme budgeting which: (a) takes into account the experience of the past biennium; (b) reviews and further elaborates the activities for the current operating period; and (c) outlines the broad programme actions and resources allocations for the next financial period.

98. Once the above has been carried out for the joint preparation of the WHO proposed programme budget for the coming biennial financial period, the regional committee will be provided with information on the proposed investment of WHO's resources in the country in terms of the programmes of the WHO General Programme of Work, rather than in the form of individual projects or detailed activities. Detailed plans of operations or work, and budgetary estimates for individual activities or groups of activities planned within defined national health programmes, will be developed at a later stage, closer to and as part of programme implementation at country level.'

99. Technical cooperation programme proposals will be presented in the WHO regional draft programme budget in the form of narrative country programme statements, supported by budgetary tables in which the country planning figures are broken down by programme so as to facilitate a programme -oriented review by the regional committee.2

100. Governments will also provide the regional committee, through the regional office, with a succinct account of the use of WHO's resources in the country by programmes of the WHO General Programme of Work in the previous and /or current biennium or in the previous year, as decided by the regional committee. In addition to indicating how WHO's resources were used, these reports will show how these were integrated with or gave rise to other activities in the country, and an attempt will be made to assess what results might be attributed to WHO's investments. Moreover, they will explain why WHO's resources were not used for certain important parts of the national health strategy. The intimate relationship between Member States and WHO, and the principle of fearless reporting mentioned in the Introduction, should make this possible without embarrassment. All this will facilitate the monitoring and evaluation of the work of WHO in support of the national health- for -all strategies and health programmes of the countries of the region. As noted in paragraph 57 above, WHO will work jointly with countries to monitor the use of WHO's resources through financial audit in policy and programme terms.

MECHANISMS IN COUNTRIES

101. To carry out the above joint policy and programme reviews and programme budgeting process, appropriate mechanisms will be needed in countries. It cannot be stressed sufficiently that the programme budget policy is not being formulated for the sake of the Secretariat. Its purpose is to enable Member States to make optimal use of WHO's resources, and this includes utilizing them to lead to the improved use by the country of its own resources for health as well as those of other external partners collaborating in the country. This fundamental principle should guide governments when deciding on the mechanism that is most appropriate for them. Depending on the situation in each country and the level of WHO resources being invested in it, these may include permanent high level government /WHO coordinating committees, joint policy and executive level coordinating forums meeting at fixed intervals, senior level offices in ministries of health dealing with cooperation with WHO and possibly with other international development agencies, joint planning and evaluation groups and the like. Whatever the mechanism, appropriate representation from relevant ministries and sectors other than health is to be encouraged. The regional programme budget policy will identify the range of mechanisms that seem to be most useful in the light of experience in the region.

102. The government /WHO coordinating mechanism provides a forum for discussing the main lines of collaborative action and the optimal use of WHO's resources in support of the country. The mechanism will guide the formulation of joint programmes and programme activities resulting from these discussions and the elaboration of the practical issues of programme implementation, monitoring, evaluation and reprogramming, including any further WHO involvement if desired. Under the auspices of the overall coordinating mechanism, it may be desirable to establish specific working groups or programme development teams to pursue work

1 Resolution WHA30.23, paras 1(1) aid 1(3). 2 Resolution WЧA30.23, para. 1(2). 74 THIRTY- EIGHTH WORLD HEALTH ASSEMBLY on certain health - for -all issues or health programmes that form part of the national strategy. In some countries it may be desirable to establish a continuing national resources coordinating committee, involving the ministries of planning, finance, health and other sectors most closely involved in health work. This committee may need to convene periodically in a wider group, including external partners, for the coordination and mobilization of external resources in line with nationally defined priorities and programmes. An appropriate mechanism may have to be established for the monitoring of programme performance, including the use of financial audit in policy and programme terms. WHO and the government will identify jointly the most suitable mechanisms for the country concerned, and the appropriate involvement and support required of WHO.

103. Whatever the mechanisms at country level, wherever WHO programme coordinators exist, whether international or national, their principal functions will be to

(1) provide the government with information and explanations concerning the policies of the governing bodies of the Organization, including the regional and global strategies for health for all and principles of the Seventh General Programme of Work, with a view to ensuring that these policies will be taken fully into account in national policy and programme reviews;

(2) support the government in the planning and further management of national health programmes, including the setting up of appropriate supportive health information systems;

(3) collaborate with the government in identifying those national programmes in which WHO could profitably have more specific functions, and in the planning and further management of joint activities for their implementation; and

(4) help the government to identify and coordinate available or potentially available external resources for the implementation of approved national health programmes.

An appropriate information system will be set up in WHO programme coordinators offices to permit them to fulfil their functions properly (see paragraphs 41 -45 above).

REGIONAL OFFICE

104. The main functions of the regional level have been listed in paragraph 75 above. As regards support to individual Member States, the regional programme budget policy, based as it is on the recognition of the prime responsibility of the government itself for the use of WHO's resources in the country in conformity with collective WHO policy, means a profound change in the way support is provided from the regional office. WHO's resources at country level are understood to be an integral part of the national health development programme and not extensions of regional programmes - a further expression of the intimate cooperative nature of the relationship between WHO and its Member States. There will thus be no imposition of vertical programmes on countries, because all programme proposals will have been screened at national level during the joint programme reviews, and what is needed, in the way of technical, administrative aid financial support, will have been worked out through joint policy and programme reviews. Once the regional director has approved the programme budget proposals for the country, based on these needs, the question at the regional level will be how these are to be provided promptly, efficiently and effectively.

105. An appropriate country support review mechanism will be established in the regional office to ensure a coordinated response from WHO to the total needs of each country, as identified by the joint government /WHO mechanism in the country. Thus, just as the WHO programme coordinator in the country holds dialogues with the government with a view to defining these needs, the country support review mechanism will hold dialogues with the joint government /WHO country mechanism to identify the most appropriate support from the regional level and from all other parts of the Organization. (In some regions, or in some countries in some regions where there are no WHO programme coordinators, the country's needs may be identified by a joint government /WHO mechanism whose WHO partner is stationed in the regional office - a sort of regional all- country or multicountry WHO programme coordinator.) The country support review mechanism will ensure that support is forthcoming from the same and other regions and from the global level as necessary. Its purposes will be: ANNEX 3 75

(1) to support the joint government /WHO mechanisms;

(2) to review programme proposals to the regional director from governments or from any level of the Organization;

(3) to ensure coordinated support to countries by providing a coherent response to their technical, administrative and financial needs;

(4) to help ensure that intercountry and regional activities are relevant to countries in conformity with the criteria mentioned in paragraphs 70 and 75 above;

(5) to support the monitoring of the use of WHO's resources through financial audit in policy and programme terms.

106. The country support review mechanism will engage in support to the government /WHO mechanism in the country in such matters as comprehensive reviews of the country's health situation and needs; policy analysis; formulation, implementation, monitoring and evaluation of strategies for health for all; development of the national health system, bringing science and technology to bear on health development through the health infrastructure; and cooperative planning of programmes in which WHO is involved and proper use of WHO's resources to this end. The mechanism will thus deal with the substance of WHO's cooperation in the light of each individual country's needs rather than of separate WHO programmes; to this end it will have to have access to the right kind of information. It goes without saying that any periodic review of support to countries will take place with the national health authorities and WHO programme coordinator of the country concerned.

107. For such country support review mechanisms to be effective they will have to be managed by senior staff designated by the regional director. They will have to be supported by multidisciplinary teams whose composition will vary in the light of the specific requirements of each country and the particular skills, technology or experience required in each case, including administration and finance as necessary. The regional director will decide on the form the country support review mechanism will take, its composition, the way it functions and involves the multidisciplinary teams, and its relationship with other regional mechanisms, making sure that it does not become a mere bureaucratic structure or clearing -house.

108. It follows that the regional director will keep the organization of the regional office under review, ensuring a "best fit" of requirements to provide well coordinated support to national health strategies and programmes, to carry out the regional strategy for health for all and to implement the WHO General Programme of Work, always bringing to bear on countries the information and programme activities most appropriate to the situation. The country, programme, managerial and administrative and finance information systems in the regional office will be updated or redesigned as necessary to permit the office to fulfil its functions properly. [At regional level, indicate specific regional developments or plans to this end.]

109. The regional director will prepare the programme budget proposals for 1988 -1989 and subsequent financial periods in accordance with this new programme budget policy. In so doing, he will provide the regional committee with programmatic and budgetary analyses - by WHO programmes - of the proposed use of WHO's resources in each country, showing for example the types of activities and the resources being devoted to critical components of primary health care, such as nutrition, immunization or training of community health workers. He will also provide information on reasons for not using WHO's resources for certain important activities, based for example on the information provided by countries on this aspect, as mentioned in paragraph 100 above.

STAFFING POLICY

110. The regional programme budget policy has obvious implications for WHO's human resources. First of all, the engagement of national health personnel in collaborative national health programme activities will be explored.l The extent to which this can be

I Resolution WHA33.17, para. 6(3). 76 THIRTY- EIGHTH WORLD HEALTH ASSEMBLY carried out will be reviewed with each Member State concerned in the light of its circumstances. This policy will influence the types and numbers of internationally recruited field staff to be engaged in countries. Moreover, the profile of WHO programme coordinators will be reviewed in the light of their functions (see paragraph 103 above) and recruitment policy modified accordingly.

111. In a similar manner, the functions of the regional office resulting from the new programme budget policy will make it necessary to free technical staff from as much bureaucratic work as possible so that they can perform the newer functions devolving on them. The performance of these functions will require a shift in emphasis from the ability to transfer techniques and manage WHO projects to the ability to work in teams and deal with all components and specific problems encountered by countries, including the ability to provide them with all the relevant information WHO has to offer and absorb the information they have to offer for exchange with other countries. The staff of administration and finance will also have modified functions. They will be more active in providing services to countries, supporting them in administrative and financial matters, and taking part in the country support reviews and related multidisciplinary teams, including financial audit in policy and programme terms. The above implies close cooperation between technical programme staff and the staff of the administration and finance support services. Moreover, regional office staff will be allotting their time in accordance with countries' needs as defined through the country support review mechanism. Pools of experts or resource persons will be identified, drawing on national and WHO personnel who can be placed "on call" for prompt response to country needs, whether these be of a technical, administrative or financial nature.

112. Training requirements for WHO staff will be identified, to update their capacity to deal with the new programme budget policy. This requires an intensive grounding in health policy and strategy matters, national health development experience, the transfer of information, and the application of validated technology through the health system. Moreover, senior national and WHO staff in the region will be involved in health - for -all leadership development efforts.

113. Staffing and recruitment policies in the region, as well as staff profiles and training needs, will be reviewed in the light of all the above and the necessary changes introduced as soon as possible.

BUDGETARY AND FINANCIAL IMPLICATIONS

114. The foregoing issues, procedures and mechanisms relating to the regional programme budget policy will have implications not so much for the overall level of WHO budgetary and financial resources of the region as for how the resources are used within the region, as well as for their distribution among Member States.

115. To recapitulate, WHO's resources will be used preferentially to strengthen national capacities for developing and implementing national health policies and strategies for health - for -all and related programmes. The Organization's resources in the region will be focused on technical cooperation activities that support the mainstream of well -defined national strategies, leading to the establishment or strengthening of health systems based on primary health care and delivering programmes that use technology which is appropriate for the country, with full governmental, intersectoral and community involvement. The resources will also be used to build up a critical mass of health - for -all leaders and managers in countries. They will ensure the transfer of appropriate technology and valid information, and promote the spectrum of research and development required. And they will be used to mobilize and foster coordinated, optimal use of all resources for health development in the countries of the region and the region as a whole.

116. WHO's resources will be used mainly for catalytic, developmental activities, as distinguished from routine, ongoing operational programmes in countries. Moreover, the input of a small amount of WHO resources may be used as seed money to attract much greater financing from internal and external sources. In considering investment of resources in national health development from different sources - national and international - assessments will be made of the best means of covering recurring costs through different forms of financing and cost -sharing or cost recovery. ANNEX 3 77

117. The budgetary and financial implications of the regional programme budget policy will be assessed and reflected in the distributive allocation of resources in the regional programme budget proposals for 1988 -1989 and future financial periods.

REGIONAL COMMITTEE

118. The regional committee has been requested by the Executive Board in resolution EB75.R71 to prepare the regional programme budget policy, submit it for review by the Executive Board and World Health Assembly, prepare the regional 1988 -1989 and subsequent budget proposals in accordance with it, and monitor and evaluate its implementation with a view to ensuring that it is properly reflected in the Organization's activities in the region. The committee will therefore review these guidelines and initiate the preparation of the regional programme budget policy in accordance with them as appropriate. It will monitor the further elaboration of the policy and will ensure that the 1988 -1989 and subsequent regional programme budget proposals are prepared in line with it. It will establish and control any necessary mechanisms to carry out the above. In reviewing the 1988 -1989 and subsequent programme budget proposals, the regional committee, in compliance with resolution WHA33.17,2 will consider the proposals for each Member State in the region with a view to ensuring that they reflect the regional programme budget policy, which in turn is a reflection of the Organization's collective policy. As part of that, they will consider each Member State's account, mentioned in paragraph 100 above, of the use or non -use of WHO's resources in the country during the preceding period.

MONITORING AND EVALUATION

119. The regional programme budget policy will be judged in the light of its implementation. This implies the need for monitoring arid evaluation to ensure that the policy is indeed being carried out and is being carried out efficiently and effectively. The main vehicle for doing that will be the review of the programme budget proposals and of the use of WHO's resources in giving effect to these proposals once they have been approved by the Health Assembly. There is no shame in admitting that there are deficiencies and problems if this leads to attempts to make good the deficiencies and overcome the problems, and thus improve implementation. There is shame in hiding the truth; to do so will help nobody and will hurt most those whom the programme budget policy is being set up to help.

120. The regional committee will therefore initiate and start to monitor the preparation of the regional programme budget policy at its session in 1985, and will submit a progress report to the Executive Board. At its session in 1986, it will finalize the policy, submitting the policy document for review by the Board, and will consider concomitantly the 1988 -1989 programme budget proposals that will have been prepared in conformity with the evolving policy. The programme budget proposals, once endorsed by the regional committee, will as usual be submitted to the Director -General before he makes final proposals to the Executive Board and World Health Assembly.

121. The processes and mechanisms in countries and in the regional office, as described earlier, will become progressively operational starting in 1985. This will include the monitoring of programme budget implementation through financial audit in policy and programme terms.

122. The Executive Board will inform the Health Assembly in 1985 about its decision concerning regional programme budget policy. In 1986 it will review the progress reports of the regional committees and will report thereon to the Health Assembly. In 1987 the Board will review the actual regional policies together with the related programme budget proposals for the financial period 1988 -1989. It is expected that the Fortieth World Health Assembly will consider the Board's report on the regional policies in 1987 when it considers these programme budget proposals.

123. The regional committee will monitor arid evaluate the implementation of the policy, starting in 1988 at the same time as it considers the regional programme budget proposals for 1990 -1991. As part of this process, it will review the way Member States in the region have

1 Document ЕВ75 /1985 /REС /1, p. 6. 2 Resolution WHA33.17, para. 3(8). 78 THIRTY -EIGHTH WORLD HEALTH ASSEMBLY used WHO's resources during the preceding period, in the light of the account presented to it by each Member State. Starting in 1989, the Executive Board and World Health Assembly will also monitor and evaluate implementation at the time they review the programme budget proposals for the coming financial period.

124. The Director -General and the regional directors will support the regional committees, the Executive Board and the World Health Assembly in monitoring progress in preparing the regional programme budget policies and in the subsequent monitoring and evaluation of their implementation.

TIMETABLE

125. The timetable for the development, review, adoption, implementation, monitoring and evaluation of the regional programme budget policy will be as follows;

(1) Decision by Executive Board - resolution EB75.R7 January 1985

(2) Consideration of Board's resolution by Global Programme Committee (GPC)1 January 1985

(3) Preparation of draft guidelines by Director -General February 1985

(4) Consideration of draft guidelines by Programme Development Working Group (PDWG)2 March 1985

(5) Provision of information on regional programme budget policy to Thirty- eighth World Health Assembly by the Executive Board representative and Director -General May 1985

(6) Consideration of draft guidelines by GPC May 1985

(7) Finalization of guidelines by Director- General June 1985

(8) Initiation of development of regional programme budget policy by regional committee September/ October 1985

(9) Concomitant preparation of 1988 -1989 programme budget proposals throughout last in the region quarter of 1985 and whole of 1986

(10) Review of progress by Executive Board January 1986

(11) Consideration of implications of Executive Board's review by GPC end January 1986

(12) Review by PDWG of problems encountered in using guidelines to prepare regional policy and related programme budget proposals March 1986

(13) Consideration by Thirty -ninth World Health Assembly of progress report by Executive Board May 1986

(14) Review by GPC of problems encountered and suggestions for mid -stream modifications May 1986

1 The GPC consists of the Director -General, the Deputy Director -General, the Assistant Directors -General and the Regional Directors.

2 The PDWG is a working group of the GPC. It consists of the Directors of Programme Management in the regional offices, the Chairman of the Headquarters Programme Committee and the Adviser on Health Policy in the Director -General's Office. ANNEX ¹ 79

(15) Finalization of regional programme budget policy and review of related 1988 -1989 programme budget proposals by regional committee September/ October 1986

(16) Review of regional programme budget policies and related programme budget proposals for 1988 -1989 by Executive Board January 1987

(17) Incorporation by Executive Board of regional programme budget policy in draft of Eighth General Programme of Work January 1987

(18) Review by Fortieth World Health Assembly May 1987

(19) ,Monitoring and evaluation of implementation by regional committee starting September 1988

(20) Monitoring and evaluation of implementation by Executive Board starting January 1989

(21) Monitoring and evaluation of implementation by World Health Assembly starting May 1989 80 THIRTY -EIGHTH WORLD HEALTH ASSEMBLY

Appendix

MANAGERIAL FRAMEWORK FOR OPTIMAL USE OF WHO'S RESOURCES IN DIRECT SUPPORT OF MEMBER STATES

[DGO /83.1 Rev.1 - March 1985]

Contents

1. Introduction 80

2. Government and WHO responsibility 81

3. Role of WHO and national WHO programme coordinators /representatives 84.

4. Role of regional offices 88

5. Role of headquarters 90

6. Programme budget presentation 92

7. Monitoring process 92

Attachment I: Broad interlinked categories of WHO programmes under the Seventh General Programme of Work 93

Attachment II: Determination of priorities for WHO activities under the Seventh General Programme of Work 94

1. Introduction

1.1 In resolution WHA33.17, on the study of the Organization's structures in the light of its functions, the Thirty -third World Health Assembly (May 1980) requested the Director -General "to ensure the provision of timely, adequate and consistent Secretariat support to the Organization's Member States, individually and collectively . . . ".

1.2 Reviewing the implementation of the plan of action for giving effect to resolution WHA33.17, the Executive Board in resolution EB69.R10 (January 1982) requested the Director -General "to strengthen further WHO's technical cooperation with governments in support of national strategies for health for all" and "to keep under constant review the support provided by the Secretariat to Member States at all operational and policy levels, and the need for any further adaptation of the management of WHO's activities in countries aid of the organizational structure and staffing of regional offices and headquarters, in order to ensure optimal support to Member States, and particularly to improve the effectiveness of the Organization's interaction with their governments, in their efforts to implement effectively their strategies as well as the regional and global strategies for health for all by the year 2000 ".

1.3 The present paper deals with ways of ensuring optimal use of WHO resources at country level, as well as with direct support to this from regional and global levels, including intercountry and interregional activities. The paper does not deal with the management of research conducted by individuals or institutions in countries.1

1 For which, see WHO Manual, Section ХV.2. ANNEX 3 81

1.4 It is necessary to develop in Member States and throughout the Secretariat a common understanding of the respective responsibilities of governments and the Secretariat - in countries, in regional offices and at headquarters - for the optimal use of WHO's resources in support of national strategies for health for all, and in line with the health policies reflected in regional and global strategies and in the Seventh General Programme of Work. The word "resources" is used here in the wide sense of people, knowledge, technology and selective material support, as well as money. WHO resources should be used to support governments in building up their health systems in accordance with the strategy for health for all, with particular emphasis on sound infrastructures that deliver health programmes using appropriate technology. To this end, WHO resources should be used to provide Member States with valid information on health systems, research findings and technology. WHO resources should be used to improve the capacity of Member States to absorb and apply this information in the light of their specific circumstances. And WHO resources should be used to help mobilize national and international resources in support of the endeavours of developing countries in these fields.1

1.5 The present paper outlines a managerial framework for ensuring optimal use of WHO's resources. However, any managerial system can only be as effective as the people who run it, and no managerial system alone can ensure the necessary attitudes and actions which are the key to optimal use of WHO. This will mean breaking any remaining psychological barriers between country, regional and global levels, and it can be partly brought about by introducing freer communication.

2. Government and WHO responsibility

2.1 If health for all by the year 2000 is to be attained in and by countries, the main issue at country level is how to ensure that governments carry out individually what they have agreed upon collectively in WHO, and also to ensure that WHO supports them in this by insisting that WHO resources should be used within the country to further that end. Such insistence is necessary particularly since the WHO resources in any given country usually represent only a tiny fraction of the national health budget and can therefore only be effective if used to support the mainstream of priority national health activities - not as a marginal addition to the national health budget.

2.2 This government responsibility implies that WHO's resources should be used only for activities that are consistent both with defined national policies and with the international health policies agreed upon collectively by the Member States in WHO. Where there is no defined national policy in the programme area concerned and the government is interested in having one, an important use of WHO's resources in the country is for cooperation with the government in developing such a policy. WHO resources should not be used for programme activities where there is no defined national policy and the government is not interested in developing one.

2.3 Where well -defined national policies exist, a crucial use of WHO's resources is to help the country translate those policies into national strategies for health for all. An important resource to this end is the Global Strategy for Health for All by the Year 2000,2 which indicates the main lines of action that governments should take in order to develop such a national strategy.

2.4 In order to develop and implement such a strategy, some form of planning and management process will have to be applied, and the development of this process is a critical undertaking for which WHO resources can be usefully employed. Reference can be made to the guiding principles for the managerial process for national health development.3

2.5 In all countries, appropriate means of programme monitoring and evaluation are needed as part of the managerial process for national health development. If such capabilities are not fully operational, it is entirely appropriate to use WHO's resources to support the monitoring and evaluation components of the overall managerial process. If national health programmes have been adequately planned and developed, then monitoring should mainly consist

1 See also Proposed programme budget for the financial period 1984 -1985 (document Рв/84 -85), Geneva, World Health Organization, 1984, pp. xiii-xviii. 2 "Health for All" Series, No. 3. 3 "Health for All" Series, No. 5. 82 THIRTY -EIGHTH WORLD HEALTH ASSEMBLY

of a "compliance" analysis in terms of stated objectives, targets, programme activities, and use of resources. Governments will wish to make use of the publications Development of indicators for monitoring progress towards health for all by the year 20001 and Health programme evaluation - Guiding principles for its application in the managerial process for national health development; and also the document 'Common framework for monitoring progress in implementing strategies for HFА /2000 ".

2.6 The government must assume responsibility for the work of WHO and the use of WHO's resources in its country, particularly those resources provided from the WHO regular budget.4 This responsibility is not synonymous with "government execution" as used in the terminology of the United Nations system, because what is involved is not the management by governments of the projects of that system but the management by governments of various national health programmes, services and institutions that form part of their health system, that conform to policies they have agreed to in WHO, and in which WHO has a supportive, participatory role.

2.7 WHO's specific involvement and the proper use of its limited regular budget resources are aimed particularly at supporting countries in strengthening their planning and managerial capacities to develop and carry out their strategies, build up their infrastructures and implement their technical programmes. Existing arrangements based on the old- style, agency -provided "project" approach will have to be phased out as quickly as possible, and be replaced by the developmental type of cooperation described above.

2.8 Moreover WHO will make every effort to assume this role vis -à -vis governments whenever it is requested by multilateral financing institutions - such as UNDP, UNFPA, or UNEP - to act as executing agency. WHO will make it clear to these institutions that what is involved are government programmes, that the government is responsible for them, and that WHO is ready to support the government in the manner described above. If WHO accepts the role of executing agency it will bear the responsibility for reporting on implementation to the financing institutions in the manner they require. To permit WHO to do so will require appropriate accounting to WHO by the government concerned. Existing projects financed by such institutions, aid for which WHO is executing agency, must be reformulated in terms of such government responsibility as soon as possible.

2.9 The above emphasizes the importance of joint government /WHO policy and programme reviews which will indicate whether existing programmes and proposed future directions conform to national and international policies and strategies for health for all. They will at the same time reveal whether WHO's resources at country level are being properly used, and will lead to decision -making on the best future use of those resources.

2.10 Joint policy reviews will be undertaken with appropriate national bodies, including wherever possible representation not only from the health sector but also from other sectors concerned in order to involve a broad range of decision -makers. Thus, the reviews could take place with ministries of health and other social and economic ministries; with task forces set up by these ministries; and also with such bodies as health councils or consensus committees, which may be supported by national health development networks. The joint government /WHO review groups at country level, with the full involvement of the WHO programme coordinator /national (WHO) programme coordinator (WPC /NWC), will call on regional office staff to provide technical or other support as and when required. Where there is no WPC /NWC in a country, periodic policy and programme reviews should be undertaken directly by the regional office and the government concerned.

2.11 Joint programme reviews will reveal whether national programmes have been adequately planned and developed. If such national programming capability is fully realized, then programmes will be developed with clear objectives, targets, lines of action, and necessary resource allocations. If the reviews reveal that national programmes have not been adequately planned and developed, then it would be an appropriate use of WHO's resources to support national efforts to initiate or strengthen national programme planning and development.

1 "Health for All" Series, No. 4.

2 "Health for All" Series, No. 6. WHO document DGO /82.1, Geneva, 1982. 4 I.e., financed by the assessed contributions of Member States. ANNEX 3 83

2.12 During such joint programme reviews it may be practical to refer to the WHO classified list of programmes as contained in the Seventh General Programme of Work covering the period 1984 -1989,1 as a kind of checklist against which to consider whether key issues and concerns in public health have been dealt with by the national health programme, and whether or not the involvement of WHO is needed. Where such involvement is needed, the Seventh General Programme of Work should also form the basis for determining its nature and the consequent use to be made of WHO's resources. It is especially important that all involved should fully understand the basic concepts and relationships reflected in the broad categories of the Seventh General Programme of Work, namely: (1) direction, coordination and management; (2) health system infrastructure; (3) health science and technology; and (4) programme support (see Attachment I). It is equally important to understand the basis for determining priorities for activities within programmes at all organizational levels (Attachment II). This holds for all organizational levels and will therefore not be repeated in the sections of this document on the role of regional offices and headquarters.

2.13 The Seventh General Programme of Work emphasizes the importance of health system infrastructure development for sustained, countrywide health care delivery. In countries where such an infrastructure is not in place, or is inadequate, corresponding priority should be given in the allocation of national resources and in the related use of WHO resources to the design and organization of a health system based on primary health care. One of the critical problems facing many countries today - and therefore one of the places where WHO resources could be expected to be most effectively used - is to find out how to integrate into the health system all the essentials of primary health care in a way that will have lasting effect and ensure that they are accessible to all people, even in the remotest rural area and in poor urban communities. WHO resources could also be expected to be used for the promotion, design, testing and support of nationwide health manpower development, including a wide range of training mechanisms.

2.14 During the programming process, attention should be paid to bringing to bear the necessary valid information, and generating and applying the kind of technology that is most appropriate for the country concerned. This means identifying and facilitating the research needed in the country or at international level. Again, the classified list of science and technology programmes in the Seventh General Programme of Work provides a convenient checklist for reviewing the national programme and deciding whether or not WHO involvement or supporting resources are needed.

2.15 The best way to ensure that decision- making in respect of the use of WHO's resources at country level and the nature of WHO's technical cooperation reinforce the outcome of the joint policy and programme reviews is to carry out properly the process of programme budgeting that was approved by the Thirtieth World Health Assembly in 1977. The WHO programme budgeting process is by definition a joint undertaking. It is designed to impose the fewest possible external procedural requirements on Member States, while at the same time emphasizing the close connection with the national programme budgeting process. It is a continuous process which: (a) reviews the current joint activities (e.g., for 1986); (b) works out in detail the activities and costs for the next year (e.g., for 1987); and ¨¬© outlines the broad programme actions and resource allocations for the next biennial financial period (e.g., 1988 -1989).

2.16 In many countries a practical joint mechanism for the above can be constituted by setting up a high -level government /WHO coordinating committee, thus providing a continuing forum for discussing the use of WHO's resources - namely people, knowledge, technology, logistic and material support, and budgetary funds - in support of national policies and programmes. These committees could also guide the formulation of the programmes resulting from their discussions and the practical elaboration of programme implementation, monitoring, evaluation and reprogramming, including any further WHO involvement if the government so desires. The committees could avail themselves of planning units, selected institutions or even health development networks to support them in this work. The forms that such mechanisms take would vary according to the situation in each country, but encouragement should be given to appropriate representation from other ministries in addition to the health ministry. It would be useful if the experience of different countries with various kinds of coordinating mechanism could be shared between countries and between WHO regions.

1 "Health for All" Series, No. 8. 2 Resolution WHА30.23. 84 THIRTY- EIGHTH WORLD HEALTH ASSEMBLY

2.17 An important function of the joint government /WHO coordinating mechanism will be the monitoring and evaluation of the use of WHO's resources in the country. This will consist mainly of ensuring that WHO inputs have been efficiently delivered and effectively used in support of the country's efforts to develop its health programmes and attain its programme targets and objectives. This implies joint monitoring of national efforts in which WHO is collaborating. It also implies monitoring the use being made of other external resources in support of those national programme activities.

2.18 Resources accountability will have to be strengthened to meet the country's own national needs, as well as to meet international standards of accountability that are acceptable to the collectivity of Member States of WHO and will earn the confidence of external partners contributing towards the national health development programme. Accountability to WHO's Member States for the proper planning and use of WHO resources in support of individual countries entails the reporting of certain basic programme and financial information to the Organization's governing bodies - the regional committees, the

Executive Board aid the World Health Assembly -- as further discussed in section 3 below.

2.19 If the foregoing is to become a reality, ministries of health or analogous governmental authorities must assume their responsibility for coordinating the broad issues and actions involved in the common effort for health for all by the year 2000. WHO will work closely with ministries of health to get this message across. WHO resources may be used to strengthen the role of ministries of health or analogous authorities in this coordinating work. WHO will help ministries of health to involve other sectors as necessary, and in federally organized countries to involve the relevant authorities at state or provincial level. This does not imply that the health ministry would assume direct administrative responsibility for all health activities necessary for health for all, but rather that it would become the focal point for coordinating these activities on behalf of the government, irrespective of the sector or executing agency by which they are carried out.

2.20 The types of agreement at present existing between WHO and Member States, and defining the working relations between the parties, may require amendment or updating as appropriate to reflect the common commitment, basic approach and new framework for joint developmental action, with the government assuming the prime responsibility for the use of WHO's resources for national programme development and execution. The present "basic agreements" between WHO and governments are largely obsolete, but they could be amended or updated only after a considerable period of time, in view of the political, legal and practical circumstances that must be taken into account in each case. It is therefore proposed to rely mainly on memoranda of understanding. These memoranda, while still formally acknowledging the "basic agreements" which remain in force, will reflect the new type of joint working relationship between WHO and Member States described in this paper - in particular the new understanding of the government's responsibility for the work of WHO in countries, and the proper use of WHO support and direct financial participation at country level. They can be supplemented if necessary by any more specific or detailed documentation that may be required, e.g., details of the scope and content of WHO's involvement in various national programmes and related agreed managerial guidelines.

2.21 After experience has been gained in applying these new approaches, a small interdisciplinary group, working in collaboration with interested regional office and headquarters staff, will see to what extent a model Memorandum of Understanding can be drafted for inclusion in the updated WHO Manual. The group will also examine what supporting documentation has proved useful in the course of planning, implementation and monitoring, with a view to designing models for similar inclusion in the Manual, but without imposing unnecessary detail or excessive standardization on those involved in these new working relationships at country level.

2.22 Only at a later stage, and taking into account the experience gained in all the foregoing, will consideration be given to designing a new Model Basic Agreement between WHO and Governments.

3. Role of WHO and national WHO programme coordinators /representatives

3.1 Where close consultations with the government lead to the decision to have a WHO programme coordinator (WPC) or a national WHO programme coordinator (NWC), the functions of the WPC /NWC will be to: ANNEX 3 85

(1) provide the government with information and explanations concerning the policies of the governing bodies of the Organization (including the regional and global strategies for health for all and the principles of the Seventh General Programme of Work), with a view to ensuring that these policies will be taken fully into account in national policy and programme reviews;

(2) support the government in the planning and further management of national health programmes, including the setting -up of appropriate supportive health information systems;

(4) help the government to identify and coordinate available or potentially available external resources for the implementation of approved national health programmes.

3.2 Formal authority will be delegated to the WPC or NWC to negotiate with the government WHO's cooperative programme activities in the country, in accordance with the policies adopted by Member States collectively in WHO's governing bodies, and in accordance with the regional director's directives on them. This will include negotiations on programme formulation, subsequent modification and implementation, as related to WHO's resources at country level.

3.3 The main process under which the WPC /NWC will conduct negotiations leading to decision -making on the use of WHO's resources in the country will be a flexible and continuing process of programme budgeting WHO's resources at the country level, with final responsibility in the hands of the government. The main lines of that joint programme budgeting process are outlined below.

3.4 More than two years prior to the biennial financial period - and within the Director -General's allocation to the region - the regional director will have established "provisional country planning figures" for the WHO regular budget resources allocated to country level. On the basis of the joint policy and programme reviews described in section 2 above (including current national programme monitoring and evaluation, together with assessment of the relevance and effectiveness of WHO participation, and using the classified list of programmes of the Seventh General Programme of Work as a checklist), the joint government /WHO coordinating committee or similar mechanism will outline the national programmes where WHO involvement would be most useful, excluding those where it would not be needed. It will indicate the kind of WHO involvement envisaged, not as detailed "objects of expenditure" but in terms of programme contribution, for example: participation in organizing community health schemes, in training the trainers, or in developing countrywide programmes in specific programme areas using appropriate technology for the delivery of such programmes through primary health care and the immediate referral level.

3.5 One of the responsibilities of the WPC /NWC will be to draft, on behalf of the government, the agreed WHO programme budget proposals for the country concerned. In indicating, in the WHO document containing those proposals, the planned future involvement of WHO and use of WHO's resources in the country, it will be necessary only to outline (in the descriptive "country statement ") the main directions for national health development, and the nature and scope of WHO's involvement and use of resources in relation to the objectives, targets and scope of the national health programmes. The supporting budgetary tables will show broad WHO resource allocations by programme, in accordance with the classified list of programmes in the Seventh General Programme of Work. For the purpose of preparing WHO's proposed programme budget two years ahead of the financial period, it will not be necessary to provide details of the activities proposed or detailed cost estimates, nor need such costs be analysed by "category of expenditure ".

3.6 For a proper presentation in the proposed programme budget document of WHO's involvement in national health programmes and the related use of WHO resources, there must be a clear understanding of the Seventh General Programme of Work, and particularly of the main categories of the classified list of programmes. For example, if WHO is participating in a national programme for delivery of the essentials of primary health care through the health infrastructure that includes the prevention, control and treatment of malaria, the WHO involvement would be reflected under "Organization of health services based on primary health 86 THIRTY- EIGHTH WORLD HEALTH ASSEMBLY

care ". But if WHO's involvement is related to the design of a nationwide strategy to control malaria (including the identification of the most appropriate antimalaria technology and related malaria research), then such involvement would appear under "Malaria" in the proposed programme budget document.

3.7 The WPC or NWC will ensure that all proposals for joint activities meet the criteria for determining the organizational level for implementation of programme activities as stated in the Seventh General Programme of Work. The criteria for country activities are:

Country activities should aim at solving problems of major public health importance in the country concerned, particularly those of underprivileged and high -risk populations, and should result from a rational identification by countries of their priority needs through an appropriate managerial process. They should give rise to the establishment and sustained implementation of countrywide health programmes. -

See also paragraph 2.2 above, which specifies the criterion of joint consistency with national health policies and policies agreed upon collectively in WHO; and also paragraphs 2.13 -2.14, which deal with the nature of countrywide programmes as defined in the Seventh General Programme of Work, e.g., health infrastructure and health science and technology programmes.

3.8 The country -level proposed WHO programme budget, after being worked out jointly by the government and the WPC/NWC, will be submitted to the regional director for his approval. Once the regional director has given his approval, the country programme is not subject to hierarchical control by staff at any other level of WHO, nor to the imposition of vertical programme activities from regional or global levels. Regional office staff will be expected to provide technical guidance and support to the country programme at the request of the WPC/NWC on behalf of the government; headquarters will be expected to do the same at the request of the regional office. This applies both to initial programme budget preparation and to flexible reprogramming up to and during the operating period. The authority delegated to the WPC/NWC includes the right and the duty, together with the national health authorities concerned, to screen technical proposals made to the government by other levels of WHO, to negotiate with those who proposed them in order to ensure their appropriateness for the country, and to reject the proposals if necessary.

3.9 After the WHO proposed programme budget for each country has been prepared for submission to the regional committee, in those programmes in which WHO is actively involved the joint programming process will continue to reinforce national efforts to refine - in increasing detail - the programme objectives, targets, main lines of action, sources of funding, aid specific activities. The kinds of related WHO support action will thus become increasingly well -defined, leading to agreement on the specific nature and level of WHO's participation in the national programmes and activities concerned.

3.10 All WHO involvement in national programmes along the lines indicated above constitutes direct support to countries. However, for the sake of financial accounting, that involvement can take two main forms: (1) "direct financial cooperation" in national programmes, and (2) provision of "international services" that contribute to national programmes. "Direct financial cooperation" is participation in defined national programmes in which WHO's resources are used to support the government in attaining defined health objectives, targets and outputs. It is not a "give away" of resources; and WHO and the government retain their shared, vital interest in the progress and performance of the specific activities agreed upon. Where WHO's resources are to be used for "direct financial cooperation" in government activities, the government will assume responsibility for budgetary control and accounting, and will report to WHO in terms of programme performance of the activities that are utilizing such resources. Where WHO's resources are to be used for the provision of "international services" - for which WHO has the accounting responsibility - details must be worked out by the WPC /NWC with greater specificity (including attribution to "category of expenditure ") and must be transmitted to regional offices so that they know what support services they will be expected to provide.

3.11 Thus the rate at which specificity is developed for WHO's participation and the use of its resources at country level depends not so much on WHO's programme budget cycle as on the national programme budget cycle of which it is an integral part. Programme details will

I "Health for All" Series, No. 8, para. 70(a). ANNEX 3 87

accordingly be worked out as appropriate nearer to - or during - the operating period, in closer harmony with the national health programming process.1 The continuous programme budget review process at country level, carried out with the help of the regional office as and when required, will ensure constant refinement and reprogramming where necessary, and afford a continuing opportunity to monitor the use of WHO resources at country level in relation to national programme objectives and targets, as well as the rate of expenditure in relation to the rate of national programme delivery.

3.12 Disbursement and control of WHO funds at country level will follow a combination of two basic patterns:

(1) Direct financial cooperation in government programme activities as agreed between WHO and the government. WHO resources are used to support carefully worked -out activities with clearly designed objectives, targets and outputs. WHO shares the costs of financing, but the government or its designated agency effects the necessary payments for specific inputs, as reflected in an agreed plan of work, exchange of letters, or other document (see paragraphs 2.20 -2.22 above). At the request of the WPC or NWC on behalf of the government, funds will be released by the regional office to the officially designated government agency or programme accounts (not to individuals) which are subject to accounting controls that meet both national requirements and international standards of accountability for the use of the collective resources of WHO's Member States. It is recommended that, in appropriate circumstances, WHO should release an initial "working capital advance ", subsequent releases being scheduled to follow receipt of returns evidencing performance and related expenditures, certified to and by the WPC/NWC or joint government /WHO management mechanism established for this purpose. Governments certify receipt of funds for the intended purposes. National accounting controls must be established or must be sufficiently in place (if necessary with WHO support) to meet the needs of both the government itself and the joint government /WHO coordinating committee in monitoring progress and the proper use of funds. WHO requires that sound accounting controls should be applied to the use of WHO's direct financial cooperation resources, but does not require reporting by WHO's "objects of expenditure ". What it does require is sound evidence that these funds have been used for the intended purpose, and that this can be measured, for example by programme output or degree of target -achievement. However, WHO reserves the right in certain circumstances to audit the use of these funds by audit "trails ", just as the use of WHO's resources at country level for international services is open to examination by its Member States.2

(2) International services provided by WHO at the express request of the government, as detailed in an agreed plan of work, exchange of letters, or other document. Such services (which may include provision of internationally recruited staff or consultants, fellowships outside the country, supplies, meetings or other activities abroad) will continue to be controlled, and the expenditure incurred, by regional offices in accordance with existing financial aid administrative rules, regulations and practices in WHO. Regional offices will keep the WPC/NWC informed of allocations, obligations, expenditures aid remaining balances so as to facilitate managerial control at country level. The regional office will also release funds or make working capital advances to governments in accordance with (1) above (providing timely financial reports to the WPС /NWC on such transfers or advances), and will transfer funds or replenish imprest accounts of the WPC/NWC as may be required. Detailed accounting will in this case be performed by the WHO regional office, while the WPC/NWC office may provide a simplified resource management function on behalf of the joint government /WHO coordinating mechanism - keeping track, for example, of the authorized staff position and related salaries, the number of man -days of temporary staff, consultant months, and funds for travel, supplies and equipment, etc., in terms of "earmarked" intentions, "obligations" for firm commitments, actual expenditures, and resources remaining available.

See resolution WHA30.23.

2 The modalities for reporting of "direct financial cooperation" will be worked out by a small group and, after approval by the Director -General, will be included in the WHO Manual. 88 THIRTY -EIGHTH WORLD HEALTH ASSEMBLY

3.13 The WPC or NWC will be accountable for WHO's activities in the country both to the government through the minister of health, and to WHO as a whole as represented by the governing bodies, the Director -General as chief technical and administrative officer of the Organization, and the regional director as the alter ego of the Director -General in the region. This means that only the Director -General and the regional director (or the staff member acting for him in his absence) may give the WPC/NWC instructions and modify or countermand his decisions if necessary. The Director -General would normally do so through the regional director concerned. As part of this accountability it may become necessary for the WPC or NWC firmly but correctly to refuse certain requests for joint activities that appear to be out of tune with the national health - for -all strategy or with the proper role and function of WHO. Such action is implicitly authorized by resolution WHA33.17, which requested the Director -General and the regional directors "to act on behalf of the collectivity of Member States in responding favourably to government requests only if these are in conformity with the Organization's policies ".1 In such a circumstance, the WPC or NWC may find it desirable not only to point out the deviation from policy to those concerned but, if the government insists on the activity, to refer the matter to the regional director for direct guidance and inform the government accordingly. If a substitute activity can be found in the same or related programme area, so much the better.

3.14 If properly implemented, the above new system of programme budget control and financial accountability should not burden the WPC /NWC or require additional manpower resources for that office, since the responsibility for management of and accountability for the use of WHO's resources at country level is being increasingly shifted to the government concerned or to its officially designated agencies accountable to WHO. Any new procedures for budgeting and accounting should be kept as simple and streamlined as possible.

3.15 Appropriate briefing, reorientation and learning -by- doing, as well as policy, technical, administrative and financial support, will be arranged for WPCs, NWCs, their office staff, and field personnel in the country.

4. Role of regional offices

4.1 In order to maximize the effect of WHO action at country level, it is necessary to examine how regional offices can best fulfil their main technical cooperation function, so as to ensure that governments and WPCs /NWCs get the support they require, and that they get it as speedily as possible. Since what is needed in the way of technical, administrative and financial support has been worked out through joint policy and programme reviews, the question is how it will be provided promptly, efficiently aid effectively.

4.2 The new approach to programme budgeting and management of WHO's resources at country level, recognizing as it does the prime responsibility of the government itself, means a profound change in the way support is provided from regional level. The WHO programme budget at country level is understood to be an integral part of the national health development programme and not simply an extension of the regional programme. Under the new approach there would be no imposition of vertical programmes on countries, because all programme proposals would be screened at national level during the joint programme reviews. To ensure a coordinated response by regional offices and headquarters, "country support review mechanisms" could be established in the regional offices.

4.3 Experiments are under way in several regional offices with the use of such review mechanisms for groups of countries. The purpose of these mechanisms is: (1) to support the joint government /WHO mechanisms; (2) to review programme proposals to the regional director from governments or from any level of the Organization; and (3) to ensure coordinated support to countries by providing a coherent response to their needs. The country support review mechanisms will provide support to the WPC /NWC and the government in: comprehensive reviews of the country's situation and needs; policy analysis; formulation, implementation, monitoring and evaluation of strategies for health for all; development of the national health system, bringing science and technology to bear on health development; and cooperative planning of programmes in which WHO is involved and proper use of WHO's resources to this end.

1 Resolution WHA33.17, operative para. 5. ANNEX 3 89

4.4 The country support review mechanisms are not meant to be structural or bureaucratic levels or clearing -houses interposed between countries and the regional office. They are an active response mechanism at regional office level dealing with the substance of WHO's cooperation, the focus being_ on the needs of individual countries rather than on separate WHO programmes. It goes without saying that any periodic review of a country's situation held in the regional office would take place with the WPC /NWC and government officials of that country.

4.5 It is recommended that the country support review mechanism should consist of a designated "focal point" and a flexible "multidisciplinary support team ". The focal point should consist of a senior officer, responsible to the regional director and responding to the WPC/NWC acting for the joint government /WHO mechanism. The multidisciplinary team would not be a fixed team with static membership: its composition would be responsive to the particular country and to the particular skills, technology or experience required in each case (including administration and finance as necessary).

4.6 The country support review mechanisms will assemble and coordinate the concerted support action of all technical, administrative and financial capabilities at the disposal of the regional office in support of countries at their request. This requires a review and redefinition of the work of regional advisers and other technical staff of the regional office, freeing them from as much bureaucratic work as possible (whether imposed by current practices in the regions or by headquarters), so that they can fulfil the much more important and satisfying role of providing technical advice and support to countries at the request of the government or the WPC/NWC. Moreover, administration and finance staff will be taking a more active role in providing services to countries, effecting transfers upon requests, and monitoring the administrative, budgetary and financial aspects of WHO support.

4.7 The country support review mechanisms will help ensure that the intercountry and regional activities provided by the WHO regional offices increasingly relate to, and directly or indirectly support health development action in countries, provided such activities meet the criteria for determining the organizational level for implementation as set forth in the Seventh General Programme of Work, namely:

Intercountry and regional activities are indicated if: similar needs have been identified by a number of countries in the same region following a rational process of programming or a common awareness of joint problems; the pursuit of the activity as a cooperative effort of a number of countries in the same region is likely to contribute

significantly to attaining the programme objective; . . . countries [practising TCDC /ECDC], whether developing countries cooperating among themselves, developed countries doing so, or developed countries cooperating with developing countries, have requested WHO to facilitate or support such cooperation; for reasons of economy the intercountry framework is useful for pooling selected national resources, e.g., for the provision of highly skilled technical services to countries; the activity encompasses regional planning, management and evaluation or is required for regional coordination; or the activity is an essential regional component of an interregional or global activity.I

In the course of their work, the country support review mechanisms will identify issues and consider modes of action that conform to the above criteria for intercountry and regional activities.

4.8 Staffing reviews and organizational restructuring may be required in each regional office. Regional advisers and other technical staff will have to allot their time in accordance with countries' needs as defined through the country support review mechanism. It may be useful to prepare and update time charts, showing when regional office staff are available and when their time has already been committed to support countries. Pools of experts or resource persons will be established, composed of national and WHO personnel who are "on call" for prompt response to urgent and often unforeseen country needs, whether these be of a technical, administrative or financial nature. The change in approach to multidisciplinary reviews, decision -making, execution and monitoring related to the programme budgeting and use of WHO's resources at country level requires a new, close cooperation between the director of programme management (DPI) and the director of support programmes (DSP) of the regional office. Henceforth the two "sides" have to work together much more

1 "Health for All" Series, No. 8, para. 70(b). 90 THIRTY- EIGHTH WORLD HEALTH ASSEMBLY closely than before, since the nature of WHO's response to country -level requests will increasingly contain mutually related technical and administrative elements.

4.9 The proposals contained in this document for reorienting and strengthening WHO support to countries do not necessarily envisage changes in the way regional offices budget, account for, and control intercountry and regional activities. However, the administration and finance information (AFI) systems in the regions will have to be redesigned so that they provide necessary and timely AFI information support to country level, as distinguished from the more conventional budgetary control and management of externally delivered "projects ", typical in past years throughout the United Nations system. The new AFI system, as well as the directors of support programmes (DSP), the budget and finance officers (BFO), and other financial and administrative staff, will have to be able to perform the functions and provide the services required by the two ways of controlling WHO resources at country level as follows:

(1) To respond promptly to requests from the government, the WPC /NWC or the joint mechanism at country level for the transfer of funds or working capital advances and for subsequent transfers to the officially designated government agency relating to WHO's direct financial cooperation, keeping the WPC/NWC informed. Where the accounting function has been shifted to the country level in this manner, it may be necessary for regional office administration aid finance staff to be "on call" to help officially designated government agencies to improve their own capabilities for managing and accounting for national, WHO and other external resources in consonance with the concept of government execution.

(2) To provide promptly the international services expressly requested by the government, as planned and documented with the WPC/NWC, and in accordance with the financial and administrative rules and regulations of WHO; and to keep the WPC /NWC informed at least monthly, through the improved AFI system. Administration and finance staff in the regional office will need to work closely with the DPI and the WPC /NWC to work out the most efficient and effective procedures for each country.

4.10 Regional office administration and finance staff may have to visit WPC /NWC offices to help set up appropriate, efficient control systems and train staff at country level, so as to enable the WPC /NWC to control the resources for the international services provided by WHO, and to provide support to the joint government /WHO coordinating committee.

4.11 These new approaches will be fully discussed by all regional office staff. Appropriate administrative, financial and technical briefing, reorientation and learning -by -doing will be required. In particular it is important to make sure that all regional office staff understand their role as being that of providing technical, administrative and financial support to countries through the WPC /NWC and not that of exercising power to impose programme activities on these agents or individual staff in the country. Likewise, regional office staff will have to resist the imposition of vertical programmes or activities on countries, either from their own level or from headquarters. Yet they must know when and how to turn for the right information and support from headquarters and from other regions, and how to judge initiatives from headquarters and other regions in the light of the needs, priorities and capabilities of the country concerned, and to act accordingly.

5. Role of headquarters

5.1 The new concept of the role of WHO at country and regional level in support of countries is accompanied by a new definition of the functions of headquarters that appears in the Director -General's report on the study of WHO's structures in the light of its functions:

Global stimulation through the generation, crystallization and promotion of ideas; worldwide coordination on behalf of the Executive Board and the Health Assembly; collation, analysis, synthesis and dissemination of valid information on health matters; central organization of global programmes; support to regional offices; and provision of the right kind of information and other support to the Executive Board and the Health Assembly and to global advisory groups, particularly those involved in multisectoral and multidisciplinary action for health aid in the international transfer of resources for health.1

1 WHO document А34/15, Annex 1 (Plan of action for implementing the recommendations of the study of WHO's structures in the light of its functions), para. 28.2. ANNEX 3 91

5.2 All headquarters staff will carry out the above functions in implementing the Seventh General Programme of Work, in the spirit of its emphasis on national health system infrastructure development for the delivery of programmes that use appropriate technology and the related scientific endeavours required. Staff will be prepared to respond to calls for specific help from regional level in support of countries.

5.3 In this connection any interregional and global activities will have to be carried out in such a way as to meet the criteria for determining the organizational level for implementation as set forth in the Seventh General Programme of Work:

Interregional and global activities are indicated if: similar requirements have been identified by a number of countries in different regions following a rational process of programming; the activity consists of facilitating or supporting technical cooperation among countries in different regions, and its pursuit is likely to contribute significantly to attaining the programme objectives; for reasons of economy the interregional framework is useful for pooling selected resources, e.g., for the provision of highly specialized and scarce advisory services to regions; the activity encompasses global planning, management and evaluation; the activity is required for global health coordination aid for central coordination with other international agencies.1

5.4 It follows that the initiatives for headquarters support, that do in fact require interregional activities, should come from the regional offices. This does not preclude headquarters staff suggesting such activities on the basis of information available to them, but, as stressed in section 4 above, the regional offices should react in the light of the needs of the countries in their region.

5.5 All headquarters staff have to understand these functions and criteria relating to their work. They must fulfil their roles of stimulating ideas and providing support, and not confuse those roles with authority to impose programme activities or bureaucratic work on regional offices, or to engage in country activities without agreement of the regional offices (i.e., the regional directors or the country support review mechanisms concerned), and the WPC/NWC on behalf of the government /WHO mechanism in the country. As noted in paragraph 1.3, contractual technical services agreements for research are a separate category not specifically dealt with in this paper. However, staff - and in particular headquarters staff - will have to accept that countries will be identifying their specific health research needs, using appropriate procedures such as the managerial process for national health development in the country, and appropriate mechanisms such as the joint policy reviews described in section 2 above. Proper account will have to be taken of these identified needs when they arise.

5.6 A substantial delegation of authority from headquarters level to the regions has already taken place in programme budgeting and in financial and administrative matters. It is not therefore expected that the new approach to programme budgeting and use of WHO resources at the country level, and related regional office and global support, will have significant implications for administrative, budgetary or financial procedures at headquarters. However, staff of administration, finance and information systems support at headquarters will have to be ready, within available time and resources, to assist regional offices in setting up administration and finance information (AFI) systems and using cost -effective data -processing and information management techniques. This will in turn facilitate regional office AFI support to the programme budgeting for proper use of WHO's resources in countries.

5.7 The new approaches will be fully discussed by all headquarters staff. Appropriate briefing, reorientation and learning -by -doing will be required so that all staff fully understand their role and functions. The organizational structure will be brought into line as closely as possible with the classified list of programmes in the Seventh General Programme of Work.

1 "Health for All" Series, No. 8, para. 70(c). 92 THIRTY -EIGHTH WORLD HEALTH ASSEMBLY

6. Programme budget presentation

6.1 The new approach to programme budgeting and use of WHO's resources does not imply any change in the system of regional allocations by the Director -General. However, the possible future presentation of the proposed programme budget may entail significant modification of the present form. Country -level statements could describe the main directions for national health development, and also the nature and scope of WHO's involvement and use of its resources in relation to the objectives, targets and scope of national health programmes. The regional -level descriptive "programme statement" for submission to the regional committee could then analytically review country situations in the region, showing in addition how the regional and intercountry activities support the country level. Thus, for a given programme of the classified list in the Seventh General Programme of Work, the descriptive regional statement would explain that certain countries were following a certain approach with defined support needs, and that therefore WHO support was being provided in a certain way.

6.2 This would make it possible, at global level, for the global "programme statements" to provide a synthesis of the approaches being used by countries worldwide; the support being provided by WHO both within countries and by intercountry or regional activities; the support needed, and being provided, by global and interregional activities; and the gaps in research, technology, information, and material and financial resources - the overall budgetary implications being given for all three levels. The new process and form of presentation at country and regional levels will therefore affect the global "programme statements" and the supporting budgetary tables that go to the Executive Board and the World Health Assembly. The new form of presentation will thus show the work of WHO much more in terms of implementation of the national, regional and global strategies for health for all.

6.3 The feasibility is being studied of implementing the new, analytical approach to the preparation and presentation of the proposed programme budget throughout the whole Organization for the 1986 -1987 financial period. However, if this is not feasible, a trial test of such presentation at regional level could be undertaken (in at least two regions), using the current 1984 -1985 programme and the initial proposed programme for 1986 -1987. In the light of the lessons learned from this trial, the new presentation could be officially applied in all regions and used for preparation at global level of the new -type proposed programme budget document for 1988 -1989.

6.4 The form of presentation of WHO's Financial Report as prepared at the close of the financial period should not be significantly affected by the new approach in programme budgeting, use of WHO resources, and presentation of the programme budget proposals. The "programme implementation" part of the Financial Report will continue to follow the basic framework of the proposed programme budget based on the Seventh General Programme of Work. The analysis of categories of expenditure contained in the the Financial Report will reflect the direct financial cooperation category. Financial accounting of expenditures against budget will have been carried out in the light of the dual approach, i.e., direct financial cooperation at country level (properly executed and controlled by the government, certified in programme terms by the joint coordinating mechanism, and reported to WHO) and international services (provided, controlled and certified by the WHO Secretariat). These approaches will be fully defined in WHO's Financial Rules. Accounting for expenditures against budget will be continued in accordance with the WHO Financial Regulations) and the Financial Rules, and will continue to be subject to verification by WHO's internal and external auditors.

7. Monitoring process

To ensure that all the modifications in the functions and structures of WHO are taking place - at country, regional and global levels - a process of monitoring and collective learning will be introduced at all levels, beginning with each and every responsible officer; involving appropriate groups in countries and regional offices, the regional directors, the assistant directors -general, and the Headquarters and Global Programme Committees; and ending with the Director-General. In this process:

1 WHO Basic Documents, 35th ed., 1985, p. 75. ANNEX 3 93

- the joint government /WHO coordination mechanism at country level will be expected to monitor performance within the country;

- in each regional office the regional director will define the most appropriate means and mechanisms for monitoring this process and for collective learning;

- at headquarters the assistant directors -general and the Headquarters Programme Committee will define the means of doing likewise; and

- the whole Organization -wide implementation will be monitored by the Global Programme Committee, the process ending with the Director- General himself, who is accountable to the Health Assembly.

Attachment I

BROAD INTERLINKED CATEGORIES OF WHO PROGRAMMES UNDER THE SEVENTH GENERAL PROGRAMME OF WORK1

1. Direction, coordination and management is concerned with formulation of the policy of WHO, and the promotion of this policy among Member States and in international political, social and economic forums, as well as the development, coordination and management of the Organization's general programme.

2. Health system infrastructure aims at establishing comprehensive health systems based on primary health care and the related political, administrative and social reforms, including a high degree of community involvement. It deals with:

- the establishment, progressive strengthening, organization and operational management of health system infrastructures, including the related manpower, through the systematic application of a well -defined managerial process and related health systems research, and on the basis of the most valid available information;

- the delivery of well -defined countrywide health programmes;

- the absorption and application of appropriate technologies that form part of these programmes; and

- the social control of the health system and the technology used in it.

3. Health science and technology, as an association of methods, techniques, equipment and supplies, together with the research required to develop them, constitutes the content of a health system. Health science and technology programmes deal with:

- the identification of technologies that are already appropriate for delivery by the health system infrastructure;

- the research required to adapt or develop technologies that are not yet appropriate for delivery;

- the transfer of appropriate technologies;

- the search for social and behavioural alternatives to technical measures; and

- the related aspects of social control of health science and technology.

4. Programme support deals with informational, organizational, financial, administrative and material support.

1 From "Health for All" Series, No. 8, paras 103, 104, 106 and 108. 94 THIRTY -EIGHTH WORLD HEALTH ASSEMBLY

Attachment II

DETERMINATION OF PRIORITIES FOR WHO ACTIVITIES UNDER THE SEVENTH GENERAL PROGRAMME OF WORK1

Priority activities within the Programme will result from careful analysis with countries of their needs in support of their strategies for health for all by the year 2000, translating these needs into WHO's response under each of the WHO programmes concerned; such priorities will also result from careful selection of the approaches to be used, individually or in combination as appropriate, for each programme, with a view to ensuring that all programmes do in fact support the progressive development by countries of comprehensive health systems based on primary health care. In addition, the selected criteria presented [in the Seventh General Programme of Work] will be applied to identify programme areas for WHO involvement, to determine the organizational level or levels for implementation of programme activities and to select the most appropriate types and sources of resources for financing programme activities. The proper application of these criteria should go far to determine the ultimate priority activities of the Organization, particularly during the sequentially linked processes of medium -term programming and programme budgeting. However, in the final analysis, the setting of priorities among the different components of the programme, and the nature and extent of WHO's involvement, will depend on the priorities fixed by the Member States themselves. At the country level, the setting of priorities among the different programmes is a national decision which governments normally take after considering the country's epidemiological, environmental and socioeconomic conditions and the state of development of their health system, taking into account what is practicable for them, through methods that are readily available and at a cost they can afford. At the regional and global levels an important role in setting these priorities is played by the regional committees, the Executive Board and the Health Assembly.

1 "Health for All" Series, No. 8, para. 122. ANNEX 4

NUMBER OF MEMBERS OF THE EXECUTIVE BOARD1

[А38/9 - 15 March 1985]

Report by the Director -General

At its thirty -fifth session in September 1984, the Regional Committee for the Western Pacific adopted resolution WPR /RC35.R10 recommending the Executive Board, and through it the Health Assembly, to give consideration to the possibility of increasing from three to four the number of Member States of the Western Pacific Region entitled to designate a member of the Executive Board. This resolution was submitted to the Executive Board at its January 1985 session during the discussion of the report by the Regional Director for the Western Pacific.2 Following the discussion that Cook place on this item, the Board adopted resolution EB75.R4, by which it recommended to the Thirty- eighth World Health Assembly that it should consider increasing the membership of the Executive Board from 31 to 32. Such a global solution would enable the number of Member States of the Western Pacific Region entitled to designate a member of the Board to be increased without however changing the existing situation for the other regions. Examination of the matter by the Health Assembly will be facilitated by the following two remarks, one touching on the substance of the matter, the other relating to the methodology to be followed in order to comply, as appropriate, with the resolution of the Board.

1. The resolutions of the Regional Committee and the Executive Board, in justifying the change that they propose, refer to two distinct elements: (1) the recent increase in the number of Member States of the Western Pacific Region, and (2) the size of the Region's population. In seeking to understand the part played by each of these two elements, it is worth considering the previous practice of the Health Assembly and the criteria hitherto adopted in selecting Member States entitled to designate a person to serve on the Board. Roughly speaking, two periods may be distinguished in the history of the Organization.

1.1 Prior to 1984 the criterion adopted by the Health Assembly for such selection appears to have been purely numerical. In practice, the number of Member States of each Region invited to designate a member of the Executive Board was roughly proportional to the total number of Member States of the Region. As an example, the following table shows the distribution of seats on the Board as it was in 1983.

SITUATION IN MAY 1983

Region Number of Theoretical number of seats Effective number Member States* (ratio 30/158 = 0.189) of seats

Africa 43 8.12 7 The Americas 31 5.85 6 South -East Asia 11 2.07 2 Europe 33 6.23 7 Eastern Mediterranean 23 4.34 5 Western Pacific 17 3.21 3 158 30

Excluding non-active Members.

1 See resolution WHA38.14. 2 Document ЕВ75 /10, para. 19 and Annex.

- 95 - 96 THIRTY -EIGHTH WORLD HEALTH ASSEMBLY

1.2 In 1984 came into force the amendment to Article 24 of the Constitution adopted in 1976 by the Health Assembly, increasing the number of members of the Executive Board from 30 to 31. It was stipulated by this amendment that not less than three Member States of each region were to be elected. From 1984 onward the distribution of the seats was therefore altered. The following table shows the situation as it now exists.

SITUATION IN MID -MARCH 1985

Region Number of Theoretical number of seats Effective number Member States* (ratio 31 /163 = 0.190) of seats

Africa 44 8.36 7 The Americas 34 6.46 6 South -East Asia 11 2.09 3 Europe 32 6.08 7 Eastern Mediterranean 23 4.37 5 Western Pacific 19 3.61 3 163 31

Excluding non-active Members.

1.3 These two examples show that the previous criterion, which was one of proportionality between the total number of Member States in a given region and the number of Member States of that region called upon to designate a member of the Executive Board, has been appreciably altered. The discussion that took place in 1976 concerning the proposed amendment shows quite clearly that the main, if not the only justification for this amendment was the size of the population of the South -East Asia Region, which had taken the initiative in requesting this increase. Since South -East Asia was the only region not to have at least three seats on the Board, the practical consequence of the amendment adopted in 1976 was to increase by one the number of Member States of the South -East Asia Region called upon to designate a member of the Board. Hence it may be concluded that, in adopting this amendment, the Health Assembly had taken account of the wish expressed by this Region and had thus wished to take the size of its population into consideration. From that time on the criterion has therefore been one that takes into account both the number of Member States of the Region and its population, at least as regards the South -East Asia Region.

2. These two factors (the number of Member States of the region and the size of its population) were the ones that the Regional Committee for the Western Pacific and the Executive Board took into consideration in their resolutions. In order to take account of them, the Executive Board recommended that the Health Assembly consider increasing the number of members of the Board from 31 to 32. This proposed increase in the total number of members of the Board calls for three comments.

2.1 First, a procedural question. Under the provisions of Article 73 of the Constitution, texts of proposed amendments have to be communicated by the Director -General to Members at least six months in advance of their consideration by the Health Assembly. Consequently, it is constitutionally impossible for the Assembly to adopt a constitutional amendment at the present session. If, in due time, such draft amendments were produced, they would have to be communicated to the Director -General within the established time limit and the Director -General would have to communicate their text to Member States before the final date set by Rule 119 of the Assembly's Rules of Procedure. Consequently, May 1986 is the earliest date at which the Assembly would be able, if need be, to adopt an amendment to the Constitution; for that amendment to come into force it would then have to be ratified by two -thirds of the Member States of the Organization.

2.2 Secondly, an increase in the total number of members of the Executive Board from 31 to 32 would not automatically involve an increase from three to four in the number of Member States of the Western Pacific Region entitled to designate a member of the Board. Undoubtedly the arguments put forward in favour of adopting this change emerge clearly from the discussion and from the text of the two resolutions that were adopted by the Regional Committee for the Western Pacific and the Executive Board respectively. Nevertheless, it must be emphasized that, failing a more specific wording of the amendment to be made to Article 24 of the Constitution, there would be no constitutional obligation to meet this point. ANNEX 4 97

2.3 Lastly, it should be noted that, since the mandate of the members of the Executive Board is for three years and the total number of 32 is not divisible by three, provision would have to be made (as is moreover the case at present) to replace a different number of members according to the year. For example, the Health Assembly could elect 10 Member States in one year and 11 in the two following years; or it could opt for any other solution leading to the same result. The amendment to Article 24 of the Constitution would therefore also require an amendment to Article 25. ANNEX 5

EMERGENCY HEALTH AND MEDICAL ASSISTANCE TO DROUGHT -STRICKEN AND FAMINE -AFFECTED COUNTRIES IN AFRICAI

[А38 /lb - 2 May 1985]

Report by the Director -General

Drought and famine are not new in sub -Saharan Africa, but the situation has recently greatly deteriorated. It has led to the displacement of many thousands of people into overcrowded camps, often in areas already stricken by drought. The population of cities and towns has similarly been swollen by the influx of people. The shortage of food and water and the poor sanitary conditions give rise to malnutrition, anaemia, and, inevitably, outbreaks of disease.

WHO has responded by providing emergency health aid to more than 20 crisis -stricken countries in Africa involving millions of dollars in addition to its regular budget.

This document is submitted in accordance with resolution WНАЭ7.29, and at the specific request of the Executive Board at its seventy -fifth session in January 1985. It illustrates how the Organization is responding to the critical situation affecting most of Africa, in close collaboration with other entities of the United Nations system, particularly UNICEF, donor governments and nongovernmental relief agencies, to ensure that immediate life -saving requirements are made available. Moreover, WHO's mandate includes the readiness to provide emergency relief as part of its main role of supporting the efforts of Member States to attain health for all through primary health care. While emergency health assistance can provide an entry -point to primary health care, all phases of the international response to the African crisis situation - emergency, rehabilitation and long -term development - must be perceived as being inextricably linked to one another. Emphasis is accordingly given in WHO's work to long -term health development. Examples of WHO's action are provided. These do not give an exhaustive survey of ongoing programmes, but should facilitate the reader's perception of WHO's sensitivity to the underlying humanitarian concerns and problems confronting most of Africa.

CONTENTS

Page

I. Introduction: The dimensions of the critical situation in Africa 99

II. The role of WHO in the international response to the emergency needs 99

III. Examples of recent action by WHO 100

IV. Interaction and coordination in relief operations 104

See resolution WHA38.29.

- 98 - ANNEX 5 99

I. INTRODUCTION: THE DIMENSIONS OF THE CRITICAL SITUATION IN AFRICA

I. The sight of starving families in camps and improvised shelters throughout sub -Saharan Africa has become almost commonplace on the world's television screens, and repetition has not made it any the less distressing. It has stimulated a remarkable outpouring of sympathy for the famine -stricken people of the countries affected and an influx of funds to alleviate their condition.

2. Drought and famine are not new in sub -Saharan Africa. The rains come in a capricious manner, if they come at all; the population is increasing at a rate that outstrips the capacity of the land to support it; and the desert, gaining ground every year, is encroaching on the pasture and cultivable land that provide the livelihood of the people. For years the Food and Agriculture Organization of the United Nations (FAO), the United Nations Environment Programme (UNEP) and other organizations have been assisting in stemming the advance of the desert; but the present unprecedented drought is a major setback to their efforts. As the herds diminish through lack of water and fodder, the nomadic pastoral people understandably move in search of sustenance. The agricultural population, its food reserves near exhaustion, begins to consume even the seed needed for next year's planting.

3. The situation is complicated by political factors which have contributed to the displacement of many thousands of people into overcrowded camps, often in areas already stricken by drought. The population of cities and towns has similarly been swollen by the huge influx of people fleeing from the drought and /or political conditions. Th' shortage of food and pure water and the poor sanitary conditions give rise to malnutrition, anaemia, and, inevitably, outbreaks of disease.

4. The first priority for the affected population is obviously food, the provision of which is the concern of the World Food Programme (WFP), FAO and other United Nations bodies, many donor governments, and a host of nongovernmental relief agencies. The refugees are within the mandate of the Office of the United Nations High Commissioner for Refugees (UNHCR). Health, nutrition, drinking- water, and sanitation are of particular concern to WHO, UNICEF, the League of Red Cross and Red Crescent Societies, and the many humanitarian agencies whose pleas for help appear regularly in the newspapers or arrive in the letterboxes of individuals in many parts of the world.

II. THE ROLE OF WHO IN THE INTERNATIONAL RESPONSE TO THE EMERGENCY NEEDS

5. The predominant role of WHO is to support countries, particularly those in greatest need, in building up a health system based on a sound infrastructure that will enable them to assure the health and wellbeing of their people and to meet whatever crisis may arise. In 1980 the World Health Assembly decided (by resolution WHA33.17) that the Organization should concentrate its activities over the coming decades, "as far as is possible in the light of all its constitutional obligations, on support to national, regional and global strategies for attaining health for all by the year 2000 ". This did not exclude help in emergencies, but placed the emphasis firmly on health development. The health problems created by the protracted drought in the Sahel and the large numbers of displaced persons and refugees led the Health Assembly four years later, however (in resolution WHА37.29), to request the Director -General "to take appropriate steps to strengthen the present support mechanisms in collaboration with the relevant agencies of the United Nations system, donor countries, and governmental and nongovernmental organizations in order to improve the support of the international community for the countries affected by drought and famine in Africa ".

6. Resolution WHA37.29 was adopted in May 1984. In December 1984 the Secretary -General of the United Nations set up a United Nations Office for Emergency Operations in Africa (OEOA), under the direction of Mr Bradford Morse (Administrator of UNDP). The overall aims of that Office are to clarify emergency needs and to facilitate resource mobilization as well as cooperation among all organizations and institutions concerned with the African crisis: UNDP, WFP, FAO, WHO, UNICEF, UNHCR, the Office of the United Nations Disaster Relief Coordinator (UNDRO), other relevant United Nations bodies, government agencies such as the United States Agency for International Development (USAID), the Arab Gulf Programme for United Nations Development Organizations (AGFUND), the Italian Nutrition Support Fund, the Belgian Third World Survival Fund, and voluntary organizations such as the League of Red Cross and Red Crescent Societies. Since he took over as head of OEOA, Mr Morse has repeatedly emphasized the importance of not diverting long -term development resources to the meeting of emergency needs: emergency relief efforts and development efforts are linked, and 100 THIRTY -EIGHTH WORLD HEALTH ASSEMBLY are both needed to combat the crisis affecting Africa. He has also stressed the necessary extension of support to the "non- food" sectors, such as water and sanitation and health. In April 1985 WHO was invited to join the Emergency Task Force of Mr Morse's Office to support its coordinating work, and a senior staff member has been assigned to this function. In this way WHO will continue to ensure close collaboration with this key United Nations focal point for the Africa crisis.

7. The latest information from lElA indicates that the crisis shows little sign of abating in the near future, even if drought conditions improve markedly in the next rainy season. It estimates that 150 million people live in areas subject to crisis, of whom 30 million are seriously affected.1 The crisis is characterized by an unprecedented displacement of population, as many as 10 million having abandoned their land in search of food, water, and pasture for their herds. lElA has also called attention to the growing number of migrants and emphasized the importance of bringing assistance whenever possible to people where they are, so that they remain on their land with their families without undergoing the added trauma of displacement and camp life with its hazards. Direct assistance to affected populations within their own settlements would also enable rehabilitation and reconstruction to proceed more rapidly when circumstances permit.

8. In 1984 the World Bank launched a Joint Programme of Action for sub -Saharan Africa, which includes health as a high priority issue and gives fresh emphasis to health sector development. The Bank's initial appeal for US$ 1000 million has been met, and discussions are under way between the Bank and WHO on how the latter can best collaborate in that programme.

III. EXAMPLES OF RECENT ACTION BY WHO

9. The following information concerns individual countries, where WHO has provided emergency -related assistance in various ways. The very nature of the situation makes it difficult to provide complete information. Nevertheless, the following examples should provide useful insight into the type and magnitude of support with which WHO is responding. This response can be summed up as the provision of emergency health aid to more than 20 crisis -stricken countries in Africa involving millions of dollars in addition to the Organization's regular budget. However, the demarcation between regular programme activities and emergency relief activities becomes academic in situations where countries exist precariously on the verge of emergency conditions of nationwide magnitude. This is the situation in which many of the affected countries find themselves. Consequently, the best way to recovery is to ensure that medium- and long -term measures of health infrastructure development are undertaken alongside emergency life -saving efforts. Only if short -term relief and longer -term infrastructure-building proceed together is it possible to avoid the ever-present danger that recovery may be short -lived and may soon "relapse" into a fresh form of emergency. It is here that WHO's regular programme activities provide an essential complement to the work of relief agencies. To break the vicious circle created by transient alleviation "relapsing" into further emergency, the development of self -sustaining national health infrastructures is essential.

10. In a number of countries the specific health needs were assessed in collaboration with UNICEF in preparation for the United Nations Conference on the Emergency Situation in Africa held in Geneva in March 1985. Earlier in the year the executive heads of UNICEF and WHO jointly renewed directives to their respective field staff in African countries on the need for close cooperation between the two organizations at field level in the identification of needs, and the planning and implementation of emergency measures to meet health, food, water and sanitation requirements.

11. For Angola WHO had already in 1981 appealed to the international community to help in the difficult situation facing the country. For the 1984 -1985 biennium the WHO Regional Office for Africa has included US$ 1 399 400 in its regular budget, plus an additional US$ 1 787 230 from extrabudgetary sources for support to programmes in nutrition, maternal and child health, and health manpower training.

1 OEOA is focusing its efforts on 20 particularly seriously affected countries of sub -Saharan Africa, namely: Angola, Botswana, Burkina Faso, Burundi, Cape Verde, Chad, Ethiopia, Kenya, Lesotho, Mali, Mauritania, Mozambique, Niger, Rwanda, Senegal, Somalia, Sudan, United Republic of Tanzania, Zambia, and Zimbabwe. ANNЕХ 5 101

12. WHO cooperated with UNDRO in a multi -agency mission to assess the situation in Benin, and subsequently provided urgently needed health laboratory material. Within the context of longer -term WHO collaboration with Benin, WHO continued its assistance to the Government in strengthening its national health development. This included a thorough updating of the country's use of health resources in support of health - for -all policies through the health resource utilization review mechanism which, when presented to potential donors at the Health Sector Round Table in October 1984, resulted in some US$ 14 million of fresh assistance being pledged. Similar WHO work in updating or in carrying out new studies was undertaken in Botswana, Burkina Faso, Gambia, Guinea, Guinea -Bissau, Lesotho, Malawi and Sierra Leone during the course of 1983 -1984 which, in some cases, has also resulted in the channelling of substantial new resources to primary health care.

13. In order to cope with an emergency in Botswana, WHO has supplied 200 000 packets of oral rehydration salts. Provision is made in an amount of US$ 684 300 in the regular budget for 1984 -1985 and US$ 327 583 from extrabudgetary sources to strengthen health services, and the necessary resources have been provided for a study on nutritional aspects of the crisis.

14. WHO has cooperated with the authorities in Burkina Faso in evaluating the impact of the drought on the health situation and in controlling the epidemics that have complicated it. It examined a list of essential drugs drawn up by the Government and it provided 600 000 doses of yellow fever vaccine to combat an epidemic of yellow fever. WHO also provided an additional 1 150 000 doses of yellow fever vaccine and 10 000 litres of fuel, and sent a multidisciplinary team to assess the epidemic situation and to make recommendations. For cholera control it sent 50 000 tetracycline tablets and 50 000 chloramphenicol capsules, 10 000 packets of rehydration salts, and 1000 litres of rehydration fluid. For the biennium 1984 -1985 the WHO Regional Office for Africa has included US$ 1 363 100 in its regular budget and US$ 594 240 from extrabudgetary sources to provide technical support for primary health care, staff training, health education, maternal and child health, water and sanitation, and immunizations. Technical support was also provided to UNICEF and UNDP in their preparations for a donor meeting to consider the financing of emergency health, nutrition, and water programmes.

15. Provision is made for US$ 1 237 500 in the regular budget for 1984 -1985 and US$ 284 220 from extrabudgetary sources for activities in Burundi, where the health situation in rural areas is reported to be precarious in certain parts of the country.

16. Many cases of drought -related diseases have been noted in Cape Verde where, owing to inadequate food resources, a large part of the population suffers from malnutrition. An amount of US$ 888 800 is included in the regular budget for 1984 -1985 for continued support to government programmes of immunization, maternal and child health, manpower training, drinking -water aid sanitation.

17. Under a special programme of assistance to Chad, WHO consultants have supported local efforts for a total of 22 months. This follows WHO's launching of an emergency appeal in November 1982. Emergency aid to the value of US$ 200 000 was requested, in order to make the country's hospital services operational again. Medicaments valued at US$ 43 000 have been provided for diarrhoeal disease control. Provision of US$ 1 245 000 is included in the regular budget for 1984 -1985 and US$ 1 014 750 is being provided from extrabudgetary sources for health infrastructure development in Chad.

18. In December 1984 a WHO technical team visited a number of shelters in affected areas of Ethiopia and confirmed the existence of excessively high rates of mortality and morbidity caused by malnutrition, diarrhoea, measles, pneumonia, malaria, relapsing fever, and eye and skin conditions. In response to an urgent request from the United Nations Secretary -General's Special Representative for Emergency Relief Operations in Ethiopia, and following up the recommendation of the special WHO assessment team, WHO has recently assigned to the Special Representative a senior consultant experienced in public health and emergency work in order to support the formulation of a coherent emergency health programme in cooperation with all active partners and to coordinate all the health inputs from outside the country. WHO also supports inter alia a national action programme on local production of essential drugs, some of which are already being manufactured.

19. In collaboration with the national authorities and the United Nations Special Representative, WHO also drew up an estimate of the funds required in Ethiopia for the equipment of health centres, the health manpower and training needs, logistics, and a 102 THIRTY- EIGHTH WORLD HEALTH ASSEMBLY nutrition programme. This estimate was submitted to the donor community in January 1985. WHO also financed a seminar on maternal and child health in the drought -stricken areas. A WHO sanitary engineer has been collaborating since 1982 with UNICEF and other agencies to improve sanitary conditions in the transit centres and camps for the displaced population. US$ 2 831 300 has been included in the regular budget together with US$ 1 432 000 from extrabudgetary sources for health programmes in Ethiopia in 1984 -1985.

20. The WHO Regional Office for Africa has included US$ 1 161 900 in its regular budget for 1984 -1985 and is providing US$ 193 815 from extrabudgetary sources for a number of health programmes in Kenya. These include primary health care, drinking -water supplies, nutrition, and maternal and child health.

21. For Lesotho the WHO Regional Office for Africa has included US$ 944 800 in its regular budget for 1984 -1985 and is providing US$ 12 215 from extrabudgetary sources for health activities.

22. In Mali WHO has collaborated with the Government in assessing the health consequences of the drought. It has provided anticholera drugs and supplies to the value of US$ 90 400, plus US$ 15 000 for village water supplies, and 30 000 tetracycline tablets to combat cholera epidemics. Provision is made for US$ 1 332 100 from the regular budget for the biennium 1984 -1985 and US$ 216 090 from extrabudgetary sources to cover technical support to the various health activities within the country.

23. WHO staff participated in an emergency multi-agency mission to assist the Government of Mauritania in dealing with the health problems arising from the drought. WHO has provided technical and material support for drought control, including US$ 187 000 for the supply of drugs. The WHO Regional Office for Africa has included US$ 1 051 400 in the regular budget for 1984 -1985 and is providing US$ 418 500 from extrabudgetary sources for health activities in Mauritania.

24. WHO advised UNDRO on procurement of drugs and surgical supplies for Mozambique and on the shipping to that country of emergency health kits and urgently needed laboratory supplies. WHO also allocated US$ 25 000 for cholera control measures, US$ 150 000 for the training of health personnel, and US$ 321 400 for a regional pilot project in training involving cooperation between Mozambique and Zambia. The WHO Regional Office for Africa has provided US$ 1 325 200 in its regular budget and US$ 268 065 from extrabudgetary sources for health projects in Mozambique in 1984 -1985.

25. WHO sent an epidemiological team to assist the Government of Niger in cholera control, and a consultant to assist in yellow fever control. It also airlifted anticholera medical supplies valued at US$ 65 000. The WHO Regional Office for Africa has provided for Niger US$ 1 334 500 from the regular budget for 1984 -1985 and US$ 894 315 from extrabudgetary sources for health development activities.

26. WHO has taken urgent action in Rwanda to control shigellosis, providing antibiotics and oral rehydration salts. The budget provision for that country is US$ 1 464 200 for health development under the regular budget for 1984 -1985.

27. The provision for Senegal from the WHO Regional Office for Africa's regular budget for 1984 -1985 is US$ 911 000, and from extrabudgetary sources US$ 92 460.

28. The WHO Regional Office for Africa has an amount of US$ 1 373 600 in its regular budget for 1984 -1985 and is providing nearly US$ 200 000 from extrabudgetary sources for health projects in the United Republic of Tanzania. The WHO budget provision to Zambia in 1984 -1985 amounts to US$ 1 408 000, with an additional US$ 1 105 000 from extrabudgetary sources. The figures for Zimbabwe are US$ 1 669 000 and US$ 184 860 respectively.

29. Health priorities for Djibouti include training in health management and environmental health. In 1984 WHO helped to combat epidemics through the provision of experts, supplies and equipment. The WHO Regional Office for the Eastern Mediterranean advises that nearly US$ 400 000 was allocated for this purpose, together with an additional US$ 32 000 for training.

30. In response to the critical situation in Somalia, joint WHO /UNICEF missions have helped to design comprehensive programmes covering health infrastructure, nutrition, drinking -water, ANNEX 5 103 and sanitation. Nearly US$ 1.5 million has been allotted by the Regional Office for the Eastern Mediterranean for personnel, equipment maintenance, and training. Nearly US$ 163 000 has additionally been made available in 1985 to cover the emergency shipment of WHO health kits, anticholera drugs and related laboratory diagnostic equipment. Other forms of WHO assistance included the formulation of emergency health projects, the coordination of donor support, the establishment of communicable disease surveillance systems, and the supervision of field control operations to combat outbreaks of cholera.

31. Emergency allocations totalling US$ 240 000 have been made to cover antimeningitis and antirabies measures, health kits, vaccines and other supplies for drought victims, including displaced persons in the Red Sea Province of Sudan. Additional assistance was provided in support of public health and maternal and child health services amounting to over US$ 900 000. With additional financing by AGFUND, WHO has been able to provide over 50 million chloroquine tablets.

32. WHO has supplied yellow fever vaccine to a number of African countries; this includes 100 000 doses to Benin, 200 000 doses to Cameroon, and 600 000 doses to Togo (see also paragraph 14 above ).Yellow fever control measures in Ghana were taken under joint Government /WHO auspices with the help of a US$ 420 000 grant, mainly from the European Economic Community (EEC).

33. WHO is also stepping up its Expanded Programme on Immunization and its Diarrhoea) Diseases Control Programme to combat some of the health problems arising from the drought. Through the former, supplies of vaccines have been furnished to nongovernmental organizations and voluntary agencies providing assistance to displaced persons and refugees. To guard against the abnormally high risk of measles in the crisis -stricken countries of Africa, WHO and UNICEF are making arrangements to stockpile a reserve of a million doses of measles vaccine with designated manufacturers. The Expanded Programme places special emphasis on the management, maintenance, and distribution of drugs and cold -chain equipment, which are of crucial importance in any emergency situation.

34. The concept of essential drugs - a limited number of good quality drugs at a low price - is also suited to emergency situations. Appropriate systems of procurement, storage, distribution, utilization, and training have been established for African countries that have an essential drugs programme; they will save lives by facilitating the assessment of needs and the rapid implementation of the emergency measures needed. In countries where there is no essential drugs programme, an emergency may stimulate policy changes leading to rationalization of the kinds and quantities of drugs distributed.

35. At WHO headquarters the programme of Emergency Relief Operations is buttressed at present by a standing emergency task force drawn from the relevant technical divisions. Its members are in a position to make a rapid and specialized assessment of the various aspects of emergency situations such as epidemics, sanitation, nutrition, medical supplies and drug procurement, transport, and information. In collaboration with the WHO regional offices, a worldwide network of disaster specialists acts as an advisory panel and can provide experts on short notice. However, the funds available for emergency relief operations under the WHO regular budget are limited; the operations depend almost exclusively on extrabudgetary sources, and WHO is also active in seeking these for the affected countries. The regional offices are increasingly assuming responsibility for emergencies. For example, in restructuring the Regional Office for Africa it is planned to strengthen the human resources for emergency relief operations. Continual liaison with the League of Red Cross and Red Crescent Societies, UNDRO, UNICEF and other United Nations, intergovernmental, and nongovernmental organizations extends the scope of WHO's health action; and constant contact with potential donors keeps open a major supply -line for funds and services.

36. Through its Emergency Relief Operations WHO has collaborated with UNDRO in field assessments and disaster surveys in, for example, Angola and Chad, and in the issue of guidelines on the sanitation aspects of disaster situations. WHO is responsible for the health work in the refugee camps under the care of UNHCR and has collaborated in a manual on refugee community health care. As already mentioned, it works closely with UNICEF in emergencies and disasters; UNICEF's warehouse in Copenhagen (UNIPAC) holds ready for dispatch the WHO health kits used in emergencies, each of which contains essential drugs and medical supplies for 10 000 refugees or displaced persons for three months.

37. WHO also collaborates with FAO and WFP on health and nutritional problems and, outside the United Nations system, with, for example, the League of Red Cross and Red Crescent 104 THIRTY- EIGHTH WORLD HEALTH ASSEMBLY

Societies, not only in furnishing supplies and services but also in helping to restore essential health services after disasters. WHO has also concluded agreements with universities on training and research in relation to emergencies and disasters. Disaster medicine has been established as a distinct discipline in several academic centres: thus the Catholic University of Louvain, Belgium, trains personnel from disaster -prone countries in natural disaster epidemiology, and the London School of Hygiene and Tropical Medicine deals with refugee health problems. WHO organizes workshops, meetings, and training courses for personnel from developing countries with the aim of enabling those with disaster management responsibilities to deploy the necessary skills for generating the organizational and operational resources required to cope with natural or manmade disasters. Within WHO, work has been undertaken on a manual on primary health care in disasters. WHO also collaborated in preparing the Dictionnaire des secours d'urgence en cas de catastrophe, published in 1984 by the Conseil international de la langue française.

IV. INTERACTION AND COORDINATION IN RELIEF OPERATIONS

38. As can be seen from the description of collaboration above, coordination of relief operations is highly essential and yet in the crisis -stricken countries of Africa is rendered difficult by the immense distances, the vast numbers of people affected, lack of data, transport and communications problems, political and administrative considerations, and the large number of international, national and voluntary agencies, which sometimes tend to regard the crisis from their own particular perspective. For example, some relief agencies may be unwilling to pool their resources with others; some donor countries prefer to provide aid - or part of their aid - bilaterally, which may lead to duplication; and some recipient countries insist on transporting and distributing donated food and other supplies by their own means, which in the end often leads to difficulties.

39. Nevertheless, as the description of WHO action shows, there is considerable coordination between WHO and other agencies. As already briefly indicated, WHO works closely with WFP in efforts to observe and introduce health aspects within the context of emergency food aid projects. For example, in a US$ 11 million WFP dairy development project in Sudan an integrated effort was made to upgrade a number of maternal and child health centres. In a tea production project, also in Sudan, WHO advocated primary health care and basic environmental sanitation programmes. For a large WFP rehabilitation project in northern Kenya, WHO drew up a primary health care programme for the health centres under construction and an endemic diseases surveillance programme, particularly for trypanosomiasis. It suggested a primary health care component for a US$ 16 million project for assisting peasant associations in Angola. As part of a US$ 15 million project in Senegal it advocated the extension of the role of women to basic health activities under the aegis of primary health care services provided by the Ministry of Health. WHO collaborates closely with WFP in Cape Verde, in the development of a nutritional surveillance system and the establishment of nutritional rehabilitation centres. It has suggested ways of improving milk hygiene control and strengthening health and environmental regulations for a WFP dairy development project in the United Republic of Tanzania. In Zambia, where WFP has a large infant -feeding programme, WHO has advised on methods of training kitchen staff, securing community participation in the operation of nutritional rehabilitation centres, and providing nutrition support in the home under the guidance of village primary health care workers.

40. WHO is actively involved with UNICEF in a large nutrition support programme financed by the Italian Government. Under an agreement concluded in 1982 a five -year programme costing US$ 85 million was approved for strengthening the national ability to cope with food and nutrition problems in 17 countries, of which eight - Angola, Ethiopia, Mali, Mozambique, Niger, Somalia, Sudan, and the United Republic of Tanzania - are in seriously affected regions of Africa. In Sidamo Province, Ethiopia, an integrated nutrition programme promotes primary health care and strengthens community structures and self -reliance. In the Red Sea Province of Sudan, self-sufficiency is promoted through primary health care and the conservation of water resources. Because of the famine affecting many of the people covered by this programme, special attention has been paid to water supplies and immunization. In Mali support is given to community efforts to produce and preserve more food, protect health and water supplies, and generate an increased income. The programme in Niger is also based on village development, the promotion of healthful practices, community water supplies, gardening, afforestation, and income earning, particularly by women. In all these countries the emphasis is on helping communities to protect themselves from adverse ecological changes. ANNEX 5 105

41. Another example of coordination is provided by the Belgian Third World Survival Fund, which finances a long -term programme totalling about US$ 200 million, of which US$ 10 million is available for 1985. UNDP, UNICEF, the International Fund for Agricultural Development (IFAD) and WHO all collaborate in this programme, which supports the development of health infrastructure in Kenya, Somalia, and Uganda, with emphasis on the creation of health centres, the training of community health workers, the provision of health care in resettlement areas, and the procurement of essential supplies.

42. WHO coordinates its Diarrhoeal Diseases Control Programme with other agencies, inter alia through the CCCD project (Combating Childhood Communicable Diseases) financed by USAID. This project provides funds for training in epidemiology, oral rehydration therapy, and the development of health information systems. WHO and other donors have supplied oral rehydration salts to a number of African countries and, where circumstances permit, the local production of these salts has been encouraged. Training centres for diarrhoea case -management have been established in Angola, Ethiopia, and Senegal and are being planned for Cameroon, Malawi, and Zaire.

43. WHO collaborated with the World Bank in February 1985 in the creation of a five -year malaria control programme in Niger that makes provision for a deterioration of the situation in the event of population migration to hyperendemic areas in the south of the country. AGFUND, through WHO, has supplied 24 million chloroquine tablets in the past year, and a further 8 million are under procurement.

44. The drought conditions in Africa are of particular concern to the International Drinking Water Supply and Sanitation Decade. Present data indicate that, halfway through the Decade, an additional 10% of urban dwellers and 5% of rural dwellers in the affected countries have access to sanitation facilities. However, the situation with regard to pure water supplies is less encouraging: while more people have access to pure water than in 1980, the increase has been unable to keep up with population growth, which averages 3% per annum. It is estimated that between 1983 and 1990 the population of the countries affected by the crisis will increase by 25% (the rural population by 17% and the urban population by over 50%). Water and sanitary facilities, even when low -cost technology is employed, entail a heavy financial burden in the form of basic installations and recurrent operating costs, and the most seriously affected countries must depend on outside support for at least 80% of their financial requirements. Within the framework of the International Decade, WHO helps to organize special consultations on these problems with key agencies of the United Nations system and with donor countries.

45. Most of the 26 countries in Africa that fall within the United Nations category of least developed countries are among those most seriously affected by the crisis; and WHO gives them special attention in relation to their health needs and the mobilization of resources to deal with them. Health sector reviews and country resource utilization reviews are carried out to assess those needs and to present them effectively to donor countries. In this connection, the round table meetings supported by UNDP and the World Bank consultative groups help in generating resources and in improving coordination among donors and agencies. United Nations resident coordinators in countries meet with United Nations agencies and donor representatives to review the country situation, assess the appropriateness of the response of the United Nations agencies to the needs of the people, and recommend further action.

46. WHO is currently strengthening its technical support at all levels so as to be able to take concerted action to help countries affected by the crisis. Staff and consultant rosters are being compiled to ensure that qualified people can be made available at the shortest notice. Methods of intensifying collaboration with other United Nations agencies and with outside organizations at the country level are being studied. As indicated in paragraph 35, a special support group has been set up at headquarters for emergency relief operations and support to refugees. The measures to be taken were discussed by the Director -General with the WHO Regional Director for Africa in a visit by the former to Brazzaville in March 1985. A meeting of WHO programme coordinators in Brazzaville on 25 -28 March 1985, attended by the Assistant Director- General responsible for the overall coordination of emergency relief operations, discussed the Organization's active involvement in emergency relief in the context of its mandate to guide countries in their development efforts. It noted the serious impediment created by poor communication facilities between African countries, and between the offices of the programme coordinators, the Regional Office, and WHO headquarters. A study is under way of methods to improve communication by the use of more electronic equipment, including satellite transmission, and the training of staff to make better use of available technology. 106 THIRTY- EIGHTH WORLD HEALTH ASSEMBLY

47. In sum, emergency action to meet the crisis in Africa is being intensified. Every possible means of increasing coordination with other organizations within the United Nations system and with relief agencies outside that system is being explored. In all its actions, WHO keeps firmly in mind the need to foster in the crisis- stricken countries the development of a health infrastructure that will enable them as far as possible to meet and possibly avert future crises from their own resources. WHO is making serious efforts within its limited resources to respond to a critical situation of unprecedented magnitude - a situation whose control lies far beyond the resources of WHO or any other single organization, and which calls for rational and concerted worldwide action. ANNEX 6

REPORT OF THE DIRECTOR- GENERAL ON THE WORK OF WHO IN 19841

and

PROGRESS REPORT ON THE GLOBAL STRATEGY FOR HEALTH FOR ALL BY THE YEAR 2000

[А38/3 - 25 February 1985]

CONTENTS

Page

I. INTRODUCTION 108

II. POLICIES, STRATEGIES AND PLANS OF ACTION 108

III. DEVELOPMENT OF HEALTH SYSTEMS

Organization of health systems based on primary health care 110 Managerial process, including information support 111 Human resources development 113 Community involvement 114 Intersectoral coordination 115

IV. ESSENTIAL ELEMENTS OF PRIMARY HEALTH CARE

Education for health 116 Food and nutrition 117 Safe water and basic sanitation 117 Maternal and child health, including family planning 118 Immunization against the major infectious diseases 119 Prevention and control of locally endemic diseases 120 Appropriate treatment and prevention of common diseases and injuries 122 Essential drugs 123 Other elements 124

V. APPROPRIATE TECHNOLOGY AND RESEARCH DEVELOPMENT 125

VI. MOBILIZATION OF HUMAN, MATERIAL AND FINANCIAL RESOURCES, INCLUDING EXTERNAL RESOURCES 127

VII. INTERCOUNTRY COOPERATION 128

VIII. COORDINATION WITHIN THE UNITED NATIONS SYSTEM AND WITH OTHER INTERNATIONAL ORGANIZATIONS 128

IX. CONCLUSION 129

1 See decision WHA38(9).

- 107 - 108 THIRTY -EIGHTH WORLD HEALTH ASSEMBLY

I. INTRODUCTION

1. This report by the Director -General is a combination of his report to the Executive Board on the implementation of the Global Strategy for Health for All by the Year 2000 (resolution W АЭ4.36) and his short report to the World Health Assembly on significant developments in WHO's programmes during even -numbered years (resolution WHA28.29). The process of combining the two reports necessitates a significant shift in emphasis and perspective: rather than being an "interim" communication from the Director -General, the new type of report indicates progress in the implementation of the Strategy for Health for All. Furthermore, it not only refers to the activities of the WHO Secretariat, but primarily attempts to reflect the progress in the implementation of the Strategy within Member States. Seen in this wider context, the activities of the Organization are no more than means and tools whose utility and effectiveness should be measured against the progress of Member States towards their collective goal.

2. It is clear that this method of reporting to the Board and the Health Assembly presupposes a more selective approach to information collation, coupled with an evaluative style of thinking which should be present at all levels. The report does not attempt to cover all the activities of WHO, some of which will be the subject of more detailed reporting in the Director -General's biennial report on the work of WHO in 1984 -1985.

II. POLICIES, STRATEGIES AND PLANS OF ACTION

3. The Thirty -seventh World Health Assembly in May 1984 reviewed the first progress report on the implementation of strategies for health for all by the year 2000. 122 Member States submitted their national monitoring reports, which were reviewed at regional and global levels. The reportl indicated that the political will to achieve the goal of health for all existed in a large majority of countries, and many had initiated the process of formulating their health policies, strategies and plans for its achievement.

4. But the Health Assembly, noting the magnitude of the overall task and the relatively short period left to achieve the goal, urged Member States to accelerate the reorientation and the modifications of health systems towards primary health care and further strengthen the managerial capacity of their health system, including the generation, analysis and utilization of the information needed; and to use WHO's resources optimally, directing them to the mainstream of activities required to implement, monitor and evaluate the national strategy. It also requested the Director-General to ensure the provision of intensive, appropriate and targeted support to Member States for the implementation, monitoring and evaluation of the Strategy, especially in countries where the needs are greatest and which are ready for it (resolution WHА37.17).

5. The critical socioeconomic situation, political strife, and the effects of drought slowed up the development of health -for -all strategies in Africa. The Regional Office for Africa contributed to the preparation of the report by the Secretary -General of the United Nations on the "Critical social aid economic situation in Africa" which was submitted to the 1984 regular session of the Economic and Social Council in Geneva in July. The 24 countries most seriously affected by the crisis are Angola, Benin, Botswana, Burkina Faso, Cape Verde, Chad, Central African Republic, Ethiopia, Gambia, Ghana, Guinea, Guinea -Bissau, Lesotho, Mali, Mauritania, Mozambique, Sao Tome and Principe, Senegal, Somalia, Swaziland, Togo, United Republic of Tanzania, Zambia and Zimbabwe. The crisis further underlined the need to pursue the goal of health for all with greater tenacity, and the Regional Office redoubled its efforts to support the Member States in the formulation of national and regional strategies.

6. A consultation on the regional plan of action for health - for -all strategies held at the Regional Office for South -East Asia in July 1984 reviewed the status of regional and national plans of action and suggested measures for improvement. It also considered the mechanisms for monitoring and evaluation of strategies, policies and plans of action at national and regional levels and the information support needed for this purpose.

7. In September 1984 the Regional Committee for Europe discussed and endorsed the regional targets in support of the regional strategy and plan of action. It also reviewed the list of proposed indicators for monitoring and evaluation of the strategy. The Regional Office is

1 Document WHA37 /1984 /REС /1, Annex 3, part 1. ANNEX 6 109 collaborating with several Member States in developing national strategies, in particular Malta, Norway, Portugal and Spain. Collaborative medium -term programmes have been drawn up and signed for the German Democratic Republic, Portugal and Spain, and negotiations are under way for such programmes in Albania, Greece, Hungary, Malta, Morocco and Turkey. The development of national plans is being supported by means of "scenarios" for health for all. Finland, the Netherlands and Sweden are seeking alternative ways of achieving health for all and analysing the possible consequences of various strategies for ultimate incorporation in such "scenarios" to be submitted to public debate and used in developing national health policies.

8. Several Member States in the Eastern Mediterranean Region have reviewed their health policies and have formulated national health -for -all strategies. In March 1984 the newly established Regional Consultative Committee reviewed progress in the implementation of national strategies and identified a number of constraints which may affect future development, such as the uneasy political situation in countries of the Region, slowing down of economic development, and inadequate national managerial capabilities, including lack of information support.

9. In the Western Pacific Region health - for -all indicators for monitoring were reviewed and revised. The first monitoring exercise has accelerated the development by Member States of procedures and mechanisms for the updating and continuous monitoring of their national strategies. WHO collaborated with three countries in policy analysis, studies and reviews in order to facilitate the formulation of national health policy, while in four countries support was provided for the review and updating of national strategies.

10. According to the Plan of Action for implementing the Global Strategy for Health for All,1 Member States are expected to undertake the first evaluation of their national strategies by March 1985. To facilitate this process, the Secretariat prepared a "Common framework and format "2 for monitoring progress in implementing the strategies for health for all by the year 2000, in consultation with the regional offices. A number of preparatory activities were undertaken at country, regional and global levels to facilitate the systematic implementation of the evaluation process. Four workshops were held in the African Region for senior national staff, WHO programme coordinators and intercountry staff from 42 Member States. The common framework and format was tested in 12 countries of Africa and the results were reported to the Regional Committee in September 1984. In the Region of the Americas it was tested in Brazil, the Dominican Republic, Jamaica and Venezuela, and the results were submitted to the Regional Committee at its session in September 1984. In the South -East Asia Region it was reviewed and endorsed by the Consultative Committee for Programme Development and Management. All regional office staff and WHO programme coodinators were especially briefed on the support required by Members in the evaluation of the strategy. The common framework and format was also tested in two countries and support was provided to other Member States.

11. The Regional Committee for Europe approved the proposed regional indicators for incorporation in the common framework and format. In the Eastern Mediterranean Region it was tested in Kuwait and Yemen, and a meeting of the national focal points to facilitate its use for evaluation of the national strategies was held in Cyprus in August 1984. The common framework was also reviewed by the Regional Committee for the Western Pacific, and regional indicators for monitoring were incorporated in it. Support was provided to the Member States in evaluating their strategies. At WHO headquarters, consultations on the evaluation process were held with senior staff to ensure the orientation of the Organization as a whole to support Member States in this important task.

12. WHO participated in the International Conference on Population held in Mexico City from 6 to 14 August 1984. The Conference re- endorsed some of the basic elements of the Strategy for Health For All. For example, the Mexico City Declaration on Population and Development, and the Conference's 88 recommendations, acknowledged the health risks of "unwanted high fertility"; urged that "special attention ... be given to maternal and child health services within a primary health care system "; mentioned specifically "breast- feeding, adequate

1 Plan of action for implementing the global strategy for health for all. Geneva,

World Health Organization, 1982 ( "Health for All" Series, No. 7).

2 Evaluating the strategies for health for all by the year 2000: Common framework and format. WHO document DGO /84.1 (1984). 110 THIRTY -EIGHTH WORLD HEALTH ASSEMBLY

sanitation, clean water, immunization programmes, oral rehydration therapy and birth spacing" as essential aspects of these services; stressed the importance of the status and role of women, and the right of couples and individuals to "decide freely, responsibly and without coercion, the number and spacing of their children'; and reiterated the need for continued research and full community participation in health development and population programmes.- The Global Strategy for Health for All provides the necessary framework for the implementation of the health -related recommendations of the World Population Plan of Action. It is essential, however, that each of these recommendations be analysed in the light of the Strategy, so that the implications for the international community, and in particular WHO, can be understood and applied in support of national action.

13. During 1984, WHO made a thorough review of the support it has provided towards the achievement of the goals set for the United Nations Decade for Women (1976 -1985) and analysed the progress achieved and obstacles encountered. All regional committees at their 1984 sessions reviewed the status and role of women in health and development and identified areas where greater efforts were required. Resolutions adopted in five regions urged Member States aid Regional Directors to continue their efforts to improve both the health status of women and their capacity to contribute to the health of others. Strategies for the advancement of women's health and their role in health and development were formulated for incorporation into the global strategies which will be reviewed at the World Conference in Nairobi in July 1985.

III. DEVELOPMENT OF HEALTH SYSTEMS

Organization of health systems based on primary health care

14. In their efforts to accelerate the strengthening or reorientation of health systems based on primary health care, several countries began systematically to identify weaknesses and difficulties in introducing the necessary changes in their health systems and to take corrective action. In the African Region primary health care reviews were undertaken with WHO support in 12 countries, utilizing a set of guidelines and prototype questionnaires adapted to each country's interests and priorities. These reviews are seen as strategic management tools to identify systematically the key administrative weaknesses and to implement the necessary corrective measures.

15. In their search for new approaches to accelerate the implementation of primary health care, several Member States in the South -East Asia Region initiated important action. Efforts by governments focused on strengthening the health system at the intermediate and lower levels and building health infrastructure to meet the growing demands of primary health care at the community level. Noteworthy examples include: the strengthening of the district -level (up zilla) health infrastructure in Bangladesh; development of an integrated family welfare "package based on the restructuring of health services in Indonesia; implementation of a primary health care model approach in Huvsgul Province (aimak) in Mongolia aimed at maximum self -reliance at the community level; development of a primary health care approach in Thailand at the community level with emphasis on the intersectoral approach, self -reliance and decentralized management; and the use of a decentralized section- doctor approach in the Democratic People's Republic of Korea. An intercountry seminar on primary health care was held in Ulan Bator in August to review these approaches and to exchange experiences.

16. A number of countries in the European Region, including Greece, Spain and Turkey, increased their efforts in reorganizing their health systems for primary health care. Among the major activities to support national efforts during 1984 were: a consultation in Madrid on criteria and guidelines for comprehensive regional health planning in the light of the 1984 Spanish law on basic health structures; a national workshop on health centre development in Athens; a teachers' training course in primary health care, at the University of Tampere in Finland; the fourth international course on the organization and evaluation of primary health care for developing countries in Brussels; the first international training course in quality assurance in Barcelona, Spain; and a consultation in Copenhagen on technology planning in health care centres.

1 United Nations document E /CONF.76/19. ANNEX 6 111

17. In the Western Pacific Region WHO collaborated with five countries in the review of their health systems and in the development of a plan of action for primary health care orientation of key national staff at intermediate and peripheral levels, strengthening of management capability in the health administration at intermediate level, and planning to meet the needs of the secondary and tertiary referral hospitals. WHO also provided support for urban primary health care development in Manila and Seoul.

18. WHO and UNICEF collaborated with selected countries in accelerating the development of primary health care, identifying critical issues and constraints in its implementation and supporting the prospective implementation of corrective measures. The UNICEF /WHO Joint Committee on Health Policy had selected Burma, Democratic Yemen, Ethiopia, Jamaica, Nepal, Nicaragua and Papua New Guinea for such support. During 1984, Indonesia and Peru also expressed interest in participating in this process. A consultation held with representatives of these countries, WHO and UNICEF in Montego Bay, Jamaica, in July 1984 evaluated joint efforts and identified key issues confronting the countries in primary health care implementation and areas where WHO /UNICEF support could be most useful. A number of specific recommendations emerged which were presented to the Joint Committee's session in January 1985.

19. To promote interest in and action for the strengthening and reorientation of urban health systems based on primary health care, WHO and UNICEF carried out reviews in a number of cities, describing urban differentials in the health situation and outlining measures for improvement of services. An interregional consultation with the countries involved was held in Guayaquil, Ecuador, in October 1984, providing an opportunity for exchange of experience with different models of care in urban areas and with methods of extending care to the urban poor. Eleven reports from nine countries (Brazil, Colombia, Ecuador, Ethiopia, Guatemala, India, Peru, the Philippines and the Republic of Korea) were discussed. The participants examined the issues of resources, community participation, and the provision of full primary health care coverage for the urban poor and made a number of suggestions for further orientation of UNICEF and WHO support. The report was examined by the Joint Committee in January 1985.

20. An interregional seminar jointly sponsored by UNDP, UNICEF, WHO and the Government of ÃÄÅ Lanka was held in Colombo to explore aspects of that country's experience in primary health care and related social programmes contributing to health with community participation; special emphasis was given to the role of women, literacy, food and nutrition including food subsidies, the primary health care needs of mothers and children, manpower development, and mechanisms for the management of national health systems. The seminar was attended by senior health and other officials of 16 countries. Following discussion of the recommendations, the Sri Lankan authorities took action on a number of them.

21. An increasing awareness in countries of the need to make the best use of available health resources and to move towards the provision of integrated health care programmes found expression in various ways, including an interregional consultation in New Delhi in June 1984 to examine the opportunities and difficulties at the operational level of health care delivery systems foгΡ the integration of health programmes. The participants from nine countries (Brazil, Ethiopia, Finland, India, Indonesia, Kenya, Malaysia, the Philippines and Saudi Arabia) explored ways of expanding and strengthening the coverage, range and effectiveness of health systems. They concluded that greater priority should be given to the development of infrastructural elements of the health system and that the experience with more fully integrated systems based on primary health care needed to be further expanded and disseminated to stimulate further progress in countries.

Managerial process, including information support

22. The first report on monitoring progress in implementing national strategies for health for all indicated that national managerial capacities, including the collection, analysis and use of information in support of the process, require further strengthening. The Thirty- seventh World Health Assembly requested the Director -General to intensify technical cooperation with Member States in these areas (resolution WHА37.17).

23. In the African Region Comoros, Malawi, Senegal, Seychelles and Zimbabwe initiated steps to strengthen the managerial process. WHO support was provided for developing the relevant teaching materials and training in management for Gabon, Namibia and Togo. Technical cooperation was provided to Guinea- Bissau for the formulation of a plan for the strengthening 112 THIRTY -EIGHTH WORLD HEALTH ASSEMBLY of information support for management of health programmes, especially in maternal and child health. A regional collaborating centre for health situation and trend assessment was established in Mauritius. The centre will provide an intercountry mechanism for sharing and strengthening the information support for the health managerial process in the countries of the Indian Ocean. National workshops to train health personnel in information collection and analysis for health programme evaluation were held in Congo and Lesotho. A plan of action for the introduction of the new managerial mechanisms was elaborated and pilot studies to introduce some of these mechanisms were initiated in seven countries.

24. Workshops on the planning, administration and evaluation of health systems were held in 1984 in the Region of the Americas for decision -makers and regional and country staff. Grants were awarded to schools of public health for courses in health systems development for health personnel, and for exchanges of teaching staff. Brazil, Colombia, Costa Rica and Mexico introduced measures for the regionalization, consolidation and integration of national health systems, and Costa Rica, Mexico and Nicaragua received grants in support of activities for decentralization and intersectoral coordination. A regional consultation was held in Mexico City on the decentralization of health services. Technical cooperation in the area of health legislation was extended to 28 countries in the Region. A review of coordination between ministries of health and social security institutions was carried out in 16 countries. The results of the review were presented to the Meeting of Ministers of Health and Directors of Social Security of Central America and Panama in July 1984.

25. Technical cooperation was provided to several countries of the South -East Asia Region in the planning process. Maldives formulated its health plan and carried out a resource utilization review; Burma formulated the third people's health plan; and Bhutan completed the formulation of its sixth plan. Concern is growing about national capacities to generate the required resources to implement health -for -all strategies and plans. An intercountry consultation on the subject in 1983 has led to national research and planning in health economics and financing in some countries. Indonesia formulated a long -term health development plan and designed and tested a national health insurance scheme, Thailand carried out an economic evaluation of its malaria control programme, and India and Nepal undertook studies on costs of health care. Studies on health organization development were made in Indonesia, Maldives and Sri Lanka. Several countries investigated methods to streamline and improve support systems in order to facilitate the efficient functioning of health services at the periphery. Monitoring and personnel administration systems are being studied in Burma, Indonesia and Thailand. New approaches to the training of health staff in management included field analysis and problem -solving models. Countries gave increased attention to evaluating progress in the implementation of health plans and programmes. A scientific working group on the evaluation of primary health care developed guidelines for use at the country level, and a regional mechanism was established for the collection, collation, storage and annual publication of health information.

26. The Third International Congress on System Science in Health Care, held in Munich, Federal Republic of Germany, in July 1984, was co- sponsored by the Regional Office for Europe. It brought together research workers from a wide range of disciplines to discuss improvements in and the evolution of health systems. The European Conference on Planning and Management for Health, held in The Hague, Netherlands, in August 1984, discussed health planning and the management process in a variety of political, social and administrative settings and health systems. The Conference provided a number of recommendations to countries and WHO on the strengthening of the managerial process and the search for alternative mechanisms. Training in the managerial process for national health development is being carried out, with the assistance of collaborating centres, in all the official working languages of the Region. Training in planning for the elderly, evaluation of health services, and prevention and control of noncommunicable diseases received special attention. The Regional Office is developing a computer -based information system to support countries in the monitoring of health indicators.

27. In the Eastern Mediterranean Region WHO widely disseminated the guiding principles and related learning materials for the managerial process in the languages of the Region. A second intercountry workshop on the process was held in Riyadh in 1984 with participants from seven countries. It was followed by national workshops in several countries. WHO also cooperated with a number of countries in the establishment of an intermediate -level supervisory system and in the improvement of health information support for the managerial process. An intercountry meeting on information and education for health policies and approaches in primary health care was held in Riyadh, with participants from 12 countries. ANNEX 6 113

In response to a resolution adopted by the Council of Ministers of Health of the Arab Countries of the Gulf Area in January 1984, plans are well advanced to carry out in those countries a series of surveys on infant and early childhood mortality and morbidity in collaboration with UNICEF. A pilot study in Tunisia, general morbidity surveys in Somalia and the Syrian Arab Republic, and hospital morbidity surveys in the Libyan Arab Jamahiriya and Pakistan have been completed.

28. WHO support to countries in the Western Pacific Region in strengthening their health information systems has been considerably increased. The regional data bank incorporated the global and regional indicators. Two countries initiated assessment of their information systems on maternal and child health. A framework for the establishment of a user -oriented health management information system was formulated in the Lao People's Democratic Republic, and training and development activities were initiated. The strengthening of epidemiological surveillance systems received high priority in the South Pacific, where national and regional workshops were held. An analysis of morbidity and mortality data for disease trend evaluation was finalized in Fiji and Tonga and is progressing in Samoa and the Solomon Islands. Countries in the South Pacific identified deficiencies in management support programmes and initiated with WHO and UNDP the development of procedures and training packages relating to supplies and logistics, maintenance of equipment and facilities, personnel management and supervision, and financial management. A review of current managerial processes and practices was undertaken in a number of countries with a view to strengthening them as necessary. Countries identified training in various aspects of management as one of their most urgent needs, and the Regional Office collaborated in national training programmes.

29. Deficiency in information support for the managerial process, including monitoring and evaluation of strategies for health for all, was noted during the first monitoring exercise. A number of countries started to assess their existing epidemiological and health statistical services with the objective of reorienting and strengthening information support for the management of national health systems and for the monitoring and evaluation of national strategies. To support these initiatives, collaboration with Member States and international agencies is being intensified.

Human resources development

30. Recognizing the need for more intensive mobilization and utilization of human resources for implementing national strategies, Member States have begun to pay increased attention to the planning and evaluation of health manpower development programmes consonant with the needs of their health systems in accordance with the provisions of resolution WHA37.17, paragraph 1(5). An interregional consultation on health manpower policies and plans was held in Indonesia in October 1984. Three major problems were identified: lack of involvement of those affected by policies and plans in their formulation, lack of managerial capacity, and low motivation. Some of the approaches suggested by the group to solve these problems included an analysis of the role of different parties affected by the plans; the involvement of health personnel at all levels of the health system in identifying goals and strategies to achieve them; assessment of the way plans are carried out; and improved communication between the different levels of the health services.

31. In the South -East Asia Region Bangladesh, Burma, Indonesia, Nepal, Sri Lanka and Thailand took significant steps to relate health manpower planning to the changing needs of their health systems and to improve consultation and coordination between the training institutions - the producers - and the ministries of health - the users. In order to collaborate with countries in reorienting to primary health care, the Regional Office for Europe undertook a review of legislation governing nursing practice in selected countries; further guidelines to assist countries in preparing standards of practice are being developed by representatives from five countries. In the Eastern Mediterranean Region health manpower development activities concentrated on revision of curricula and training of health personnel. An intercountry meeting on community- based, task -oriented curricula was held at the Gezira Medical School in Sudan, and evaluation studies on nursing services in Somalia and the Syrian Arab Republic gave impetus to an intercountry meeting in Pakistan to prepare recommendations for improvement of such services. About two -thirds of the countries of the Region also reported that they were taking steps to reorient their training programmes so that the health workers can perform functions that are relevant to priority health problems and needs. Training of traditional birth attendants and teacher -training in primary health care received particular emphasis during the year in several countries. 114 THIRTY -EIGHTH WORLD HEALTH ASSEMBLY

32. In the Western Pacific Region an intercountry workshop on training programmes in management for national health development was organized at the WHO Regional Teacher Training Centre, Sydney, Australia. Health manpower research as an important component of health services research was discussed at the ninth session of the Western Pacific Advisory Committee on Medical Research in April 1984. WHO support was provided to China, the Lao People's Democratic Republic and the Philippines in several specific aspects of manpower planning and training.

33. Fifteen case studies on leadership for primary health care were analysed and are being published as a complement to The primary health worked and On being in charge.2 A background paper and a guiding framework for health service managers have been prepared to assist in the presentation of case studies on supervision of health personnel with particular reference to primary health care. In order to mobilize nurses for leadership in primary health care the International Council of Nurses, with WHO's cooperation, held five regional workshops with participants from 63 countries. WHO also collaborated with the International Nursing Foundation of Japan in gearing the latter's cooperative nursing activities in countries of South -East Asia and the Western Pacific towards the development of leadership strategies and guidance materials for nurses in support of primary health care. The implementation of changes in nursing evaluation and practice is being monitored in seven countries to ensure reorientation towards primary health care.

34. Under the UNDP -assisted interregional health learning materials programme, detailed plans were developed during 1984 for five -year national projects in Benin, Kenya, Morocco, Mozambique, Nepal, Rwanda, Sudan and the United Republic of Tanzania aimed at achievement of national self -reliance in the development and production of relevant teaching and learning materials. Preparatory phases under way in all these countries involved training of key staff, the setting -up of infrastructure and premises, and ordering and installation of equipment and supplies.

35. The Technical Discussions at the Thirty- seventh World Health Assembly on "The role of universities in the strategies for health for all" focused the attention of governments and academic circles on the challenge of harnessing the potential of universities to play a major role in health and human development. The report of the Discussions,3 incorporating recommendations to governments, universities and WHO, was issued for wide circulation in order to promote much -needed dialogue and further action.

Community involvement

36. While many countries are increasing measures for community involvement in health development, there seems to be very little progress in the decentralization and delegation of authority to the intermediate and local levels of health administration and to the communities. Some countries are trying innovative approaches. For example, in Bangladesh the decentralized administration went to the extent of involving people's representatives in decision-making in development activities; and in Thailand self- reliance and management of community -based services were encouraged through measures for direct participation. A meeting on the role of religious institutions in health development in Alexandria, Egypt, explored ways to promote healthy life -styles and community self -reliance. Sixteen case studies on community participation in health and development were carried out in eight Latin American and Caribbean countries, to define and refine concepts and information on community participation in health.

37. In eight countries of the Western Pacific Region WHO cooperated in activities to intensify community involvement and intersectoral coordination through a series of seminars, workshops or meetings on primary health care. While these workshops, whether national (as in Tokelau and Vanuatu) or provincial (as in Papua New Guinea), were aimed at promoting the concept of primary health care, those at the district and community levels were action -oriented and resulted in the organization of groups working in the community to

1 World Health Organization. The primary health worker: working guide, Дuidelines for training, guidelines for adaptation, revised edition. Geneva, 1980.

2 McMahon, R. et al. On being in charge: A guide for middle -level management in primary health care. Geneva, World Health Organization, 1980.

3 The role of universities in the strategies for health for all: A contribution to human development and social justice. (WHO document, 1984.) ANNEX 6 115 generate collective action for health development. Activities among the village health committees in Fiji and the village development committees in the pilot area of Papua New Guinea were particularly encouraging, while similar village organizations started to emerge in Kiribati, Solomon Islands and Vanuatu. In one country, village primary health care councils were developed from existing village development councils in more than 90% of villages.

38. Two trends relating to community involvement must be monitored closely. One is the tendency to look to community involvement as the panacea for problems of scarce resources. The other is to limit community involvement to time -limited actions oriented to single problems. While such actions could be useful entry -points, they are not sufficient to promote self -sufficiency and self-reliance. Experience from innovative efforts in some countries has shown that adequate coverage and use of preventive and curative health services at the village level have been achieved when the population takes the major responsibility for primary health care in collaboration with the health services. Such participation usually guarantees the community's motivation to accept and use the services, and provides information on its felt needs and aspirations for the decision -makers. The Caribbean strategy on community participation and community health education, arising from a Caribbean workshop held in Antigua in June 1984, stressed that decentralization of the planning process is fundamental in promoting the involvement of members of the community, field workers from health and related sectors, and voluntary and nongovernmental organizations. Decentralization as a vehicle for achieving community participation should take due account of the needs, problems and resources of the community, its socioeconomic and political climate, cultural factors, the literacy level of the people, the health infrastructure and the degree of commitment at various levels.

Intersectoral coordination

39. Notwithstanding the recognition at national, regional and global levels of the need for the involvement of other key sectors in health development as one of the fundamental components of primary health care, intersectoral coordination and cooperation still remains a complex area, and many countries are trying to tackle this difficult issue.

40. In the Region of the Americas a working group on intersectoral action for health has been formed and has made concrete proposals for stepping up action at the country level. A follow -up to the working group on intersectoral action for health was a working paper submitted to the Regional Committee on "The economic crisis in Latin America and the Caribbean and its repercussions on the health sector ". A study, "Health and social development in Costa Rica: Intersectoral action ", was completed, and provided a comprehensive analysis of the effects of experience and action in other sectors on the patterns of health, the health consequences of economic adjustments to the current economic crisis, and the mechanisms for intersectoral coordination that have been unusually effective.

41. In Thailand a project has been implemented in Korat Province that provides for intersectoral cooperation involving the Ministries of Public Health, Education, Agriculture and Cooperatives, and the Interior, at national, provincial, district, subdistrict and village levels, with public involvement in the development process at the village level and the use of social indicators as a planning tool in identifying projects and allocating resources. As a follow -up to the study undertaken by the larga Institute in Sri Lanka, research has been initiated in an agricultural settlement and plantation area; the parts played by the health and other sectors and the causes of the prevailing health situation are being studied.

42. Work with other organizations of the United Nations system has been actively pursued. A major attempt has been made to move away from meetings in capital cities to the promotion and implementation of concrete action in communities. The Task Force on Rural Development of the United Nations Administrative Committee on Co- ordination (ACC) is becoming an increasingly useful vehicle for intersectoral action for health. Its panel on people's participation conducted a workshop in Arusha, United Republic of Tanzania, in October in which case studies on participation in rural development, including health, agriculture and labour, and involving women's organizations, were discussed. Case studies from Botswana, Burkina Faso, Congo, Ghana, Kenya, Malawi, Senegal, the United Republic of Tanzania and Zambia were presented. The workshop, and the fourth meeting of the panel which followed it, agreed on a joint programme of action involving UNICEF, UNDP, ILO, FAO, WHO and the International Fund for Agricultural Development (IFAD). Nigeria, Senegal, Uganda aid Zimbabwe, all countries 116 THIRTY -EIGHTH WORLD HEALTH ASSEMBLY where WHO collaboration involving women's organizations in health development is functioning successfully, were selected for initial activities in this interagency, multisectoral programme.

43. Sub -Committee A of the 1984 session of the Regional Committee for the Eastern Mediterranean (13 -16 October) held Technical Discussions on "Intersectoral collaboration in health development ". Among the suggestions arising from the discussions were: the need to develop clear procedures and mechanisms for collaboration between different levels of the health services; and improved and constant communication and contact between the health sector and other sectors which have health -related or health -affecting activities. The Sub -Committee also concluded that, while legislation affecting methods of and procedures for collaboration was important, intersectoral collaboration can be enhanced by the availability and sharing of valid and reliable information about health and health -related issues. It was considered that such channels of communication need to be created and used. Intersectoral collaboration is essentially a national concern and the need for deeper analysis of the constraints and the sharing of information on successful approaches among Member States is clearly evident.

IV. ESSENTIAL ELEMENTS OF PRIMARY HEALTH CARE1

Education for health

44. Efforts by Member States to inform and educate people in order to promote healthy life -styles and practices encouraging self -reliance were supported by WHO at country, regional and global levels through exchange of experiences, technical cooperation, training, research and dissemination of information. An intercountry workshop in the South-East Asia Region on integration of public information and education for health examined existing strategies and mechanisms and prepared plans to strengthen them. A Caribbean workshop on community participation and community health education discussed and adopted the first Caribbean strategy and plan of action for community participation. The first symposium on smoking and health in southern Europe, held in Barcelona, Spain, led to the creation of the Mediterranean Committee on Health Promotion and Smoking Control. An intercountry meeting on information and education for health held in Riyadh formulated guidelines for countries on the of health education within primary health care and on collaboration between the ministries of health and education, and identified research needs.

45. Several countries in all regions undertook steps to strengthen their health education services, including development of educational policies, training of health personnel and development of appropriate information and educational materials, and initiated related research in the behavioural sciences. Increased technical and financial support was given to countries in the Region of the Americas to develop programmes for the promotion of the health of schoolchildren. An intercountry course on methods to evaluate the impact of health education and mass media activities on primary health care services in Mexico enabled participants to identify and apply steps for planning and implementing community health education activities and evaluating them in measurable terms.

46. The World Health Day theme, "Children's health - tomorrow's wealth ", was used in many countries to promote related health education and information activities. Other supportive activities of WHO during the year included seminars for media personnel and the development and dissemination of press kits and relevant information materials to Member States, institutions and media. In the European Region a system linking government departments, universities, research and training centres and experts in a network for the exchange of education technology and information was established. Similar networks are being considered in the Region of the Americas and the Western Pacific Region. A draft manual on health

1 See Global strategy for health for all by the year 2000. Geneva, World Health Organization, 1981, reprinted 1984 ( "Health for All" Series, No. 3), p. 32, and Alma -Ata 1978. Primary health care. Geneva, World Health Organization, 1978, reprinted 1983 ( "Health for All" Series, No. 1), p. 4. The Declaration of Alma -Ata states in section VII(3) that primary health care includes at least: "education concerning prevailing health problems and the methods of preventing and controlling them; promotion of food supply and proper nutrition; an adequate supply of safe water and basic sanitation; maternal and child health care, including family planning; immunization against the major infectious diseases; prevention and control of locally endemic diseases; appropriate treatment of common diseases and injuries; and provision of essential drugs ". ANNEX 6 117 education in primary health care for use by health workers was circulated to Member States, collaborating institutions and technical experts for review and field -testing.

Food and nutrition

47. 1984 marked the beginning of full -scale implementation of food and nutrition projects in Burma, Dominica, Ethiopia, Haiti, Mali, Saint Vincent and the Grenadines, Sudan and the United Republic of Tanzania, with support from the Joint WHO /UNICEF Nutrition Support Programme and funding from the Government of Italy. Another joint programme with UNICEF, UNDP and 'FAD, and with financial assistance from the Belgian Third World Survival Fund, was implemented in Kenya aid Uganda. Nutrition education was the object of collaboration in the Central African Republic, Congo, Gabon and Zaire. Health systems research on nutrition was the subject of WHO- assisted projects in seven African countries, and research on breast - feeding was supported in five others.

48. Food subsidies and food donation programmes for low- income and other vulnerable groups, including mothers and children, were evaluated in selected countries of the Americas. The Health Plan for Central America and Panama identified food and nutrition as a priority area; and the Regional Office in collaboration with the Institute of Nutrition of Central America and Panama (INCAP) provided technical support in the formulation of country project proposals for submission to donors. Several countries in the Western Pacific Region (China, Malaysia, Papua New Guinea, the Republic of Korea, Viet Nam and countries of the South Pacific) carried out or initiated infant and young child nutrition studies and national nutrition surveys.

49. A global review of related education materials was made to identify those suitable for "packaged" distribution and use in training programmes. An evaluation of the work of the FAO /WHO /OAU Regional Food and Nutrition Commission was also carried out to increase the efficiency of food aid in Africa. Standard terms of reference for its programming missions were agreed.

50. A report on selected global and regional nutrition status and related indicators was reviewed by the Thirty- seventh World Health Assembly, which recommended the development of measures against vitamin A deficiency and xerophthalmia. Follow -up activities in this area included a situation analysis, the development of a long -term interagency plan of action, and the organization of a meeting of international and bilateral agencies to decide on an effective strategy for preventing and controlling vitamin A deficiency and xerophthalmia, including the mobilization of financial resources.

Safe water and basic sanitation

51. The status of provision of safe water and basic sanitation and of implementation of the objectives of the International Drinking Water Supply and Sanitation Decade was reviewed at an interregional consultation. More than 80 Member States and territories reported, representing about three -quarters of the population of the developing world.

52. While some progress has been made, the review further underlined the need for improved information support, more realistic planning, improved intersectoral cooperation and increased community participation. In close coordination with UNDP, the World Bank and other agencies, WHO reviewed the mobilization of external resources for support to water supply and sanitation in the Decade. It also cooperated with the Ministry for Economic Cooperation of the Federal Republic of Germany in the organization of a meeting of European donor agencies for exchange of information and to discuss policies and strategies for support to water supply and sanitation in developing countries, based on the experience of the first three years of the Decade.

53. Technical support was provided to several countries in the formulation of national plans, the development of adequate information support for monitoring of water supply and sanitation programmes, and manpower and institutional development. An agreement for a project aimed at strengthening the institutional capability for human resources development in Central America, Panama and the Dominican Republic was concluded with the Inter -American Development Bank and the Agency for Technical Cooperation (GTZ) of the Federal Republic of Germany. The Pan American Centre for Sanitary Engineering and Environmental Sciences (CEP'S) organized an international seminar in Brasilia on unaccounted -for losses in water systems. The 50 participants from 10 countries in the Region of the Americas developed strategies for prevention of wastage and drew up an agreement on intercountry cooperation through a network 118 THIRTY- EIGHTH WORLD HEALTH ASSEMBLY

of centres. An international course was held in August, also in Brazil, on the operation and maintenance of small water -supply systems. In the Eastern Mediterranean, it was decided to establish a WHO regional centre for environmental health activities in Amman to develop human resources and disseminate technical information on appropriate technology. The Arab Gulf Programme for United Nations Development Organizations (AGFUND) approved funding of US$ 1 million to meet the cost of fellowships, equipment and personnel for the centre.

54. To further promote the development of human resources, a human resources development handbook and a guide on planning for community participation in water -supply and sanitation projects were produced and widely distributed; and for reporting on human resources development and to facilitate the sharing of experiences, a case study format was developed. The first two volumes of the new WHO guidelines for drinking -water quality were published,1 and regional and national workshops were held on the subject. Other major activities included the promotion and development of low -cost sanitation technology and case studies to identify reasons for success and failure in areas related to human resources development and community education and participation in water -supply and sanitation projects.

55. Principles for evaluating health risks to progeny associated with exposure to chemicals during pregnancy were published.2 Prepared by a group of 40 experts from 13 countries, the publication provides a description of the use of laboratory data in defining the potential embryotoxic hazards of chemicals and outlines methods of assessing the risks.

Maternal and child health, including family planning

56. A large majority of countries throughout the world are engaged in improving their health care services for mothers and children. WHO provided technical and managerial support to some 90 countries. To strengthen national managerial capabilities, WHO and the United Nations Fund for Population Activities (UNFPA) jointly initiated a series of workshops for national programme managers and WHO and UNFPA country staff to improve programme formulation, problem -solving and evaluation skills. Two such workshops were held in 1984 for English -speaking countries of Africa, and one for countries from the European and Eastern Mediterranean Regions. Technical collaboration with Member States was further aimed at improving the coverage aid effectiveness of maternal and child health care, strengthening health manpower capabilities, developing health indicators and information support, and supporting health systems research, including the application of the risk approach as a managerial tool to identify the priority health needs of mothers and children.

57. Several countries initiated studies on perinatal, infant, early childhood and maternal mortality and morbidity with a view to identifying priority areas for action and developing . the most appropriate preventive approaches. A regional meeting in the Americas on infant mortality and primary health care strategies, held in Mexico in May, highlighted the important advances made in reducing infant and child mortality and the relation between these advances and the implementation of primary health care strategies.

58. As part of its support to countries wishing to develop and strengthen their health information systems, WHO organized a technical consultation in Yerevan, USSR, in September, at which national experiences in the development and use of indicators relating to the health of mothers and children were discussed by participants from all regions. Guidelines were drawn up for the development of indicators and information support for effective management of national programmes for maternal and child health, including family planning.

59. An international task force worked closely with WHO collaborating centres, research institutes in developing countries, and interested nongovernmental organizations. Specific research activities in 1984 included evaluation of equipment aid methods for home deliveries; development of birth -weight surrogates; evaluation and quality control of supplies aid equipment intended for use in programmes for maternal and child health, including family planning, in health systems based on primary health care; appraisal of various means of temperature control in relation to the newborn; and evaluation of

1 World Health Organization. Guidelines for drinking -water quality, Vol. 1, Recommendations, and Vol. 2, Health criteria and other supporting information, Geneva, 1984.

2 World Health Organization. Principles for evaluating health risks to progeny associated with exposure to chemicals during pregnancy. Geneva, 1984 (Environmental Health Criteria, No. 30). ANNEX 6 119

environments in which deliveries and care of the newborn take place. During the year WHO also supported two major research projects concerning the nature and extent of child labour and its health and social dimensions in India and Kenya, thus marking the culmination of its activities in this area. The study in India provided the stimulus for a national meeting of leading specialists in a variety of disciplines, including child health, welfare and law, and national policy- makers, who discussed the health implications for young people and a reorientation of national policies.

60. Focus on the health of children and adolescents included promotion of intersectoral awareness of the health aspects of child labour and participation in preparations for International Youth Year (1985). WHO convened a study group on young people and health for all by the year 2000 in June 1984 in order to review adolescent and youth health and health -related issues, and to analyse established health systems on the basis of their relevance, resources, and service gaps in respect of the specific needs of this age group. The study group emphasized the impact of the formative years on the development of healthy life- styles and the later health effects of attitudes formed at this time in relation, for example, to smoking, drinking, drugs, and reproductive behaviour. It recommended the adoption of national programme strategies designed not only to meet more fully the health needs of this age group but also to tap its idealism aid creative energy as a means of reinforcing their impact on the achievement of national health goals. Health literacy, particularly among young women, was considered a key to guaranteeing child health in future generations.

61. Parallel studies started in China, India and Thailand to identify "milestones" of optimal physical and psychosocial development of the child. An inventory of items for assessing the quality of day care for children was developed and tested in Greece, Nigeria and the Philippines. The revised inventory will be used in research and for the improvement of such care.

62. Following an informal meeting in May 1983 of African delegates to the Health Assembly with the Nongovernmental Organization Subcommittee on the Status of Women and the Working Group on Female Circumcision established under the auspices of the United Nations Commission on Human Rights, the Government of Senegal was host to a seminar in February 1984 on traditional practices affecting the health of women and children in Africa. WHO provided technical, administrative and financial support for this seminar and assisted in the preparation of the final report. The seminar represented an important event in a series of efforts which WHO has made since 1976, especially through its Regional Offices for Africa and the Eastern Mediterranean, to determine the extent, the antecedents, aid the significance for health of certain traditional practices, and to provide opportunities for informed and objective discussion of these practices by responsible authorities of the countries concerned.

Immunization against the major infectious diseases

63. During 1984 several countries in all regions began to report improvements in immunization services as a part of primary health care, and an increase in coverage. Reductions in the incidence of target diseases covered by the Expanded Programme on Immunization were also reported in some countries. In the Region of the Americas all countries have set specific national coverage targets for immunization against diphtheria, pertussis, tetanus, poliomyelitis, measles and tuberculosis; if these targets are reached by 1985, all countries and territories in the Region will have coverage ranging from 70% to 100X. The health - for -all strategy for the European Region specifies that by the year 2000 there should be no indigenous measles, poliomyelitis, neonatal tetanus, congenital rubella or diphtheria in the Region.

64. WHO supported the development of immunization services in Member States through the implementation of its five -point action programme for immunization, focused on the promotion of the Expanded Programme within primary health care; the development of human resources; the mobilization and investment of financial resources; continuous monitoring and evaluation to increase the programme's effectiveness; and appropriate research. Training of health workers in immunization continued to be a priority, the emphasis in 1984 shifting from courses for managers using materials developed at global level to training of middle and peripheral level health workers using materials adapted for national use, often in a national language. Programme reviews and evaluation were done in several countries, often including other primary health care components, with the active involvement of national health managers. Through these reviews operational and managerial problems in the implementation of 120 THIRTY -EIGHTH WORLD HEALTH ASSEMBLY the Programme were identified and action plans were developed to solve them. Community participation needed to be strengthened in many countries, especially to reduce the large drop -out rate between the first and the last dose of multidose vaccines. Lack of trained staff and of management skills still represented severe constraints in several countries.

65. Notable in the area of "cold chain" development and logistics in 1984 was the further development of the cold -chain monitor and of solar refrigeration, as well as the evaluation of sterilizable plastic syringes and pressure -cooker sterilizers for use in rural health centres. On the whole the vaccine availability and cold -chain situation in the countries continued to improve.

66. The Bellagio Conference in March 1984 gave a further impetus to the mobilization of financial resources for the Expanded Programme on Immunization. The Conference, co- sponsored by UNICEF, WHO, the World Bank and UNDP, with support from the Rockefeller Foundation, created a task force for child survival. The task force's objective is to promote the reduction of childhood morbidity and mortality through the acceleration of key primary health care activities. During the first year support is concentrated on three countries - Colombia, India and Senegal - in which activities have started. The task force will continue its efforts to mobilize financial resources.

Prevention and control of locally endemic diseases

67. A considerable number of locally endemic diseases continue to affect vast populations of many developing countries, where diarrhoeal diseases, acute respiratory infections and the target diseases of the Expanded Programme on Immunization constitute the major causes of death and illness among young children. Malaria, tuberculosis and parasitic and tropical diseases such as schistosomiasis, leprosy and filariasis affect the health of people of all ages in many developing countries. With some recent advances in technologies for diagnosis and treatment, hopes and efforts for the control and prevention of these diseases have increased, and Member States are taking steps to strengthen this element of primary health care.

68. Notable progress was made in diarrhoeal disease control activities. WHO technical cooperation continued to be provided to Member States for the development of national plans, training of managerial and supervisory personnel and programme evaluation, with a view to improving operational management. At the end of 1984 88 developing countries had well -formulated plans of operation for the control of diarrhoeal diseases; 62 of these countries had begun implementing their plans. During 1984 approximately 1000 national staff participated in WHO- supported training courses on management and supervision. Fourteen countries carried out mortality and morbidity reviews and eight countries made formal reviews of their diarrhoeal disease control programmes with WHO collaboration. One country, Indonesia, field -tested new guidelines on the cost -effectiveness of oral rehydration therapy. Appropriate training and educational materials were developed and widely disseminated. In collaboration with UNICEF, support was provided to countries in ensuring local production and availability of oral rehydration salts. Progress was made in research on diagnostic microbiology, epidemiology and ecology, immunology and vaccine development, and clinical management.

69. Health systems research and clinical studies on acute respiratory infections were being carried out in over 20 countries in all WHO regions, seven of them started in 1984 (in India, Indonesia, Malaysia, Nepal, Pakistan, Sri Lanka and Tunisia), mainly to test the feasibility of a standard plan for case management at the primary health care level. A working group on case management in developing countries evaluated methods of diagnosis and treatment in children, identifying those most suitable for rural areas and formulating recommendations for training material.

70. The intake of countries participating in the programme on the evaluation of the effectiveness of BCG vaccination in infants and young children was completed with the admission in 1984 of Brazil and the Republic of Korea. The first national prevalence survey in the Philippines was completed in April. A global survey of mycobacterial resistance to antituberculosis drugs was started with the WHO collaborating centres in bacteriology of tuberculosis in order to determine regional and global levels of initial and acquired drug resistance. A regional seminar on chemotherapy of tuberculosis was organized in Bucharest in October with the collaboration of the Romanian Tuberculosis Institute and the participation of 11 countries. Information on the applicability of new knowledge on the treatment of ANNEX 6 121 tuberculosis was reviewed, and guidelines relevant to the situation of tuberculosis control in Europe were formulated. A manual was prepared on tuberculosis control within the framework of primary health care.

71. Leprosy remained an important public health problem in many developing countries. The activities of WHO were concentrated largely on research and development, including clinical trials with multidrug therapy, training, the promotion of community involvement, and the integration of leprosy control services into primary health care. Efforts to mobilize financial resources in support of the leprosy programme from several multilateral and bilateral agencies continued. A videotape, "The leprosy network ", was produced for training and promotion purposes.

72. A small working group was convened to prepare a field manual on the application of measures for the control of sexually transmitted diseases at the primary health care level. In the Eastern Mediterranean Region Djibouti and Somalia prepared national programmes for the control of these diseases and for laboratory diagnostic support. A regional training course was held in Tunisia on their epidemiology, clinical aspects and case management.

73. In April a fourth international symposium on yaws aid other treponematoses brought together medical experts and public health officials from over 25 countries to consider the improved control and potential eradication of these diseases. A WHO collaborating centre on acquired immune deficiency syndrome (AIDS) was designated in Paris to collect and analyse the data reported by countries, to ensure the rapid exchange of information between them, and to stimulate collaborative studies in Europe.

74. The world malaria situation has changed little from that described in the biennial report of the Director -General for 1982 -1983;1 new information on numbers of cases in the last 10 years was published together with a map of the distribution of chloroquine- resistant Plasmodium falcíparum in the World Health Statistics Quarterly.2 Member States continued to search for more effective ways to implement malaria control strategies within primary health care and for new, effective and simple technologies. WHO provided technical support in programme planning and evaluation, training and research, and promoted intercountry cooperation. The report of the study group on malaria control as part of primary health care was published.3 Antimalarial drug requirements for planning of action by countries within primary health care systems were updated and communicated to countries. Basic principles for malaria control and general guidelines for UNICEF /WHO support were issued in a joint statement by the two organizations, advocating in particular: implementation of the programme as a part of primary health care to prevent mortality; an increase in related information and health education; the supply of antimalarials; improvement of measures for vector control; avoidance of drug resistance in the parasite; and training of workers at the community level in diagnosis and monitoring.

75. The third international course in the English language on malaria and the planning of malaria control took place in Italy and Turkey from 7 March to 29 June 1984, and the first in the French language in Burkina Faso and France from 1 October 1984 to 25 January 1985. Research and development activities focused on improvements in diagnostic and prevention technologies, antimalarial drugs, and vaccines (see section V).

76. Measures related to health -for -all strategies in the control of other parasitic diseases included the widespread introduction of antischistosomal drugs and inexpensive techniques for diagnosis of schistosomiasis and African trypanosomiasis, and the formulation of strategies for the prevention and control of these diseases through primary health care. Diethylcarbamazine treatment of lymphatic filariasis was implemented as part of primary health care in India, and a drug administration campaign was also started in Samoa. Monofilament nylon sieves were developed and used for filtration of water in dracontiasis control. (For further details on technology and research development, see section V.)

77. Progress in vector biology and control included the development of impregnated bed -nets for malaria mosquito control in the African and Western Pacific Regions and simple tsetse -fly

1 World Health Organization. The work of WHO, 1982 -1983: Biennial report of the Director- General. Geneva, 1984, paragraph 13.43 et seq. 2 World Health Statistics Quarterly, 37(2): 130 -161 (1984). 3 WHO Technical Report Series, No. 712, 1984. 122 THIRTY -EIGHTH WORLD HEALTH ASSEMBLY traps in West Africa, elimination of larval habitats of filariasis vectors in southern India, and a large -scale trial of control of Aedes aegypti vectors of dengue and dengue haemorrhagic fever, employing students and schoolteachers with other volunteers, in Thailand. Field trials of new insecticides against Anopheles vectors of malaria were carried out in Indonesia, and against Simulium vectors under the Onchocerciasis Control Programme in West Africa. A symposium on environmental management for vector control was organized in Japan (in Tokyo and Toyama) in collaboration with the Japanese Association of Tropical Medicine.

78. In measures against the zoonoses, progress was made in some countries in integrating the prevention and control of zoonoses and related foodborne diseases in national strategies. Plans were developed for a managerial process to formulate canine rabies control activities in eight countries in the South -East Asia Region, and projects were started in five countries in other regions.

79. A WHO expert committee on viral haemorrhagic fevers met in Geneva from 19 to 23 March 1984. The epidemiology, clinical pathophysiology and laboratory diagnosis of this group of diseases were reviewed. Special attention was given to patient management and prevention and control of viral haemorrhagic fevers in man and animals.

80. In response to general concern in Member States for the integration of disease control programmes with primary health care, a protocol was prepared to promote and support research and development in countries. This work will be further pursued during 1985.

Appropriate treatment and prevention of common diseases and injuries

81. In a number of countries the health care delivery infrastructure requires considerable strengthening, especially at the community level, so as to incorporate appropriate treatment of common diseases and injuries. Referral systems are not functioning adequately in many countries to provide continuity of care at the appropriate level. In collaboration with WHO Member States continued to search for simple technologies and practical approaches to the prevention and control of common noncommunicable diseases and the promotion of oral health, mental health, and health of workers and of the elderly.

82. Recognizing the need to strengthen material resources and the training of health workers, especially at primary health care levels, for the management of these health problems, and to promote the active involvement of people in self -care and preventive measures, WHO supported information exchange among countries, training, transfer of technology, research, especially on appropriate technology, and dissemination of information. In order to strengthen the technical capability of health workers at community and first referral levels, essential medical and surgical procedures were discussed with a view to preparing suitable technical guides and materials. A guide on managing services for the disabled in the community was prepared in order to increase the competence of health and community workers in this field. WHO supported training activities in rehabilitation at national and intercountry levels. Financial resources were provided by the Norwegian Red Cross, NORAD and SIDA for intercountry and global activities. Member States, particularly in the South -East Asia and Western Pacific Regions, took steps to strengthen eye care services within primary health care. WHO support was provided in training, programme planning and provision of education materials. Collaboration with nongovernmental organizations was further strengthened through joint reviews and the setting -up of a nongovernmental organization consultative group on the prevention of blindness.

83. Noncommunicable diseases, particularly cancer and cardiovascular diseases, are assuming increasing importance in the health of the adult population in both developed and developing countries, and many countries have accelerated health promotion activities aimed at prevention through change in life -styles and behaviour, early detection and treatment, and promotion of self -care. WHO further supported research, training and exchange of experience in technology.

84. An estimate of the overall burden of 12 major cancers on the five continents was published in the Bulletin of the World Health Organi•zation.1 "Guiding principles for formulation of national cancer programmes in developing countries" were prepared2 and are being used to identify priorities in a number of countries, including India and Sri Lanka.

1 Bulletin of the World Health Organization, 62: 163 -182 (1984).

2 WHO document CAN /84.1 (1984). ANNEX 6 123

Model cancer care programmes and guidelines for programme planning were developed by the Regional Office for Europe. A meeting on the control of cervical cancer was held in Mexico City in January 1984 to determine the extent of the problem in the Region of the Americas and to review strategies for decreasing mortality. A manual of norms and procedures for cervical cancer control was prepared.

85. A WHO expert committee on prevention and control of cardiovascular disease in the community was convened in December to review the state of knowledge and to make practical recommendations for public health authorities that can be applied within the context of existing health systems in both developing and industrialized countries, concentrating on hypertension (including cerebrovascular stroke), coronary heart disease, and rheumatic fever /rheumatic heart disease.

86. In Europe the combined control of a number of risk factors associated with some major noncommunicable diseases has been adopted by the Regional Committee as part of the regional policy for noncommunicable disease prevention and control. Agreements of understanding have been concluded between WHO and eight European Member States for long -term collaboration in community -based integrated programmes for the prevention and control of noncommunicable diseases. A meeting of principal investigators held in Brioni, Yugoslavia, from 4 to 7 September reviewed the progress made at the national level in respect of this programme activity, and a two -step group consultation on programme monitoring and evaluation methodology was held from 3 to 4 December in Copenhagen and from б to 7 December in Moscow.

87. At the global level a consultation on risk modelling for noncommunicable diseases, held in Geneva from 26 to 30 March, reviewed and summarized statistical methodology to assess such risks in the community and provided advice on how the existing statistical models might be used for risk classification for the community, for the prediction of effects of intervention, and to provide information on cost -effectiveness.

88. A guide to non- invasive diagnosis of pulmonary hypertension in chronic lung disease, prepared by a working group at the Regional Office for Europe, was issued in 1984 and distributed at the Ninth European Congress of Cardiology in Düsseldorf, Federal Republic of Germany, in July. A conference on primary prevention of ischaemic heart disease was held in Anacapri, Italy, from 15 to 19 October to discuss the practical application of the recommendations of a WHO expert committee) on this subject.

89. The worldwide situation regarding fetal diagnosis of hereditary disease was reviewed by a meeting in Geneva in May which evaluated the current experience and use of genetic services and identified the need for an international collaborative study to evaluate the obstetric risk of early fetal diagnosis. The design of this collaborative research and standardized protocols were worked out by a WHO consultation held in Rapallo, Italy, in October. To assist in initiating the collaborative study an international registry for such diagnosis of hereditary diseases was established in the United States of America to collect and disseminate information on the safety and efficiency of early fetal diagnosis.

Essential drugs

90. A large number of countries have accelerated actions towards the development of drug legislation, policies and implementation plans along the lines of the Action Programme on Essential Drugs and Vaccines. A review of the progress in countries of five regions showed that about 90 had already established a list of essential drugs, while 36 countries were in various stages of establishment or implementation of measures in accordance with the Action Programme. Another 27 Member States were developing national policies. Most countries already implementing essential drug programmes were making good progress with or without international collaboration. During 1984 a number of countries accelerated activities in this area, including Bhutan, Burkina Faso, Burundi, Democratic Yemen, Djibouti, Equatorial Guinea, Ethiopia, Kenya, Mali, Nicaragua, Oman, Sierra Leone, Yemen, Zambia and Zimbabwe. WHO collaborated with Member States in: the formulation of national plans and programmes; drug legislation; training; exchange of experience and dissemination of information; procurement and production of essential drugs; and quality control. Intercountry cooperation and coordination at the international level were particularly promoted.

91. Training materials have been developed to support national efforts. Examples of topics dealt with are: national drug policies; drug legislation and regulations; management of

1 WHO Technical Report Series, No. 678, 1982. 124 THIRTY- EIGHTH WORLD HEALTH ASSEMBLY drug supplies; training and retraining of manpower; and guidelines related to pharmaceutical technology and quality assurance. These materials are freely available on request to countries and interested agencies.

92. A four -day international conference on essential drugs in primary health care sponsored by UNICEF, USAID, WHO and member companies in the International Federation of Pharmaceutical Manufacturers Associations, held at the Harvard School of Public Health, Boston, USA, attracted more than 160 participants, including 60 from developing countries. The purpose of the conference was to develop problem -oriented teaching and training material for use in schools of public health. Several schools of medicine, public health and pharmacy were approached to promote interest in a collaborative scheme to teach essential drug principles. The London School of Hygiene and Tropical Medicine began such teaching, and the National School of Public Health in Rennes, France, began a test project with support from the French Government for the training of multidisciplinary groups from developing countries.

93. Opportunities for promoting consolidated procurement within individual countries, as well as among groups of countries through pool procurement schemes, were explored in the African Region, the Region of the Americas and the Western Pacific Region. In Central America and Panama high priority was placed on the promotion and development of national and subregional programmes, and a revolving fund for the joint procurement of essential drugs, based on studies undertaken by РАНО and the Central American Bank, is in the process of establishment. WHO cooperated in the formulation of country projects in this subregion. In the Western Pacific Region a scheme to modify the South Pacific pharmaceutical service was agreed and implemented in April 1984; a WHO pharmaceuticals officer based in Apia is now assigned to organize the joint purchasing of pharmaceuticals and medical supplies.

94. In May the Thirty -seventh World Health Assembly reviewed a progress report on the Action Programme) and urged Member States to intensify their action, particularly in the implementation of drug policies and training of personnel, and to strengthen cooperation among themselves. The Health Assembly also requested the Director -General to arrange in 1985 a meeting of experts of concerned parties, including governments, pharmaceutical industries, and patients' and consumers' organizations, to discuss the means and methods of ensuring the rational use of drugs, in particular through improved knowledge and flow of information, and to discuss the role of marketing practices in this respect, especially in developing countries. Consultations and preparations for this meeting were initiated.

95. Efforts to mobilize financial and technical support for the programme were intensified. Discussions with the pharmaceutical industry have been stepped up with a view to facilitating drug procurement by developing countries under favourable conditions. WHO and UNICEF continued to collaborate in support of the procurement of essential drugs by developing countries. An outline of proposed international measures to improve drug procurement was presented to the April -May 1984 session of the Executive Board of UNICEF, and explained to the Thirty -seventh World Health Assembly. Extrabudgetary contributions were received from or promised by Canada, Denmark, Finland and Sweden. Negotiations are under way with other bilateral agencies for increased collaboration.

Other elements

96. Support was provided to several Member States in the development of health policies for the care of the elderly as an integral part of primary health care. The role of nongovernmental and voluntary organizations in this area was promoted. A nongovernmental organization /WHO collaborating group on aging supported these developments, for example, through the provision of simple manuals for community workers on self -care and health promotion, suitably adapted to particular regional aid cultural groups. Two important reports were published in 1984: (1) The uses of epidemiology in the study of the elderly,2 a WHO scientific group report which should serve to alert decision -makers and professionals to the need for measurement and assessment among populations for the design of cost -effective programmes; it provides practical guidance to Member States that have little or no information on their own elderly population; and (2) The wellbeing of the elderly: approaches to multidimensional assessment,3 which will assist in selecting appropriate

1 Document ЕВ73 /1984 /RЕС /1, Annex 7. 2 WHO Technical Report Series, No. 706 (1984).

3 Fillenbaum, G. G. The wellbeing of the elderly: approaches to multidimensional assessment. Geneva, World Health Organization, 1984 (WHO Offset Publication No. 84). ANNEX 6 125 methods for any survey on the subject. Such surveys are under way in countries in four regions.

97. Field trials of various models of primary health care delivery to underserved working people in agriculture and small industries were made in a number of countries, including Burkina Faso, Chile, China, Egypt, Nigeria, the Republic of Korea, Sudan, Thailand, the United Republic of Tanzania, and Zimbabwe. Countries exchanged experiences through regional workshops in the Americas and the South -East Asia Region.

98. In the field of mental health a major multicentre study on the epidemiology of schizophrenia and related disorders was completed in 13 geographically defined areas in Colombia, Czechoslovakia, Denmark, India, Ireland, Japan, Nigeria, the United Kingdom, USA and USSR. This was the first investigation of the incidence of this group of disorders in which uniform instruments and research techniques were employed, allowing direct comparisons of areas in different countries. The findings provide a basis for long -term forecasts of treatment needs and for the planning of appropriate services, as well as clues to etiologically oriented research.

99. Neuroepidemiological studies coordinated by WHO in China, Ecuador and Nigeria were completed, providing information for programmes for the prevention and control of neurological disorders, and for application after suitable adaptation in Chile, India, Italy, Peru, Senegal, Tunisia and Venezuela. A related training programme included seminars co- sponsored by WHO in Quito and in Bombay, India.

100. Investigators from six countries met in Urea, Sweden, to agree on a research protocol for comparative assessment of services provided for the mentally ill. An informal consultation on alcohol and health in Geneva brought together workers in the public information media and health professionals to develop approaches for the media related to WHO's advocacy role concerning alcohol -related health problems. A review and analysis of legislation on the treatment of alcohol and drug dependence was finalized, and a manual including guidelines for teaching on drug and alcohol dependence in medical and health institutions was prepared.

101. In response to resolution WНA37.23, in which concern was expressed about the dramatic global increase in abuse of drugs, particularly cocaine, WHO launched a project to study the adverse health consequences of cocaine and coca-paste smoking. In this context an advisory group met in Bogotá to review the methodology of problem assessment, treatment approaches and research priorities, and to develop proposals for a worldwide plan of action.

V. APPROPRIATE TECHNOLOGY AND RESEARCH DEVELOPMENT

102. Research and development activities form part of most of WHO's programmes and salient examples are given below. These activities have focused largely on finding more effective technologies for the control of major communicable diseases affecting a large number of people in the developing countries; on the development or identification of more appropriate diagnostic and rehabilitative technology for use at the primary health care level; on identifying more effective and appropriate contraceptive technology taking into account psychosocial aspects; on health systems research aimed at the application or delivery of the available technology through the health care delivery system; and on the dissemination of relevant information.

103. Encouraging progress has been made in the Special Programme for Research and Training in Tropical Diseases over the past 12 months. Mefloquine, a potent antimalarial which is effective against strains of Plasmodium resistant to chloroquine and other drugs and is well tolerated, is now ready for use. It is being initially registered for use in adult males and will soon be made available for use in women and children. Simple kits for testing the sensitivity of malaria parasites to drugs in common use have been developed and widely tested under the Special Programme; they are now being widely used in malaria control programmes. Research on malaria vaccines is advancing rapidly. A new technique has been developed for detecting sporozoites in infected mosquitos - an important advance over dissection and microscopy. A promising compound, ivermectin, for the control of filariasis is now undergoing chemical trials and preliminary results are very encouraging. New technologies have recently become available for the control of African trypanosomiasis and others are at an advanced stage of development. These include simple diagnostic tests and new methods of vector control including the use of traps. The Scientific Working Group on the Chemotherapy 126 THIRTY -EIGHTH WORLD HEALTH ASSEMBLY of Leprosy has conducted surveys on the distribution of dapsone resistance in leprosy and has supported research to define the best multidrug treatment regimens. Evaluation of a leprosy vaccine has begun aid remarkable progress has been made in the development of diagnostic tests for leprosy.

104. A biosafety collaborating centre was established at Fairfield Hospital in Victoria, Australia. The United States and the United Kingdom published new national guidelines and regulations for handling of infectious micro -organisms. A programme for vaccine development was started to promote the use of new technology for the production of vaccines for diseases not covered by other WHO programmes; the targets include acute respiratory viruses, dengue, encapsulated bacteria, hepatitis A and tuberculosis. The programme is guided by a scientific advisory group of experts, while the work of each component is the responsibility of a steering committee. So far, funds have been provided for 47 research projects.

105. A WHO working group on research on the development of poliomyelitis vaccine using modern biotechnologies met in Geneva from 17 to 19 April. The group recommended that work on infectious poliovirus, DNA and genetically engineered polioviruses should be encouraged with the aim of accelerating progress towards the development of improved vaccines against poliomyelitis, and that WHO should continue collaborative studies on the evaluation of monoclonal antibodies for poliovirus strain characterization.

106. To further support laboratory diagnostic capability at the peripheral levels of health care systems, evaluation of a small, rugged, low -cost field microscope has been completed and has shown that the instrument is well accepted for laboratory work; further technical improvement to achieve greater sensitivity is required. The basic radiological system (BRS) training package consisting of three manuals was finalized. The BRS Manual of radiographic interpretation for general practitioners has been prepared for publication.1 Field trials of BRS machines were carried out in Burma, Colombia, Cyprus, Denmark, Egypt, Iceland, Indonesia, Nepal, Sweden and Yemen, and have been started in Albania, Jordan, Morocco, Nicaragua, Pakistan, Sudan and the United Kingdom. A scientific group on the future use of new imaging technologies in developing countries met in September -October to analyse data gathered by a WHO inquiry, and made recommendations on such use.

107. An interregional consultation of senior staff of national training institutions and programmes from Cameroon, Colombia, Ethiopia, Lebanon, Malaysia, Mexico, Nigeria, the Republic of Korea, Sri Lanka, Sudan, Thailand, Yugoslavia and Zambia was held in Cameroon in July 1984 to review and exchange experience on the training in health systems research available in different countries and regions. A training package including a guide for planning training programmes, a course manual, and a guide for administrators and trainers was discussed with participants and improved on the basis of their suggestions. The consultation also made recommendations with a view to generating political and managerial support for health systems research aid related training; encouraging administrative activities to promote such research and training; ensuring that adequate materials for training are provided; and ensuring follow -up.

108. At its twenty -fifth session, in 1983, the global Advisory Committee on Medical Research (ACMR) decided that it should concentrate on broad issues related to health research policy rather than confine itself to the review of specific technical programmes. To this effect, three subcommittees were established: on health research strategy for health for all, on health manpower research, and on enhancement of transfer of technology to developing countries with special reference to health. The first results of their activities were presented to the twenty -sixth session, in October 1984, and received priority attention. They had addressed challenging issues which stimulated fruitful discussions within ACIR itself, and in the light of these the work is continuing. In addition to presenting their progress reports on regional research activities, the chairmen of the regional ACMRs made valuable contributions to the debate on the crucial issues discussed, particularly on the health research strategy for health for all. It was decided that this debate would continue at all levels of the Organization, and in particular all regional ACMRs would consider this item at their next session in order to build up a common health research policy framework designed to meet the varying needs and aspirations of Member States. In this connection, the need was expressed to further strengthen coordination within the ACMR system at global,

1 Palmer, P. E. S. et al. Manual of radiographic interpretation for general Practitioners. Geneva, World Health Organization, 1985. ANNEX 6 127

regional and national levels (medical research councils). It was decided that a working group would consider the structural and functional implications for an integrated ACMR system.

VI. MOBILIZATION OF HUMAN, MATERIAL AND FINANCIAL RESOURCES, INCLUDING EXTERNAL RESOURCES

109. Collaboration with bilateral agencies, funding agencies within the United Nations system, the World Bank, regional banks and other regional organizations and nongovernmental organizations to mobilize resources for health for all continued during 1984. There were increased consultations and contacts with donors such as Denmark, Finland, the Federal Republic of Germany, Japan, the Netherlands, Norway, Sweden, AGFUND and the Japan Shipbuilding Industry Foundation. Greater coordination between USAID and WHO to assist countries in the implementation of their national health-for-all strategies was the purpose of a three -day meeting held in July with 11 senior USAID health advisers and representatives of four WHO regional offices.

110. The Committee of the Health Resources Group for Primary Health Care met for the fourth time in November. It considered the efforts being made for the global coordination and rationalization of resource mobilization in support of the Strategy for Health for All as crucial in the light of the severe economic constraints facing so many developing countries, especially the least developed countries, and the limitations affecting the evolution of technical and financial cooperation with those countries. The Committee made a special effort to explore ways and means of assessing the impact of the country health resource utilization reviews carried out with WHO support during the past three years. In 1984 Botswana, Guinea, Maldives, Sierra Leone, Togo and Zambia carried out such reviews, bringing the total to 20 countries (of which 16 are least developed countries). Australia, the Federal Republic of Germany, the Netherlands and the World Bank provided both financial and technical support for several of the reviews. Follow -up began in a number of countries by means of discussions with donor agencies, and the review documents for Benin and Gambia served as the basis for presenting health sector needs at UNDP "round- table" meetings.

111. With a view to promoting greater understanding at the regional and country level of the approaches involved in the mobilization of extrabudgetary resources for health, a workshop on health resources mobilization was organized in Geneva in November in which regional office and headquarters staff and WHO programme coordinators participated. The workshop examined lines of approach to donors, stressing the importance of adequate country proposals, collaboration with nongovernmental organizations, and appropriate consolidation of information to permit WHO to use its powers of persuasion to rationalize the use of, and mobilize additional, resources from the international community for the health -for -all strategies of developing countries.

112. Despite the efforts made by Member States of WHO in committing themselves to the goal of health for all and the primary health care approach, some resources were still used for low -priority health sector expansion in developing countries, such as large hospital construction, which impeded sound national health development and effective use of resources.

113. Examples of measures to mobilize resources for health included the support given or pledged by AGFUND in 1984, with US$ 1 million for activities of the Expanded Programme on Immunization in the Eastern Mediterranean Region, another US$ 1 million towards the establishment of a WНO centre for environmental health activities in Amman, and cooperation in various training programmes in the Region. Environmental health work, particularly that for water supply and sanitation in the context of the International Drinking Water Supply and Sanitation Decade, was also the object of collaboration drawing on the resources of UNDP, while maternal and child health and nutrition activities were supported by UNICEF, a partner with WHO in the Joint Nutrition Support Programme being funded by the Government of Italy. UNICEF and WНO also collaborated with 'FAD and the Belgian Government's Third World Survival Fund in further nutrition support activities, including health education. Collaboration with UNFPA continued in maternal and child health and family planning, especially at the country level. An impetus to the mobilization of financial resources for the Expanded Programme on Immunization was given by the Bellagio Conference (see paragraph 66).

114. "Guidelines on external financial resource mobilization for health in the Region of the Americas" were prepared by PAlO in 1984 and circulated to Member States. Consultations with prospective donors were initiated to mobilize financial support for the "Basic plan on priority health needs of Central America and Panama" (see paragraph 116). In the Eastern Mediterranean Region close contacts were maintained with the Council of Arab Ministers of Health and the Council of Ministers of Health of Arab Countries of the Gulf Area. 128 THIRTY- EIGHTH WORLD HEALTH ASSEMBLY VII. INTERCOUNTRY COOPERATION

115. WHO participated actively in the inter -organization programme analysis of activities of the United Nations system related to economic and technical cooperation among developing countries (TCDC /ECDC). A number of meetings were held to identify further scope for TCDC, and global and regional programmes were reinforced for the identification, promotion and implementation of TCDC activities.

116. In May 1984 the Thirty- seventh World Health Assembly adopted resolution WНА37.14, in which it expressed its full support for the initiative taken by the countries of Central America (Belize, Costa Rica, El Salvador, Guatemala, Honduras and Nicaragua) and Panama embodied in their joint "Basic plan on priority health needs" for the subregion. As a first step in response to this resolution the Organization initiated consultations with major donors in Europe and North America, and also with UNDP, UNICEF and the World Bank. Preparations were made for a "round- table" donor meeting to be held in March 1985 on the island of Contadora (Panama) to mobilize bilateral support.

117. One of the objectives of the medium-term programme on TCDC for health for all (1984 -1989) adopted by the non- aligned and other developing countries is to accelerate the development of national capabilities for health systems development. The first of a series of leadership development colloquia planned for the period 1984 -1986 was held in Brioni, Yugoslavia, in October and was attended by 30 senior health officials from Cuba, India, Thailand, the United Republic of Tanzania and Yugoslavia.

118. Ministers of health of countries of the South -East Asia Region took the initiative for development 'of a technical cooperation programme to mobilize resources through national efforts. High -level bilateral discussions on aspects of cooperation were held between government representatives of Nepal and of Bangladesh, Sri Lanka and Thailand. An ad hoc committee of senior national officials of countries of the Region met in Yogyakarta, Indonesia, in April to discuss modalities of intercountry cooperation. An interregional seminar on health for all was held from 26 August to 7 September, and health ministers of countries of South -East Asia discussed progress in the implementation of strategies at their fourth meeting, held in New Delhi from 25 to 27 September.

119. Collaboration was pursued in the European Region with the Council of Europe, particularly regarding the European pharmacopoeia, prevention of hospital infections, and postbasic nursing training. Health policy and training were discussed with the Commission of the European Communities. The role and contribution of the medical profession in the achievement of regional targets was discussed with representatives of national medical associations on 7 and 8 December.

120. Countries of the Western Pacific Region continued to cooperate in the South Pacific pharmaceutical supply service and many countries took part in missions to China for exchange of experience in the primary health care approach for health - for -all strategies.

VIII. COORDINATION WITHIN THE UNITED NATIONS SYSTEM AND WITH OTHER INTERNATIONAL ORGANIZATIONS

121. In addition to the cooperative programmes and other joint activities reported in earlier sections, coordination with organizations of the United Nations system covered WHO's representation at interagency meetings and other measures to communicate its policies and programmes and ensure awareness of the decisions and planned activities. WHO participated in the first overall review and appraisal of the implementation of the International Development Strategy for the Third United Nations Development Decade. The Director -General submitted the Organization's contribution on the basis of the "Report on monitoring progress in implementing strategies for health for all" submitted by the Executive Board to the Thirty -seventh World Health Assembly (see paragraphs 3 -4). In addition, the Director -General reported to the second regular session of the Economic and Social Council on the progress made by Member States of WHO in the attainment of health for all by the year 2000.

122. Following the appeal by the Secretary -General of the United Nations for urgent action on the critical economic and social situation in Africa, the Director-General, in collaboration with the Regional Director for Africa, took the necessary measures to ensure a concerted response to this initiative. An emergency standing committee on the African crisis was established at the WHO Regional Office in Brazzaville, and support was given to several ANNEX 6 129

countries to set up national emergency committees in order to define plans of action to combat the effects of drought, including epidemics. WHO and other organizations of the United Nations system are cooperating with the World Bank, which initiated a joint programme of action for sustained development in sub -Saharan Africa in response to the African crisis. Cooperation with the World Food Programme on the health and health -related aspects of food aid projects led to the initiation of a sectoral evaluation of the impact of food aid projects on primary health care, emphasizing the role they can play in the Global Strategy for Health for All. Special cooperative activities with UNICEF included the review of primary health care development in selected countries and the Joint Nutrition Support Programme (see sections III and IV). In March the WHO /UNICEF intersecretariat meeting examined various collaborative activities of the two organizations and made recommendations to strengthen them further.

123. Collaboration with the 131 nongovernmental organizations in official relations with WHO was strengthened in various programme areas. Information on health and health -related nongovernmental organizations was collected and their role and potential in support of national health -for -all strategies in collaborative programmes with governments were analysed. Consultations for this purpose were further pursued at national level in Bolivia, India, Malaysia, Nepal, the Philippines, Sri Lanka and Thailand. Preparatory activities were initiated for the Technical Discussions on collaboration with nongovernmental organizations in implementing the Global Strategy for Health for All to be held during the Thirty- eighth World Health Assembly in May 1985. Relations with nongovernmental organizations were the subject of special studies in the Philippines and Thailand.

IX. CONCLUSION

124. Although the accomplishments evident in 1984 were important, the magnitude of the challenge to Member States in implementing their strategies for health for all in the years ahead is enormous. The worsening socioeconomic situation and threatened environment in Africa, the uncertain sociopolitical and economic climate in Latin America aid the Eastern Mediterranean, and the continuing struggle to maintain infrastructure in the face of difficulties in obtaining adequate financial resources for social sectors in many of the developing countries have continued to tax the capacity of the Member States to reorient their health systems to the primary health care approach upon which they have collectively agreed. From the limited and selected information presented in this report, evidence of the continuing commitment of Member States and encouraging signs of progress towards the goal of health for all can be discerned.

125. Special mention should be made of two areas in which, although there has been recognition of the need for action, progress remained very slow during 1984: community involvement in health and intersectoral coordination and cooperation. Member States would therefore do well to examine these aspects of their strategies critically and search for innovative and courageous ways to harness the support of other sectors and, even more important, of their people. With worsening economic prospects, the public health sector as a separate entity is unlikely to meet the challenge of health for all. All relevant resources therefore have to be mobilized, and the inherent capacities of people and communities enlisted. To this end governments will no doubt find it necessary to create appropriate mechanisms and to exploit all available opportunities. WHO stands ready to support Member States in these crucial areas to the best of its capacity.

126. During 1984 and 1985 Member States will have carried out the first evaluation of their health - for -all strategies. They will have an opportunity for thorough review of the relevance and adequacy of their policies and measures taken thus far, the real progress in implementing their strategies, the efficiency with which they are doing so, and the effectiveness of these strategies. They will be able to identify the main constraints and obstacles to the implementation of their strategies and develop corrective measures and approaches. For some, evaluation may appear to have come too early, especially if their national strategies and plans have not been clearly formulated. They can still use the evaluation as an opportunity to convert their political will into action.

MEMBERSHIP OF THE HEALTH ASSEMBLY

LIST OF DELEGATES AND OTHER PARTICIPANTS

DELEGATIONS OF MEMBER STATES

AFGHANIS TAN Mr B. DELI', First Secretary (Economic Affairs), Permanent Mission of the Democratic People's Republic of Algeria Delegates to the United Nations Office at Geneva Dr N. KAMYAR, Minister of Public Health and the Other International (Chief Delegate) Organizations in Switzerland Mr M. A. KHERAD, Chargé d'affaires, Miss H. TOUATI, Attaché, Permanent Permanent Mission of the Democratic Mission of the Democratic People's Republic of Afghanistan to the United Republic of Algeria to the United Nations Office and Other International Nations Office at Geneva and the Other Organizations at Geneva International Organizations in Dr A. H. ZEBAD, Director of Health Switzerland Services, Afghan Red Crescent Society, Mr A. OMARI, Attaché, Permanent Mission Kabul of the Democratic People's Republic of Algeria to the United Nations Office at Geneva and the Other International ALBANIA Organizations in Switzerland Mr A. AOUN- SEGHIR, Attaché, Ministry of Foreign Affairs Delegates Professor A. ALUSHANI, Minister of Public Health (Chief Delegate) ANGOLA Dr M. BOCI, Director of Hygiene and Epidemiology, Ministry of Public Health Dr M. XHAFERI, Ministry of Public Health Delegates Dr A. J. FERREIRA NETO, Minister of Health Alternate (Chief Delegate) Mr K. HYSENAJ, Counsellor, Embassy of the Dr R. J. LOPES FEIO, Director, Planning People's Socialist Republic of Albania Office, Ministry of Health (Deputy in France Chief Delegate) Dr A. P. FILIPE JUNIOR, Provincial Medical Delegate, Namibe ALGERIA Alternates Dr Maria F. A. DIAS MONTEIRO, Delegates Officer -in- charge, Malaria Programme, Professor A. BENADOUDA, Technical Adviser, Ministry of Health Ministry of Public Health (Chief Mrs F. -F. I. ALMEIDA- ALVES, Deputy Delegate) Director, Office of the Minister of Professor D. MANNER', Technical Adviser, Health Ministry of Public Health Dr M. BELAOUANE, President of the Algerian Red Crescent ANTIGUA AND BARBUDA

Alternates Mr M. I. MADANY, Director of External Delegates Relations, Ministry of Public Health Mr C. M. O'MARD, Minister of Health Professor M. M. BENHASSINE, (Chief Delegate) Director -General of the Pasteur Mr H. BARNES, Permanent Secretary, Institute, Algiers Ministry of Health

- 131 132 THIRTY -EIGHTH WORLD HEALTH ASSEMBLY

ARGENTINA Mr N. CAMPBELL, First Secretary, Permanent Mission of Australia to the United Nations Office and the Other Delegates International Organizations at Geneva Dr A. C. NERI, Minister of Health and Social Affairs (Chief Delegate) Dr C. H. CANITROT, Under -Secretary for AUSTRIA Regulation and Control, Ministry of Health and Social Affairs Dr Mabel BIANCO, Ministry of Health and Delegates Social Affairs Dr G. LIEBESWAR, Director General of Public Health, Federal Ministry of Alternates Health and Environmental Protection Mr O. LÓPEZ NOGUEROL, Ambassador, (Chief Delegate) Permanent Representative of the Professor V. H. HAVLOVIC, Director, Republic of Argentina to the United Federal Ministry of Health and Nations Office and the Other Environmental Protection (Deputy Chief International Organizations at Geneva Delegate) Dr J. C. BARBEITO, Vice -Chairman, Dr R. HAVLASEK, Director General, Legal Commission on Social Welfare and Public Department, Federal Ministry of Health Health, Chamber of Deputies and Environmental Protection Professor M. J. MARTINEZ MARQUEZ, Alternates Secretary, Commission on Social Welfare Dr Elfriede FRITZ, Director, Federal and Public Health, Chamber of Deputies Ministry of Health and Environmental Miss N. FASANO, First Secretary, Protection Permanent Mission of the Republic of Dr Helga HALBICH, Federal Ministry of Argentina to the United Nations Office Health and Environmental Protection and the Other International Dr E. KUBESCH, Counsellor, Permanent Organizations at Geneva Mission of Austria to the United Mr J. J. ARCURI, First Secretary, Nations Office and the Specialized Permanent Mission of the Republic of Agencies at Geneva Argentina to the United Nations Office aid the Other International Adviser Organizations at Geneva Professor A. LUGER, former Medical Mrs N. NASCIMBENE DE DUMONT, Second Director, Hospital of Vienna -Lainz, and Secretary, Permanent Mission of the Chief Physician, Ludwig -Boltzmann Republic of Argentina to the United Institute for Dermatovenereological Nations Office and the Other Serodiagnosis International Organizations at Geneva Miss L. NAREZO MONACO, Attaché, Permanent Mission of the Republic of Argentina to the United Nations Office and the Other International Organizations at Geneva BAHAMAS

AUSTRALIA Delegates Dr N. GAY, Minister of Health (Chief Delegate) Delegates Mr L. E. SMITH, Permanent Secretary, Dr D. DE SOUZA, Deputy Secretary and Chief Ministry of Health (Deputy Chief Commonwealth Medical Officer, Delegate) Department of Health (Chief Delegate) Dr V. T. ALLEN, Chief Medical Officer, Mr R. H. ROBERTSON, Ambassador, Permanent Ministry of Health Representative of Australia to the United Nations Office and the Other Alternate International Organizations at Geneva Dr Carol CHANEY -GAY Dr B. P. KEAN, Assistant Secretary, International Health and Tuberculosis Branch, Department of Health BAHRAIN Alternates Dr R. C. RAIN, Counsellor (Health), Australian High Commission in the Delegates United Kingdom of Great Britain and Mr J. S. AL- ARRAYED, Minister of Health Northern Ireland (Chief Delegate) MEMBERSHIP OF THE HEALTH ASSEMBLY 133

Mr K. AL- SHAKAR, Ambassador, Permanent BELGIUM Representative of the State of Bahrain to the United Nations Office and Specialized Agencies at Geneva (Deputy Delegates Chief Delegate) Mr F. AERTS, Secretary of State for Dr E. YACOUB, Assistant Under-Secretary Public Health aid the Environment for Preventive and Primary Health Care, (Chief Delegate) Ministry of Health Dr P. DE SCHOUWER, Secretary -General, Ministry of Public Health and Family Alternates Welfare (Deputy Chief Delegate)1 Mr I. AKBARI, Head, International, Arab Mr A. ONKELINX, Ambassador, Permanent and Public Relations Office, Ministry Representative of Belgium to the United of Health Nations Office and the Specialized Mr N. AL- RUMAIHI, Personal Secretary Agencies at Geneva2 to the Minister of Health

Alternates Professor A. LAFONTAINE, Honorary BANGLADESH Director, Institute of Hygiene and Epidemiology, Brussels Mr A. BERWAERTS, Senior Inspector, Delegates International Relations Section, Mr A. H. S. ATAUL KARIM, Ambassador, Ministry of Public Health and Family Permanent Representative of the Welfare People's Republic of Bangladesh to the Dr J. BURKE, Senior Physician, Director, United Nations Office and Other General Administration of Cooperation International Organizations at Geneva for Development (Chief Delegate) Mr P. CHAMPENOIS, Deputy Permanent Dr M. M. RAHAMAN, Associate Director, Representative of Belgium to the United International Centre for Diarrhoeal Nations Office and the Specialized Disease Research, Dhaka Agencies at Geneva Mr S. N. HOSSAIN, Counsellor, Permanent Professor J. CEULEERS, Chef de Cabinet of Mission of the People's Republic of the Community Minister of Health Policy Bangladesh to the United Nations Office (Flemish Executive) and Other International Organizations at Geneva Advisers Dr Irène BORLEE- GRIMÉE, School of Public Alternate Health, Catholic University of Louvain Mr L. A. CHOUDHURY, Second Secretary, Mr L. D'AES, Second Secretary, Permanent Permanent Mission of the People's Mission of Belgium to the United Republic of Bangladesh to the United Nations Office and the Specialized Nations Office and Other International Agencies at Geneva Organizations at Geneva Professor Anne Marie DEPOORTER, Faculty of Medicine, Free University of Brussels (Flemish Section) Mr F. DIELENS, Counsellor to the BARBADOS Community Minister of Health Policy (Flemish Executive) Professor L. EYCKMANS, Director, Prince Delegates Leopold Institute of Tropical Medicine, Mr O. TROTMAN, Minister of Health (Chief Antwerp Delegate) Professor W. J. EYLENBOSCH, Section of Dr Beverly MILLER, Acting Chief Medical Epidemiology and Social Medicine, Officer, Ministry of Health University of Antwerp Mr C. YARD, Deputy Permanent Mrs J. GENTILE, Attaché, Permanent Secretary, Ministry of Health Mission of Belgium to the United Nations Office and the Specialized Alternate Agencies at Geneva Miss D. WATSON, First Secretary, Barbados Mr K. GUTSCHOVEN, Executive Secretary, High Commission in the United Kingdom Ministry for the Flemish Community of Great Britain and Northern Ireland

1 Chief Delegate from 8 May. Adviser 2 Dr H. MOSELEY, Queen Elizabeth Hospital Deputy Chief Delegate from 8 May. 134 THIRTY -EIGHTH WORLD HEALTH ASSEMBLY

Professor A. LAURENT, Dean, School of BOLIVIA Public Health, Free University of Brussels Professor M. F. LECHAT, Dean, School of Delegates Public Health, Catholic University of Dr J. ТORRES GOYTIA, Minister of Social Louvain Welfare and Public Health (Chief Mr G. LEENEN, Secretary, Office of the Delegate) Secretary of State for Public Health Mr A. CRESPO, Ambassador, Permanent and the Environment Representative of the Republic of Dr Gilberte REGINSTER, Institute of Bolivia to the United Nations Office Hygiene and Social Medicine, University and the Other International of Liége Organizations at Geneva Professor K. VUYLSTEEK, Faculty of Mrs C. SANCHEZ-PENA DE LORENZ, Minister Medicine, University of Ghent Counsellor, Permanent Mission of the Professor A. PRIMS, Faculty of Medicine, Republic of Bolivia to the United Catholic University of Louvain Nations Office and the Other Dr Jacqueline CORBIER- SIMONART, Senior International Organizations at Geneva Inspector, Ministry of the French Community Alternate Dr Christiane WILLIOT- JURISSE, Medical Mr I. PAZ CLAROS, First Secretary, Director, Ministry of the French Permanent Mission of the Republic of Community Bolivia to the United Nations Office Mr DE MAAGD, Deputy Counsellor, Ministry and the Other International of the French Community Organizations at Geneva Dr E. MINTIENS, Attaché, Office of the Minister - Member of the Executive of the French Community BOTSWANA Professor F. BARO, Catholic University of Louvain Professor C. THILLY, Free University of Delegates Brussels Mr P. K. BALOPI, Professor P. RECIT, Honorary Director of Minister of Health Public Health (Chief Delegate) Dr D. B. SEBINA, Permanent Professor E. G. A. SAND, Director, WHO Secretary for Health Collaborating Centre on Health and Mrs K. Psychosocial and Psychobiological M. MAKHWADE, Assistant Director of Health Services (Hospitals), Factors, Free University of Brussels Ministry of Health Dr (Mrs) A. MINNE-RINGOET, Ministry of Public Health and Family Welfare Alternate Dr E. T. MAGANU, Assistant Director of Health Services (Primary Health Care), Ministry of Health BENIN

BRAZIL Delegates Delegates Mr V. GUEZODJE, Minister of Public Health Mr P. NOGUEIRA BATISTA, Ambassador, (Chief Delegate) Permanent Representative of Brazil to Dr N. DE MEDEIROS, Ministry of Public the United Nations Office and the Other Health International Organizations at Geneva (Chief Delegate) Dr J. YUNES, Secretary for Health, State of Sao Paulo (Deputy Chief Delegate) BHUTAN Mrs V. RUMJANEK CRAVES, Coordinator of International Affairs, Ministry of Health Delegates Dr T. YOUNТAN, Director General of Health Alternates Services (Chief Delegate) Mr F. J. DE CARVALНO- LOPES, Counsellor, Dr B. Y. ANAYAT, Coordinating Officer, Permanent Mission of Brazil to the Tuberculosis and Leprosy Control United Nations Office and the Other Programme, Department of Health Services International Organizations at Geneva MEMBERSHIP OF THE HEALTH ASSEMBLY 135

Dr D. KYELEM, Chief, Planning Service, Mr C. DE MELO, Secretary, Permanent Public Health Mission of Brazil to the United Nations Ministry of Office and the Other International Mrs R.-M. MEDA, Counsellor for Social Organizations at Geneva Affairs, Ministry of Family Development and National Solidarity

BRUNEI DARUSSALAM Delegates BURMA Mr H. A. AZIZ UMAR, Minister of Education and Health (Chief Delegate) Delegates Mr P. A. H. A. CHUCHU, Deputy Permanent Mr TUN WAI, Minister for Health (Chief Secretary, Ministry of Education and Delegate) Health (Deputy Chief Delegate) Mr MAUNG MAUNG GYI, Ambassador, Permanent Dr H. JOHAR NOORDIN, Director of Medical Representative Socialist and Health Services, Ministry of of the Republic Education and Health of the Union of Burma to the United Nations Office and Other Alternates International Organizations at Geneva Dr (Mrs) P. DURAYAPPAH, Senior Medical (Deputy Chief Delegate) Officer of Health, Ministry of Mr 'LA TUN, Honorary Secretary, Education and Health Burmese Red Cross Society Mr H. MAIDIN AHMAD, Senior Administrative Officer, Ministry of Education and Alternates Health Dr TIN U, Director -General, Department of Health, Ministry Health Mr HARUN ISMAIL, Medical Secretary, of Dr KYAW, Director of Medical Care, Ministry of Education and Health Department of Health, Ministry of Health Dr THEIN DAN, Deputy Director (Training), Department of Health, Ministry of Health BULGARIA Mr TIN NYUNT, Personal Assistant to the Minister of Health

Delegates Professor R. POPIVANOV, Minister of Public Health (Chief Delegate) BURUNDI Professor A. MALEEV, President of the Academy of Medicine (Deputy Chief Delegate) Delegates Dr N. VASSILEVSKI, Director, Department Dr F. SABIMANA, Minister of Public Health of International Relations, Ministry of (Chief Delegate) Public Health Dr P. MPITABAKANA, Inspector -General for Coordination, Office of Inspection and Advisers Planning, Ministry of Public Health Dr I. SETCHANOV, President, Central Dr T. NYUNGUKA, Director, Department of Committee of the Union of Public Health Health Care, Ministry of Public Health Workers Dr Stefanka BATCHVAROVA, Senior Medical Officer, Ministry of Public Health Dr K. TCHAMOV, Scientific Collaborator, CAMEROON Institute of Social Medicine, Academy of Medicine Mr S. STEFANOV, Department of Delegates International Economic Organizations, Professor V. A. NGU, Minister of Public Affairs Ministry of Foreign Health (Chief Delegate) Mr R. DEYANOV, Second Secretary, Mr F. -X. NGOUBEYOU, Ambassador Permanent Mission of the People's Extraordinary and Plenipotentiary of Republic of Bulgaria to the United the Republic of Cameroon to the United Nations Office and the Other Nations Office at Geneva and the International Organizations at Geneva Specialized Agencies in Switzerland (Deputy Chief Delegate) Dr P. C. MAFIAMBA, First Technical BURKINA FASO Counsellor, Ministry of Public Health

Delegates Alternates Mr A. S. KABORE, Minister of Public Dr N. A. NJINJOН, Deputy Director of Health (Chief Delegate) Health, Ministry of Public Health 136 THIRTY -EIGHTH WORLD HEALTH ASSEMBLY

Dr J. -M. BOB'OYONO, Deputy Director of CAPE VERDE Preventive Medicine and Public Health in charge of the National Primary Health Care Programme, Ministry of Delegates Public Health Dr I. F. BRITO GOMES, Minister of Health Dr L. -M. MBALА- NTSAMA, and Social Affairs (Chief Delegate) Paediatrician /Medical Adviser, Dr A. P. DA COSTA DELGADO, Director "Ad Lucem" Medical Foundation of General of Health, Ministry of Health Cameroon and Social Affairs Dr Maria J. DE CARVALHO, Head, Gynaecology and Obstetrics Service, CANADA Agostinho Neto Hospital, Praia

Delegates Mr J. EPP, Minister of National Health and Welfare (Chief Delegate), CENTRAL AFRICAN REPUBLIC replaced from 8 May by: Mrs G. BERTRAND, Member of Parliament and Parliamentary Secretary Delegates Mr J. A. BEESLEY, Ambassador, Permanent Mr X. -S. YANGONGO, Minister of Public Representative of Canada to the United Health and Social Affairs (Chief Nations Office and the Other Delegate) International Organizations at Geneva Dr V. MBARINDI, Director General of Dr Maureen LAW, Associate Deputy Minister, Public Health, Ministry of Public Department of National Health and Health and Welfare Social Affairs

Alternates Mr F. TANGUAY, Minister, Deputy Permanent Representative of Canada to the United CHAD Nations Office and the Other International Organizations at Geneva Mrs P. BROWES, Member of Parliament Delegates Mr R. DE BURGER, Assistant Deputy Mr K. DJIMASTA, Minister of Public Health Minister, Department of Health, (Chief Delegate) Province of British Columbia Dr W. -H. AMOULA, Director of Public Mr K. WORNELL, Deputy Minister of Health Health, Ministry of Public Health and Social Services, Province of Prince Mr P. -A. SARALTA, Legal Counsellor, Edward Island Ministry of Foreign Affairs and Cooperation Advisers Dr C. W. L. JEANES, Chief, Health and Population Sector, Professional Services Branch, Canadian International Development Agency CHILE Dr J. LARIVIÉRE, Senior Medical Adviser, Intergovernmental and International Affairs Branch, Department of National Delegates Health and Welfare Dr W. CHINCHON, Minister of Public Health Mrs J. CARON, United Nations Affairs (Chief Delegate) Division, Department of External Affairs Dr R. CARAM, Chef de Cabinet of the Dr Y. ASSELIN, Medical Adviser, Minister of Public Health Department of Social Affairs, Province Dr A. GUZMAN VÉLIZ, Head, Human Resources of Quebec Department, Ministry of Public Health Dr Helen GLASS, Canadian Nurses Alternates Association Mr F. PEREZ, Counsellor, Permanent Mr G. DAFOE, Executive Director, Canadian Mission of Chile to the United Nations Public Health Association Office at Geneva and the Other Mr R. ROCHON, Counsellor, Permanent International Organizations in Mission of Canada to the United Nations Switzerland Office and the Other International Organizations at Geneva Mr E. RUIZ, First Secretary, Permanent of Chile to United Mr I. SHUGART, Adviser to the Minister of Mission the Nations National Health and Welfare Office at Geneva and the Other Mrs J. VOYER, Adviser to the Minister of International Organizations in National Health aid Welfare Switzerland MEMBERSHIP OF THE HEALTH ASSEMBLY 137

CHINA COMOROS

Delegates Delegates Professor CНEN Minzhang, Deputy Minister Mr A. MROUDJAE, Minister of State for the of Public Health (Chief Delegate) Interior and Social Affairs (Chief Dr LIU Xirong, Director, Bureau of Foreign Delegate) Affairs, Ministry of Public Healthl Mr C. GUY, Director, Office of the Mr CAO Yonglin, Deputy Director, Bureau of Minister of State for the Interior and Foreign Affairs, Ministry of Public Social Affairs Health Dr A. BACAR, Chief, Paediatric Section, Hospital of E1- Maarouf de Moroni Alternates Mr CНEN Fengchun, Chief, Division of Alternate Planning, Department of Planning and Dr S. 0. BEN ACHIRAFI, Chief, Finance, Ministry of Public Health Administration and Equipment Section, Mrs lU Sixian, Second Secretary, Directorate General of Health Department of International Organizations, Ministry of Foreign Affairs Mr CIEN Fuqing, Deputy Chief, General CONGO Office, Bureau of Foreign Affairs, Ministry of Public Health Mrs CНEN Haihua, Second Secretary, Delegates Permanent Mission of the People's Professor C. BOURANOUE, Minister of Republic of China to the United Nations Health and Social Affairs (Chief Office at Geneva and the Other Delegate) International Organizations in Dr D. NDELI, Health Adviser, Ministry of Switzerland Health and Social Affairs Mr A. GAND°, Director -General of Public Adviser Health, Ministry of Health and Social Mrs ZHANG Hong, Liaison Division, Affairs Bureau of Foreign Affairs, Ministry of Public Health Alternates Miss C. SAMBA- DEHLOT, Chief of section, Primary Health Care /Community COLOMBIA Development Project, Ministry of Health and Social Affairs Mr A. BEMBA, Deputy Executive Secretary, Delegates Congo- Assistance Foundation Dr R. DE ZUBIRIA, Minister of Public Mr E. IBALOULA, Attaché, Department of Health (Chief Delegate) Medico -Social Affairs, Office of the Mr H. CHARRY SAMPER, Ambassador, Deputy President Permanent Representative of Colombia to the United Nations Office and the Specialized Agencies at Geneva (Deputy COOK ISLANDS Chief Delegate) Mrs C. DUQUE ULLOA, Counsellor, Permanent Mission of Colombia to the United Delegates Nations Office and the Specialized Dr T. MAOATE, Minister of Health (Chief Agencies at Geneva Delegate) Mr P. PUNA, Chief Administration Officer, Alternates Ministry of Health Mr C. ARÉVALO YEPES, Third Secretary, Permanent Mission of Colombia to the United Nations Office and the COSTA RICA Specialized Agencies at Geneva Dr D. BERSH, Director, Health Division, National Federation of Coffee Producers Delegates Dr M. NISMANN SAFIRZTEIN, Vice- Minister of Health (Chief Delegate) Mr J. RHENAN SEGURA, Counsellor, Permanent Mission of the Republic of Costa Rica to the United Nations Office and the Other International 1 Chief Delegate from 13 May. Organizations at Geneva 138 THIRTY -EIGHTH WORLD HEALTH ASSEMBLY

CUBA Advisers Dr G. MICHAELIDES, President of the Pancyprian Medical Association Delegates Mrs S. KYRIAKIDOU, President of the Dr C. A. RAMIREZ, Vice -Minister of Public Cyprus Nurses Association, School of Health (Chief Delegate) Nursing, Ministry of Health Mrs G. GARCÎA DE GONZÁLEZ, Acting Chargé d'affaires, Permanent Mission of the Republic of Cuba to the United Nations CZECHOSLOVAKIA Office at Geneva and the Other International Organizations in Switzerland Delegates Professor J. R. MENCHACA MONTANO, Professor E. MATEJICEK, Minister of Director of International Relations, Health of the Slovak Socialist Republic Ministry of Public Health (Chief Delegate) Professor J. PROKOPEC, Minister of Health Alternates of the Czech Socialist Republic (Deputy Dr G. MONTALVO, Chief, International Chief Delegate)1 Organizations' Department, Ministry of Dr K. GECIK, Director, Secretariat of the Public Health Ministry of Health of the Slovak Mrs A. M. LUETTGEN DE LECHUGA, Second Socialist Republic Secretary, Permanent Mission of the Alternates Republic of Cuba to the United Nations Dr Elis�ka KLIVAROVA, Director, Foreign Office at Geneva and the Other Relations Department, International Organizations in Ministry of Health Switzerland of the Czech Socialist Republic Mr B. BEDNAR, Counsellor, Permanent Mrs T. GARCÍA, Directorate of Non- aligned Countries, Ministry of External Mission of the Czechoslovak Socialist Relations Republic to the United Nations Office and the Other International Advisers Organizations at Geneva Dr J. A. PAGÉS, Directorate of Mr M. BOCHENEK, Federal Ministry of International Relations, of Foreign Affairs Public Health Mr V.STEFANAK, Ministry of Health of the Czech Professor C. ORDÓÑEZ, Department of Socialist Republic Preventive Medicine, University of Havana DEMOCRATIC KAMPUCHEA Mr A. V. GONZÁLEZ PÉREZ, Third Secretary, Permanent Mission of the Republic of Cuba to the United Nations Office at Delegates Geneva and the Other International Professor THIOUNN Organizations in Switzerland THOEUN, Minister responsible for the Coalition Government's Committee on Coordination CYPRUS for Health and Social Affairs (Chief Delegate) Professor CIHAY HAN CHENG, former Delegates Minister (Deputy Chief Delegate) Dr C. PELEKANOS, Minister of Health Mr KHEK SYSODA, Ambassador (Deputy Chief (Chief Delegate) Delegate) Mr C. VAКIS, Director -General, Alternates Ministry of Health Mr NGO НАС TEAM, Ambassador, Permanent Mr A. A. NICOLAIDES, Ambassador, Representative of Democratic Kampuchea Permanent Representative of Cyprus to to the United Nations Office at Geneva the United Nations Office at Geneva and and the Other International Specialized Agencies in Switzerland Organizations in Switzerland Alternates Dr YO ENG HORN Dr Dr A. MARKIDES, Director of Medical and OUM NAL Public Health Services, Ministry of Mrs THIOUNN THOEUN, Ministry of Health Health and Social Affairs Mr C. YIANGOU, Counsellor, Permanent Dr EA KIM LENG, Pharmacist Mission of Cyprus to the United Nations Office at Geneva and Specialized Agencies in Switzerland 1 Chief Delegate from 13 May. MEMBERSHIP OF THE HEALTH ASSEMBLY 139

Mrs POC MONA, First Secretary, Permanent DENMARK Delegation of Democratic Kampuchea to the United Nations Office at Geneva and the Other International Organizations Delegates in Switzerland Mrs B. SCHALL HOLBERG, Minister for Dr SENG CНEN AN Health, Ministry of the Interior (Chief Dr SALY MATHAY Delegate) Mr O. ASMUSSEN, Permanent Secretary, Ministry of the Interior Dr S. К. SДΡ)RENSEN, Director -General, National Board of Healthl DEMOCRATIC PEOPLE'S REPUBLIC OF KOREA Alternates Mrs J. MERSING, Deputy Permanent Delegates Secretary, Ministry of the Interior Mr KIM Yeung Ik, Vice -Minister of Public Dr N. ROSDAHL, Deputy Director-General, Health (Chief Delegate) National Board of Healthl Mrs Mr SIN Hyeun Rim, Minister, Deputy E. LUND, Head of division, Ministry Permanent Observer, Office of the of the Interior Mr E. FIIL, Head Permanent Observer of the Democratic of division, Ministry of People's Republic of Korea to the Foreign Affairs United Nations Office and Permanent Mr J. MOLDE, First Secretary, Permanent Delegation to the Other International Mission of Denmark to the United Organizations at Geneva Nations Office and the Other Mr KIM Wen Ho, Director, Institute of International Organizations at Geneva Histology, Ministry of Public Health Mrs I. M. МADSEN, Chief Nursing Officer, National Board of Health Alternates Mr J. JaGE NSEN, Head of section, Mr DJANG Seung Tcheul, Ministry for Ministry of the Interior Foreign Affairs Mrs T. RIIS, Head of section, Mr YOUN Myeung Djin, First Secretary, (International Coordination), National Office of the Permanent Observer of the Board of Health Democratic People's Republic of Korea Miss M. K. NIELSEN, Head of section, to the United Nations Office and Ministry of Foreign Affairs Permanent Delegation to the Other International Organizations at Geneva Advisers Mr KWEN Seung Yeun Mr K. REPSDORPH, Ambassador, Permanent Representative of Denmark to the United Nations Office and the Other International Organizations at Geneva Dr J. C. SIIM, Scientific Director, State Serum Institute, Copenhagen DEMOCRATIC YEMEN Mr J. RNING, Director, State Serum Institute, Copenhagen Delegates Mr N. PREISLER, Personal Secretary to the Dr A. A. BUKEIR, Minister of Health Minister of the Interior (Chief Delegate) Mr M. ALQUTAISH, Ambassador, Permanent Representative of the People's DJIBOUTI Democratic Republic of Yemen to the United Nations Office at Geneva and the Specialized Agencies in Switzerland Delegates Dr A. A. ABDULLATIF, Director -General of Mr M. ADABO KAKO, Minister of Public Primary Health Care, Ministry of Health Health and Social Affairs (Chief Delegate) Alternates Dr A. E. ADOU, National Coordinator Mr N. S. HAITIAN, Counsellor, Permanent of Primary Health Care, Ministry of Mission of the People's Democratic Public Health (Deputy Chief Delegate) Republic of Yemen to the United Nations Mr A. TALEB, Officer responsible for Office at Geneva and the Specialized Public Relations, Ministry of Public Agencies in Switzerland Health Mr H. M. OBADI, Counsellor, Permanent Mission of the People's Democratic Republic of Yemen to the United Nations 1 Chief Office at Geneva and the Specialized Delegate on 9 and 10 May. 2 Agencies in Switzerland Chief Delegate from 11 May. 140 THIRTY -EIGHTH WORLD HEALTH ASSEMBLY

Alternates Advisers Mrs S. ALI -HIGO, Officer responsible for Dr H. EL BERMAWY, Director -General, the Training Centre for Health General Department of Planning Affairs, Personnel, Ministry of Public Health Ministry of Health Mrs K. ALI, Ministry of Public Health Dr H. S. HELMY, Director-General, General Foreign Health Relations Department, Ministry of Health DOMINICAN REPUBLIC Dr W. Z. KAMIL, Counsellor, Permanent Mission of the Arab Republic of Egypt to the United Nations Office at Geneva, Delegates, the Specialized Agencies in Switzerland Dr A. PEREZ HERA, Secretary of State for and the Other International Public Health aid Social Welfare (Chief Organizations at Geneva Delegate) Miss S. GAMIL, Third Secretary, Permanent Miss A. BONETTI HERRERA, First Secretary, Mission of the Arab Republic of Egypt Permanent Mission of the Dominican to the United Nations Office at Geneva, Republic to the United Nations Office the Specialized Agencies in Switzerland and the Other International and the Other International Organizations at Geneva Organizations at Geneva

ECUADOR EL SALVADOR Delegates Dr V. MACIAS, Minister of Public Health Delegates (Chief Delegate) Dr В. VALDEZ, Minister of Public Health Dr G. LEORO, Ambassador, Permanent and Social Affairs (Chief Delegate) Representative of the Republic of Mr A. GONZÁLEZ, Ambassador, Deputy Ecuador the United Nations Office at to Permanent Representative, Acting Chargé Geneva (Deputy Chief Delegate) d'affaires, Permanent Mission of the Dr F. PARRA, Director, National Institute Republic of El Salvador to the United of Public Health Nations Office at Geneva Dr R. R. HUEZO MELARA, Minister Alternate Counsellor, Deputy Permanent Mr M. SAMANIEGO, First Secretary, Representative of the Republic of Permanent Mission of the Republic of El Salvador to the United Nations Ecuador to the United Nations Office at Office at Geneva Geneva Alternates Dr R. HERNANDEZ ARGUETA, Director General EGYPT of Epidemiology, Ministry of Public Health and Social Affairs Dr G. TRAВANINO, Adviser, Ministry of Delegates Public Health and Social Affairs Dr M. S. ZAKI, Minister of Health (Chief Mr C. A. BARAHONA, Secretary, Permanent Delegate) Mission of the Republic of El Salvador S. AL- Permanent Mr FARARGI, Ambassador, to the United Nations Office at Geneva Representative of the Arab Republic of Egypt to the United Nations Office at Geneva, the Specialized Agencies in Switzerland and the Other International Organizations at Geneva EQUATORIAL GUINEA Dr A. A. EL GAMAL, First Under -Secretary of State, Ministry of Health Delegates Alternates Dr J. ENEME OYONO, Director General of Dr Aleya H. AYOUB, Under -Secretary for Health, Ministry of Health (Chief Development and Research, Ministry of Delegate) Health Mr J. ELA-ABEME, Ambassador Extraordinary Dr A. M. BADRAN, General Secretary, and Plenipotentiary of Equatorial Health Council Guinea in France MEMBERSHIP OF THE HEALTH ASSEMBLY 141

ETHIOPIA Dr Liisa ELOVAINIO, Chief of Health Education, National Board of Health Mr J. KIVISTO, Head of Department, Delegates Association of Finnish Cities Dr G. TSEHAI, Minister of Health (Chief Mrs A. LIND, Legal Counsellor, Finnish Delegate) Municipal Association Mr H. MECHE, Head, Planning and Mr J. VASAMA, Secretary -General, Programming Bureau, Ministry of Health Collaborative Association of Social, (Deputy Chief Delegate)1 Welfare and Health Organizations Mr S. W. ABRAHAM, Head, Hospital Services Mr P. -E. ISAKSSON, Managing Director, Division, Ministry of Health Folkh�lsan Public Health Organization

Alternate Mr K. SHENKORU, Second Secretary, FRANCE Permanent Mission of Ethiopia to the United Nations Office at Geneva Delegates Mr E. NERVE, Secretary of State for FIJI Health (Chief Delegate) Professor R. SENAULT, Department of Hygiene and Social Medicine, Faculty of Delegates Medicine, Nancy (Deputy Chief Dr T. M. BIUMAIWAI, Permanent Secretary Delegate)3 for Health and Social Welfare (Chief Mr M. BROCHARD, Counsellor for Foreign Delegate) Affairs, Ministry of External Relations Mrs M. ELIASSON, Medical Research Adviser, Ministry of Health and Social Alternates Welfare Miss C. AVELINE, Chargé de mission, Ministry of External Relations (Directorate of United Nations and FINLAND International Organizations Affairs) Mr J. -P. DAVIN, Chargé de mission, Ministry of Social Affairs and National Delegates Solidarity (Division of International Dr Eeva KUUSKOSKI- VIKATMAA, Minister of Relations) Social Affairs and Health (Chief Professor Marie -Pascale DEBEY, Chargé de Delegate) mission, Ministry of External Relations Dr M. RUOKOLA, Director -General, National (Cooperation and Development Service, Board of Health (Deputy Chief Development Policies Directorate) Delegate) 2 Dr B. DURAND, Assistant Director, Dr K. LEPPO, Director, Department of Subdirectorate for Health and Social Planning, National Board of Health Affairs, Cooperation and Development Service, Ministry of External Relations Alternates Dr B. FLOURY, Chargé de mission, Ministry International Mrs L. OLLILA, Secretary for of External Relations ( Subdirectorate Affairs, Ministry of Social Affairs and for Health and Social Affairs, Health Cooperation and Development Service) Dr T. MELKAS, Medical Officer, Department Mr G. MARTIN- BOUYER, Technical of Health, Ministry of Social Affairs Counsellor, Directorate -General of and Health Health, Secretariat of State for Health Mrs T. RAIVIO, First Secretary, Permanent Mr J. -M. MOMAL, Second Counsellor, Mission of Finland to the United Permanent Mission of France to the Nations Office and the Other United Nations Office at Geneva and the International Organizations at Geneva Specialized Agencies in Switzerland Mrs U. VAISTO- MELLERI, First Secretary, Ministry for Foreign Affairs Advisers Mr A. PIERRET, Director of United Advisers Nations and International Organizations Miss H. LEHTINEN, Attaché, Permanent Affairs, Ministry of External Relations Mission of Finland to the United Mrs J. Т. DE LA BATUT, Chargé de mission, Nations Office and the Other Ministry of External Relations International Organizations at Geneva (Directorate of United Nations and International Organizations Affairs) 1 Chief Delegate from 13 May. 2 3 Chief Delegate from 10 May. Chief Delegate from 11 May. 142 THIRTY -EIGHTH WORLD HEALTH ASSEMBLY

Mr J. -L. CARTIER, Head, Division of GAмBIA International Relations, Ministry of Social Affairs and National Solidarity Dr J. -M. COHEN- SOLAL, Technical Adviser Delegates to the Secretary of State for Health Mr M. C. JALLOW, Minister of Health, Professor M. ATTISSO, Faculty of Labour and Social Welfare (Chief Pharmacy, Montpellier Delegate) Mrs F. DURAND, Chargé de mission, Mr A. M. JOBARTEH, Permanent Secretary, Ministry of Social Affairs and National Ministry of Health, Labour and Social Solidarity (Division of International Welfare Relations) Dr F. S. J. OLDFIELD, Director of Medical Mr J. WEBER, President of the Health Services, Ministry of Health, Labour Services Commission and Social Welfare Mrs M. D. CAMPION, Chief, Office of Community and International Affairs, Directorate of Pharmacy and Drugs, GERMAN DEMOCRATIC REPUBLIC Secretariat of State for Health Mr J. LECUGY, Secretary General, "Cooperation- Development" Committee Delegates Professor M. GENTILINI, Faculty of Professor L. MECKLINGER, Minister of Medicine, Pitié -Salpêtrière, Paris Health (Chief Delegate) Dr J. -P. PICARD, Director, National Dr R. MÜLLER, Deputy Minister of Health School of Public Health, Rennes (Deputy Chief Delegate)1 Dr J. ROUAULT, Chargé de mission, Dr K. -H. LEBENTRAU, Deputy Chief, National School of Public Health, Rennes Department of International Relations, Ministry of Health

Alternates CABO N Mr H. HASCIKE, Minister Plenipotentiary, Deputy Permanent Representative of the German Democratic Republic to the United Nations Office and the Other Delegates International Organizations at Geneva Dr J. -P. OKIAS, Minister of Public Health Professor H. HUYOFF, Director, Institute and Population (Chief Delegate) for Public Hygiene, Ernst Moritz Arndt Dr L. ADАNDÉ- MENEST, Inspector-General of University, Greifswald Public Health, Ministry of Public Mr F. WEGМARSHAUS, Deputy Head of Health and Population (Deputy Chief International Delegate) Division, Department of Relations, Ministry of Health Mr J. -R. ODZAGA, Ambassador, Permanent Representative of the Gabonese Republic Mrs C. WOLF, First Secretary, to the United Nations Office and the International Economic Organizations Specialized Agencies at Geneva Division, Ministry of Foreign Affairs Dr H. BRAMER, Scientific Adviser, Alternates Permanent Mission of the German Democratic Republic to the United Dr M. МВОUл ВА, Director General of Public Nations Office and the Other Health, Ministry of Public Health aid International Organizations at Geneva Population Mrs K. ADAMCZYK, Scientific Adviser, Dr L. -D. AKEREY RASSAGUIZA, Adviser to Centre for WHO Affairs, Ministry of

Minister of Public Health and . the Health Population Dr B. OBIANG OSSOUВITA, Inspector - General of Labour Medicine, Ministry of Labour GERMANY, FEDERAL REPUBLIC OF and Employment Mr J. -B. NGOUNANGO, Attaché, Office of the Minister of Public Health and Population Delegates Professor M. STEINBACH, Director- General, Mr M. NZE EKOME, Second Counsellor, Federal Ministry for Youth, Family Permanent Mission of the Gabonese Affairs and Health (Chief Delegate) Republic to the United Nations Office and the Specialized Agencies at Geneva Professor A. MBUMBE -KING, Chief Surgeon, Owendo Paediatric Hospital, Libreville 1 Chief Delegate from 13 May. MEMBERSHIP OF THE HEALTH ASSEMBLY 143

Dr H. ARNOLD, Ambassador, Permanent Mr S. E. QUARM, Ambassador, Permanent Representative of the Federal Republic Representative of the Republic of Ghana of Germany to the United Nations Office to the United Nations Office at Geneva and the Other International and the Specialized Agencies in Organizations at Geneva (Deputy Chief Switzerland (Deputy Chief Delegate) Delea�а� te) Dr J. D. OTOO, Acting Director of Medical Dr W. HOYNCK, Minister, Deputy Permanent Services, Ministry of Health Representative of the Federal Republic of Germany to the United Nations Office Alternate and the Other International Mr K. DUWIEJUAH, First Secretary, Organizations at Geneva Permanent Mission of the Republic of Ghana to the United Nations Office at Alternates Geneva and the Specialized Agencies in Mr H. VOIGTLANDER, Director of Switzerland International Health Relations, Federal Ministry for Youth, Family Affairs and Health GREECE Mr J. WEITZEL, Deputy Director of International Health Relations, Federal Ministry for Youth, Family Affairs and Delegates Health Professor J. PAPAVASSILIOU, President, Professor Ruth MATTHEIS, Director, Public Central Health Council (Chief Delegate) Health Department, Berlin (West) Mr A. PETROPOULOS, Ambassador, Permanent Dr E. BISKUP, Counsellor, Permanent Representative of Greece to the United Mission of the Federal Republic of Nations Office at Geneva aid the Germany to the United Nations Office Specialized Agencies in Switzerland and the Other International Dr K. SFANGOS, Lecturer, Athens University Organizations at Geneva Mr C. WUNDERLICH, Second Secretary, Alternates Permanent Mission of the Federal Dr Catherine APOSTOLOU, Adviser, Ministry Republic of Germany to the United of Health and Social Welfare Nations Office and the Other Mr A. CAMBITSIS, Counsellor (Economic International Organizations at Geneva Affairs), Permanent Mission of Greece Dr W. -D. ERNERT, Director, United Nations to the United Nations Office at Geneva Specialized Organizations and and the Specialized Agencies in Multilateral Cooperation, Federal Switzerland Ministry for Economic Cooperation Mr M. CARAFOTIAS, Counsellor, Permanent Dr K. CORDEL, Director, Health, Nutrition Mission of Greece to the United Nations and Population Policies, Federal Office at Geneva and the Specialized Ministry for Economic Cooperation Agencies in Switzerland Mr E. VON SCHUBERT, First Secretary, Permanent Mission of the Federal Adviser Republic of Germany to the United Dr Vasiliki LANARA, Director, Evangelismos Nations Office and the Other Hospital International Organizations at Geneva

Advisers GRENADA Mr H. BRUCKNER, Senator for Health aid Sport, Bremen Mr H. MARCKHOFF, Personal Assistant to the Delegates Senator for Health and Sport, Bremen Mr D. C. WILLIAMS, Minister of Health Dr R. KORTE, Head, Health, Nutrition and and Housing (Chief Delegate) Population Matters, German Agency for Dr Doreen MURRAY, Deputy Chief Medical Technical Cooperation Officer of Health, Ministry of Health Dr H. VON STACKELBERG, German Green Cross

GUATEMALA

GHANA Delegates Mr C. A. MOREIRA-LOPEZ, Ambassador,' Permanent Representative of Guatemala Delegates to the United Nations Office aid the Mr E. G. TANOH, Secretary for Health, Specialized Agencies at Geneva (Chief Ministry of Health (Chief Delegate) Delegate) 144 THIRTY -EIGHTH WORLD HEALTH ASSEMBLY

Mrs N. M. DE CONTRERAS- SARAVIA, Minister Mr G. CHARLES, Ambassador, Deputy Counsellor, Deputy Permanent Permanent Representative of Haiti to Representative of Guatemala to the the United Nations Office at Geneva and United Nations Office and the the Other International Organizations Specialized Agencies at Geneva in Switzerland

GUINEA HONDURAS

Delegates Delegates Professor M. K. BAH, Minister of Health Dr R. GARCIA-MARTINEZ, Minister of Public (Chief Delegate) Health and Social Welfare (Chief Dr M. SYLLA, Director, Donka University Delegate) Hospital Centre Mr J. M. MALDONADO MUÑOZ, Ambassador, Dr M. KOUYATE, Director of Health, Permanent Representative of the Prefecture of Conakry III, Ministry of Republic of Honduras to the United Health Nations Office at Geneva and the Other International Organizations in Switzerland GUINEА- BISSAU Dr J. B. RIVERA, Director, Department of Environmental Sanitation, Ministry of Public Health and Social Welfare Delegates Mr A. NUNES CORREIA, Minister of Public Alternates Health (Chief Delegate) Mr J. M. RITTER ARITA, Minister Dr C. M. MENDES COSTA, Regional Director Counsellor, Permanent Mission of the of Health, Вafatá, Ministry of Public Republic of Honduras to the United Health Nations Office at Geneva and the Other Dr P. MENDES, Regional Director of International Organizations in Health, Gabú, Ministry of Public Health Switzerland Miss A. ARIZA, Second Secretary, Alternate Permanent Mission of the Republic of Dr J. C. GON9ALVES, Ministry of Public Honduras to the United Nations Office Health at Geneva and the Other International Organizations in Switzerland Miss B. VALENZUELA, Attaché, Permanent GUYANA Mission of the Republic of Honduras to the United Nations Office at Geneva and the Other International Organizations Delegates in Switzerland Dr R. VAN WEST-CHARLES, Minister of Mr R. CASTRO, Attaché, Permanent Mission Health and Public Welfare (Chief of the Republic of Honduras to the Delegate) United Nations Office at Geneva and the Dr Enid DENBOW, Chief Medical Officer, Other International Organizations in Ministry of Health and Public Welfare Switzerland Mr C. PHILADELPHIA, Permanent Secretary, Mr F. MEJIA, Attaché, Permanent Mission Ministry of Health and Public Welfare of the Republic of Honduras to the United Nations Office at Geneva and the Other International Organizations in HAITI Switzerland

Delegates HUNGARY Dr R. GERMAIN, Minister of Public Health and Population (Chief Delegate) Dr S. TOUREAU, Director General, Ministry Delegates of Pub is Health and Population Dr L. MEDVE, Minister of Health (Chief Mr R. ÉTIENNE, Executive Secretary, Delegate) Haitian Association of Voluntary Professor I. HUTAS, Secretary of State, Agencies Ministry of Healthl

Alternates Dr F. MILORD, Director, Office of the Minister of Public Health and Population 1 Chief Delegate from 14 May. MEMBERSHIP OF THE HEALTH ASSEMBLY 145

Dr L. SANDOR, Head, Department of Mrs S. GREWAL, Secretary, Ministry of International Relations, Ministry of Health and Family Welfare (Deputy Chief Health (Deputy Chief Delegate) Delegate) 2 Mr M. DUBEY, Ambassador, Permanent Representative of India to the United Alternates Nations Office and the Other Professor I. FORGACS, Vice -Rector, International Organizations at Geneva Postgraduate Medical School, and Director, Institute of Social Medicine, Alternates Budapest Mr P. K. UMASHANKAR, Additional Secretary, Dr Zsuzsanna JAKAB, Head, Ministry of Health and Family Welfare International Organizations Division, Dr D. B. BISHT, Director General of Health Department of International Relations, Services, Ministry of Health and Family Ministry of Health Welfare Mrs E. OLASZ, First Secretary, Mr P. P. CHAUHAN, Joint Secretary, Ministry of Foreign Affairs Ministry of Health and Family Welfare Dr. L. ELIÁS, Head Physician, Ministerial Mr B. R. IYENGAR, Counsellor, Permanent Counsellor (retired), Ministry of Health Mission of India to the United Nations Office and the Other International Advisers Organizations at Geneva Miss K. VITTAY, Head of section, Centre Mr B. BALAKRISHNAN, First Secretary, for Health Information and Computer Permanent Mission of India to the Technology, Ministry of Health United Nations Office and the Other Mr I. K'S, First Secretary, Permanent International Organizations at Geneva Mission of the Hungarian People's Mr I. S. BISHT, Private Secretary to the Republic to the United Nations Office Minister of Health and Family Welfare and the Other International Organizations at Geneva

ICELAND INDONESIA

Delegates Delegates Dr Mr D. A. GUNNARSSON, Special Adviser to S. SURJANINGRAT, Minister of Health the Minister of Health and Social (Chief Delegate) Security (Chief Delegate) Dr S. YAHYA, Director General of Dr G. MAGNUSSON, Chief Medical Officer, Community Health, Ministry of Health (Deputy Chief Ministry of Health and Social Security Delegate) Dr BROTO WASISTO, Chief, Bureau (Deputy ,Chief Delegate)1 of Planning, Ministry of Health Mr T. INGOLFSSON, Minister Counsellor, Deputy Permanent Representative of Alternates Iceland to the United Nations Office Dr A. R. SURONO, and the Other International Secretary, Directorate General of Community Health, Organizations at Geneva Ministry of Health Alternate, Dr R. UNTORO, Chief, Minister's Mr H. PALSSON, Chief of division, Ministry Secretariat, Ministry of Health of Health and Social Security Advisers Adviser Mr P. KOENTARSO, Ambassador Extraordinary Mr H. HAFSTEIN, Ambassador, Permanent and Plenipotentiary, Permanent Representative of Iceland to the United Representative of the Republic of Nations Office and the Other Indonesia to the United Nations Office and International Organizations at Geneva the Other International Organizations at Geneva Dr W. B. WANANDI, Technical Adviser to the INDIA Minister of Health Mr JUWANA, Minister Counsellor, Permanent Mission of the Republic of Indonesia Delegates to the United Nations Office aid the Mrs M. KIDWAI, Minister of Health Other International and Family Welfare (Chief Delegate) Organizations at Geneva

2 1 Chief Delegate from 12 May. Chief Delegate from 13 May. 146 THIRTY -EIGHTH WORLD HEALTH ASSEMBLY

Miss R. TANZIL, Third Secretary, Permanent Alternates Mission of the Republic of Indonesia to Dr I. AL- NOURI, President of the Red the United Nations Office and the Other Crescent Society of Iraq and Director International Organizations at Geneva of the Red Crescent Hospital, Baghdad Mr E. LEMBONG, Pharmacist Dr M. AL-NAJJAR, Director -General, Office for Health Relations, Ministry of Health Dr F. JURJI, Director- General of Preventive and Environmental Health IRAN (ISLAMIC REPUBLIC OF) Services, Ministry of Health Dr A. HASSOUN, Director of International Health Affairs, Ministry of Health Delegates Dr A. JOMARD, First Secretary, Permanent Dr A. MARANDI, Minister of Health (Chief Mission of the Republic of Iraq to the Delegate) United Nations Office at Geneva and the Dr B. SADRIZADEH, Acting Deputy Minister Specialized Agencies in Switzerland for Health Affairs (Deputy Chief Dr A. S. MOHAMED, Ministry of Health Delegate) Professor H. MALEK AFZALI, Representative of the Minister to the Coordinating IRELAND Council of Primary Health Care Network

Alternates Delegates Dr P. REZA', Director-General of Malaria Dr J. WALSH, Deputy Chief Medical Officer, Eradication and Communicable Diseases Department of Health (Chief Delegate) Control, Ministry of Health Mr F. M. HAYES, Ambassador, Permanent Mr M. A. AВВASSI TEHRANI, Director Representative of Ireland to the United General, Department of International Nations Office and the Specialized Relations, Ministry of Health Agencies at Geneva Mr A. BOUSHEL, Assistant Secretary - Advisers General, Department of Health Mr N. KAZEMI- KAMYAB, Ambassador, Permanent Representative of the Islamic Republic Alternates of Iran to the United Nations Office Mr J. D. BIGGAR, First Secretary, and the Other International Permanent Mission of Ireland to the Organizations at Geneva United Nations Office and the Mr F. SHÀHАВI SIRJANI, First Secretary, Specialized Agencies at Geneva Permanent Mission of the Islamic Dr Jane BUTTIMER, Medical Officer, Republic of Iran to the United Nations Department of Health Office and the Other International Organizations at Geneva Advisers Mr A. SHAFII, Second Secretary, Permanent Miss H. MARCHANT, Deputy General Mission of the Islamic Republic of Iran Secretary, Irish Nurses' Organisation to the United Nations Office aid the Mr M. CRADDOCK, Attaché, Permanent Other International Organizations at Mission of Ireland to the United Geneva Nations Office and the Specialized Mr M. TALE, Permanent Mission of the Agencies at Geneva Islamic Republic of Iran to the United Nations Office and the Other International Organizations at Geneva ISRAEL

IRAQ Delegates Mr M. CUR, Minister of Health (Chief Delegate) Delegates Professor D. MICHAEL', Director -General, Dr S. H. ALWASH, Minister of Health Ministry of Health (Deputy Chief (Chief Delegate) Delegate)1 Dr A. H. AL- TAWEEL, President, General Mr E. DOWEK, Ambassador, Permanent Foundation for Health Education and Representative of Israel to the United Training, Ministry of Health (Deputy Nations Office and the Specialized Chief Delegate) Agencies at Geneva2 Mr I. MAIBOUB, Minister Plenipotentiary Acting Chargé d'affaires, Permanent 1 Chief Delegate from 10 to 14 May. Mission of the Republic of Iraq to the United Nations Office at Geneva and the 2 Deputy Chief Delegate from 10 to Specialized Agencies in Switzerland 14 May, Chief Delegate from 15 May. MEMBERSHIP OF THE HEALTH ASSEMBLY 147

Alternates Dr G. ВERTOLASO, Department of Mr P. ELIAV, Ambassador, Assistant Development Cooperation, Ministry of Director General, International Foreign Affairs Organizations Division, Ministry of Dr Marta DI GENNARO, Department of Foreign Affairs Development Cooperation, Ministry of Mrs P. HERZOG, Director, Department of Foreign Affairs External Relations, Ministry of Health Mr E. F. HARAN, Ambassador, Deputy Advisers Permanent Representative of Israel to Dr V. FATTORUSSO, Ministry of Health the United Nations Office and the Dr A. MOCHI, Department of Development Specialized Agencies at Geneva Cooperation, Ministry of Foreign Affairs Professor D. DANON, Chief Scientist, Dr F. L. ODDO, Technical Adviser, Ministry of Health Ministry of Health Professor M. DAVIES, Director, School of Mrs A. VOLPINI, Office of International Public Health, Hebrew University of Relations, Ministry of Health Jerusalem Mrs S. CASTORINA, Office of International Mr D. DANIEL', First Secretary, Permanent Relations, Ministry of Health Mission of Israel to the United Nations Mr G. GAUDINO, Office of International Office and the Specialized Agencies at Relations, Ministry of Health Geneva Mr E. ROCCO, Ministry of Health Mr S. LIVNE, Second Secretary, Miss P. VOLPATI, Health Assistant, Office Permanent Mission of Israel to the of International Relations, Ministry of United Nations Office and the Health Specialized Agencies at Geneva Mrs A. TURCO, Technical Secretary, Office Mr O. FRENKEL, Attaché, Permanent Mission of International Relations, Ministry of of Israel to the United Nations Office Health and the Specialized Agencies at Geneva Mr S. RAGUSA, Office of International Mr J. HANEIN, Attaché, Permanent Mission Relations, Ministry of Health of Israel to the United Nations Office Dr Virginia BARONIO, National Nurses' and the Specialized Agencies at Geneva Federation Mrs R. BRIGNONE, National Association of Nurses and Social Workers ITALY Mrs L. SASSI- CONTI, National Association of Midwives

Delegates Mr C. DEGAN, Minister of Health (Chief Delegate) Professor M. COLOMBIN', Head, Office of International Relations, Ministry of IVORY COAST Health (Deputy Chief Delegate) Professor L. GIANNICO, Director -General of Public Health, Ministry of Health Delegates Professor M. A. DJEDJE, Minister of Alternates Public Health and Population (Chief Professor D. POGGIOLINI, Director -General Delegate), of the Pharmaceutical Service, Ministry Mr A. TRAORE, Ambassador, Permanent of Health Representative of the Republic of the Professor F. POCCHIARI, Director -General, Ivory Coast to the United Nations Istituto Superiore di Sanità Office and the Specialized Agencies at Professor G. LOIACONO, Director, Higher Geneva Institute of Economic Planning Dr B. A. BELLA, Director of International Professor B. PACCAGNELLA, Director, and Regional Relations, Ministry of Institute of Hygiene, University of Public Health and Populationn Padua Mr E. DE MAIO, First Counsellor, Alternates Permanent Mission of Italy the to Dr I. KONE, Director, Institute of United Nations Office and the Other Hygiene, Abidjan International Organizations at Geneva Professor K. G. GUESSENND, Director of Dr N. MANDUZIO, Department of Development Public Health, Ministry of Public Cooperation, Ministry of Foreign Affairs Health and Population Mr F. FORMICA, Second Secretary, Mr K. F. EKRA, Counsellor, Permanent Permanent Mission of Italy to the Mission of the Republic of the Ivory United Nations Office and the Other Coast to the United Nations Office and International Organizations at Geneva the Specialized Agencies at Geneva 148 THIRTY -EIGHTH WORLD HEALTH ASSEMBLY

JAMAICA Mr N. IGUCHI, First Secretary, Permanent Mission of Japan to the United Nations Office and the Other Delegates International Organizations at Geneva Dr K. BAUGH, Minister of Health (Chief Delegate) Advisers Mr K. G. A. HILL, Ambassador, Permanent Mr K. FUKUYAMA, Deputy Director, Representative of Jamaica to the United International Affairs Division, Nations Office and the Specialized Minister's Secretariat, Ministry of Agencies at Geneva Health and Welfare Dr J. McHARDY, Chief Medical Officer, Dr H. NAKATANI, Deputy Director, Medical Ministry of Health Professions Division, Health Policy Bureau, Ministry of Health and Welfare Advisers Dr Y. HASEGAWA, Temporary Adviser, Miss C. CLAYTON, Minister Counsellor, International Affairs Division, Permanent Mission of Jamaica to the Minister's Secretariat, Ministry of United Nations Office and the Health and Welfare Specialized Agencies at Geneva Mr P. A. ROBOTHAM, First Secretary, Permanent Mission of Jamaica to the JORDAN United Nations Office and the Specialized Agencies at Geneva Delegates Dr Z. HAMZEH, Minister of Health (Chief JAPAN Delegate) Dr H. OWEIS, Director, Hospitals Department, Ministry of Health (Deputy Delegates Chief Delegate)1 Mr K. CHIBA, Ambassador Extraordinary and Dr S. QUBEIN, Director of Primary Health Plenipotentiary, Permanent Care Services, Ministry of Health Representative of Japan to the United Nations Office and the Other Alternates International Organizations at Geneva Dr M. SHAHID, Director, Department of (Chief Delegate) Planning, Ministry of Health Mr H. YOSHIMURA, Vice -Minister of Health Dr S. HIJAZI, Dean, Faculty of Medicine, and Welfare Yarmouk University, Irbid Dr E. NAKANURA, Director-General, Statistics and Information Department, Adviser Minister's Secretariat, Ministry of Mr H. MUHAISEN, Minister Plenipotentiary, Health aid Welfare Permanent Mission of the Hashemite Kingdom of Jordan to the United Nations Alternates Office at Geneva and the Specialized Agencies in Switzerland . Dr S. KITAGAWA, Councillor for Science and Technology, Minister's Secretariat, Ministry of Health and Welfare Mr H. SATO, Counsellor, Permanent Mission KENYA of Japan to the United Nations Office and the Other International Organizations at Geneva Delegates Mr Y. KUSUMOТО, First Secretary, Permanent Mr P. C. J. O. NYAKIAMO, Minister of Mission of Japan to the United Nations Health (Chief Delegate) Office and the Other International Dr W. KOINANGE, Director of Medical Organizations at Geneva Services, Ministry of Health Mr H. ISHIMOTO, Deputy Director, Policy Mr J. K. NGUTA, Deputy Secretary, Ministry Planning and Evaluation Division, of Health Minister's Secretariat, Ministry of Health and Welfare Alternate Mr T. INOUE, First Secretary, Embassy of Mrs T. M. ODUORI, Deputy Chief Nursing Japan in the United Kingdom of Great Officer, Ministry of Health Britain and Northern Ireland Dr N. KOINUMA, Deputy Director, International Affairs Division, Minister's Secretariat, Ministry of Health and Welfare 1 Chief Delegate from 12 May. MEMBERSHIP OF THE HEALTH ASSEMBLY 149

KIRIBATI Adviser Dr N. M. KRONFOL, Adviser, Ministry of Health Delegate Dr T. TIRA, Secretary for Health and Family Planning LESOTHO

KUWAIT Delegates Mr P. L. LEHLOENYA, Minister of Health (Chief Delegate) Delegates Mr V. T. NDOBE, Principal Secretary for Dr A. R. AL- AWADI, Minister of Public Health, Ministry of Health (Deputy Health and Minister of Planning (Chief Chief Delegate) Delegate) Dr Arabang P. MARUPING, Director of Mr H. AL- DABBAGH, Ambassador, Permanent Health Services, Ministry of Health Representative of the State of Kuwait to the United Nations Office at Geneva Alternate and the Specialized Agencies in Mrs N. T. BOROTHO, Senior Planning Switzerland (Deputy Chief Delegate) Officer, Ministry of Health Dr A. AL -SAIF, Director, Department of International Health Relations, Ministry of Public Health LIBERIA

Alternates Dr S. AL- KANDARI, Director, Infectious Delegates Diseases Hospital, Safat Mrs M. K. BELLEH, Minister of Health and Mr A. AL- HADDAD, Researcher, Department of Social Welfare (Chief Delegate) International Health Relations, Dr I. CAMANOR, Chief Medical Officer, Ministry of Public Health Ministry of Health and Social Welfare Mr M. F. TAWFIQ, Legal Adviser, Ministry Mrs A. GREAVES, Assistant Minister of Public Health (Planning and Research), Ministry of Health and Social Welfare

LAO PEOPLE'S DEMOCRATIC REPUBLIC Alternates Dr A. COLE, Ministry of Health and Social Welfare Delegates Mrs E. BOWEN-CARR, Counsellor, Acting Dr K. PHOLSENA, Minister of Public Health Chargé d'affaires, Permanent Mission of (Chief Delegate) the Republic of Liberia to the United Dr K. SOUVANNAVONG, Director, Department Nations Office at Geneva of Hygiene and Preventive Medicine, Dr A. HANSON, Director, Liberian Ministry of Public Health Institute for Biomedical Research, Dr B. S. CHOUNLAMOUNTRI, Deputy Director Robertsfield of the Office of the Minister of Public Health, responsible for External Relations LIBYAN ARAB JAMAHIRIYA

Delegates LEBANON Professor M. LE NGHI, Secretary, People's General Committee for Health (Chief Delegate) Delegates Professor B. SAGHER, Counsellor (Health Mr J. ABI- SALER, Director General of Affairs), Permanent Mission of the Health (Chief Delegate) Socialist People's Libyan Arab Mr H. DIMACHKIÉ, First Secretary, Deputy Jamahiriya to the United Nations Office Permanent Representative of the at Geneva and the Specialized Agencies Republic of Lebanon to the United in Switzerland Nations Office at Geneva and the Dr A. A. EL- SHERIF, Director of the Specialized Agencies in Switzerland Libyan Red Crescent Mr N. FATTAL, Secrétaire d'ambassade, Permanent Mission of the Republic of Alternates Lebanon to the United Nations Office at Professor A. G. SHERIF, Director -General, Geneva and the Specialized Agencies in Technical Centre for Environmental Switzerland Protection 150 THIRTY -EIGHTH WORLD HEALTH ASSEMBLY

Mr D. TUMI, Technical Adviser, Ministry Mrs J. M. G. RASHIDI, Senior Nursing of Health Officer, Ministry of Health Mr B. BASHIR, People's General Committee for Health, Ministry of Health MALAYSIA

LUXEMBOURG Delegates Mr CHIN Hon Ngian, Minister of Health Delegates (Chief Delegate) Mr B. BERG, Minister of Health and Social Dr A. KHALID BIN SARAN, Director General Security (Chief Delegate) of Health, Ministry of Health (Deputy Dr J. KOHL, Director of Health, Ministry Chief Delegate) of Health (Deputy Chief Delegate)1 Mr A. AHMAD FAIZ, Ambassador, Permanent Mr J. RETTEL, Ambassador, Permanent Representative of Malaysia to the Representative of the Grand Duchy of United Nations Office and the Other Luxembourg to the United Nations Office International Organizations in at Geneva Switzerland (Deputy Chief Delegate)

Alternates Alternates Dr E. J. P. DUHR, Honorary Director of Dr A. RAHMAN, Director of Health Health, Ministry of Health Services, Ministry of Health Professor M. REINEN, Attaché, Ministry of Dr CHEONG Weng Hoof, Deputy Director of Health Dental Services, Ministry of Health Mrs A. SCHLEDER, Administrative Mr TAN Kim n San, Deputy Permanent Counsellor, Ministry of Health Representative of Malaysia to the Dr Danielle HANSEN- KOENIG, Deputy United Nations Office and the Other Director of Health, Ministry of Health International Organizations in Mr J. -L. WOLZFELD, Counsellor, Deputy Switzerland Permanent Representative of the Grand Mr M. RADZI, Second Secretary, Permanent Duchy of Luxembourg to the United Mission of Malaysia to the United Nations Office at Geneva Nations Office and the Other International Organizations in Switzerland MADAGASCAR

Delegates Professor E. ANDRIAМAМPIHANTONA, MALDIVES Secretary General, Ministry of Health (Chief Delegate) Dr S. R. RAMAROSON, Chief, Provincial Delegates Health Service, Toamasina Mr A. JAMEEL, Minister of Health (Chief Mr A. RAKOTONOME NJANAHARY, Chief, Delegate) International Relations Section, Dr A. S. ABDULLAH, Director General of Ministry of Health Health Services, Ministry of Health Mrs A. ARMED, National Women's Committee

MALAWI

MALI Delegates Mr D. S. KATOPOLA, Minister of Health (Chief Delegate) Delegates Mr R. N. L. NKOMBA, Principal Secretary Professor M. DEMBELE, Minister of Public for Health, Ministry of Health (Deputy Health and Social Affairs (Chief Chief Delegate) Delegate) Dr M. W. MBVUNDULA, Principal Mr Y. SANGARE, Technical Adviser, Paediatrician, Kamuzu Central Hospital, Ministry of Public Health and Social Lilongwe Affairs Dr G. TRAORE, National Director of Public Alternates Health, Ministry of Public Health and Mr A. M. D. MOSIWA, Principal Social Affairs Administrative Officer, Ministry of Health Alternate Mr V. TRAORE, National Directorate of 1 Chief Delegate from 13 May. Planning, Ministry of State for the Plan MEMBERSHIP OF THE HEALTH ASSEMBLY 151

MALTA Mr F. FERNÁNDEZ, Secretary, Interministerial Commission on the Pharmaceuticals Industry President, Mexican Delegates Professor E. AMTMANN, Dr V. MORAN, Minister of Health and Businessmen's Council Environment (Chief Delegate) Dr A. GRECH, Chief Medical Officer, Health (Deputy Chief Ministry of MONACO Delegate)1 Mr A. FALZON, Ambassador, Permanent Republic of Malta Representative of the Delegates Nations Office and the to the United Dr E. BOERI, Technical Adviser, Permanent at Geneva Specialized Agencies Delegate of the Principality of Monaco to the International Health Alternate Organizations (Chief Delegate) Adviser, Ministry of Dr J. GRECH ATTARD, Professor D. -L. GASTAUD, Director, Health Health and Social Affairs, Ministry of State

MAURITANIA

MONGOLIA Delegates Mr D. TAFSIROU, Minister of Health and Social Affairs (Chief Delegate) Delegates Dr M. M. HACEN, Technical Adviser, Dr D. NYAM -OSOR, Minister of Public Ministry of Health and Social Affairs Health (Chief Delegate) Dr M. L. BA, Director of Health, Ministry Dr Z. JADAMBA, Head, Foreign Relations of Health and Social Affairs Department, Ministry of Public Health

MAURITIUS MOROCCO

Delegate Dr J. C. MOHITH, Chief Medical Officer, Delegates of Health Ministry Mr T. BENCHEIKH, Minister of Public Health (Chief Delegate) Mr A. SKALLI, Ambassador, Permanent MEXICO Representative of the Kingdom of Morocco to the United Nations Office at Geneva and the Specialized Agencies in Delegates Switzerland (Deputy Chief Delegate) Dr G. SOBERON ACEVEDO, Secretary for Mr I. JENNANE, Secretary -General, Health (Chief Delegate) Ministry of Public Health Dr M. QUIJANO, Director of International Affairs, Secretariat for Health Alternates Miss O. GARRIDO -RUIZ, Third Secretary, Mr M. FERAA, Inspector-General, Ministry Permanent Mission of Mexico to the of Public Health at Geneva and the United Nations Office Dr N. FIKRI- BENBRAHIM, Chief, Division of International Organizations in Other Epidemiology and Director of External Switzerland Relations, Ministry of Public Health Dr A. CHERKAOUI, Chief, Division of Alternates Technical Training, Ministry of Public Dr J. LAGUNA, Secretary, Public Health Health Council, Secretariat for Health Dr A. CHAWKI, President, Council of the Dr M. LIEBERMAN, Director General of Order of Pharmacists, Ministry of Medical Supplies Control, Secretariat Public Health for Health Mr O. HILALE, First Secretary, Permanent Mr A. HEGEWISCH, Under -Secretary for Mission of the Kingdom of Morocco to Commerce and Industrial Development the United Nations Office at Geneva and the Specialized Agencies in Switzerland Mr J. KHETTABI, Chargé de mission, Office 1 Chief Delegate from 9 May. of the Minister of Public Health 152 THIRTY -EIGHTH WORLD HEALTH ASSEMBLY

MOZAMBIQUE Mrs M. A. VAN DRUNEN LITTEL, International Organizations Department, Ministry of Foreign Affairs Delegates Mr L. J. VAN DEN DOOL, First Secretary, Dr P. M. MOçUMBI, Minister of Health Permanent Mission of the Kingdom of the (Chief Delegate) Netherlands to the United Nations Dr L. SIMAO, Director of Health, Zambézia Office and the Other International Province Organizations at Geneva Mr J. F. M. TOMO, Head, Department of International Cooperation, Ministry of Advisers Health Mr R. J. VAN SCHAIK, Ambassador Extraordinary and Plenipotentiary, Advisers Permanent Representative of the Kingdom Dr A. R. NOORMAHOMED, Head, Planning of Netherlands to the United Nations Department, Ministry of Health Office and the Other International Mrs A. МО UМВI, Ministry of Health Organizations at Geneva Dr Custódia DAS DORES I. MANDLATE, Dr H. COHEN, Director -General, National Ministry of Health Institute of Public Health and Environmental Hygiene, Ministry of Welfare, Health and Cultural Affairs NEPAL Mr R. SAMSOM, Director -in- chief, Health Protection Branch, Ministry of Welfare, Health and Cultural Affairs Delegates Mr R. P. GIRI, Minister for Health and Communications (Chief Delegate) Dr D. N. REQ{I, Director General of NEW ZEALAND Health Services, Ministry of Health (Deputy Chief Delegate) Dr S. K. PAHARI, Chairman, Health Delegates Services Coordinating Committee Dr M. E. R. BASSETT, Minister of Health (Chief Delegate) Dr G. C. SALMOND, Deputy Director - General Alternate of Health, Department of Health (Deputy Mr P. L. SHRESTHA, Acting Chargé Chief Delegate) d'affaires, Permanent Mission of the Mr K. G. IRWIN, Director, Presbyterian Kingdom of Nepal to the United Nations Support Services, Otago Office and the Other International Organizations at Geneva Alternates Mr R. F. NOTTAGE, Ambassador, Permanent NETHERLANDS Representative of New Zealand to the United Nations Office at Geneva Mr B. T. LINEHAM, Counsellor, Deputy Delegates Permanent Representative of New Zealand Geneva Mr J. P. VAN DER REIJDEN, State Secretary to the United Nations Office at Mr A. M. BRACEGIRDLE, Second Secretary, of Welfare, Health and Cultural Affairs (Chief Delegate) Permanent Mission of New Zealand to the United Nations Office at Geneva Dr J. VAN LINDEN, Director- General of Miss H. RIDDELL, Second Secretary, Health, Ministry of Welfare, Health and Permanent Mission of New Zealand to the Cultural Affairs United Nations Office at Geneva Mr F. ZANDVLIET, Head, Staff Bureau for Mrs H. ABBOTT, Private Secretary to International Health Affairs, Ministry the Minister of Health of Welfare, Health and Cultural Affairs

Alternates Dr J. A. C. DE KICK VAN LEEUWEN, Adviser to the Director-General of Health, NICARAGUA Ministry of Welfare, Health and Cultural Affairs Dr C. I. PANNENBORG, Chief of Long -Term Delegates Health Planning, Staff Bureau for Mrs L. GUIDO, Minister of Health (Chief Policy Development, Ministry of Delegate) Welfare, Health and Cultural Affairs Dr J. ZAPATA, Director of Planning, Professor A. S. MULLER, Director, Ministry of Health Department of Tropical Hygiene, Royal Dr E. MIRANDA, Chief of Multilateral Tropical Institute, Amsterdam Cooperation, Ministry of Health MEMBERSHIP OF THE HEALTH ASSEMBLY 153

Alternates Miss O. AGUNBIADE, Senior Social Welfare Mr N. MIRANDA CASTILLO, Minister Officer, Division of Primary Health Counsellor, Acting Chargé d'affaires, Care, Federal Ministry of Health Permanent Mission of Nicaragua to the United Nations Office and the Other International Organizations at Geneva Mr O. ALEMÁN, Counsellor, Permanent Mission of Nicaragua to the United NORWAY Nations Office and the Other International Organizations at Geneva Delegates Dr T. KIRK, Director -General of Health NIGER Services, Directorate of Health (Chief Delegate) Dr 0. T. CHRISTIANSEN, Deputy Director, Delegates Directorate of Health (Deputy Chief Dr A. MOUDI, Minister of Public Health and Social Affairs (Chief Delegate) Delegate) Mr B. UTHEIM, Counsellor, Dr I. CISSÉ ALFA, Director of Hygiene and Minister Mobile Health Care, Ministry of Public Deputy Permanent Representative of Health and Social Affairs Norway to the United Nations Office and the International Dr A. DAOUDOIk Director of Health, Other Organizations at Geneva Department of Diffa, Ministry of Public Health and Social Affairs Alternate Dr F. MELLBYE, Chief Medical Officer of Health, City of Oslo NIGERIA Advisers Mrs L. HAARSTAD, Head of division, Delegates Directorate of Health Dr E. N. NSAN, Federal Minister of Health Mr H. F. (Chief Delegate) LEINE, Second Secretary, Mr D. MOHAMMAD, Permanent Secretary, Permanent Mission of Norway to the Federal Ministry of Health (Deputy United Nations Office and the Other Chief Delegate)± International Organizations at Geneva Mr B. O. TONWE, Ambassador, Permanent Mrs I. EIDHEIM, Executive Officer, Directorate Health Representative of the Federal Republic of Mrs A. НAUGE, of Nigeria to the United Nations Office Executive Officer, Ministry for Development and the Other International Cooperation Miss B. ELLEFSEN, Lecturer, Organizations at Geneva Norwegian Nurses' Association Alternates Dr A. B. SULAIMAN, Director of National Health Planning, Federal Ministry of Health Dr A. D. KOLAWOLE, Chief Consultant (Primary Health Care), Federal Ministry OMAN of Health Mr B. I. OLINMAH, Principal Secretary (State and External Relations), Federal Delegates Ministry of Health Dr M. AL-KHADURI, Minister of Health (Chief Delegate) Advisers Dr A. AL- GHASSANY, Director of Mr В. A. ADEYEMI, Ambassador, Deputy Preventive Medecine, Ministry of Health Permanent Representative of the Federal Mr M. AL- ZARAFI, First Secretary, Republic of Nigeria to the United Permanent Mission of the Sultanate of Nations Office and the Other Oman to the United Nations Office at International Organizations at Geneva Geneva Mr A. U. ABUBAKAR, Second Secretary, Permanent Mission of the Federal Advisers Republic of Nigeria to the United Mr Z. AL- MANTHRI, Senior Administrative Nations Office and the Other Officer, Minister's Office, Ministry of International Organizations at Geneva Health Dr A. R. M. FERGANY, Adviser on Health 1 Chief Delegate from 11 May. Affairs, Ministry of Health 154 THIRTY -EIGHTH WORLD HEALTH ASSEMBLY

PAKISTAN PAPUA NEW GUINEA

Delegates Delegates M. M. PAL, Director- General of Health, Dr Mr P. KANGE, Minister for Health (Chief Ministry of Health (Chief Delegate) Delegate) Professor B. JAZBI Dr Q. REILLY, Secretary for Health, Mr R. MAHDI, Acting Permanent Ministry of Health (Deputy Chief Representative of the Islamic Republic Delegate) Pakistan to the United Nations of Professor L. AIPU, Senior Research Office and the Specialized Agencies at Officer, Ministry of Health Geneva

Advisers Mr Z. AKRAM, Second Secretary, Permanent PARAGUAY Mission of the Islamic Republic of Pakistan to the United Nations Office and the Specialized Agencies at Geneva Delegates Mr B. KHAN, Permanent Mission of the Dr A. GODOY JIMÉNEZ, Minister of Public Islamic Republic of Pakistan to the Health and Social Welfare (Chief United Nations Office and the Delegate) Specialized Agencies at Geneva Dr J. E. ALDERETE ARIAS, Director -General of Health, Ministry of Public Health and Social PANAMA Welfare Dr A. ÁVILA ORTIZ, Director General, National Medical Centre, Ministry of Public Health Delegates and Social Welfare Dr C. BRANDARIZ, Minister of Health (Chief Delegate) Dr A. MOLTO, Director General of Health, Ministry of Health PERU Dr R. CABALLERO, Director of Health, Province of Chiriqui, Ministry of Health Delegates Alternates Dr C. BAZAN, Minister of Health (Chief Dr Ruth DECEREGA, Deputy Permanent Delegate) Representative, Acting Chargé Mr R. VILLARAN KOECHLIN, Ambassador, d'affaires, Permanent Mission of Panama Permanent Representative of Peru to the to the United Nations Office at Geneva United Nations Office and the Other Mrs I. AIZPURÚA PEREZ, First Counsellor, International Organizations at Geneva Permanent Mission of Panama to the (Deputy Chief Delegate) United Nations Office at Geneva Dr J. DE VINATEA COLLINS, Director General of International Relations, Advisers Ministry of Health Mr O. FERRER ANJIZOLA, Deputy Permanent Representative of Panama to the United Alternates Nations Office at Geneva Dr D. ALZAMORA, Director General of Professor R. G AJALES ROBLES, Counsellor Health Services, Ministry of Health (Scientific Affairs), Permanent Mission Mr J. GONZALES TERRONES, Deputy Permanent of Panama to the United Nations Office Representative of Peru to the United at Geneva Nations Office and the Other Mr L. AGUIRRE GALLARDO, Third Secretary, International Organizations at Geneva Permanent Mission of Panama to the Mr V. ROJAS, First Secretary, Permanent United Nations Office at Geneva Mission of Peru to the United Nations Mrs C. HERNANDEZ, Attaché, Permanent Office and the Other International Mission of Panama to the United Nations Organizations at Geneva Office at,Geneva Mr J. F. RUBIO, Third Secretary, Mrs C. DE VASQUEZ, Attaché (Scientific Permanent Mission of Peru to the United Affairs), Permanent Mission of Panama Nations Office and the Other to the United Nations Office at Geneva International Organizations at Geneva MEMBERSHIP OF THE HEALTH ASSEMBLY 155

PHILIPPINES Dr L. F. DE CARVALHO MAGRO, Director, Office of Studies and Planning, Ministry of Health Delegates Dr J. F. CASTEL-BRANCO, Director - General Dr J. AZURIN, Minister of Health (Chief of Primary Health Care, Ministry of Delegate) Health Mr H. J. BRILLANTES, Ambassador, Permanent Representative of the Philippines to Alternates the United Nations Office and the Other Professor A. RE NDAS, Director, Institute International Organizations at Geneva of Hygiene and Tropical Medicine, Lisbon (Deputy Chief Delegate) Mr F. CABRITA MATIAS, International Mr T. SYQUTA, Ambassador, Deputy Permanent Relations Seсtion, Office of Studies Representative of the Philippines to and Planning, Ministry of Health the United Nations Office and the Other Dr M. M. de J. PINHO DA SILVA, Director, International Organizations at Geneva Health Services of Macao Mr J. VIEIRA BRANCO, Office of the Alternate Secretary of State for Cooperation Mrs V. S. BATACLAN, Second Secretary, Dr A. BARREIROS E SANTOS, Secretariat of Permanent Mission of the Philippines to State for Emigration the United Nations Office and the Other Mr A. PINTO DE LEMOS, Counsellor (Economic International Organizations at Geneva Affairs), Permanent Mission of Portugal to the United Nations Office and the Other International Organizations at POLAND Geneva

Delegates QATAR Dr T. SZELACHOWSKI, Minister of Health and Social Welfare (Chief Delegate) Professor W. J. RUDOWSKI, Director, Delegates Institute of Haematology, Warsaw Mr K. AL -MANA, Minister of Public Health Professor J. NAUMAN, Head, Department of (Chief Delegate) Biochemistry, Postgraduate Medical Mr M. S. R. AL- KUWARI, Ambassador, Education Centre, Warsaw Permanent Representative of the State of Qatar to the United Nations Office Alternates at Geneva and the Specialized Agencies Mr J. ZAWALONKA, Counsellor, Minister in Switzerland (Deputy Chief Delegate) Plenipotentiary, Deputy Permanent Dr A. J. SALMAN, Assistant Under- Secretary Representative of the People's Republic for Technical Affairs, Ministry of of Poland to the United Nations Office Public Health and the Other International Organizations at Geneva Alternates Professor J. JELJASZEWICZ, Chairman, Dr K. AL- JASER, Director of Preventive Scientific Council of the Minister of Medecine, Acting Director of Health and Social Welfare International Relations, Ministry of Professor J. A. INDULSKI, Director, Public Health Institute of Occupational Health in the Mr M. ABU -ALFAIN, Director, Office of the Textile and Chemical Industry, Lódz Minister of Public Health Mr A. H. AL- ABDULLA, Officer in charge of Advisers International Relations, Ministry of Mrs B. BITNER, Department of Public Health International Relations, Ministry of Health and Social Welfare Mr J. RYCHLAK, Counsellor, Permanent Mission of the People's Republic of REPUBLIC OF KOREA Poland to the United Nations Office and the Other International Organizations at Geneva Delegates Mr Hun Ki LEE, Vice -Minister of Health and Social Affairs (Chief Delegate) PORTUGAL Mr Joun Yung SUN, Minister, Office of the Permanent Observer of the Republic of Korea to the United Nations Office and Delegates Permanent Delegation to the Other Mr A. M. MALDONADO GONELHA, Minister of International Organizations at Geneva Health (Chief Delegate) (Deputy Chief Delegate) 156 THIRTY- EIGHTH WORLD HEALTH ASSEMBLY

Dr Sung Woo LEE, Director -General, Bureau RWANDA of Medical Affairs, Ministry of Health and Social Affairs Delegates Dr F. MUGANZA, Minister of Public Health Alternates and Social Affairs (Chief Delegate) Mr Jong Ku AIN, Counsellor, Office of the Dr J. -B. RWASINE, Director -General, Permanent Observer of the Republic of Rwandese Pharmaceuticals Bureau, Korea to the United Nations Office and Ministry of Public Health and Social Permanent Delegation to the Other Affairs International Organizations at Geneva Dr J. -B. KANYAMUPIRA, Director -General of Mr Hong Suk 'WANG, Director, International Public Health, Ministry of Public Affairs Division, Ministry of Health Health and Social Affairs and Social Affairs Mr Sung Yup KIM, First Secretary, Embassy Adviser of the Republic of Korea in Italy Mr R. HORNIKX, Executive Secretary, Mr Tae Sup KIM, Secretary to the Office of Medical Training Vice -Minister of Health and Social Affairs Mr Dong Sun PARK, Third Secretary, Office SAMOA of the Permanent Observer of the Republic of Korea to the United Nations Delegates Office and Permanent Delegation to the Mr F. NONUMALO, Minister of Health (Chief Other International Organizations at Delegate) Geneva Dr G. A. SCHUSTER, Acting Director - General Mr Young Han BAE, Third Secretary, Office of Health, Ministry of Health of the Permanent Observer of the Republic of Korea to the United Nations Office and Permanent Delegation to the SAN MARINO Other International Organizations at Geneva Delegates Dr Emma ROSS', Minister of Health and Adviser Social Security (Chief Delegate) Mrs Mi-1m KIM, Member of the Board of Mr D. E. THOMAS, Minister Trustees of the Korean Nurses' Plenipotentiary, Permanent Observer of Association the Republic of San Marino to the United Nations Office and Permanent Delegate to the Other International Organizations in Switzerland (Deputy ROMANIA Chief Delegate) Dr S. CANDUCCI, Chief, Gynaecological Section, Hospital of San Marino Delegates Mr I. DATCU, Ambassador, Permanent Alternates Representative of the Socialist Mr F. MATSER, Counsellor, Deputy Republic of Romania to the United Permanent Observer of the Republic of Nations Office and the Specialized San Marino to the United Nations Office Agencies at Geneva (Chief Delegate) and Deputy Permanent Delegate to the Professor D. ENACHESCU, Dean, Faculty of Other International Organizations in Medicine, Bucharest (Deputy Chief Switzerland Delegate) Mrs H. ZEILER, First Secretary, Permanent Mission of the Mr T. MELESCANU, Counsellor, Permanent Republic of San Marino Mission of the Socialist Republic of to the United Nations Office at Geneva Romania to the United Nations Office and Permanent Delegation to the Other and the Specialized Agencies at Geneva International Organizations in Switzerland Alternates Mr P. BALOIU, First Secretary, Permanent Mission of the Socialist Republic of SAO TOME AND PRINCIPE Romania to the United Nations Office and the Specialized Agencies at Geneva Delegates Mr I. GOSTIAN, Officer responsible for Dr F. J. H. SEQUEIRA, Minister of Health Relations with WHO, Ministry of Health and Sport (Chief Delegate) MEMBERSHIP OF THE HEALTH ASSEMBLY 157

Dr A. S. M. DE LIMA, Director of Medical Mr M. NDIAYE, Secretary of Embassy, Assistance, Ministry of Health and Sport Permanent Mission of the Republic of Dr J. G. VIEGAS DE CELTA, Director, Senegal to the United Nations Office Malaria Eradication Mission, Ministry and the Specialized Agencies at Geneva of Health and Sport Mr M. SANÉ, Secretary of Embassy, Permanent Mission of the Republic of Senegal to the United Nations Office SAUDI ARABIA and the Specialized Agencies at Geneva

Delegates SEYCHELLES Mr F. AL- HEGELAN, Minister of Health (Chief Delegate) Dr A. A. M. AL- JABARTY, Assistant Deputy Delegates Minister for Manpower Development, Mr J. E. JUMEAU, Minister of Health Ministry of Health (Deputy Chief (Chief Delegate) Delegate) Mrs M. -P. LLOYD, Principal Secretary, Dr Y. Y. AL- MAZROU, Director General, Ministry of Health Primary Health Care Centres, Ministry Mrs P. D. REVERA, Senior Assistant of Health Secretary, Ministry of Health

Alternates Mr S. F. AL- DARER, Acting Director, SIERRA LEONE Department of Management and Organization, Ministry of Health Delegates Mr A. U. AL- KHATTABI, Acting Director, Dr F. SUКU- TAMBA, Minister of Health Department of International Health, (Chief Delegate) Ministry of Health Mr D. Q. B. KAMARA, Permanent Secretary, Mr N. H. QUTUB, Director, Foreign Ministry of Health Relations Department, Ministry of Health Dr Belmont WILLIAMS, Chief Medical Mr A. ZIDAN, Second Secretary, Permanent Officer, Ministry of Health Mission of the Kingdom of Saudi Arabia to the United Nations Office and the Specialized Agencies at Geneva SINGAPORE

Adviser Dr S. FAQIR, Director, Soleiman Faqih Delegates Hospital, Jeddah Dr CHEW Chin Hin, Deputy Director of Medical Services (Hospitals), Ministry of Health (Chief Delegate) Dr WING Kum Leng, Medical Director, SENEGAL Singapore General Hospital, Ministry of Health Mr CHEW Tai Soo, Ambassador, Permanent Delegates Representative of the Republic of Mr A. SENE, Ambassador, Permanent Singapore to the United Nations Office Representative of the Republic of and the Specialized Agencies at Geneva Senegal to the United Nations Office and the Specialized Agencies at Geneva Alternates (Chief Delegate) Mr S. SUBRAMANIAM, First Secretary, Mr M. G. L0, Technical Adviser, Office of Permanent Mission of the Republic of the Minister of Public Health Singapore to the United Nations Office Professor D. BA, Director of Research, and the Specialized Agencies at Geneva Planning and Training, Ministry of Mr Y. RAHMAN, Third Secretary, Permanent Public Health Mission of the Republic of Singapore to the United Nations Office and the Alternates Specialized Agencies at Geneva Mr I. SY, First Counsellor, Permanent Mission of the Republic of Senegal to the United Nations Office and the SOLOMON ISLANDS Specialized Agencies at Geneva М. S. C. KONATE, Second Counsellor, Permanent Mission of the Republic of Delegates Senegal to the United Nations Office Mr J. TEPAIKA, Minister of Health and and the Specialized Agencies at Geneva Medical Services (Chief Delegate) 158 THIRTY- EIGHTH WORLD HEALTH ASSEMBLY

Mr P. FUNIFAKA, Permanent Secretary, Advisers Ministry of Health and Medical Services Mr A. DE LA SERNA, Ambassador, Permanent Dr N. KERE, Under -Secretary, Ministry Representative of Spain to the United of Health and Medical Services Nations Office at Geneva and Other International Organizations in Alternate Switzerland Miss J. KIRIAN, Ministry of Dr C. NAVARRO, Deputy Director General Foreign Affairs for International Affairs, Ministry of Health and Consumer Affairs Mr M. PÉREZ DEL ARCO, Counsellor, SOMALIA Permanent Mission of Spain to the United Nations Office at Geneva and Other International Organizations in Delegates Switzerland Dr Y. H. ELM', Minister of Health (Chief Mr M. GOIZUETA SANCHEZ, Counsellor Delegate) (Financial and Fiscal Affairs), Mrs F. ISAK BIHI, Ambassador, Permanent Permanent Mission of Spain to the Representative of the Somali Democratic United Nations Office at Geneva and Republic to the United Nations Office Other International Organizations in at Geneva and the Specialized Agencies Switzerland in Switzerland (Deputy Chief Delegate) Professor A. K. SHIRE, Director General of Curative Medicine, Ministry of Health SRI LANKA

Alternates Professor A. SHERIF ABВAS, Delegates Director -General of Preventive Dr R. ATAPATTU, Minister of Health (Chief Medicine, Ministry of Health Delegate) Professor K. M. SUFI, Adviser, Mr L. PANAMBALANA, Secretary, Ministry of Ministry of Health Health Mrs F. ENO- HASSAN, Second Counsellor, Dr M. FERNANDO, Director General of Health Permanent Mission of the Somali Services, Ministry of Health Democratic Republic to the United Nations Office at Geneva and the Alternate Specialized Agencies in Switzerland Mr M. SAMARASINGHE, First Secretary, Permanent Mission of the Democratic Socialist Republic of Sri Lanka to the SPAIN United Nations Office aid the Other International Organizations at Geneva

Delegates Adviser Professor E. LLUCH, Minister of Health Mr J. DHANAPALA, Ambassador, Permanent and Consumer Affairs (Chief Delegate) Representative of the Democratic Dr C. H. GIL, Under -Secretary, Ministry Socialist Republic of Sri Lanka to the of Health and Consumer Affairs (Deputy United Nations Office and the other Chief Delegate) International Organizations at Geneva Dr A. DEL RfO, Executive Adviser to the Minister of Health and Consumer Affairs

Alternates SUDAN Dr J. ARTIGAS, Secretary General (Technical Affairs), Ministry of Health and Consumer Affairs Delegates Dr H. S. ABU SALIH, Dr J. NADAL, Director of the Office of Minister of Health (Chief Delegate) the Minister of Health and Consumer Affairs Dr M. Y. EL AWAD, Under -Secretary, Ministry Dr E. VIGIL, Director General of Health of Health and Social Welfare Planning, Ministry of Health and Dr Z. A. NUR, Director -General of Consumer Affairs International Health, Ministry of Mr J. LdPEZ DE clICHERI, Minister Health and Social Welfare Plenipotentiary, Deputy Permanent Representative of Spain to the United Alternates Nations Office at Geneva and Other Dr Y. OSMAN, Director -General of International Organizations in Occupational Health, Ministry of Health Switzerland and Social Welfare MEMBERSHIP OF THE HEALTH ASSEMBLY 159

Dr M. I. EL DEER, Ambassador, Permanent Dr Barbro WESTERHOLM, Director General, Representative of the Democratic National Board of Health and Welfare Republic of Sudan to the United Nations (Deputy Chief Delegate)1 Office at Geneva and the Specialized Mr G. DAHLGREN, Head, Department of Agencies in Switzerland Health and Health Services, Ministry of Mr M. S. ABBAS, Counsellor, Permanent Health and Social Affairs Mission of the Democratic Republic of Sudan to the United Nations Office at Alternates Geneva and the Specialized Agencies in Mr L. DANIELSSON, First Secretary, Switzerland Permanent Mission of Sweden to the United Nations Office and the Other Advisers International Organizations at Geneva Professor A. R. M. MUSA, Dean, Faculty of Mr B. EKLUNDH, Head of section, National Medicine, University of Khartoum Board of Health and Welfare Mr O. B. SHOUNA, Ambassador, Deputy Mr H. V. EWERLOF, Ambassador, Permanent Permanent Representative of the Representative of Sweden to the United Democratic Republic of Sudan to the Nations Office and the Other United Nations Office at Geneva and the International Organizations at Geneva Specialized Agencies in Switzerland Miss A. -C. FILIPSSON, Head of section, Mr Y. E. ISMAIL, Minister Plenipotentiary, Ministry of Health and Social Affairs Permanent Mission of the Democratic Mr C. -J. GROTH, Minister Plenipotentiary, Republic of Sudan to the United Nations Deputy Permanent Representative of Office at Geneva and the Specialized Sweden to the United Nations Office and Agencies in Switzerland the Other International Organizations at Geneva Mrs C. REGNELL, Head of section, Swedish International Development Authority SURINAME Mr D. SKALIN, Chief Investigator, Swedish Federation of County Councils

Delegates Adviser Dr R. E. VAN TRIKT, Minister of Health Mr H. CEDER, Secretary -General, National (Chief Delegate) Society for the Disabled Dr H. M. TJON JAW CHONG, Permanent Secretary, Ministry of Health Dr M. KERPENS, Ministry of Foreign Affairs SWITZERLAND

Alternate Mr C. DE BACK, Ministry of Health Delegates Professor B. A. ROOS, Director, Federal Office of Public Health (Chief Delegate) Mr J. -P. VETTOVAGLIA, Minister, Deputy SWAZILAND Head of the Permanent Mission of Switzerland to the International Organizations at Geneva Delegates Dr Immita CORNAZ, Scientific Assistant, Н. R. Н. Prince Phiwokwakhe DLAMINI, Directorate for Cooperation in Development Minister of Health (Chief Delegate) and Humanitarian Aid, Mr H. B. MALAZA, Under -Secretary, Federal Department of Foreign Affairs Ministry of Health (Deputy Chief Delegate) Alternates J. Dr Ruth T. TSHABALALA, Deputy Director of Dr SCHEURER, Scientific Assistant, Medical Services, Ministry of Health Federal Office of Public Health Mr Y. D. EMERY, Scientific Assistant, Alternate Federal Financial Administration Miss M. MAKIUBU, Chief Nursing Officer, Miss S. BORNAND, Specialist, Federal Ministry of Health Office of Public Health Dr W. FLURY, Vice -Director and Chief, Medical Section, Intercantonal Office for Control of Drugs SWEDEN

Delegates Mrs G. SIGURDSEN, Minister of Health and 1 Chief Delegate on 6 May and from Social Affairs (Chief Delegate) 9 May. 160 THIRTY -EIGHTH WORLD HEALTH ASSEMBLY

Advisers TONGA Mrs M. MEYRAT, Head, Health and Social Affairs Section, Swiss Red Cross Dr H. R. SAHLI, Vice -President, Swiss Delegate Doctors' Federation Dr S. TAfA, Minister of Health Mrs E. SCHLAEPPI, President, Swiss Nurses' Association TRINIDAD AND TOBAGO

SYRIAN ARAB REPUBLIC Delegates Professor Norma LEWIS-PHILLIPS, Minister Delegates of Health and Environment (Chief Dr G. RIFAI, Minister of Health (Chief Delegate) Delegate) Mr L. E. WILLIAMS, Ambassador, Permanent Dr M. BARS, Vice -Minister of Health Representative of the Republic of (Deputy Chief Delegate) Trinidad and Tobago to the United Dr W. HUSSEIN, Director of International Nations Office in Geneva and the Relations, Ministry of Health Specialized Agencies in Europe (Deputy Chief Delegate) Alternates Dr A. 1M POW, Permanent Secretary, Mr H. JOUNDI, Minister Counsellor, Ministry of Health and Environment Permanent Mission of the Syrian Arab Alternates Republic to the United Nations Office at Geneva and the Specialized Agencies Dr Elizabeth S. M. QUAMINA, Chief Medical in Switzerland Officer, Ministry of Health and Environment Dr G. KAWAS, Director of Medical Services, Ministry of Health Mrs J. -E. GEORGE, Counsellor, Permanent Mission of the Republic of Trinidad and Tobago to the United Nations Office in THAILAND Geneva and the Specialized Agencies in Europe

Delegates Mr M. BUNNAG, Minister of Public Health TUNISIA (Chief Delegate) Dr A. NONDASUТA, Permanent Secretary, Delegates Ministry of Public Health Professor Souad LYACOUBI- OUACHI, Minister Dr U. SUDSUКН, Deputy Permanent Secretary, of Public Health (Chief Delegate) Ministry of Public Health Mr F. MEBAZAA, Ambassador, Permanent Representative of Tunisia to the United Alternate Nations Office at Geneva and the Dr D. BOONYOEN, Director, Health Planning Specialized Agencies in Switzerland Division, Office of the Permanent (Deputy Chief Delegate) Secretary, Ministry of Public Health Mr M. FEKIH, Chargé de mission, Inspector General of Health, Ministry of Public Adviser Health Mr C. SATJIPANON, Second Secretary, Permanent Mission of Thailand to the Alternates United Nations Office at Geneva and the Mr M. GHACHEM, Chargé de mission, Specialized Agencies in Switzerland Coordinator of Technical Cooperation Units, Ministry of Public Health Dr H. SAIED, Inspector General of Health, TOGO Ministry of Public Health Mr N. НADJ ALI, Attaché, Office of the Minister of Public Health Delegates Professor A. AGBETRA, Minister of Public Advisers Health, Social Affairs and Conditions Miss R. BEN LAHBIB, Head of section, of Women (Chief Delegate) Directorate of International Dr K. SIAMEV, Chief Physician, National Cooperation, Ministry of Public Health Health Education Section, Ministry of Mr K. EL HAFDHI, Minister Public Health and Social Affairs Plenipotentiary, Deputy Permanent Dr O. TIDJANI, Chief Physician, Major Representative of Tunisia to the United Communicable Diseases Service, Nations Office at Geneva and the University Hospital, Lomé Specialized Agencies in Switzerland MEMBERSHIP OF THE HEALTH ASSEMBLY 161

Mr I. LEJRI, Counsellor, Permanent UNION OF SOVIET SOCIALIST REPUBLICS Mission of Tunisia to the United Nations Office at Geneva and the Specialized Agencies in Switzerland Delegates Professor Saida DOUKI, Ministry of Public Dr S. P. BURENKOV, Minister of Health of Health the USSR (Chief Delegate) Professor Ju. F. ISAKOV, Deputy Minister of Health of the USSR TURKEY Mr M. D. SYTENKO, Ambassador, Permanent Representative of the USSR to the United Nations Office and the Other Delegates International Organizations at Geneva Mr M. AYDIN, Minister of Health and Social Assistance (Chief Delegate) Advisers Professor Y. МÜFTÜ, Under -Secretary of Dr E. V. KOSENKO, Chief, External State, Ministry of Health and Social Relations Board, Ministry of Health of Assistance (Deputy Chief Delegate) the USSR Mr T. TARLAN, Deputy Permanent Mr A. D. JUKOV, Deputy Permanent Representative of Turkey to the United Representative of the USSR to the Nations Office at Geneva and the Other United Nations Office and the Other International Organizations in International Organizations at Geneva Switzerland Dr A. M. GLOTOV, Deputy Chief, External Relations Board, Ministry of Health of Alternates the USSR Professor Neclâ CEVIK, Director, Dr V. N. IVANOV, Assistant to the External Affairs Department, Ministry Minister of Health of the USSR of Health and Social Assistance Dr V. I. KAZEI, Head, Research Professor MUnevver BERTAN, Faculty of Coordination Department, Academy of Medicine, Hacettepe University; Medical Sciences of the USSR Adviser, Ministry of Health and Social Mr D. A. SOKOLOV, Counsellor, Ministry of Assistance Foreign Affairs of the USSR Dr U. ÜNSAL, Acting Director General, Mr V. V. FEDOROV, Counsellor, Permanent Primary Health Care Department, Mission of the USSR to the United Ministry of Health and Social Assistance Nations Office and the Other Mr E. APAKAN, Counsellor, Permanent International Organizations at Geneva Mission of Turkey to the United Nations Mr M. M. ROUFOV, Second Secretary, Office at Geneva and the Other Permanent Mission of the USSR to the International Organizations in United Nations Office and the Other Switzerland International Organizations at Geneva Mr H. G6GUS, First Secretary, Permanent Dr A. I. SAVINYH, Senior Medical Officer, Mission of Turkey to the United Nations External Relations Board, Ministry of Office at Geneva and the Other Health of the USSR International Organizations in Mr A. S. PETUKHOV, Senior Administrative Switzerland Officer, External Relations Board, Ministry of Health of the USSR Mr A. S. GRITSENKO, Chief, All -Union Department Of International UGANDA Communications, Ministry of Health of the USSR Dr M. N. SAVEL'EV, Chief, Department of Delegates International Health, Semagko All -Union Dr E. R. NKWASIBWE, Minister of Health Institute for Research on Social (Chief Delegate) Hygiene and Public Health Dr S. ETYONO, Director of Medical Administration, Ministry of Health of Services, Ministry of Health the USSR Dr I. S. OKWARE, Assistant Director of Dr E. V. GALAHOV, Chief of unit, Foreign Medical Services (Public Health), Health Services Department, Semasko Ministry of Health All -Union Institute for Research on Social Hygiene and Public Health Alternates Administration, Ministry of Health of Professor J. T. KAKITAHI, Associate the USSR Professor of Public Health, Director of Mr V. S. NEMTSEV, Attaché, Permanent Nutrition Services, Ministry of Health Mission of the USSR to the United Mr Z. KALEGA, Executive Secretary, Nations Office and the Other Uganda Protestant Medical Bureau International Organizations at Geneva 162 THIRTY -EIGHTH WORLD HEALTH ASSEMBLY

Dr Lydia I. NOVAK, President of the Alternates Central Committee of the Trade Union of Dame Anne WARBURTON, Ambassador, Permanent Medical Professionals of the USSR Representative of the United Kingdom to Dr Natalia N. VOROB'EVA, Vice -President the United Nations Office and the Other of the Central Committee of the Trade International Organizations at Geneva Union of Medical Professionals of the Dr J. J. A. REID, Chief Medical Officer, USSR Scottish Home and Health Department Mrs A. POOLE, Chief Nursing Officer, Department of Health and Social Security UNITED ARAB EMIRATES Dr D. OWER, Senior Principal Medical Officer, Department of Health and Social Security Delegates Mr D. MOSS, Counsellor, Deputy Permanent Mr H. AL-MADFA, Minister of Health (Chief Representative of the United Kingdom to Delegate) the United Nations Office and the Other Dr S. AL- QASSIMI, Under -Secretary, International Organizations at Geneva Ministry of Health Mr G. LUPTON, Assistant Secretary, Dr F. AL- QASSIMI, Assistant International Relations Division, Under- Secretary, Ministry of Health Department of Health and Social Security

Alternates Advisers Dr A. R. JAFFAR, Assistant Mrs J. MIXER, Principal, International Under-Secretary, Ministry of Health Relations Division, Department of Mr E. K. AL- MUHAIRI, Director, Department Health and Social Security of World Health and International Miss J. McKESSACK, Private Secretary to Relations, Ministry of Health the Parliamentary Under-Secretary of Dr M. M. FIKRI, Director, Kalba Hospital State for Health, Department of Health aid Eastern District, Ministry of Health and Social Security Dr A. G. M. ABDUL GHAFOOR, Director of Mr T. J. DAVID, First Secretary, Permanent Health School, Ministry of Health Mission of the United Kingdom to the Mr A. -R. AL SHAMLAN, Acting Chargé United Nations Office and the Other d'affaires, Permanent Mission of the International Organizations at Geneva United Arab Emirates to the United Mr A. R. MICHAEL, Second Secretary, Nations Office and the Specialized Permanent Mission of the United Kingdom Agencies at Geneva to the United Nations Office and the Mr I. BUSHEHAB, First Secretary, Permanent Other International Organizations at Mission of the United Arab Emirates to Geneva the United Nations Office and the Mr R. W. KYLES, Third Secretary, Permanent Specialized Agencies at Geneva Mission of the United Kingdom to the Mr Y. HUREIZ, Permanent Mission of the United Nations Office and the Other United Arab Emirates to the United International Organizations at Geneva Nations Office and to the Specialized Mr H. GIBES, International Relations Agencies at Geneva Division, Department of Health and Social Security

UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND UNITED REPUBLIC OF TANZANIA

Delegates Mr J. PATTEN, Parliamentary Delegates Under -Secretary of State for Health Dr A. D. CHIDUO, Minister for Health (Chief Delegate) (Chief Delegate) Dr E. D. ACHESON, Chief Medical Officer, Mr M. M. ABDULLAH, Minister for Health, Department of Health and Social Zanzibar (Deputy Chief Delegate) Security (Deputy Chief Delegate)1 Dr W. K. CHAGULA, Ambassador, Permanent Dr E. L. HARRIS, Deputy Chief Medical Representative of the United Republic Officer, Department of Health and of Tanzania to the United Nations Social Security2 Office at Geneva

Alternates Dr A. Y. ‚GENT, Director, Preventive Health Department, Ministry of Health 1 Chief Delegate from 6 to 8 May. Dr U. M. KISUMKU, Director, Preventive 2 Chief Delegate from 11 May. Health Department, Zanzibar MEMBERSHIP OF THE HEALTH ASSEMBLY 163

Assistant Mr S. J. ASIAN, Counsellor, Permanent Dr J. M. McGINNIS, Deputy Mission of the United Republic of Secretary for Health, United States of Tanzania to the United Nations Office Public Health Service, Department at Geneva Health and Human Services H. First Mr P. B. HANDO, Executive Secretary, Mr G. SHEINBAUM, Secretary, Christian Medical Board, Dar es Salaam United States Permanent Mission to the United Nations Office and the Other International Organizations at Geneva UNITED STAТES OF AMERICA Mr M. de H. DWYRE, Attaché, United States Permanent Mission to the United Nations Office aid the Other International Delegates Organizations at Geneva Mrs M. M. HECKLER, Secretary of Health and Human Services (Chief Delegate) Dr C. E. KOOP, Surgeon General of the URUGUAY United States Public Health Service and Director, Office of International Health, Department of Health and Human Delegates Services (Deputy Chief Delegate) Dr R. UGARTE ARTOLA, Minister of Public Mr G. P. CARMEN, Ambassador, United States Health (Chief Delegate) Dr C. General of Permanent Representative to the United МIGUES B., Director- Nations Office and the Other Health, Ministry of Public Health International Organizations at Geneva Mr C. A. FERNANDEZ-BALLESTEROS, Minister, Deputy Permanent Representative of the Alternates Eastern Republic of Uruguay to the Dr F. YOUNG, Commissioner of Food and United Nations Office at Geneva and the Drugs, United States Public Health International Organizations in Service, Department of Health and Human Switzerland Services Dr T. MALONE, Deputy Director, National Alternate Institutes of Health, Department of Dr J. MEYER -LONG, Second Secretary, Health aid Human Services Permanent Mission of the Eastern Mr N. A. BOYER, Director for Health and Republic of Uruguay to the United Narcotics Programmes, Bureau of Nations Office at Geneva and the International Organization Affairs, International Organizations in Department of State Switzerland

Advisers VANUATU Mr W. C. BARTLEY, International Health Attaché, United States Permanent Mission to the United Nations Office and the Other International Delegates Organizations at Geneva Dr W. KORISA, Minister of Health (Chief Miss R. BELMONT, Associate Director for Delegate) Multilateral Programs, Office of Mr S. LEODORO, First Secretary, International Health, Department of Ministry of Health Health and Human Services Mr N. BRADY, Senior Assistant Administrator for Science and VENEZUELA Technology, United States Agency for International Development Delegates Mr R. D. FLACK, Political Counsellor, United States Permanent Mission to the Dr J. M. PADILLA, Vice -Minister of Health United Nations Office and the Other and Social Welfare (Chief Delegate) International Organizations at Geneva Dr. L. V. MORALES ARAUJO, Sectoral Miss J. A. GREGG, Second Secretary, Director -General of Health, Ministry of United States Permanent Mission to the Health and Social Welfare (Deputy Chief United Nations Office and the Other Delegate) International Organizations Geneva at Dr Maria- Esperanza RUESTA DE FURTER, Dr D. HOPKINS, Deputy Director, Centers Attaché, Permanent Mission of the for Disease Control, United States Republic of Venezuela to the United Public Health Service, Department of Nations Office and the Other Health and Human Services International Organizations at Geneva 164 THIRTY -EIGHTH WORLD HEALTH ASSEMBLY

Alternate Mr K. VIDAS, Ambassador, Permanent Mrs M. FERRERO DE BARRIOS, Second Representative of the Socialist Federal Secretary, Permanent Mission of the Republic of Yugoslavia to the United Republic of Venezuela to the United Nations Office and the International Nations Office and the Other Organizations at Geneva (Deputy Chief International Organizations at Geneva Delegate) Professor V. STAROVA, President, Yugoslav Commission for Cooperation VIET NAM with WHO

Alternates Delegates Miss Z. ILIC, Counsellor, Permanent Mr NGUYEN THUONG, Ambassador, Permanent Mission of the Socialist Federal Representative of the Socialist Republic of Yugoslavia to the United Republic of Viet Nam to the United Nations Office and the International Nations Office and the Other Organizations at Geneva International Organizations at Geneva Mr D. BOBAREVIC, Head of the Group for (Chief Delegate) International Cooperation in the Field Dr NGUYEN KIM PRONG, Deputy Director, of Health and Social Welfare, Federal Department of Prevention and Treatment, Committee for Labour, Health aid Social Ministry of Health (Deputy Chief Welfare Delegate) Mr LE DIN' CAN, Counsellor, Permanent Adviser Mission of the Socialist Republic of Dr N. GEORGIEVSKI, Assistant to the Viet Nam to the United Nations Office President of the Federal Committee for and the Other International Labour, Health and Social Welfare Organizations at Geneva

Alternate ZAIRE Mr VU HUY TAN, Third Secretary, Permanent Mission of the Socialist Republic of Viet Nam to the United Nations Office Delegates and the Other International Mr K. W. MUSHOBEKWA, Commissioner of Organizations at Geneva State for Public Health (Chief Delegate) Dr M. MOUCKA, Chargé de relations, Department of Public Health YEMEN Mr F. B. KIBIKONDA, Director of Pharmacies and Laboratories, Department Delegates of Public Health Dr M. AL-KABAB, Minister of Health (Chief Delegate) Alternates Dr K. LUVIVILA, Director, National Mr H. M. AL MAGBALY, Ambassador, Permanent Health Care, Representative of the Yemen Arab Directorate of Primary Department of Public Health Republic to the United Nations Office NKUBA, Department Public at Geneva aid the Specialized Agencies Mr A. -M. of in Europe Health Counsellor, Dr M. M. НAJAR, Director General of Mr O. N. MONSHEMVULA, First Health Affairs, Ministry of Health Permanent Mission of the Republic of Zaire to the United Nations Office at and Specialized Agencies in Alternates Geneva the Switzerland Mr K. AL- SAKKAF, Director of International Health Relations, Ministry of Health Dr A. A. ZABARAH, Director of Primary Health Care, Ministry of Health ZAMBIA

YUGOSLAVIA Delegates Mr P. CHANSHI, Minister of State, Ministry of Health (Chief Delegate) Delegates Dr S. L. NYAYWA, Assistant Director of Professor D. JAKOVLJEVIC, Member of the Medical Services (Primary Health Care), Federal Executive Council; President Ministry of Health of the Federal Committee for Labour, Mrs R. BANDA, Assistant Chief Nursing Health and Social Welfare (Chief Officer (Administration), Ministry of Delegate) Health MEMBERSHIP OF THE HEALTH ASSEMBLY 165

ZIMBABWE Dr D. G. MAKUTO, Deputy Secretary for Health, Rural Health Services Division, Ministry of Health Delegates Dr S. T. SEKERAMAYI, Minister of Health Alternate (Chief Delegate) Mrs J. T. TAGWIREYI, Acting Director, Professor 0. S. CHIDEDE, Secretary for Department of Nutrition, Ministry of Health, Ministry of Health (Deputy Health Chief Delegate)

REPRESENTATIVES OF AN ASSOCIATE MEMBER

NAMIBIA

Mr G. TOWO- ATANGANA, Counsellor, United Nations Council for Namibia Mrs I. L. AMATHILA, Deputy Secretary for Health and Social Welfare Dr T. DUBE, Department of Political Affairs, Trusteeship and Decolonization, United Nations

OBSERVERS FOR A NON- MEMBER STATE

HOLY SEE

Monsignor G. BERTELLO, Acting Chargé d'affaires, Permanent Mission of the Holy See to the United Nations Office and the Specialized Agencies at Geneva Dr J. BONNEMAIN, Permanent Mission of the Holy See to the United Nations Office and the Specialized Agencies at Geneva

OBSERVERS

ORDER OF MALTA

Dr O. FALCO, Ambassador, Permanent Delegate Mr R. VILLARD DE THOIRE, Counsellor, of the Sovereign Order of Malta to the Permanent Delegation of the Sovereign International Organizations at Geneva Order of Malta to the International Count G. DE PIERREDON, Hospitaller of the Organizations at Geneva Order of Malta Professor J. LANGUILLON, Technical Adviser, Count E. DECAZES, Ambassador, Deputy International Committee of the Sovereign Permanent Delegate of the Sovereign Order Order of Malta for Aid to Leprosy Victims of Malta to the International Dr C. R. FEDELE, Technical Legal Adviser, Organizations at Geneva Permanent Delegation of the Sovereign Order of Malta to the International Organizations at Geneva 166 THIRTY -EIGHTH WORLD HEALTH ASSEMBLY

OBSERVERS INVITED IN ACCORDANCE WITH RESOLUTION WHA27,37

AFRICAN NATIONAL CONGRESS Dr A. BASHIR Miss H. AL-AYOUBI Mr R. KHOURI Dr P. MFELANG Dr R. HUSSEINI Dr E. TAROUBA

PALESTINE LIBERATION ORGANIZATION PAN AFRICANIST CONGRESS OF AZANIA

Dr F. ARAFAT, President of the Palestine Red Crescent Society Mr R. JOHNSON Mr N. RAMLAWI, Permanent Observer of the Palestine Liberation Organization to the United Nations Office at Geneva

MEMBERS OF THE SPECIAL COMMITTEE OF EXPERTS APPOINTED TO STUDY TIE HEALTH CONDITIONS OF THE INHABITANTS OF THE OCCUPIED TERRITORIES IN THE MIDDLE EAST

Dr T. IONESCU (Chairman) Dr SOEJOGA Dr Madiou TOURE

REPRESENTATIVES OF THE UNITED NATIONS AND RELATED ORGANIZATIONS

United Nations Mr K. KURODA, Co- ordination Officer, Office of the United Nations Disaster Mr W. H. TARZI, Deputy Director -General Relief Co- ordinator of the United Nations Office at Geneva Mrs A. DJERМAKOYE, External Relations and Mrs T. OPPENHEIMER, Director, Division of Inter -Agency Affairs Officer Narcotic Drugs Miss R. MARTINEAU, Nongovernmental Mr E. OTEIZA, Director, United Nations Organizations Liaison Officer Research Institute for Social Mr. H. NABULSI, Executive Coordinator, Development, Geneva United Nations Volunteers Programme Mr Т. S. ZOUPANOS, Chief, External Mr S. M. FINN, Deputy Executive Relations and Inter -Agency Affairs Coordinator, Programme Operations Mr F. RAMOS- GALINO, Deputy Director, Division, United Nations Volunteers Division of Narcotic Drugs Programme Mr H. ANSAR -KHAN, Senior Liaison Officer, Mr E. MURAI, Chief, Programme Policy and Centre against Apartheid, Geneva Support Division, United Nations Mr C. RICHARD, Head, Statistical Unit, Volunteers Programme United Nations Research Institute for Miss V. SAURWEIN, Nongovernmental Social Development, Geneva Organizations Liaison Officer Mr A. H. GAHAM, Human Rights Officer, Dr D. D. C. DON NANJIRA, Co- ordination Centre for Human Rights, Geneva Officer, Office of the United Nations Mr V. LISSITSKY, External Relations and Disaster Relief Co-ordinator Inter- Agency Affairs Officer Mr W. SCOTT, Senior Research Officer, United Nations Research Institute for Social Development, Geneva United Nations Children's Fund Mr F. VERHAGEN, Co- ordination Officer, Ms S. BARRY, External Office of the United Nations Disaster Senior Relations Relief Co- ordinator Officer MEMBERSHIP OF THE HEALTH ASSEMBLY 167

Mr W. HOOKS, Programme Officer (Emergency) United Nations Fund for Drug Abuse Control Ms M. NEWMAN- BLACK, Nongovernmental Organizations Liaison Officer, UNICEF Mr H. EMBLAD, Assistant Executive Director Office for Europe Ms M. BENNETT, Evaluation Officer Mrs M. L. CARDWELL, External Relations Officer, Reference Centre, UNICEF Nations Fund for Population Office for Europe United Activities Mr D. DRUCKER, Guest Editor, "UNICEF News" Mr R. GOODALL, Adviser, Essential Drugs Mr B. S. MUNТASSER, Principal Liaison Section, Division of Programme Geneva Office Development and Planning, UNICEF Officer, G. ARGUELLO, Liaison Officer, Headquarters, New York Mr PEREZ- Geneva Office Dr P. FAZZI, Coordinator, WHO /UNICEF Joint Nutrition Support Programme, Mr L. N. N'DIAYE, Chief of Africa Branch UNICEF Headquarters, New York Dr P. -E. MANDL, Senior Officer, UNICEF United Nations High Office for Europe Office of the Commissioner for Refugees Mrs C. TARIMO, UNICEF Office for Europe Mr M. M. RAJENDRAN, Senior Programme H. MATSUMOTO, Head, Inter -Agency Officer, UNICEF Headquarters, New York Mr Coordination, External Affairs Division Mrs G. SAGARRA, Inter -Agency Technical Cooperation Officer, Assistance Division United Nations Relief and Works Agency for Palestine Refugees in the Near East International Labour Organisation Dr H. J. H. HIDDLESTONE, Director of Health and WHO Representative to UNRWA Mrs A. SETH -MANI, Office of the Adviser for Inter- Organisation Affairs Mr J. J. DE MARTINO, Office of the Adviser for Inter -Organisation Relations United Nations Development Programme

Mr A. AJELLO, Assistant Administrator and Food and Agriculture Organization of the Director, UNDP European Office United Nations Mr E. BONEV, Principal Officer, External Relations, UNDP European Office Mr J. C. VIGNAUD, FAO Representative to the United Nations Organizations in Geneva Mr A. PURCELL, Economist, Office of the United Nations Environment Programme FAO Representative to the United Nations Organizations in Geneva Dr A. KOUTCHERENKO, Scientific Affairs Miss C. LUMSDEN, Office of the FAO Officer, International Register of Representative to the United Nations Potentially Toxic Chemicals Organizations in Geneva

United Nations Educational, Scientific and United Nations Conference on Trade and Cultural Organization Development Mrs J. WYNTER, Head, UNESCO Liaison Ms A. VON WARTENSLEBEN, Chief, Advisory Office in Geneva Service on Transfer of Technology, Technology Division World Bank

Mr L. P. CHATENAY, World Bank United Nations Industrial Development Representative to the United Nations Organization Organizations, Geneva

Mr A. PATHMARAJAH, Special Representative of the Executive Director of UNIDO at International Atomic Energy Agency Geneva Mr G. PAPULI, Assistant to the Special Mrs M. S. OPELZ, Head, IAEA Office Representative of the Executive in Geneva Director of UNIDO at Geneva Miss A. WEBSTER, IAEA Office in Geneva 168 THIRTY -EIGHTH WORLD HEALTH ASSEMBLY

REPRESENTATIVES OF OTHER INTERGOVERNMENTAL ORGANIZATIONS

Commission of European Communities Intergovernmental Committee for Migration

Dr E. BENNETT, Director, Health and Safety Dr C. SCHOU, Director of Medical Services Directorate, Directorate -General of Mr H. HABENICHT, Director, Department of Employment, Social Affairs and Education Planning, Liaison and Research Dr H. ERISKAT, Head of division, Directorate -General of Employment, Social Affairs and Education International Civil Defence Organization Mr C. DUFOUR, Secretary, Permanent Delegation of the Commission of the Dr M. M. BID', Secretary -General European Communities to the United Dr J. C. PINEDA, Director, Technical Nations Office and the Other Cooperation Division International Organizations at Geneva Dr A. BERLIN, Head, Toxicology Section, Health and Safety Directorate, International Committee of Military Medicine Directorate -General of Employment, and Pharmacy Social Affairs and Education Professor H. SCHWAMM, Counsellor, Dr E. SCHWARZ Permanent Delegation of the Commission of the European Communities to the United Nations Office and the Other League of Arab States International Organizations at Geneva Miss F. NOËL, Administrator, Permanent Mr I. E. ALBRAHIM, Assistant Secretary Delegation of the Commission of the General European Communities to the United Mr M. EL -MAY, Ambassador, Permanent Nations Office and the Other Observer for the League of Arab States International Organizations at Geneva to the United Nations Office at Geneva Dr F. EL- GERBI, Director, Department of Health and Environmental Protection, Arab League, Tunis Commonwealth Secretariat Mr M. OREIBI, Deputy Permanent Observer for the League of Arab States to the Mr M. MALHOUTRA, Assistant Secretary - United Nations Office at Geneva General Dr B. SAMARA, Department of Health and Miss J. COLE, Health Administrator Environmental Protection, Arab League, Professor A. M. NHONOLI, Regional Health Tunis Secretary for East, Central and Mr O. EL- НAJJE, Attaché (Legal and Social Southern Africa Affairs), Permanent Delegation of the Professor K. THAIRU, Medical Adviser League of Arab States to the United Professor P. O. FASAN, Executive Director, Nations at Geneva West African Health Community Mr A. ALAIMI, League of Arab States, Tunis Mr M. HENRY, Programme Coordinator, Caribbean Community Mr M. Y. ALI Organization of African Unity Professor R. BADGLEY Mrs N. JARRET Mr M. L. ALLOUANE, Assistant Secretary - General Dr A. H. SALAMA, Director, Health and Nutrition Bureau Council of Ministers of Health of Arab Mr A. FARAG, Counsellor, Permanent Countries of the Gulf Area Delegation of the Organization of African Unity to the United Nations Dr J. M. AASHI, Secretary - General Office at Geneva

Council for Mutual Economic Assistance Organisation of the Islamic Conference

Dr S. A. SIAGAEV, Chief, Health Department Mr BIRZADAH MEMBERSHIP OF THE HEALTH ASSEMBLY 169

REPRESENTATIVES OF NONGOVERNMENTAL ORGANIZATIONS

African Medical and Research Foundation Dr R. P. LINDSAY International Miss M. E. EDMUNDS Miss A. LAEMMLEN Mr D. LACKEY Dr R. MORGAN Professor C. PAPATHEODOROU Professor Ann HELM Aga Khan Foundation Dr N. TEKLE MICHAEL Dr D. MENGНESНA Dr J. MANENO Dr W. T. MARIAM Dr N. J. VERJEE Ms L. A. TEMANSON Dr D. KASEJE Mr E. Н. VAN NESS Dr A. MOHAMED Dr H. SJAARDEMA Dr E. BOOSTROM Dr P. DEAN Dr R. CRONIN Mrs D. DEAN Dr J. MONTAGUE Dr H. STORGER Mr H. CEDER Mrs B. JUNGSTEDT Biometric Society Mr T. S6DERHORN Mr M. ARCE Dr H. FLÜHLER Dr W. BANNENBERG Dr V. L. DE SILVA Dr A. CAFLISCH Christian Medical Commission Mr A. SAR Mrs UYGUR Dr E. CASTRO Mrs V. DWYRE Dr E. R. RAM Mrs A. ALLAIN Dr Cécile DE SWEEМER Miss J. MANTELL Dr R. AMON00- LARTSON Dr R. P. BERNARD Dr Ruth HARNAR Dr B. SUPIT Dr Harikumari JOHN International Academy of Pathology Dr G. PARAJON Dr Marie -Jo BONNET Professor S. WIDGREN Mr J. VATTAMATTOM Dr Zilda ARNS NEUMANN Dr J. KWERI International Agency for the Prevention Dr Margrd MARQUART of Blindness Dr Magdalena OBERHOFFER J. AL Mr MURDOCK Dr C. KUPFER VELIATH Mr A. Mr W. WALTHER Mrs R. M. JONES Mr A. JOHNS M. WOODEN Mrs Professor F. BILLSON Dr C. GILL Mr W. FLUME NBAUN Ms M. REIDY Dr M. CHOVET Mrs A. DOZIER Mr A. JENKYNS Mrs R. BLOEM Mr V. CLEMMESEN Mrs J. TURNER- CROWSON Sir John WILSON Council for International Organizations of Medical Sciences International Association for Accident and Dr M. BELCHIOR Traffic Medicine Dr Z. BANKOWSKI Dr Н. J. FLAX Dr R. ANDRÉASSON Dr H. J. HACHEN Professor A. MEYER-LIE Lady Jean WILSON Mrs A. AIMED Professor C. J. GARCIA DIAZ International Association of Agricultural Dr A. S. ELAWAD Medicine and Rural Health Dr EL AMI N Dr V. MACMURRAY Professor P. MACUCH 170 THIRTY -EIGHTH WORLD HEALTH ASSEMBLY

Association International of Cancer International Committee for Standardization Registries in Haematology

Professor G. RIOTTON Professor A. LAFONTAINE Dr M. ROZENBERG International Association for Child and Adolescent Psychiatry and Allied International Council on Alcohol and Professions Addictions

Dr F. LADAME Dr Eva TONGUE Mr A. TONGUE International Association Hydatid of Disease International Council on Jewish Social and Welfare Services Dr D. M. PEREZ GALLARDO Professor R. MARTIN MENDY Mr T. D. FEDER

International Association of Logopedics and International Council of Nurses Phoniatrics

Miss C. HOLLERAN Dr A. HULLER Dr Doris KREBS Mrs M. KINGMA Mrs H. MORROW International Association of Medical Mrs B. WESТPНAL CHRISТENSEN Laboratory Technologists

Mr D. SLADE International Council of Scientific Unions Mr A. McMINN Miss G. MAIER Dr R. MORF

International Astronautical Federation International Council on Social Welfare

Dr P. JOVANOVIC Mrs C. KELLY Mrs A. HERDT

International Centre of Social Gerontology International Council of Societies of Mr J. FLESCH Pathology

Professor G. RIOTTON International Commission on Occupational Health International Council of Women Professor W. SINGLETON Mrs P. HERZOG Dr Annick DENYS International Committee of Catholic Nurses

Miss L. FIORI International Cystic Fibrosis Miss M. DERVOIGNE (Mucoviscidosis) Association

Mr R. McCREERY International Committee of the Red Cross Mrs L. HEIDET

Dr R. RUSSBACH Dr M. VEUTHEY International Dental Federation Mr A. D. MICHELI Mr A. WICKI Dr J. JARDINE Mr J. DE COURTEN Dr R. GONZALEZ- GIRALDA Mr J. HOEFLIGER Dr H. ERNI Mr J.-M. BORNET Dr J. E. AHLBERG Mr A. PASQUIER Dr A. HEYBOER P. Mr KUNG Dr A. CORRE Mr M. MARTIN. Dr 0. SJ6SТR6M MEMBERSHIP OF THE HEALTH ASSEMBLY 171

International Diabetes Federation Dr M. SAVICEVIC Professor M. NIKOLIC Dr J.-P. ASSAL Professor J. DEL REY CALERO Dr A. SUCHET

International Electrotechnical Commission International Federation for Medical and Mr J. -P. BROTONS -DIAS Biological Engineering Mr H. BERTHEAU Miss J. HUBERDEAU Dr Winfried BECKER

International Eye Foundation International Federation of Medical Students' Associations Dr R. MEADERS Mr I. ELIASSON Dr Ann Marie JANSON International Federation on Ageing Mr F. MARRER Mr U. HAENNI Mr D. HOBMAN Mrs S. GREENGROSS Mrs V. OSTRANDER International Federation of Multiple Sclerosis Societies

International Federation of Chemical, Energy Miss В. DE RHAM and General Workers' Unions

Mr M. D. BOGGS International Federation of Ms A. RICE Ophthalmological Societies Mr J. RASK Dr A. FRANCESCHETTI

International Federation of Clinical International Federation of Pharmaceutical Chemistry Manufacturers Associations

Dr A. DEOM Dr R. B. ARNOLD Miss M. C. CONE Mrs M. ÇAILLAT International Federation for Family Life Dr H. DESARMENIEN Promotion Mr J. KINGHAM Dr C. ROEPNACK Dr Michéle GUY Dr M. PHILIPPE Dr W. M. PRUZENSKY Mr Н. WAGNER Mr C. M. PINTAUD

International Federation of Gynecology and Obstetrics International Federation of Surgical Colleges Professor F. BÉGUIN Dr S. W. A. GUNN

International Federation of Health Records International Group National Organizations of Associations of Manufacturers of Agrochemical Products Miss C. A. LEWIS

Mr E. BERNET International Federation for Hygiene, Preventive and Social Medicine International Hospital Federation

Professor G. A. CANAPERIA Mr M. C. HARDIE Professor R. SENAULT Dr M. ROCHAIX Dr E. MUSIL Mr P. CADENE Professor K. SCHWARZ Dr J.-C. ALBARELLOS 172 THIRTY -EIGHTH WORLD HEALTH ASSEMBLY

International Leprosy Association International Society of Blood Transfusion

Professor М. F. LECHAT Dr J. LEIKOLA Mr H. E. M. DE ВОК

International Society for Burn Injuries International Organization for Standardization Professor J. A. BOSWICK Professor F. BENAIM Dr L. D. EICHER

International Society of Haematology International Organization against Trachoma Professor A. LAFONTAINE Professor G. COSCAS Dr M. ROZENBERG Professor G. CORNAND Dr L. SÁNCHEZ MEDAL Dr V. MOLINA

International Paediatric Association International Society of Radiographers and Professor Y. MÜFTÜ Radiological Technicians

International Pharmaceutical Federation Mr E. G. MERCER Miss E. TYRER Mr P. BLANC Mr 0. JEPSEN Dr C. FEDELE Mrs B. BOTTCHER Dr A. BÉDAT Mr J. MINNS Dr J. M. H. A. MARTENS Miss M. FRANK Professor D. D. BREIMER Professor P. D'ARCY Mr L. BAGGER HANSEN International Society of Radiology Dr Jesusa CONCHA Professor M. DARWISH SAYED Dr W. A. FUCHS Professor L. КROWCZYNSКI Dr C. MARINEZ- OSORIO Dr J. A. ODDIS International Society for the Study of Dr L. PARISELLA Behavioural Development Mr A. RUSSELL Professor P. SPEISER Dr A. AMBROSE Mr L. G. FÉLIX-FAURE Dr P. DASEN Dr D. STEINBACH Professor F. MERКUS International Union of Biological Sciences

Professor H. HUGGEL International Physicians for the Prevention of Nuclear War International Union for Conservation of Dr J. O. PASTORS Nature and Natural Resources

Mr P. LIVINGSTONE ARMSTRONG International Planned Parenthood Federation Professor M. T. FARVAR

Mrs A. B. WADIA International Union for Health Education Dr Pramilla SENANAYAКE Miss K. NEWMAN Professor R. SENAULT Mrs H. SADEK Mr P. HINDSON Dr E. BERTHET Dr H. M. SAID International Radiation Protection Dr E. KALIMO Association Dr J. LAOYE

Dr G. ВRESSON International Union of Pure and Applied International Society of Biometeorology Chemistry

Dr W. WEIHE Dr J. BIERENS DE HAAN MEMВERSHIP OF THE HEALTH ASSEMBLY 173

International Union of School and Mr M. A. ARGAL University Health and Medicine Miss M. LORRAIN Dr B. BACH Dr Claire CHAUDIERE Mrs К. BESSON Mrs M. М. ARNAUD Dr (Mrs) M. INZOLI International Union against Tuberculosis Miss C. POLLASTRI Dr A. KORDE Dr Annik ROUILLON Mr H. DE KOK Mr V. G. WILBERG Dr J. KAMEL Dr BLEIKER Dr J. RADEMAKER Dr H. KUSNADI Dr T. PULS Professor S. SANGARE Dr S. 0. RYPKEMA Dr E. WIDMER Dr R. VOLT International Union against the Venereal Mr T. BUCHEGGER Diseases and the Treponematoses Mrs J. LETHBRIDGE Mr J. WALTER Professor A. LUGER Miss G. FREMER Mrs V. FREMER Dr P. LAMY Inter- Parliamentary Union Dr I. DÎEZ Dr F. J. URCELAY Mr P.-C. TERENZIO Dr C. ARECHABALE TA Mr F. WILCOX Mrs E. UBERTI Dr T. REARO Dr Eleonore LIPPITS League of Red Cross and Red Crescent Dr J. STEINBART Societies

Mr H. HQIEGH Dr S. W. A. GUNN Rehabilitation International Dr A. K. KISSELEV Mrs I. CASSAIGNEAU-RILLIET Dr H. J. HACHEN Miss М. ESNARD Miss M. IcTAMNEY Miss М. ROBINSON Dr D. SUTHERLAND Rotary International Dr H. ZIELINSKI Dr J. LEIKOLA Dr J. SEVER Dr S. KISTNER Dr H. R. АСИЛiA Mr S. LEGHMARY Mr J. H. STUCKY Dr I. A. AL NOURI Ir E. BARAKAT Mr H. A. PIGMAN Mr S. MULITSCH Medical Women's International Association

Dr Anne -Marie SCHINDLER Mrs R. BONNER World Confederation for Physical Therapy

Miss E. M. McKAY

Medicus lundi Internationalis (International Organization for Cooperation in Health Care) World Federation of Associations of Clinical Toxicology Centers and Poison Control Mr P. D. M. SLEIJFFERS Centers Professor V. VAN AMELSVOORT Dr J. L. M. LELIJVELD Dr Ionique GOVAERTS Mr W. J. P. TŸSSE CLAASE Professor L. ROCHE Dr М. DE BRUYCKER Mrs F. WIJCKMANS Dr A. BORLÉE Dr H. VAN BALEN World Federation of Hemophilia Dr F. ABEL Dr M. CORACHAN Dr Lili FULOP- ASZODI 174 THIRTY -EIGHTH WORLD HEALTH ASSEMBLY

World Federation for Medical Education Professor J. A. PAPDAKIS Professor T. ABELIN Professor H. J. WALTON Professor O. JEANNERET Dr T. ZIMMERMAN Professor F. GUTZWILLER Professor W. LAММERS Dr J. MARTIN Dr O. K. HARLEM Dr P. SCHUCH Professor N. BEN EL KADI Mr G. A. DAFOE Dr Y. OSМAN Professor G. A. CANAPERIA World Federation for Mental Health

Dr S. FLACHE World Federation of United Nations Mr D. DEANE Associations Mrs E. MORGAN Mr С. HEGINBOTHAM Dr D. P. TRIPATHI Dr G. T. JOSE Dr Mêropi VIOLAKI-PARASKEVA World Federation of Neurology

Professor D. KLEIN World Organization of National Colleges, Academies and Academic Associations of General Practitioners /Family Physicians

World Federation of Parasitologists Dr A. HOFMANS Dr Judilherry JUSTAM Professor A. MANTOVANI Dr P. JACOT Dr D. DiSWEL

World Psychiatric Association World Federation of Proprietary Medicine Manufacturers Professor C. CAZZULLO Professor C. STEFANIS Professor M. F. Dr K. REESE SCHULSINGER Mr S. TSUMURA Mr H. W. MUNRIE World Veterans Federation

World Federation of Public Health Dr K. TICHY Associations Ms A. HELM

Dr W. McBEATH Dr Susi KESSLER World Veterinary Association Mr A. C. VAN PERNIS Professor Asghari K. AWAN Dr J. R. PRIETO Professor M. MUBASHER Professor D. GROSSKLAUS

REPRESENTATIVES OF THE EXECUTIVE BOARD

Dr J. M. BORGOÑO Mr A. GRÍMSSON Dr R. HAPSARA Professor J. ROUX MEMBERSHIP OF THE HEALTH ASSEMBLY 175

OFFICERS OF THE HEALTH ASSEMBLY AND MEMBERSHIP OF ITS COMMITTEES

President: General Committee Dr S. SURJANINGRAT (Indonesia) The General Committee was composed of the President and Vice -Presidents of the Health Vice-Presidents: Assembly and the Chairmen of the main Mr D. S. KATOPOLA (Malawi) committees, together with delegates of the Dr W. CHINCHON (Chile) following Member States: Burma, Cameroon, Dr Barbro WESTERHOLM (Sweden) China, Cuba, Ethiopia, France, Iraq, Dr Aleya Н. AYOUB (Egypt) Jamaica, Jordan, Morocco, Nigeria, Senegal, Dr E. NAKAMURA (Japan) Sudan, Union of Soviet Socialist Republics, United Kingdom of Great Britain and Northern Ireland, United States of America. Secretary: Dr H. MAILER, Director - General Chairman: Dr S. SURJANINGRAT (Indonesia), President of the Health Assembly Secretary: Dr H. MAILER, Director -General Committee on Credentials

The Committee on Credentials was composed of delegates of the following Member States: Austria, Botswana, Czechoslovakia, MAIN COMMITTEES Ivory Coast, Mexico, Norway, Oman, Papua New Guinea, Sri Lanka, Trinidad and Under Rule 35 of the Rules of Procedure Tobago, Tunisia, Zaire. of the Health Assembly, each delegation was entitled to be represented on each main Chairman: Mr N. HADJ ALI (Tunisia) committee by one of its members. Vice -Chairman: Dr Q. REILLY (Papua New Guinea) Rapporteur: Dr E. KUBESCH (Austria) Secretary: Mr D. DEVLIN, Office of the Legal Counsel Committee A

Chairman: Dr D. G. MAKUTO (Zimbabwe) Vice -Chairmen: Dr J. Committee on Nominations VAN LINDEN (Netherlands) and Dr A. AL -SAIF (Kuwait) Rapporteur: Mr J. F. (Peru) The Committee on Nominations was composed RUBIO Secretary: Dr D. K. RAY, of delegates of the following Member Scientist, Health Manpower Planning States: Angola, Argentina, Bahrain, Barbados, Brazil, China, Egypt, Finland, France, Gambia, Guinea, Jordan, Maldives, Nigeria, Pakistan, Poland, Solomon Islands, Suriname, Thailand, Togo, Union of Soviet Committee B Socialist Republics, United Kingdom of Great Britain and Northern Ireland, Chairman: Mr R. ROCHON (Canada) United Republic of Tanzania, United States Vice -Chairmen: Dr B. P. KEAN (Australia) of America. and Dr M. M. PAL (Pakistan) Rapporteur: Dr Zsuzsanna JAKAB (Hungary) Chairman: Dr A. NONDASUТA (Thailand) Secretary: Mr I. CHRISTENSEN, Secretary: Dr H. MAILER, Director -General Administrative Officer

INDEX TO RESOLUTIONS AND DECISIONS

(Numerals bearing the symbol "WHA38..." refer to resolutions; numerals alone in parentheses refer to decisions)

Page Page

Adolescence and responsible parenthood Director -General's Development Programme (WHA38.22) 16 (WHA38.28) 22 Africa, emergency assistance to disaster - Disability prevention (WНАз8.18) 13 affected countries (WHАЭ8.29) 22 Displaced persons and refugees, health southern, liberation struggle (WHA38.28) . 22 assistance, in Cyprus (WНАЗ8.25) 19 Agenda, adoption (6) 29 in southern Africa (WHАЭ8.28) 22 Appropriation resolution for 1986 -1987 Drought -affected countries in Africa, (WHA38.32) 26 emergency assistance (WНАЭ8.29) 22 Arab population in the occupied Arab territories, including Palestine, health conditions (WHA38.15) 11 Economic and political sanctions,

Assessment, of Brunei Darussalam (WHA38.6) . 3 repercussions on health (W1Á38.17) . . . . 13

of Saint Christopher and Nevis (WHАЭ8.5) . 2 Emergency assistance to disaster- affected scale, for 1986 -1987 (WHA38.7) countries in Africa (WHA38.29) 22 Assistant Directors -General, salaries European Region, assignment of Israel (WHA38.10) 8 to (WHA38.1) 1 Exchange rates, budgetary (WHA38.4) 2 Executive Board, Members entitled to designate

Brunei Darussalam, assessment (WHA38.6) . . . 3 a person to serve on, election (10) . . . 30 Budget, see Appropriation Resolution; number of members (WHA38.14) 10 Programme budget on seventy -fourth and seventy -fifth Budgetary exchange rates (WHАЭ8.4) 2 sessions (13) 31 Budgets, national health, maintenance at level compatible with attainment of objective of health for all (W1А38.21) 15 Famine -affected countries in Africa, emergency assistance (WНАЭ8.29) 22 Financial report, interim, for the year Cancer, of the lung, prevention and control 1984 (WHA38.2) 1 (WHA38.30) 23 Front-line States in southern Africa, Cardiovascular diseases, prevention aid assistance (W1Á38.28) 22 control (WHАЭ8.30) 23 Casual income (WHАЭ8.4) 2

Childbearing, maturity before (WHА38.22) . . 16 General Committee, establishment (5) 29 Contributions, Members in arrears (WHF.38.3, General Programme of Work, Eighth, research on WHA38.13) 1,10 combined prevention and control of several status of collection (WHA38.3) 1 noncommunicable diseases (WНАЭ8.30) . . . 23 see also Assessment technical cooperation among developing Committee on, composition (1) . 28 Credentials, countries (WHАЭ8.23) 17 verification (8) 6 Currency fluctuations, use of casual income to reduce adverse effects on programme budget (WНАЭ8.4) 2 Health Assembly, see World Health Assembly Cyprus, health assistance to refugees and Health - for -all leaders (WНАЭ8.23) 17 displaced persons (WHАЗ8.25) 19 Hearing impairment and deafness, prevention (WHA38.19) 14 Deafness and hearing impairment, prevention (WHА38.19) 14

Deputy Director -General, salary (WHАЭ8.10) . 8 Israel, assignment to European Region Developing countries, least developed among, (WНА38.1) 1 additional support (WHАЭ8.16) 12 technical cooperation (WHA38.23) 17 Diabetes mellitus, prevention and control Leadership development for health -for -all (WHA38.30) 23 (WHA38.23) 17 Director-General, interim financial report Lebanon, health and medical assistance for the year 1984 (WвАЗ8.2) 1 (WНАз8.26) 19

report on the work of WHO in 1984 (9) . . 30 Liberation struggle in southern Africa salary (WHАЭ8.10) 8 (WHA38.28) 22

-177- 178 THIRTY -EIGHTH WORLD HEALTH ASSEMBLY

Page Lage

Malaria control (WHA38.24) 18 Staff of WHO, international, recruitment

Maturity before childbearing (WHА38.22) . . 16 (WHA38.12) 9 ungraded posts, salaries and allowances (W1A38.10) 8 National health budgets, maintenance at level Strategies for health for all, implementation compatible with attainment of objective of (WHА38.20) 15 health for all (WHА38.21) 15 collaboration with nongovernmental Nominations, Committee on, composition (2) . 28 organizations (WHА38.31) 25 Noncommunicable diseases, chronic, prevention least developed among developing countries, and control (WHA38.30) 23 additional support (WHA38.16) 12 Nongovernmental organizations, collaboration technical cooperation among developing in implementing the Global Strategy for countries (WHA38.23) 17 Health for All (WHA38.31) 25

Technical and economic cooperation among Officers of the Thirty- eighth World Health developing countries (WHА38.23) 17 Assembly (3) 28 Technical Discussions, at the Thirty-eighth main committees (4) 28 World Health Assembly, appointment of General Chairman (7) 29

Palestine Liberation Organization (WHА38.15) . 11 Parenthood, responsible, promotion of United Nations Decade for Women (WHA38.22) 16 (WHA38.27) 20 Pension Board, United Nations Joint Staff, United Nations Decade of Disabled annual report for 1983 (11) 31 Persons (WHA38.18) 13 Pension Committee, WHO Staff, appointment of United Nations Humanitarian Assistance

representatives (12) 31 in Cyprus, Coordinator (WHA38.25) . . . . 19 Poliomyelitis, prevention (WHA38.18) 13 United Nations Joint Staff Pension

Political and economic sanctions, Board, annual report for 1983 (11) . . . . 31

repercussions on health (WHA38.17) . . . . 13 United Nations system, collaboration and Pregnancy before maturity, prevention coordination, health and medical (WHA38.22) 16 assistance, to Cyprus (WHА38.25) 19 Programme budget, for 1986 -1987, use of to disaster- affected countries in Africa casual income (WHA38.4) 2 (WHA38.29) 22 regional policies (WHA38.11) 8 to Lebanon (WHA38.26) 19

women, health and development (WHА38.27) . 20

Real Estate Fund (WHA38.9) 8 Recruitment of international staff in WHO (WHA38.12) 9 Voluntary Fund for Health Promotion, Special Refugees and displaced persons, health Account for Assistance to the Least assistance, in Cyprus (WHA38.25) 19 Developed among Developing Countries in southern Africa (WHA38.28) 22 (WHA38.1б) 12 Regional Directors, salaries (WHA38.10) 8 Regional programme budget policies (WHA38.11) Î 8 Rehabilitation of the disabled (WHA38.18) . . 13 Respiratory diseases, chronic, prevention and Western Pacific Region, increase in the number control (WНА38.30) 23 of Members entitled to designate a person to serve on the Executive Board (WHA38.14) 10 WHO Staff Pension Committee, appointment of Saint Christopher and Nevis, assessment representatives (12) 31

(WHA38.5) 2 Women, health and development (WHA38.27) . . 20 Salaries and allowances, for ungraded posts on the staff of WHO (WHA38.12) 9

. 8 and the Director-General (W1A38.10) . . Working Capital Fund, review (WHA38.8) . . . 6 Sanctions, economic and political, status of advances (WHA38.3) 1 repercussions on health (WHА38.17) . . . . 13 World Health Assemblies, future, place of (14) 31 Southern Africa, liberation struggle World Health Assembly, Thirty -ninth, country (WHA38.28) 22 of meeting (15) 31