WНASЗ /2000/REC/2

WORLD HEALTH ORGANIZA TION ORGANISAТION MONDIALE DE LA SANTE

FIFTY-THIRD WORLD HEALTH ASSEMBLY

GENEVA, 15-20 МАУ 2000

VERBATIМ RECORDS OF PLENARY MEETINGS AND LIST OF PARTICIPANTS

' CINQUANTE-TROISIEME, ASSEMBLEE MONDIALE, DELASANTE GENEVE, 15-20 МАI 2000

COMPTES RENDUS IN EXTENSO DES SEANCES PLENIERES ЕТ LISTE DES PARTICIPANTS

GENEVA GENEVE 2000 WНASЗ/2000/REC/2

WORLD HEALTH ORGANIZAТION ORGANISAТION MONDIALE DE LA SANTE

FIFTY-THIRD WORLD HEALTH ASSEMBLY

GENEVA, 15-20 МАУ 2000

VERBATIM RECORDS OF PLENARY MEETINGS AND LIST OF PARTICIPANTS

CINQUANTE-TROISIEME'

ASSEMBLЙE MONDIALE, DELASANTE GENEVE, 15-20 МАI 2000

COMPTES RENDUS IN EXTENSO DES SEANCES PLENIERES ЕТ LISTE DES PARTICIPANTS

GENEYA GENEVE 2000

PREFACE

The Fifty-third World Health AssemЫy was held at the Palais des Nations, Geneva, from 15 to 20 Мау 2000, in accordance with the decision of the Executive Board at its 104th session. Its proceedings are issued in three volumes, containing, in addition to other relevant material:

Resolutions and decisions, annex- document WНA53/2000/REC/l

Verbatim records of plenary meetings, list of participants- document WНA53/2000/REC/2

Summary records of committees and ministerial round taЫes, reports of committees - document WНA53/2000/REC/3

For а list of abbreviations used in these volumes, the officers of the Health AssemЬly and membership of its committees, the agenda and the list of documents for the session, see preliminary pages of document WНA53/2000/REC/l.

In these verbatim records, speeches delivered in Arabic, Chinese, English, French, Russian or Spanish are reproduced in the language used Ьу the speaker; speeches delivered in other languages are given in the English or French interpretation. The texts include coпections received up to 28 July 2000, the cut-off date announced in the provisional version, and are thus regarded as final.

AVANT-PROPOS

La Cinquante-Troisieme AssemЫee mondiale de la Sante s'est tenue au Palais des Nations а Geneve du 15 au 20 mai 2000, conformement а la decision adoptee par le Conseil executif а sa cent quatrieme session. Ses actes paraissent dans trois volumes contenant notamment :

les resolutions et decisions et une annexe- document WНA53/2000/REC!l,

les comptes rendus in extenso des seances plenieres et la liste des participants - document WНA53/2000/REC/2,

les proces-verbaux des comm1ssюns et des taЫes rondes ministerielles et les rapports des commissions - document WНA53/2000/REC/3.

On trouvera dans les pages preliminaires du document WНA53/2000/REC/l une liste des abreviations employees dans la documentation de l'OMS, l'ordre du jour et la liste des documents de la session ainsi que la presidence et le secretariat de 1' AssemЬlee de la Sante et la composition de ses commissions.

Les presents comptes rendus in extenso reproduisent dans la langue utilisee par l' orateur les discours prononces en anglais, arabe, chinois, espagnol, fraш;ais ou russe, et dans leur interpretation anglaise ou franyaise les discours prononces dans d'autres langues. Ces comptes rendus comprennent les rectifications reyues jusqu'au 28 juillet 2000, date limite annoncee dans leur version provisoire, et sont donc consideres comme finals.

- 111 - ПРЕДИСЛОВИЕ

Пятьдесят третья сессия Всемирной ассамблеи здравоохранения проходила во Дворце Наций в Женеве с 15 по 20 мая 2000 г. в соответствии с решением Исполнительного комитета, припятым на его Сто четвертой сессии. Материалы сессии публикуются в трех томах, в

которых, помимо других документов, содержатся:

резолюции и решения и приложеимя - документ WНA53/2000/REC/1

стенографический отчет о пленарных заседаниях и список участников - документ WНA53/2000/REC/2

протоколы заседаний и заседаний круглого стола для министров, доклады комитетов - документ WНA53/2000/REC/3

Список сокращений, используемых в этих изданиях, и перечень должностных лиц Ассамблеи здравоохранения, так же как и членский состав Комитетов, повестка дня и список документов для данной сессии приводятся в начале документа WНA53/2000/REC/1.

В стенограммах засеДаний выступления на английском, арабском, испанском, китайском, русском и французском языках приводятся в оригинале; выступления на других языках даны в переводе на английский и французский языки. Указанные тексты включают исправления, полученные Секретариатом до 28 июля 2000 г., как о том было объявлено в предварительных протоколах, и потому настоящая редакция считается окончательной.

INTRODUCCION

La 53а AsamЬlea Mundial de la Salud se celebr6 en el Palais des Nations, Ginebra, del 15 al 20 de mayo de 2000, de acuerdo con la decisi6n adoptada por el Consejo Ejecutivo en su 1043 reuni6n. Sus debates se puЫican en tres volumenes que contienen, entre otras cosas, el material siguiente:

Resoluciones у decisiones, у anexos: documento WНA53/2000/REC/1

Actas taquignificas de las sesiones plenarias у lista de participantes: documento WНA53/2000/REC/2

Actas resumidas de las comisiones у de las mesas redondas ministeriales е informes de las comisio­ nes: documento WНA53/2000/REC/3.

En las paginas preliminares del documento WНA53/2000/REC/1 figuran una lista de las siglas empleadas en estos volumenes, la composici6n de Ja Mesa de la AsamЫea у de sus comisiones, el orden del dia, у la lista de documentos de la reuni6n.

En las presentes actas taquigraficas los discursos pronunciados en arabe, chino, espafiol, frances, ingles о ruso se reproducen en el idioma utilizado por el orador. De los pronunciados en otros idiomas se reproduce Ja interpretaci6n al frances о al ingles. Las actas contienen las correcciones reciЬidas hasta el 28 de julio de 2000, fecha limite anunciada en la versi6n provisional, у por consiguiente se consideran definitivas.

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- v-

CONTENTS

Page

Preface ...... н1

VERВATIM RECORDS OF PLENARY MEETINGS

First plenary meeting

1. Opening ofthe session ...... 1 2. Address Ьу the representative ofthe Secretary-General ofthe United Nations ...... 2 3. Address Ьу the representative ofthe Conseil d'Etat ofthe RepuЫic and Canton of Geneva ...... 3 4. Address Ьу the Vice-President ofthe Fifty-second World Health AssemЬly ...... 5 5. Appointment ofthe Committee on Credentials ...... б б. Election ofthe Committee оп Nominations ...... б 7. First report ofthe Committee on Nominations ...... 7 8. Second report ofthe Committee on Nominations ...... 8

Second plenary meeting

1. Presidential address ...... 10 2. Adoption of the agenda and allocation of items to the main committees ...... 12 3. Announcement ...... 1б 4. Review and approval of the reports of the Executive Board on its 104th and 105th sessions ...... 17 5. Address Ьу the Director-General: Challenges and opportunities for the health leaders oftoday (including overview of The world health report 2000) ...... 20

Third plenary meeting

Invited speaker ...... 41

Fourth plenary meeting

Address Ьу the Director-General (including overview of The world health report 2000) (continued) ...... 4б

Fifth plenary meeting

1. First report of the Committee on Credentials ...... 7б 2. Address Ьу the Director-General (including overview of The world health report 2000) ( continued) ...... 77

- Vll- Page

Sixth plenary meeting

Awards...... 120 Presentation of the Sasakawa Health Prize ...... 120 Presentation ofthe United Arab Emirates Health Foundation Prize ...... 126

Seventh plenary meeting

1. Second report of the Committee on Credentials...... 13 О 2. Announcement...... 131 3. Executive Board: election [of Members entitled to designate а person to serve оп]...... 131 4. F irst report of Committee А ...... 131 5. First report ofCommittee В...... 132

Eighth plenary meeting

1. Second report of Committee В ...... 140 2. Third report of Committee В ...... 141 3. Fourth report ofCommittee В...... 141 4. Second report ofCommittee А...... 141 5. Selection ofthe country in which the Fifty-fourth World Health AssemЬly will Ье held..... 142

Ninth plenary meeting

Closure of the session ...... 143

MEМВERSHIP OF ТНЕ HEALTH ASSEМВLY

List of delegates and other participants ...... 151 Representatives of the Executive Board ...... 204

Indexes (names ofspeakers; countries and organizations) ...... 205

- Vlll - TABLE DES MATIERES

Pages

Avant-propos ...... iii

COMPTES RENDUS IN EXTENSO DES SEANCES PLENIERES

Premiere seance pleniere

1. Ouverture de 1а session ...... 1 2. Allocution du representant du Conseil d'Etat de la RepuЬlique et Canton de Geneve ...... 2 3. Allocution du representant du Secretaire general de l'Organisation des Nations Unies ...... 3 4. Allocution du Vice-President de la Cinquante-Deuxieme AssemЬlee mondiale de la Sante ...... 5 5. Constitution de la Commission de V erification des Pouvoirs ...... 6 6. Election de la Commission des Designations ...... 6 7. Premier rapport de la Commission des Designations ...... 7 8. Deuxieme rapport de la Commission des Designations ...... 8

Deuxieme seance pleniere

1. Discours du President de l' Assemblee ...... 1 О 2. Adoption de l'ordre dujour et repartition des points entre les commissions principales...... 12 3. Communication ...... 16 4. Examen et approbation des rapports du Conseil executif sur ses cent quatrieme et cent cinquieme sessions ...... 17 5. Allocution du Directeur general : defis et opportunites pour les responsaЬles de la sante (у compris un apers:u du Rapport sur la sante dans le monde, 2000) ...... 20

Troisieme seance pleniere

Intervenant invite...... 41

Quatrieme seance pleniere

Allocution du Directeur general (у compris un apers:u du Rapport sur la sante dans le monde, 2000) (suite)...... 46

Cinquieme seance pleniere

1. Premier rapport de la Commission de V erification des Pouvoirs ...... 7 6 2. Allocution du Directeur general (у compris un apers:u du Rapport sur la sante dans le monde, 2000) (suite)...... 77

- lX- Pages

Sixieme seance pleniere

Distinctions...... 120 Remise du Prix Sasakawa pour 1а Sante ...... 120 Remise du Prix de la Fondation des Emirats arabes unis pour la Sante ...... 126

Septieme seance pleniere

1. Deuxieme rapport de la Commission de V erification des Pouvoirs...... 13 О 2. Communication ...... 131 3. E1ection de Membres haЬilites а designer un representant au Conseil executif ...... 131 4. Premier rapport de la Commission А ...... 131 5. Premier rapport de la Commission В ...... 132

Huitieme seance pleniere

1. Deuxieme rapport de la Commission В...... 140 2. Troisieme rapport de la Commission В...... 141 3. Quatrieme rapport de l.a Commission В ...... 141 4. Deuxieme rapport de la Commission А ...... 141 5. Choix du pays ou se tiendra la Cinquante-Quatrieme AssemЬlee mondiale de la Sante 142

Neuvieme seance pleniere

Clбture de la session ...... 143

COMPOSITION DE L' ASSEMBLEE DE LA SANTE

Liste des delegues et autres participants ...... 151 Representants du Conseil executif ...... 204

Index (noms des orateurs; pays et organisations) ...... 205

-х- A53/YR/1 page 1

VERВATIM RECORDS OF PLENARY MEETINGS

COMPTES RENDUS IN EXTENSO DES SEANCES PLENIERES

FIRST PLENARY MEETING

Monday, 15 Мау 2000, at 10:00

President: Mr М. TELEFONI RETZLAFF (Samoa) later: Dr L. AMATHILA (Namibia)

PREMIERE SEANCE PLENIERE

Lundi 15 mai 2000, 10 heures

President: М. М. TELEFONI RETZLAFF (Samoa) puis: Dr L. AMATНILA (Namibie)

1. OPENING OF ТНЕ SESSION OUVERTURE DE LA SESSION

The PRESIDENT:

The AssemЬly is called to order. Distinguished delegates, ladies and gentlemen. The President of the Fifty-second World Health AssemЬly, Mrs М. de Belem Roseira, is unaЬle to officiate here today. lt is а great honour for me, as first Vice-President, to preside at this opening session until the election ofthe President ofthe Fifty-third World Health AssemЬly. 1 now have great pleasure in welcoming, on behalf of the AssemЬly and the World Health Organization, our special guests: Mr Guy-Olivier Segond, Councillor of State, Department of Social Action and Health of the RepuЬlic and Canton of Geneva, representing the Geneva State Council; Mr Jerбme Koechlin, Chief of Protocol of the RepuЬlic and Canton of Geneva; Mr Francis Nordmann, Ambassador, Permanent Representative of Switzerland to the Intemational Organizations at Geneva and Permanent Observer to the United Nations; Mrs Alice Ecuvillon, President of the Geneva City Council; Mr Mehmet Ulktimen, Chief of Protocol, United Nations Office at Geneva; Dr Brian Gushulak, replacing Mr Brunson McKinley, Intemational Organization for Migration; Mrs Liselot Кraus-Gumey, replacing Mr Jakob Kellenberger, President of the Intemational Committee of the Red Cross. 1 also have pleasure on behalf of the AssemЬly, to we\come: the representatives of the United Nations Specialized Agencies, and the representatives of the various United Nations bodies; the delegates of Member States. A53NR/1 page 2

1 also welcome: the observers of non-Member States, the observers from the Order of Malta, the lntemational Committee of the Red Cross, the lntemational Federation of the Red Cross and Red Crescent Societies and from Palestine. 1 also welcome the representatives of the Executive Board. 1 would also like to welcome Mr Ricupero, who is representing the Secretary-General of the United Nations.

2. ADDRESS ВУ ТНЕ REPRESENTATIVE OF ТНЕ CONSEIL D'ETAT OF ТНЕ REPUBLIC AND CANTON OF GENEVА ALLOCUTION DU REPRESENTANT DU CONSEIL D'ETAT DE LA REPUBLIQUE ЕТ CANTON DE GENEVE

The PRESIDENT:

1 now give the floor to Mr Guy-Olivier Segond, Councillor of State, Department of Social Action and Health of the RepuЫic and Canton of Geneva.

М. SEGOND (representant du Conseil d'Etat de la RepuЫique et Canton de Geneve):

Monsieur le President, Madame la Directrice generale, Mesdames et Messieurs les delegues, Excellences, Mesdames et Messieurs, а l'occasion de l'ouverture de la Cinquante-Troisieme AssemЫee mondiale de la Sante, j'ai le plaisir, l'honneur aussi, de vous souhaiter, au nom des autorites suisses, la bienvenue а Geneve. Au cours des cinquante demieres annees, depuis la fondation de l'ONU et de l'OMS, !е monde а bien change, politiquement, economiquement et socialement. Apres l'effort de reconstruction qui а suivi la Seconde Guerre mondiale, apres les luttes de liheration nationale et apres l' independance de nombreux nouveaux Etats, la rivalite Est-Ouest а ete progressivement remplacee par la dynamique Nord-Sud. La globalisation de tous les proЫemes а bouleverse le cours ordinaire des choses et, griice au prodigieux developpement des nouvelles technologies de communication, le monde est devenu un. Ces demieres annees, de formidaЫes forces de changement sont nees. Les attitudes politiques et culturelles а l'egard de l'Etat se sont profondement modifiees. D'importants proЫemes demographiques et sociaux lies aux migrations, au vieillissement et а l'exclusion se sont developpes et, partout dans le monde, il у а des mouvements amples et puissants en faveur d'une reforme des systemes de sante. Au cours du ХХе siecle, l'OMS а pris sa part de ces grands changements mondiaux, notamment en conduisant le passage d'un systeme de sante centralise, privilegiant la pathologie urbaine, а une pratique communautaire de soins de sante primaires. Les resultats sont la : les taux de mortalite infantile ont baisse dans la plupart des pays, l'esperance de vie а !а naissance а augmente regulierement et la sante de la plus grande partie de la population mondiale s'est nettement amelioree durant les cinquante demieres annees. Aujourd'hui, au debut du ххе siecle, la situation se presente sous un jour different. De nouvelles technologies sont nees, de nouveaux modes d'intervention se developpent et de nouvelles generations de professionnels prennent la releve. Plusieurs facteurs determinants de la sante, qu'ils soient environnementaux, sociaux, politiques, economiques, demographiques ou epidemiologiques, ont affecte !е profil sanitaire des populations. Des proЫemes specifiques de sante vont croissant, tels que !а resistance aux antimicroblens, la mortalite Jiee au tabac et le VIН/SIDA. Enfin, dans trop de pays encore, les inegalites concemant l'etat de sante continuent de s'elargir en fonction du niveau de developpement et des classes sociales. 11 est donc temps d'examiner la performance des systemes de sante et d'elargir la mission de l'OMS. Traditionnellement, l'OMS а trois priorites strategiques : d'abord, placer la sante au coeur de la politique de developpement, ensuite, s'attaquer efficacement aux principaux facteurs de risque et aux principales maladies, enfin, reduire la surmortalite des populations pauvres et marginalisees en ameliorant l'acces aux soins. А ces trois priorites strategiques, il faut donc, au debut du XXIe siecle, en ajouter une quatrieme: l'analyse de la performance des differents systemes de sante. A53NR/l page 3

Que faut-il donc pour avoir un bon systeme de sante performant et equitaЫe? А l'evidence, les reponses varient selon que l' on parle au ministre de la sante ou au ministre des finances, au professeur de medecine ou au directeur d'hбpital, aux syndicats ou aux caisses maladie, а la maman qui accouche ou а la famille du vieillard qui s'eteint. Une chose est sure : dans certains Etats, les systemes de sante fonctionnent Ьien et, dans d'autres Etats, les systemes de sante fonctionnent mal. Се n'est pas toujours du а des differences de moyens financiers : des Etats qui опt des revenus semЫaЫes et qui consacrent а la sante des moyens equivalents ont des systemes de sante dont les performances sont tres differentes. Il est donc important d'avoir une methode reconnue permettant de parvenir а un jugement equilibre sur la conception, l'organisation, le financement, la gestion et la performance des differents systemes de sante. Tel est le but du Rapport sur !а sante dans !е monde, 2000. Се document remarquaЫe ne fait pas seulement une analyse de la performance des differents systemes de sante et des dizaines de millions de professionnels qui les font fonctionner, се document influencera aussi profondement la duree de la vie et la qualite de la vie de plus de six milliards d'etres humains. Le Rapport sur !а sante dans le monde, 2000 permettra en effet а l'OMS de rappeler aux chefs d'Etat et aux chefs de gouvemement qu'ils sont eux-memes des ministres de la sante. En investissant mieux dans les systemes de sante, on luttera mieux contre les proЫemes de sante qui touchent 90 % de la population de la planete ; on obtiendra une amelioration de la qualite de la vie et on constatera une amelioration de la productivite, се qui permettra de s'attaquer а l'une des causes fondamentales de la pauvrete, qui est au centre de la prochaine session extraordinaire de l' AssemЫee generale des Nations Unies, qui se tiendra а Geneve а la fin du mois de juin. Ainsi, je suis convaincu que, par un plaidoyer efficace а l'echelle mondiale, l'OMS, sous la ferme direction du Dr Gro Harlem Brundtland, atteindra au debut du XXIe siecle l'objectif d'une meilleure sante pour tous, entrainant un vrai changement de la vie des haЬitants du monde entier.

The PRESIDENT:

Thank you, Mr Segond.

3. ADDRESS ВУ ТНЕ REPRESENTATIVE OF ТНЕ SECRETARY-GENERAL OF ТНЕ UNITED NATIONS ALLOCUTION DU REPRESENTANT DU SECRETAIRE GENERAL DE L'ORGANISATION DES NATIONS UNIES

The PRESIDENT:

1 now give the floor to Mr Ricupero, Secretary-General of UNCTAD, representative of the Secretary-General ofthe United Nations, who will address the AssemЬly.

Mr RICUPERO (Secretary-General, UNCTAD, representing the Secretary-General of the United Nations):

Thank you, Mr President. Mr President, Madam Director-General, Monsieur Segond, excellencies, ladies and gentlemen, it is an honour and а privilege for те to address this distinguished AssemЬly of the World Health Organization, and to convey to you the very best wishes of the Secretary-General ofthe United Nations, Mr Kofi Annan, for the success ofyour work. This year, а transition year from the twentieth century, is rich in historic events in the life of the United Nations and the organizations of its system. The United Nations has declared the year 2000 the Intemational У ear for the Culture of Реасе. With the escalation of ethnic conflicts, xenophoЬia, and racism, it is а decision of special relevance. We are committed to overcoming centuries of а culture of war and violence, and to move through the United Nations from violence to dialogue, from force to tolerance, from а culture of war to а culture of реасе. A53NR/1 page4

As his contribution to this year's Millennium AssemЬiy of the United Nations, the Secretary­ General has submitted а report entitled "We the peoples: the role of the United Nations in the 21st century". The report addresses key challenges the inteпшtional community will face in the decade ahead, together with proposals for ways in which the Member States can respond effectively to the imperative of ensuring to successive generations freedom from want, freedom from fear, and an environmentally sustainaЬie future. One of the main themes of this modem era is development in the context of globalization. The challenge before us is to seek constructive ways of managing globalization so that it benefits the greatest number of people and nations. The industrialized world must not try to solve its own proЬiems at the expense of the poor. It is necessary to shape а universal consensus, that should form the basis for developing countries' efforts to achieve greater social justice. An important step towards the solution to the challenge of globalization is the global compact proposed Ьу the United Nations Secretary­ General, under which the United Nations will work with business, in particular transnational corporations, to act in accordance with intemationally accepted principles of human rights, labour standards and the rational use of resources. The major United Nations conferences of the 1990s expressed commitment to halving the number living in poverty Ьу the year 2015. One ofthe causes ofthe continuous prevalence ofthe poor quality of life, hunger, unemployment and lack of resources for health is the excessive burden of extemal debt, which contributes to the exclusion of two-thirds of the world's population, and reinforces the marginalization of the most impoverished peoples. А particularly perverse aspect of the debt proЬiem is that in all the highly indebted countries, the resources destined to service payment of the debt largely exceed what is spent on puЬiic health, even in the middle of the AIDS pandemic that threatens the very survival ofmany ofthose peoples. In June this year, the opportunity provided Ьу the special session ofthe United Nations General AssemЬiy on follow-up to the 1995 World Summit for Social Development should Ье used to reassert commitment to effective social development and equality between men and women. In this respect, WHO has а decisive role to play in placing health in а broader context, acknowledging that better health depends on contributions from outside, as well as from within the health sector. The corporate strategy proposed Ьу the Director-General of WHO, Dr Gro Harlem Brundtland, rightly emphasizes reduction of the excess mortality of poor and marginalized populations, and places health at the centre of the development agenda. From the WНО perspective, health, together with education, are key determinants of growth and development. Better educated and healthier people are empowered to make better choices and lead fuller lives, which also make them more productive and their economies more competitive. Investment in people, in other words, is the best use of our limited development resources. There is an urgent need for public health involvement in key discussions about the future structure of global development and provision of much-needed govemance to manage the rapidly growing spectrum of global activities. These discussions should cover promotion of debt relief, а fairer trading system, а global code of adequate puЬiic services for all, and а more reliaЬie supply of and access to global puЬiic goods, such as global health and control of infectious diseases. Greater focus should Ье placed on access to pharmaceutical drugs, in order to make them affordaЬie. The fact remains that essential and lifesaving drugs exist while millions of people cannot afford them, and this is at а time when, as the Secretary-General ofthe United Nations notes in his report, 36 million people are living with НIV1 AIDS worldwide, more than 23 million in sub-Saharan Africa. The latest estimates indicate that last year AIDS killed far more people than all of Africa's conflicts comЬined. lt is obvious that access to relevant drugs constitutes not only а moral and а political proЬiem, but also presents the proЬiem of crediЬility for the global market system. WHO can provide technical information for assessing the puЬiic health consequences of intemational trade agreements. Making trade work to improve health is а major part of the technical discussions with WTO. lt is certainly important that, within the framework of the Agreement on Trade-Related Aspects of Intellectual Property Rights, these rights should Ье protected since they are necessary to stimulate innovation. But they should Ье balanced Ьу the equally important need to facilitate access of the poorest countries to drugs that are availaЬie only at high prices because of increased patent protection. We have also to find ways and means to encourage and to stimulate research in tropical diseases where we face one of the examples of the shortcomings of the market mechanism because of the lack A53NR/1 page 5 of adequate profit prospects. Since 1978, when the Alma-Ata Conferenc~ estaЫished the goal of health for all Ьу the year 2000, significant progress has been achieved in life expectancy; yet, despite this, over а billion people will enter the twenty-first century without having benefited Поm the health gains. In many countries acute inequalities needlessly continue to burden disadvantaged populations and prolong their poverty. Their lives remain short and scaпed Ьу diseases, in particular Ьу diseases of the poor, such as the НIV epidemic. New proЫems are arising with the threat of resurgent diaпhoea, malaria or the unexpected magnitude and consequences of increasing use of tobacco. The Roll Back Malaria project led Ьу WHO deserves full support as it seeks to control and prevent this deadly disease. I cannot but welcome the emphasis placed Ьу WHO on forging more influential partnerships in order to achieve better health for all. Cooperation and joint efforts are needed with а number of partners, including the private sector. Market mechanisms have enormous utilities in many sectors and have underpinned rapid economic growth in Europe, North America and elsewhere. At the same time, the countries that have relied heavily on the market to achieve high incomes are the same countries that rely most heavily on governments to finance health services. This is the reason why WНО advocates а new universalism in order to attain better health within the framework of international development goals. This approach recognizes governments' limits but retains governments' responsibility for leadership, regulation and finance of the health system. In addition to public-private contacts, efforts are required to strengthen partnerships with civil society, in particular, parliamentarians, local authorities, nongovernmental and academic institutions, as well as with the European Union and with the organizations of the United Nations system. EnaЫing WHO to provide the necessary human and financial resources should Ье coupled with the effective implementation of approved decisions. The keyword and the raison d'etre of The world health report 2000 are "improving performance". The inaЬility to translate commitment into action to provide more effective follow-up and monitoring procedures on implementation of norms represents an oveпiding concern, not only for the international health community. In the context of the "quiet revolution" launched Ьу the United Nations Secretary-General in 1997, efforts are being undertaken to adapt international institutions, through which Member States govern together, to the realities of the new era. Coalitions for change, often with nongovernmental organizations, are intended to moЬilize public opinion to secure compliance with the commitments made Ьу governments within the United Nations framework. In conclusion, let me once more express my own best wishes, together with the wishes of the Secretary-General ofthe United Nations, for the success ofthis Fifty-third World Health AssemЬly.

The PRESIDENT:

Thank you, Mr Ricupero.

4. ADDRESS ВУ ТНЕ VICE-PRESШENT OF ТНЕ FIFTY-SECOND WORLD HEALTH ASSEMBLY ALLOCUTION DU VICE-PRESIDENT DE LA CINQUANTE-DEUXIEME ASSEMBLEE MONDIALE DE LA SANTE

The PRESIDENT:

Director-General, excellencies, distinguished delegates, ladies and gentlemen, it is а great honour for me to preside at the opening of the Fifty-third World Health AssemЬly. One of the prominent topics of this AssemЬly is the development of health systems, which constitutes the theme ofthe ministerial round taЬles. 1 would like to commend the choice ofthis topic which is so central to the mission of the World Health Organization. People's health and well-being depend essentially on the performance of the health systems that serve them; yet, there is а wide variation in performance and in many countries health systems fail to fulfil their potential. This failure often results in а very A53/VR/1 page 6 large number of preventaЬle deaths and disaЬilities, unnecessary suffering, inequality and denial of basic human rights. The impact of this failure is most severe on the poor who are driven deeper into poverty Ьу lack of financial protection against ill-health. Hence, the importance of strengthening health systems, enaЬling them to meet new challenges and fulfil their goals. These goals are: protecting people's health, reducing,inequality in the distribution of services, responding to people's needs and expectations and, lastly, assuring faimess offinancial contribution in ways that improve the situation of those who are worst off. I had the honour of chairing two of the round taЬles last year and 1 would encourage the Ministers present to participate in this excellent opportunity to exchange views with peers. I also would like to commend the Director-General, Dr Gro Harlem Brundtland for this initiative which began at last year's Health AssemЬly. Before closing, I would like to express once again my appreciation of the work carried out Ьу WHO over the last year and to wish the new President every success in leading the AssemЬly through this year's agenda.

5. APPOINTMENT OF ТНЕ СОММIТТЕЕ ON CREDENTIALS CONSTITUTION DE LA COMMISSION DE VERIFICATION DES POUVOIRS

The PRESIDENT:

We shall now proceed with the Appointment ofthe Committee on Credentials. The AssemЬly is required to appoint а Committee on Credentials in accordance with Rule 23 of the Rules of Procedure ofthe AssemЬly. In conformity with this Rule, 1 propose for your approval the following 12 Member States: Barbados, Burundi, Chile, Gabon, lndonesia, Ireland, Poland, RepuЬlic of Korea, San Marino, Syrian Arab RepuЬlic, United RepuЬlic ofTanzania, Tunisia. Are there any objections? If there are no objections, I declare the Committee on Credentials, as proposed Ьу me, appointed Ьу the AssemЬly. Subject to the decision of the General Committee, this Committee will hold its first meeting on Tuesday, 16 Мау at 14:30.

6. ELECTION OF ТНЕ СОММIТТЕЕ ON NOMINATIONS ELECTION DE LA COMMISSION DES DESIGNATIONS

The PRESIDENT:

We shall now proceed with the Election of the Committee on Nominations. This item is govemed Ьу Rule 24 of the Rules of Procedure of the AssemЬly. ln accordance with this Rule, а list consisting of 24 Member States and the President ех o.fficio has been drawn up, which 1 shall submit to the AssemЬly for its consideration. Мау I explain that, in compiling this list, the following distribution Ьу region has been applied: African Region: 6 Members; Americas: 5; South-East Asia: 2; Eastem Mediterranean: 3; European: 6; Westem Pacific: 3. I therefore propose to you the following Member States: Angola, Argentina, Bahamas, Bahrain, Benin, Bhutan, Botswana, Brunei Darussalam, Bulgaria, Cameroon, China, ColomЬia, Costa Rica, Cyprus, France, Mauritius, Mexico, Morocco, Portugal, Russian Federation, Samoa (ех o.fficio), Slovakia, Sri Lanka, United Kingdom of Great Britain and Northem Ireland, ZamЬia. Are there any observations? ln the absence of observations, 1 declare the Committee on Nominations elected. As you know, Rule 25 of the Rules of Procedure, which defines the mandate of the Committee on Nominations, also states that "the proposals ofthe Committee on Nominations shall Ье forthwith communicated to the Health AssemЬly". A53NR/l page 7

1 will now suspend the meeting so that the Committee on Nominatioпs may meet in Room VII. As soon as the Committee on Nominations has completed its deliberations, we will resume in plenary in half an hour.

The meeting was suspended at 10:45 and resumed at 11:20. La seance est levee а 10h45 et reprend а llh20.

7. FIRST REPORT OF ТПЕ COMMITTEE ON NOМINATIONS 1 PREMIER RAPPORT DE LA COMMISSION DES DESIGNATIONS1

The PRESIDENT:

The AssemЬly is called to order. We will now consider the first report of the Committee on Nominations. 1 shall now read this report which will Ье made availaЬle to you in the aftemoon. The Committee on Nominations, consisting of delegates of the following Member States: Angola, Argentina, Bahamas, Bahrain, Benin, Bhutan, Botswana, Brunei Darussalam, Bulgaria, Cameroon, China, Colombla, Costa Rica, Cyprus, France, Mauritius, Mexico, Morocco, Portugal, Russian Federation, Slovakia, Sri Lanka, United Kingdom of Great Britain and Northem lreland, Zambla, and myself, from Samoa (ех officio), met on 15 Мау 2000. ln accordance with Rule 25 of the Rules of Procedure of the Health AssemЬly and respecting the practice of regional rotation that the AssemЬly has followed for many years in this regard, the Committee decided to propose to the AssemЬly the nomination of Dr Libertina Amathila (Namibla) for the office ofPresident ofthe Fifty-third World Health AssemЬly. Are there any observations?

Election of the President Election du President de 1' AssemЬiee

The PRESIDENT:

ln the absence of any observations, and as it appears that there are no other proposals, 1 suggest, in accordance with Rule 80 of the Rules of Procedure, that the AssemЬly approves the nomination submitted Ьу the Committee and elects its President Ьу acclamation.

(Applause/Applaudissements)

Dr Libertina Amathila is thereby elected President of the Fifty-third World Health AssemЬly and 1 invite her to take her seat on the rostrum.

Dr Libertina Amathila (Namibla) took the presidential chair. Le Dr Libertina Amathila (Namible) prend place au fauteuil presidentiel.

The PRESIDENT:

У our excellencies, honouraЬle ministers, ambassadors, delegates, Madam Director-General, 1 would like to thank this AssemЬly for the trust in electing me as the President ofthe Fifty-third World Health AssemЬly. Taking this opportunity, 1 would like to express my appreciation to Mrs Maria de Belem Roseira, my predecessor, for her contribution to the last Health AssemЬly, and also to

1 See reports of committees in document WНA53/2000/REC/3. 1 Voir les rapports des commissions dans le document WНA53/2000/REC/3. A53NR/1 page 8

Mr Telefoni Retzlaff for presiding at the opening session. 1 shall deliver the customary address later today and we will now continue with our work.

8. SECOND REPORT OF ТНЕ COMMITTEE ON NOMINATIONS1 DEUXIEME RAPPORT DE LA COММISION DES DESIGNATIONS1

The PRESIDENT:

1 invite the AssemЬly to consider the second report of the Committee on Nominations. 1 shall now read this report which will Ье made availaЬle to you in the aftemoon. ln accordance with Rule 25 of the Rules of Procedure and having regard to an equitaЬle geographical distribution, the list below gives the names of delegates and countries that have been proposed for consideration. President of the Health AssemЬly, Dr Libertina Amathila (NamiЬia). Vice-Presidents are as follows: Dr М. Amedee-Gedeon (Haiti), Dr М.А. Al-Jarallah (Kuwait), Professor F. Nazirov (Uzbekistan), Mr N.T. Shanmugam (lndia), Professor R. Smallwood (Australia). Chairmen of Committee А and Committee В are proposed to Ье: Professor S.M. Ali (Bangladesh) for Committee А; Dr К. Karam {Lebanon) for Committee В. Other members of the General Committee are Bosnia and Herzegovina, Burkina Faso, Саре Verde, Canada, China, Cuba, France, Germany, Ghana, Lesotho, Oman, Palau, Russian Federation, South Africa, United Кingdom of Great Britain and Northem lreland, United States of America, and Uruguay. 1 now invite the AssemЬly to pronounce, in order, on the nominations proposed for its decision.

Election of the five Vice-Presidents Election des cinq vice-presidents de 1' AssemЬiee

The PRESIDENT:

We shall begin with the election of the five Vice-Presidents of the AssemЬly. The following names 1 have just read have been proposed: Dr М. Amedee-Gedeon (Haiti), Dr М.А. Al-Jarallah (Kuwait), Professor F. Nazirov (Uzbekistan), Мr N.T. Shanmugam (lndia), Professor R. Smallwood (Australia). Are there any comments? There being no comments, 1 propose that the AssemЬly declare the five Vice-Presidents elected Ьу acclamation.

(Applause/Applaudissements)

1 shall now determine Ьу lot the order in which the Vice-Presidents shall Ье requested to serve should the President Ье unaЬle to act in between sessions. The names ofthe five Vice-Presidents have been written down on five separate sheets of paper which 1 am going to draw Ьу lot. Professor F. Nazirov (Uzbekistan) is the first Vice-President. The second Vice-President is Mr N.T. Shanmugam (lndia). The third is Professor R. Smallwood (Australia). The fourth is Dr М.А. Al-Jarallah (Kuwait), and the fifth is Dr М. Amedee-Gedeon (Haiti). 1 request the Vice-Presidents kindly to соте to the rostrum and take their place accordingly, as we read them, from the first to the fifth.

Election of the Chairmen of the main committees Election des presidents des commissions principales

1 See reports ofcommittees in document WHA53/2000/REC/3. 1 Voir Ies rapports des commissions dans le document WHA53/2000/REC/3. A53NR/1 page 9

The PRESIDENT:

We now соте to the election of the Chairman of Committee А. Professor S.M. Ali (Bangladesh) was proposed as the Chairman of Committee А. Are there any comments? There being no comments, 1 invite the AssemЬly to declare Professor Ali elected Chairman of Committee А Ьу acclamation.

(Applause/Applaudissements)

We have now to elect the Chairman of Committee В. Dr К. Karam (Lebanon), was proposed. Are there any comments? There being no comments, 1 invite the AssemЬly to declare Dr Karam elected Chairman of Committee В Ьу acclamation.

(Applause/Applaudissements)

Estahlishment of the General Committee Constitution du Bureau de 1' Assemhlee

The PRESIDENT:

We shall now look at the estaЬlishment of the General Committee. ln accordance with Rule 31 of the Rules of Procedure, the Committee on Nominations has proposed the names of 17 countries, the delegates of which, added to the officers just elected, would constitute the General Committee of the AssemЬly. These proposals provide for an equitaЬle geographical distribution of the General Committee. lf there are no objections, 1 will declare those 17 countries elected. 1 see no objection. The members of the General Committee are the President and the Vice-Presidents of the AssemЬly, the Chairmen ofthe main Committees, and the delegates ofthe 17 countries you have just elected, and whose names 1 shall now repeat: Bosnia and Herzegovina, Burkina Faso, Саре Verde, Canada, China, Cuba, France, Germany, Ghana, Lesotho, Oman, Palau, Russian Federation, South Africa, United Kingdom of Great Britain and Northem lreland, United States of America, and Uruguay. Before adjouming this plenary meeting, 1 would like to remind you that the General Committee of the AssemЬly will Ье meeting at 11 :30 in Room VII. The next plenary meeting will Ье held this aftemoon at 14:30. This meeting is adjoumed.

The meeting rose at 11:30. La seance est levee а llh30. A53NR/2 page 10

SECOND PLENARY MEETING

Monday, 15 Мау 2000, at 14:30

President: Dr L. АМАТНILА (Naтibia)

DEUXIEME SEANCE PLENIERE

Lundi 15 mai 2000, 14h30

President: Dr L. AМATHILA (NaтiЬie)

1. PRESШENTIAL ADDRESS DISCOURS DU PRESШENT DE L' ASSEMBLEE

The PRESIDENT:

The тeeting is called to order; тау I please have your attention. First Vice-President of the Fifty-second World Health AsseтЬly, the Director-General, Dr Gro Harleт Brundtland, honouraЬle тinisters of health, excellencies, distinguished delegates, ladies and gentleтen, on behalf of the people and Govemтent of Naтibla, the Southem African Developтent Coттunity, the African Region, and woтenfolk throughout the world, I thank you тost sincerely for the honour you have bestowed on те Ьу electing те as President ofthe first World Health AsseтЬly of the twenty-first century and the new тillenniuт. I ат cognizant of the great responsiЬility that goes with being President of such an august body and appreciate the confidence you have shown in те and the African Region Ьу electing те to this position. I assure you of ту determination to do ту best and, with your support, to таkе this а successful AsseтЬly. I would like to соттеnd the President ofthe Fifty-second AsseтЬly for аЬlу steering the deliberations of last year, таnу of whose outcoтes will form the basis on which the work of this AsseтЬly will build on. I ат therefore convinced that the work ofthe current AsseтЬly is coттencing on а sound footing. Our тission as the Fifty-third World Health AsseтЬly is iтportant, considering that the decisions we take here will affect the health of тоrе than six Ьillion people throughout the world, not only this year but in the years to соте. I ат sure that we will deal with the issues on the agenda with the highest sense of responsiЬility and utтost dispatch. The enormous progress таdе in science and тedicine in the last century has brought about а draтatic iтproveтent in the health situation worldwide. А nuтber of dreadful diseases have been eradicated or brought under control. Life expectancy has been consideraЬly increased and the quality of life greatly iтproved for а large nuтber of people. However, it is saddening to note that there are таnу poor people who have not benefited froт these twentieth century technological developтents. They continue to suffer froт diseases where the tools for their control and effective treatтent are availaЬle, but are neither accessiЬle nor affordaЬle to theт. For these reasons, we have а long way to go to attain our goal of health for all. The health situation in таnу parts ofthe world is а cause for concem. New diseases, such as AIDS and Ebola, are eтerging, while sоте of those we thought we had controlled, such as tuberculosis, are re-eтerging with а vengeance. In fact, we increasingly see forms of tuberculosis which are resistant to all but а coтЬination of very expensive drugs. We know that tuberculosis takes its greatest toll on the poor: A53NR/2 page 11

98% of the deaths due to tubercu1osis and 95% of the eight million new cases every year are in deve1oping countries, thus adding to the burden of the poor and affecting local economies. At the same time, noncommunicaЬle diseases are posing growing challenges to health systems as а result of changing lifestyles and increasing risk factors. То make matters worse, natural disasters such as the recent floods in MozamЬique and Madagascar, as well as man-made disasters are destroying the health systems in some countries, causing massive humanitarian and health proЬlems affecting millions of people. То bring health care to those whom the twentieth century's technological developments have bypassed, as well as to rebuild or increase the capacity of health systems to соре, we need to redouЬle our efforts in strengthening the use of primary health care as the strategy to implement priority programmes in our countries. lt is encouraging to note that African Heads of State and govemment are increasingly demonstrating commitment to deal with priority health concems in their countries and in the Region, as evidenced Ьу, among others, the recent Abuja Declaration on Malaria. Such а concerted effort is essential in the fight against а disease which is responsiЬle for almost one million to two million deaths а year in Africa. It represents а burden of US$ 12 thousand million annually, while it can Ье controlled for а small fraction of that amount. lt is also important to overcome the sense of despair and resignation often surrounding malaria, especially where the disease has long been endemic. We know that there are means of combating it, but we also know that to Ье effective they must reach all at risk, even those who cannot рау for protection. Malaria, AIDS, and tuberculosis continue to plague many parts of the world, particularly the developing world. These diseases are compounded Ьу poverty and they also lead to poverty. About half the world's population is so poor that it cannot afford proper housing, adequate health care or education for its children. About one-third of the world's children are undemourished. Over the last few years, the Human Development lndex has declined in more than 30 countries. Poverty and its causes need to Ье seriously addressed in order effectively to reduce the burden of illness. At the same time, improving people's health also means enabling them to provide for their own and their families' basic needs, as well as for their children's education, thus breaking the vicious circle of poverty. This will require joint efforts with countries working to this end, in full collaboration with all communities and partners. lt also requires allocation of substantial financial, logistic and human resources which are commensurate with the magnitude of the proЬlem. As we enter the new millennium, it is appropriate that we consider convening а meeting similar to the 1978 Alma-Ata conference to develop jointly and in а participatory manner а new strategic framework for strengthening health systems. We all have experience in reforming health systems with varying degrees of success and probaЬly failures. ls it not timely for Member States to converge again to chart the way forward? As we debate our agenda in this AssemЬly, we might wish to keep this in mind. Wе congratulate the Director-General of the Wor ld Health Organization for her initial stand on the inclusion of women and people from developing countries, particularly the African Region, in the mainstream of WHO structures. Dr Brundtland has made а strong and vigorous commitment to integrating gender into all policies and programmes of the Organization. This principle is fundamental to achieving the goals and objectives of WHO, providing relevant and accessiЬle health care to all peoples. Hence, her efforts to achieve gender parity and geographical distribution are imperative. We thank the Director-General for her efforts in this regard and wish to encourage her to forge ahead with this agenda. The agenda before us is consideraЬly heavy given the reduced duration ofthe AssemЬly. 1 have no doubt, however, that we will measure up to the task. With the support ofthe Vice-Presidents and all the delegates here, both in the plenary sessions and in the committees, 1 have no doubt that we shall complete the consideration of all agenda items successfully and conclude this AssemЬly Ьу the due date, which is Saturday. 1 now call on you all to join me and move the work ofthe AssemЬly forward with necessary speed; 1 look forward to your cooperation and support over the next coming six days. 1 thank you all for your attention.

(Applause/Applaudissements) A53NR/2 page 12

2. ADOPTION OF ТНЕ AGENDA AND ALLOCATION OF ITEMS ТО ТНЕ MAIN COMMITTEES ADOPTION DE L'ORDRE DU JOUR ЕТ REPARTITION DES POINTS ENTRE LES COMМISSIONS PRINCIPALES

The PRESIDENT:

The first item to Ье considered this aftemoon is item 1.4, "Adoption of the agenda and allocation of items to the main committees", which was examined Ьу the General Committee at its first meeting earlier this moming. The Genera1 Committee examined the provisional agenda for the Fifty-third World Health AssemЬly ( documents АSЗ/1 and АSЗ/1 Corr.1) as prepared Ьу the Executive Board and sent to all Member States. The General Committee recommended the following deletions to the provisional agenda contained in documents АSЗ/1 and АSЗ/1 Corr.1: deletion of item 5, "Admission of new Members and Associate Members"; deletion ofitem 14.1, "Assessment ofnew Members and Associate Members". Since no applications have been received, it was thus recommended that we delete these two items. Does the AssemЬly agree with the recommendations of the General Committee? I see no objections. It is so decided.

Inclusion of а supplementary item оп the provisional agenda Inscription d'un point supplementaire а l'ordre du jour provisoire

The General Committee also considered the addition of one supplementary agenda item, for which а proposal had been received Ьу the Director-General. The proposal was to include а supplementary agenda item "Inviting the RepuЫic of China (Taiwan) to participate in the World Health AssemЬly as an Observer". The Committee took the same position as the AssemЬly did last year when presented with the same proposal and recommended not to include this item in the agenda. Мау I therefore assume that the AssemЬly agrees to adopt the provisional agenda as amended without the addition of а supplementary agenda item? 1 give the floor to the delegate of Swaziland.

Dr DLAMINI (Swaziland):

Madam President, Madam Director-General, distinguished delegates, we are indeed concemed about the rejection of the item that proposes the inclusion of Taiwan as an observer of the World Health Organization. The Кingdom of Swaziland and many other delegations are fully convinced that the participation ofthe RepuЬlic ofChina (Taiwan) in WНО сап constitute а constructive force for the better functioning ofthis Organization, and would help the cause of intemational cooperation. The Constitution of WHO solemnly states that the health of all peoples is fundamental to the attainment of реасе and security and is dependent upon the fullest cooperation of individuals and States. It is our belief that in order to attain this goal, intemational organizations should Ье open to all intemational participants, and should promote among nations the exchanges of the experience they have acquired, thus facilitating the sharing between all nations of the achievements of civilization. This is especially true of WНО, an organization dedicated to the noЫest humanitarian purpose of promoting and protecting the health of all people across the world. Let us recall the history of this Organization, especially its abllity to manage the question of the participation of divided nations, such as the case of the former East and West Germany and that of the currently divided North and South Korea, both of which were resolved. The opposition to Taiwan's participation in this Organization therefore runs counter to the world trend set Ьу WHO itself and does harm to people who are just asking to live а normallife. The allegations that Taiwan's participation in WHO as an observer is aimed at creating two Chinas, or one China, one Taiwan, in WHO is totally groundless. At present the Holy See, Palestine and the Intemational Committee of the Red Cross are all WHO observers. Granting RepuЫic of China A53NR/2 page 13

(Taiwan), observer status, does not engender any disputes over sovereignty. Besides, both United Nations General AssemЬ!y resolution 2758 and resolution WНА25.1 were products of the 1970s, when both the People's RepuЫic of China and the RepuЫic of China claimed to Ье the sole legitimate representatives of China. Today, the proposal to invite Taiwan to participate in WHO is not meant to raise the issue of China's representation but rather to include 23 million unrepresented people of Taiwan in WHO. lndeed the issue of unification of the RepuЬ!ic of China (Taiwan) and the People's RepuЬ!ic of China is а matter that can only Ье resolved Ьу the people of both sides of the Taiwan Straits themselves. And this issue should not Ье а matter for this AssemЬly to debate. However, the continuing exclusion of Taiwan from participation in WHO constitutes а discrimination against those 23 million people, while the primary purpose of our great AssemЬly is to ensure the participation of all in our work, so as to realize our objectives. 1 urge my Chinese colleagues to take а positive approach Ьу supporting your own Taiwanese brothers' participation in the Health AssemЬ!y as observers and thus build confidence across the Taiwan Straits. Madam President, distinguished delegates, Taiwan has expressed its willingness and demonstrated its aЬility to help fulfil the purposes of this Organization. Taiwan has indeed promoted Ьilateral cooperation in the fields of puЬ!ic health and medicine with many countries in the South Pacific, the Caribbean, the Central American region and our own Region, Africa. Both its Govemmeht and people are committed to support efforts on the global poliomyelitis eradication initiatives, the prevention and control of iodine deficiency disorders programme, and many others. They have also pledged to cooperate with intemational efforts for the control of malaria in Africa, and the global network to fight against AIDS. Based upon the aforesaid facts, we believe that consideration should Ье given to allowing the voices of the 23 million people of Taiwan to Ье heard in this Organization. We therefore deeply regret that the General Committee did not recommend including the item conceming the RepuЫic ofChina's (Taiwan) participation in WHO on the agenda.

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Dr AUMANU (Solomon Islands):

Madam President, Madam Director-General, distinguished delegates, ladies and gentlemen, firstly 1 should like to thank you for giving me this great opportunity to express my view on behalf of the Government of the Solomon Islands and of other countries, reaffirming the purpose of the World Health Organization to promote the happiness, harmonious relations and security of all peoples, and in this context reaffirming in particular the role ofWHO in the field ofhealth, as well as the commitment of Member States to cooperate among themselves and with others to promote and protect the health of all mankind. Pursuant to the Rules of Procedure, the Solomon Islands, as а Member State of WHO, would like to support the right of the RepuЬ!ic of China (Taiwan) to participate in the World Health AssemЬly as an observer. The justification for supporting the RepuЬlic of China's involvement in global health development is genuine and worthwhile, and is for the benefit of many developing countries in the world. lt should Ье noted here with appreciation that the RepuЬ!ic of China has made substantial achievements in the health field, and in recent years has extended humanitarian and medical aid to many parts ofthe world through both puЬ!ic and private organizational networks to deal with both health-related and non-health-related proЬlems, at times of disasters as well as in normal situations. The RepuЬlic of China could provide а significant input to global health development in the area ofhuman resource development to many countries in need. Having an additional partner in global health development is crucial, and will further boost the Organization's initiative for the development of partnerships in health. The RepuЬlic of China could Ье а model for many successful health development programmes, particularly in the field of controlling the most widespread and fatal infectious diseases. It has been very successful in controlling major health proЬlems such as malaria, leprosy and other communicaЬ!e diseases, and proЬ!ems conceming population, environmental health, and matemal health. Attaining health is one of the fundamental rights of every human being. lt should Ье promoted without distinction of race, religion or political belief. То let the World Health Organization hear the voice of the RepuЬlic of China would never cause any political change inside or outside the Organization, nor constitute any interference in the intemal affairs of its members. Its only effect would Ье to accord justice to the people living in the RepuЬlic of China (Taiwan) and in countries in great need. 1 would like us to Ье conscious of the serious clшllenges in world health that human beings need to address in the new millennium, and also to Ье aware of the important role the Health Organization plays in promoting and coordinating intemational efforts in the fulfilment of its objectives, as stated in its Constitution. With those remarks, Madam President, 1 sincerely hope that the RepuЬlic ofChina (Taiwan) may participate in the session and in the work ofthe Health AssemЬly in the capacity of an observer. We have to move ahead in promoting health for all, with no barriers. A53NR/2 page 15

Dr СНА Т AUT (Nepal):

Madam President, excellencies, distinguished delegates, ladies and gentlemen: first of all, 1 would like to express, on behalf of the delegation of Nepal, our congratulations to you, Madam President, and to the members of the Bureau on your election. 1 am confident that under your honouraЬle leadership and guidance this AssemЬly will achieve resounding success in its deliberations. 1 would also like to express the appreciation of my delegation to your predecessor. Madam President, this year again we are facing the same issue: the attempt to include on the Health AssemЬly agenda the item inviting the "so-called" RepuЬlic of China to participate in the W orld Health AssemЬly as an observer. We have seen such attempts being made repeatedly in the past, but without any success. This vindicates the refusal Ьу the intemational community of such an attempt. То try to do so again simply diverts the attention of the AssemЬly away from the several critical health issues that are in front of us. The constant refusal Ьу the intemational community of such an attempt stems from the very fact that, in accordance with the Constitution of WHO, only а sovereign State is qualified to apply for membership and only а sovereign State, or а [non-self-goveming] territory with the consent of its sovereign State and the relevant intemational organizations admitted into relationship with WHO, is qualified to have observer status. Moreover, even resolution 2758 of the 26th United Nations General AssemЬly and resolution WНА25.1 of 1972 of this august body have both unamЬiguously stated that the Govemment of the People's Republic of China is the sole legal representative of China in the United Nations and WHO. Ву such, Nepal considers that Taiwan, as а province ofChina, is not entitled to apply for membership or observership ofthis august body. Madam President, 1 wish to take this opportunity to reiterate that His Majesty's Govemment of Nepal has always supported the "one China" policy. His Majesty's Govemment considers that the Taiwan issue is an intemal affair of China and it should Ье left solely to the Chinese people to resolve it. Any attempt or proposal to invite Taiwan to participate in the activities of WHO would Ье tantamount to the creation of two Chinas, or one China, one Taiwan. Му delegation will oppose any proposal to provide observership to Taiwan in the Health AssemЬly and its inclusion on the agenda of the AssemЬly. We call on all Member States to reject this proposal as in previous years and to support the proposal of the Chinese delegation and of the General Committee.

Le Dr DRAME (Guinee):

Madame la Presidente, je voudrais avant tout vous feliciter, et feliciter les membres du Bureau, pour votre election et je souhaite que, sous votre direction, notre AssemЬlee arrive а trouver un consensus sur les proЬlemes de sante qui preoccupent nos pays et la communaute intemationale. Je voudrais, au nom de ma delegation, appuyer la proposition du Bureau de ne pas inclure un point concemant l'admission de Ta"iwan comme observateur а l' Assemblee mondiale de la Sante. Cette proposition, comme vous le savez, а deja ete rejetee par trois fois, meme а l'issue de votes des Etats Membres ici presents. La delegation guineenne considere qu'il s'agit la d'un conflit inteme et que l' AssemЬlee mondiale de la Sante ne saurait etre une tribune de debats politiques. Les declarations faites par le delegue de la Republique populaire de Chine sont suffisamment claires et je pense que notre AssemЬlee devrait enteriner la proposition du Bureau pour eviter de nous laisser distraire par des considerations qui ne nous avanceront pas а grand-chose.

Dr STAMPS (Zimbabwe):

Thank you Madam President. 1 want to raise а point of order. Му understanding of the rules relating to such items is that there shall Ье two speakers, two on each side, and no more. Therefore, 1 will not contribute to this debate other than to say that the People's RepuЬlic ofChina should Ье heard and supported. A53NR/2 page 16

The PRESIDENT:

Мау we now accept the suggestion Ьу Zimbabwe and go ahead with what 1 was about to say. Now that there are no further speakers, may 1 assume that the AssemЬly is prepared to adopt Ьу consensus the provisional agenda as amended without the addition of supplementary agenda items? 1 see no objection. The agenda is adopted as amended. Document А53/1 Rev.1 reflecting the changes will Ье distributed tomorrow moming to the honouraЬle delegates.

Allocation of items to the main committees Repartition des points de l'ordre du jour entre les commissions principales

The provisional agenda of the AssemЬly was prepared Ьу the Executive Board in such а way as to indicate а proposed allocation of items to Committee А and Committee В, on the basis of the terms ofreference ofthe main committees. The General Committee has recommended that the items appearing on the agenda of the plenary as amended, which have not yet been disposed of, Ье dealt with in plenary. With regard to item 10 of the provisional agenda "Round taЬles", the General Committee made the following proposals: On Tuesday moming following item 4 in plenary there will Ье four concurrent round taЬles on "Addressing the major health system challenges". Each of these round taЬles will Ье considered as а separate committee of limited membership. They will Ье limited in membership to those ministers of health or delegates designated to represent the ministers at this AssemЬly who have registered with the Secretariat. The list of participants in each of the round taЬles is puЬlished in the Joumal. As 1 have a1ready said, on1y those participants will Ье considered as members of each of the round taЬles. All other delegations and observers to the Wor1d Hea1th AssemЬly, inc1uding members of the delegation of the minister of hea1th participating in the round taЬle, wou1d attend as observers. Consequent1y, on1y the participants- that is to say, the ministers of hea1th, or those designated Ьу them, constituting the membership of each of the round taЬles - will Ье permitted to speak with the objective of ensuring а full debate between all participants. As the purpose of the round taЬles is to permit everyone to profit from an exchange of views between the participants, and not necessarily to an agreed position in all cases, the round taЬles wou1d not have а mandate to adopt resolutions, but rather only to submit а summary of the discussions to the p1enary. The Committee has proposed the following Ministers of Hea1th present at the AssemЬly as chairpersons of the four round taЬles. These are: Professor Kwaku Danso-Boafo (Ghana); Mr Jose Antonio Gonza1ez Femandez (Mexico); Dr Ponmek Da1aloy (Lao People's Democratic Republic); Mrs Andrea Fischer (Germany). The Committee has a1so agreed that one of these chairpersons would provide the plenary with an oral report summarizing the discussions between the participants. lt is understood that, later in the session, it may become necessary to transfer items from one committee to the other, depending on each main committee's workload. Does the AssemЬly agree with these proposa1s? 1 see no objection. It is so decided.

3. ANNOUNCEMENT COMMUNICATION

The PRESIDENT:

1 wish now to make an important announcement conceming the annual election of Members entitled to designate а person to serve on the Executive Board. Rule 1О 1 of the Rules of Procedure as amended in resolution WНА50.18 reads: A53NR/2 page 17

At the commencement of each regu1ar session of the Hea1th AssemЬ!y the President shall request Members desirous of putting forward suggestions regarding the annual election of those Members to Ье entit1ed to designate а person to serve on the Board to р1асе their suggestions before the General Committee. Such suggestions shall reach the Chairman of the General Committee not 1ater than 24 hours after the President has made the announcement in accordance with this Rule. 1 therefore invite delegates wishing to put forward suggestions conceming these elections to submit them to the Assistant to the Secretary of the AssemЬly not later than Tuesday aftemoon, 16 Мау, at 16:00, in order to enaЬle the General Committee to meet and to draw up its recommendations to the AssemЬly regarding these elections. When considering the tentative programme of work of the AssemЬly, the General Committee, realizing that the list of speakers when reviewing item 3 may not Ье completed Ьу Tuesday, 16 Мау, recommended an additional plenary meeting and suggested that the discussion continue on the moming of Wednesday, 17 Мау, after the report of the Committee on Credentials. Following the discussion, Committee А will hold its second meeting, while Committee В will hold its first meeting when the plenary adjoums. ls this agreeaЬ!e to the AssemЬly? 1 see no objection. lt is so decided. The programme ofwork for tomoпow Tuesday, 16 Мау, will Ье as follows: in the moming, the plenary will meet at 9:00 to hear the presentation of the invited speaker, Presidential Distinguished Professor William Foege. After the plenary, at 10:00, the round-taЬ!e committees will meet to exchange views on the theme "Addressing the major health system challenges". The fourth plenary meeting, which is to take place at 14:30, will continue the general discussion on item 3, while Committee А and the Committee on Credentia1s will hold their first meetings. On Wednesday, 17 Мау, the plenary will meet at 9:00 to consider the report of the Committee on Credentials and to continue with item 3. 1 would like to remind the few delegates who have not yet submitted their formal credentials that they should hand them over to the secretariat of the Credentials Committee in office А.667 of this building, before 11:00 tomoпow.

4. REVIEW AND APPROVAL OF ТНЕ REPORTS OF ТНЕ EXECUTIVE BOARD ON ITS 104ТН AND 105ТН SESSIONS EXAMEN ЕТ APPROBATION DES RAPPORTS DU CONSEIL EXECUTIF SUR SES CENT QUATRIEME ЕТ CENT CINQUIEME SESSIONS

The PRESIDENT:

We shall pass on to item 2, "Reports of the Executive Board on its 104th and 105th sessions". Before giving the floor to the representative ofthe Executive Board, 1 should like to explain briefly the role of the Executive Board representatives at the Health AssemЬly and of the Board itself, in order to avoid any uncertainty on the part of some delegates on this matter. The Executive Board has an important role to play in the affairs of the Health AssemЬ!y. This is quite in keeping with WНO's Constitution, according to which the Board has to give effect to the decisions and policies of the Health AssemЬly, to act as its executive organ and to advise the Health AssemЬly on questions refeпed to it. The Board is also called upon to submit proposals on its own initiative. The Board, therefore, appoints four members to represent it at the World Health AssemЬly. The role of the Executive Board representatives is to convey to the Health AssemЬly, on behalf of the Board, the main issues raised during the discussion and the flavour of the Board' s discussions during its consideration of the items which need to Ье brought to the attention of the Health AssemЬly, and to explain the rationale and nature of any recommendations made Ьу the Executive Board for the AssemЬly's consideration. During the debate in the Health AssemЬly on these items the Executive Board representatives are also expected to respond to any points raised whenever they feel that а clarification of the position taken Ьу the Board is required. Statements Ьу the Executive Board representatives, speaking as members of the Board appointed to present its view~, are therefore to Ье A53NR/2 page 18 distinguished from statements of delegates expressing the views of their governments. 1 now have pleasure in giving the floor to the representative of the Executive Board, Dr A.J.M. Sulaiman, Chairman of the Board.

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( ~ ~ ~ 'f г. ·f' ·t' ~: k ~ ,f: .. ·f г. 1~ t: ~.. ~ l1 r;;~ { • [ ~ ~ L-.: ~ ~ ~ ~' i 'L t \.о 'L Е .~' ( ;: !. . v о• • [• ~- ~- )>- r С· \::... ~ с; ~ 't\ - -· ~ \.о 1'1 \.о \.о .~ сЕ .~ <;;;-: ~ ~ \.о ' -: С· - ~- 'Е: ' 1-;. \.о ~ ( ~ ~ L 1> С· l) 0\ [ ,1:' .с ~ Е' \ v•, '(> r Е t' t' ~. ~ ~ ~ [• ,t 1-; l) .~~ t ~ [~ ~· ,t' ~ ~ .21', ~~ ~ . ~t' •f' ~ ~: ~ 'l - \r t ~ t' J: ~. ~ 'r 'r ~ t [ :Г. ·~· i ~ l: Cf-·1 ~ 0 r : ' v - :.: \.о• ~ ,~;· .с- Ei '!:- { ~ (;} ' ·Е:- .. .с [• - r "' 11- [ .l:v "О (Н L \.о • с_ L -- , - '::с [• _.: L .с- v ~ - С" - ~ - ' ' - t' - .1: ~· ' о ~ t t ~ l r .[ t \ ·( t ~ r. t r. ~? ~ ~ f ~ 'fJ: r t Е Е ~ t :t· r t ~. ~ ~· 't ~ ~ A53NR/2 page 20 у~~ ..,.J=JI_, ~\ J'+JI ._,! ~\ 1"~1 и-о o~UI ~ ui ~ о1ъ ~ ~i_, 1 и" ? J.\ ~ы1 U)WI и4JJI ~1...... :,) ~~ ~"~i_, -~~1_, ~LaJI ~ 0_)~' ~wi ~ts _; r-11..a..!l ~)\ _;~ r-S~i u-4-JI ~1...4c.i lJc. ~~-' ,4..\~1 ~ ~\J;.·,-,1\ u-4-JI .ljL.., и-о JSj_, ~~\ .о.) _,.J\ ~\ ~ ~~_}j ("~~ ~ _jj\ о1ъ ~ ~ . ..utsY..J .&\ 4...... ::.._)_, ~ ~\_, The PRESIDENT:

Thank you, Dr Sulaiman for your excellent report. 1 should like to take this opportunity of paying tribute to the work of the Executive Board and, in particular, to express our appreciation and our warm thanks to the outgoing members who have contributed very actively to the work of the Board.

5. ADDRESS ВУ ТНЕ DIRECTOR-GENERAL: CHALLENGES AND OPPORTUNITIES FOR ТНЕ HEALTH LEADERS OF TODAY (INCLUDING OVERVIEW OF ТНЕ WORLD HEALTH REPORT 2000) ALLOCUTION DU DIRECTEUR GENERAL: DEFIS ЕТ OPPORTUNITES POUR LES RESPONSABLES DE LA SANTE (У COМPRIS UN APERCU DU RAPPORT SUR LA SANTE DANS LE MONDE, 2000)

The PRESIDENT:

lt is now my pleasure and privilege to give the floor to Dr Gro Harlem Brundtland, Director­ General, so that she may present, under item 3 of the agenda, her report on the work of WHO. You have the floor, Madam.

The DIRECTOR-GENERAL:

Madam President, once again, the world tums its attention to Geneva and the World Health AssemЬly. You are the health leaders of the world, and your World Health Organization is the lead agency in health. Ours are the crucial issues of the time: health, survival, development, equity, and opportunity. Global puЬlic opinion is starting to realize where health belongs: at the core of every child's opportunity to reach his or her full potential; at the core of every parent's opportunity to work, to care and to innovate. It is at the core of every community's opportunity to secure sustainaЬle economic development for its citizens; and at the core of our efforts to combat poverty, and foster development for all- not only the privileged few- but for the many, for all. The first World Health AssemЬly ofthe 21st century is our crossroads. А warm welcome to you all. Madam President, health is long term. Health is right now. Health is on the front page, and together we are making the news. ln January 2000, 1 highlighted the issue of drugs for people living with AIDS from the rostrum of the Executive Board. Today, I say: the moves that have happened in the last few days are welcome because they were badly needed. We cannot accept that important drugs - which have been discovered, produced and made availaЬle - can only Ье used Ьу а fortunate few. We cannot accept that, for the millions who need them most, they might as well Ье on another planet. The НIV 1AIDS pandemic is а drama and tragedy of historic dimensions, but it cannot Ье seen in isolation. It is an illustration of а world that is full of inequities. It goes to the core of our value base. We can bridge the gap, but drug prices are only part of the issue. They are а step in the right direction. W е still need financing, distribution, delivery and functioning health systems. А process has been started. А momentum is emerging. The tide is turning. Let us look at the landscape for international health. We see straight away that it is changing in fundamental ways. The landscape reflects our increasingly interdependent world. У es, globalization frightens some people and causes uncertainty among many more. But it also presents us all with genuine opportunities. We live at an important moment in history. While there is great convergence, A53NR/2 page 21 we have the opportunity to benefit from our cultural and linguistic diversity. lt is our responsibility to shape events in line with our values of equity and faimess. As health workers we are increasingly well placed to make sure that greater economic integration brings benefits to those who need them. Now that health is big news it is no longer the exclusive concem of health professionals. We are working with а much wider constituency. Think about it: as heads of State, including the G8 \eaders, debate the major politica\ issues facing our world, health issues are prominent on their agenda. Health is on the minds of finance ministers attending the World Bank and IMF meetings as they discuss debt relief. Health is seen as а key component of human security; as а concept which brings together human development and national security as the basis offoreign policy in а growing number of States. For the first time in history, а health issue - НIV1 AIDS in Africa- has been discussed Ьу the Security Council ofthe United Nations. Health is а key theme in the Millennium Report Ьу the Secretary-General ofthe United Nations. Health now has а central role in the follow-up to United Nations conferences: for example, the Beijing +5 Review in New York, and the World Summit for Social Development and beyond to Ье held in Geneva next month. Achievements in health are critica\ to fulfilment of the intemational development targets. Let us reflect on what this means. Health is now at the heart of the development agenda. Health is now increasingly accepted as а powerful tool in the fight against poverty. Now we must capitalize on this opportunity. Together we have succeeded in changing the development agenda in ways that many would not have thought possiЬ\e а few years ago. The new \andscape is changing too. There are several new intemational initiatives designed to improve the health of poor people. They include: Roll Back Malaria, the Intemational Partnership against AIDS in Africa, the Global Alliance for Vaccines and Immunization, Stop Tuberculosis and Making Pregnancy Safer. These ventures are bringing in new partners and are further widening the constituency for better health. Last month 1 saw this in Abuja, Nigeria. President Obasanjo hosted 19 of Africa's Heads of State in а meeting to push forward the Roll Back Malaria efforts in Africa. They reviewed the analyses Ьу their ministers of health and а report on the economic impact of malaria. They then approved а strategy for tackling malaria in the home and in the community. They backed it with intense commitment, clear targets and nationa\ resources. They received powerful support from an intemational community that is determined to work together to support Africa's health and development campaigns. These new initiatives are а challenge to all of us. The test, and the question we must keep at the back of our minds is, "will they result in actions that can transform people's lives?". We know that this is beginning to happen: more bednets over children as they sleep; more anti-tubercu\osis drugs availaЬ\e for supervised treatment; and more trained attendants at deliveries. W е must remain vigilant. The promises made in intemational meetings and the plans set out in partnership agreements mean nothing if they do not change what happens in towns and villages and in people's homes. How can today's health leaders translate intemational commitments into practical actions, bringing rea\ benefits to those in need? 1 asked WHO's staff the same question \ast month. They provided а variety of answers. In particular, they talked about the importance of the capacity, within countries, to plan and to act. WHO, with its regional and country offices provides а unique and powerful resource to support national health actions. Those offices support health systems development, provide guidance on critica\ technical issues, and help during times of crisis. Several over-arching findings arise from our recent experience. They are relevant to a\l of us who work together, intensifying our efforts for better health. The first finding: we have seen how govemments and development partners are finding new and creative solutions to really difficult proЬ\ems. There is immense goodwill. As one example, the Global Alliance for Vaccines and Immunization (GA VI), is now seen Ьу many as а model for partnerships in intemational health. It has attracted substantial funding. GA VI now promises support for а dramatic increase in the coverage of existing vaccines and the introduction of new ones. At this Health AssemЬ\y, country delegates will receive guidelines for the submission of GA VI proposals. With а rapid response on your part, funds should start to flow before the end of the year. This shows that, to get these results and to get them quickly, we must contemplate the unorthodox. One challenge is critical to all our work: we need better ways to channe\ funds to groups who can imp\ement vital services at national and at subnationallevel. At the same time, national authorities need to own the effort. The challenge of moving funds for effective action is critical for the success of all intemational health action, whether it is GA VI, stopping tuberculosis, preventing HIV infection or rolling back ma\aria. A53NR/2 page 22

The second finding is that building and maintaining partnerships requires patience and trust. This is on our minds today as we think about the global response to the НIV 1AIDS epidemic. ln my speech to the WHO Executive Board in January 2000 1 focused on the immense suffering caused Ьу HIV1 AIDS. 1 reflected on the unprecedented response that is required from the intemational community. 1 noted that the political leadership, openness and multisectoral responses being demonstrated Ьу some countries has led to а reversal in the epidemic. We can tum the tide. We share а perspective on НIV/AIDS; an unshakeaЬle commitment within which the health sector plays а critical role. 1 indicated the continuing importance of partnerships in helping to reduce the impact of НIV on those who are affected, with countries at the centre. Several pharmaceutical companies have already responded to my invitation to take а fresh look at how to increase access to relevant drugs. They have contacted а group of United Nations agencies and the World Bank. We have worked with them, together, under the leadership ofUNAIDS. Companies indicate that they are ready to explore practical and specific ways to work with countries and communities affected Ьу HIV and immune deficiency. They want to help make HIV1 AIDS care and treatment more affordaЬle to significantly greater numbers of people in developing countries. We have jointly agreed а "Statement of lntent". То get where we are today has taken careful and protracted negotiations, and this is just the start. So to all those concemed let me say this: we must strive to Ье constructive and we must search for common ground. All involved are taking risks, but we will ensure that there are safeguards, for we must keep our eyes on the prize: а better, longer and more productive life for many people who would otherwise suffer and die prematurely. The third finding: partners in intemational health recognize that complex proЬlems rarely have simple solutions, and they are prepared to invest time and take trouЬle to address the complexities. Let us think about the issue ofНIV/AIDS care. Until recently, the cost oftherapy has been thought ofby many as being the insuperaЬle proЬlem preventing access to care. It is increasingly clear that cost is only one of several factors involved in improving access. Even if the price of antiretrovirals falls to а few hundred dollars each treatment year, the impact of that cost on household and health systems and budgets could Ье devastating. At the same time, а focus on price alone overlooks other vital issues: reliaЬle supply systems, adequate financing, laboratory backup, patient supervision and the need to set clear ethical guidelines and politically acceptaЬle priorities for puЬlic subsidies. Because of our shared commitment to health equity, we are working on all ofthese issues together, carefully but urgently. The fourth finding is that partners, whether national govemments, development agencies or private entities, are committed to results. They want to Ье sure that poor people benefit. They want to see increased access to services and care to roll back malaria, to stop tuberculosis, to prevent HIV infection, and to alleviate the suffering caused Ьу AIDS. They want to see increased access to help for those at risk because they smoke tobacco, to support and services that result in safer pregnancy. We all work together to achieve what is just and right within existing intemational regulations. We must find equitaЬle solutions that enaЬle all who need them to access essential health care, medicines, safe Ьlood, and commodities, like mosquito nets. Sometimes this means developing new products or improving access to products covered Ьу patents. As for intellectual property rights, WHO's position is clear: they must Ье protected. We depend on them to stimulate innovation. Equity must Ье our watchword as we think about the way in which people рау for care and treatment in individual countries. Fair financing is а concept which should apply in both the intemational and national arenas. In the intemational domain, we need to work with а wide range of partners carefully to define the concept of equity pricing. Working together, we must explore strategies which enaЬle low-income countries to рау less than rich ones for essential services, medicines and commodities of vital puЬlic health importance. ln our work on health systems we must ensure that the poor are not prevented from obtaining the medicines and services that they need Ьу the imposition of fees or other costs that they cannot afford. The fifth finding is on factors that are critical to our success, such as being prepared to stay the course until the job is done. 1 am thinking most immediately about poliomyelitis and leprosy, but the same will soon need to Ье said about guinea worm, river blindness and measles. Over the past 12 months, the poliomyelitis eradication effort has delivered impressive results. More than 190 countries and territories are on track to Ье poliomyelitis-free Ьу the end of 2000, representing а 95% decline in the number of cases since the initiative was launched. The Global Technical A53NR/2 page 23

Consultative Group for Poliomyelitis Eradication met last week to assess the Jatest data. lt found that there is а high risk of continued poliomyelitis transmission in parts of sub-Saharan Africa and the lndian subcontinent. Armed conflict, а temporary shortage of vaccine, Jate detection of the virus in poliomyelitis-endemic countries where surveillance is not adequate, and extreme Jogistical challenges: all these factors mean that, а year from now, the wild virus will still Ье infecting children. This does not change, however, our ultimate goal. The certification date for global eradication of poliomyelitis is 2005, and we are on track to meet that target. There is no room for complacency. lfwe fail to keep up the pressure now, success could slip through our fingers. We know that the final phase is always the hardest. We must redouЫe our efforts to succeed. 1 appeal to politicalleaders, particularly in the high­ risk countries, to increase their commitment all the way to 2005. 1 appeal to manufacturers, to ensure that all necessary vaccine is availaЫe; to waпing factions for реасе, to ensure access to every child; and to govemments and donors to continue providing the necessary funding. For Jeprosy, the global elimination target is likely to Ье achieved Ьу the end of the year 2000. Just 12 countries now carry about 90% of the remaining Jeprosy burden. А long-term alliance between govemments, WHO, nongovemmental organizations and the Nippon Foundation is implementing а focused strategy to improve access to free treatment. lt aims to ensure that the remaining 2.8 million leprosy sufferers in the world will Ье аЫе to access treatment and to Ье cured. lt plans to do this through а sustained effort over the next five years; an extraordinary prospect resulting from а long-term commitment to human dignity. Му sixth finding: as important as staying to the end is to come in early. 1 am talking about the role of health partners in complex emergencies. During humanitarian responses in Kosovo, in East Timor, in Turkey and Mozambique, numerous lives were saved because health issues were addressed early on. Yet, if we are really to offer hope, we need to go further than relief. We need to focus on relief and social reconstruction at the same time. We need to Ье there when needed- early- but we need to stay on after the television crews have left. Rehabilitation guides our actions from the very start. When the Kosovo refugees flooded into Albania and The former Yugoslav RepuЬlic of Macedonia, WHO urged that health care should, as far as possiЫe, take place through existing facilities. We cautioned against investing millions of dollars in temporary health facilities while health centres remained under-equipped. Ву strengthening the existing facilities we could together make а contribution to the future. Diseases respect neither borders nor frontlines. We know that women and children face particular risks. Health workers and their ministers have found that а focus on health during conflict can help bring together communities that are divided Ьу conflict. lndeed, health often serves as а bridge for реасе and reconciliation. When 1 first spoke to this AssemЬly two years ago 1 emphasized the need to base WHO's work on solid facts. 1 spoke of sound evidence in the context of explicit values: health for all, which means human rights, equity, participation and an insistence on making а difference. These values lie at the heart of all WНO's work. With these principles in mind, let me look again at the implications of the six findings for the World Health Organization. One immediate conclusion is that we operate in an increasingly complex environment. Many health professionals would like to concentrate on their vital technical tasks, focusing on ways to bring more benefits to more people in need. That is our vocation. However, none of us can sidestep the political context of our work. Effective puЫic health professionals work to put themselves at the heart ofthe political process. We in WHO take this reality into account. It is not easy; the demands are numerous. Every issue is presented as а priority, and budgets are tight. То help us соре we have developed а corporate strategy. lt was endorsed Ьу the Executive Board in January 2000. It restates our values and our commitment to evidence and our four strategic directions. These are: reducing excess mortality and disaЬility; reducing risks to human health; developing health systems that equitaЬly improve health outcomes; and putting health at the centre of economic and development policy. The corporate strategy identifies priorities. It also indicates WHO's core functions in pursuit ofthese priorities: advocacy; management of information; technical support; partnership building; innovation; and the development and monitoring of norms and standards. Each is important. In many areas, advocacy is а key part of our work. Mental health and food safety are issues which are immensely important in world health. They are also issues which have been given far less attention than they deserve. lt is our task to redress that situation, but advocacy alone is not enough. Food safety is an immensely political issue, and the economic stakes for many A53NR/2 page 24

countries are very high indeed. Our core function is to act as an independent provider of knowledge and evidence. Then policy-makers, regulatory authorities and trade bodies can make the best decisions possiЬle. The same is true, in many ways, of mental health. First we raise the profile of the whole issue, then we help in reaching technical consensus in а highly contested and politicized field. We will play а similar role in the ethics of Ьiotechnology. The tougher the issue for society, the greater the need for WHO to help decision-makers reach informed judgements. Next, let us look at the issue of matemal mortality. Our data show that this is the area where the difference in health outcomes between developed and developing countries is greatest. А hundredfold difference in the lifetime risk of dying in pregnancy or childhood is simply not acceptaЬle. Evidence must translate into action. We must speak out about the information we possess, broaden the constituency of organzations that have the power to act, and build coalitions of different partners nationally and intemationally. Working with others will translate ideas and commitments into better and more effective health systems, that will make pregnancy safer. We are embarking on new approaches for translating evidence into action, moving from norms and standards into puЬlic health legislation through legally Ьinding conventions. Our work on the framework convention for tobacco control is the trailЬlazer. For the first time in June we will Ье holding puЬlic hearings at which all parties, including the tobacco industry, will make their case and provide space in which negotiations can Ье taken forward. We realize that, just because we deal in facts, does not mean that we can avoid conflict or risktaking. We cannot shy away from challenging orthodoxy or spelling out the reality of health inequities. Equity is one of the core values, but we are under no illusion: it is an elusive concept when it comes to the performance of health systems. Our message may Ье uncomfortaЬle for some. We have to indicate clearly the large proportion ofthe world's population who still cannot access the basic services and commodities that they need. То advance the work of health ministers, we offer new approaches to the analysis of health systems. These cover their essential functions and their performance. Assessing health system performance is not easy, especially ifthe assessment covers the responsiveness and the faimess of aпangements for health financing. lt is even more difficult if the assessment also looks at the distribution of performance across different social groups. We have made а start in The world health report for this year. The early results have had to make use of sometimes limited and imperfect data. They are revealing; they will, 1 am sure, provoke debate. They will also provide information and analysis that will renew attention to critical issues. Sometimes the report will point out the need for policy change and for reprogramming. 1 believe we must all Ье bold and outspoken about variations in systems performance. Unless we do so, we limit our potential for gaining new insights and stimulating change. The bottom line for us all is to ensure better health outcomes in relation to the resources that are invested. While pursuing the theme of evidence and action, let те retum to the issue that underpins so much ofWHO's work. This is the contribution that health can make to reducing poverty in all parts of the world. То make our case, we must subject the availaЬle evidence to the scrutiny of those with expertise and influence well beyond the field of health. This is the rationale behind the Commission on Macroeconomics and Health. The Commission brings together some of the world's leading economists and economic policy-makers. lt makes critical assessments of linkages between health and development. Commissioners met recently in lndia for their second meeting. As their work continues, they will Ье аЬlе to indicate the potential for better health as а contributor to human well-being and prosperity. The Commission will work hard on this difficult agenda over the next 18 months, and 1 1ook forward to reporting to you on its findings. As we look ahead, we must never lose sight of the 1.5 Ьillion people who live in extreme poverty, perpetuated Ьу ill health, for whom effective health care is really accessiЬie. At least another one Ьillion people, while slightly better off, are unaЬie to have access to the care they need. They find it hard to рау for the care: maybe the services simply do not exist. Hundreds of millions more are at risk of noncommunicaЬle disease, and the effects of tobacco, and are unaЬie or unwilling to change to healthier lifestyles. Millions are affected Ьу violence and cruelty, and powerless to act in their own defence. Му challenge goes to you: what we agree at the Health AssemЬly has little meaning if it is not followed up. What we agree here means little unless you practise at home what you preach from the rostrum. It is only when another child goes to sleep under а bednet, when all who need them can get drugs to treat tuberculosis, when people are no longer afraid to talk about preventing the spread of A53NR/2 page 25

AIDS: it is only then that our job will Ье done. Our words only have meaпing when primary health systems deliver essential care to all who need it. Take tobacco: agreeing а ban on advertising is key because it is absolutely right. lt has been proved again and again that it makes а difference. Our work will not Ье done until tobacco-related deaths are drastically reduced, so, let us do it. Time is not on our side. Do not allow any extra millions to Ье added to the "death row" of tobacco. 1 know it is difficult. Health ministers cannot always change the Ьig decisions in the way that they would like, but they can Ье influential. Start the process, seek our advice, tell us how we can help. Demonstrate to your citizens that political will, when added to solid evidence, can make а huge difference. We can change the world. Before 1 end, let me рау tribute to my colleagues, the staff of WHO. Working in new partnerships, taking new initiatives forward, building our base of technical excellence: these tasks have required their undivided commitment. They are coping in the most challenging of circumstances, in Pristina, in East Timor and Sierra Leone, in many other parts of the world that do not make the news, in our country offices and regional offices, and here in Geneva. They work ridiculously long hours; they put up with uncertainty and frustrations, and this is not the half of it. WHO's success is built on committed and skilled people dedicated to the task of improving peoples' lives. Health workers, nongovemmental organizations, health ministers, heads of" State: we are all part of а huge organization for world health. Let us grab the opportunities for solidarity and service to society. Nothing has more meaning in life. Thank you, Madam President.

The PRESIDENT:

Thank you, Dr Brundtland, for your inspiring speech. Before we start the review of item 3, 1 would call the delegates' attention to resolution WНА50.18, recommending that delegates should limit their statements to five minutes and that statements should give special attention to the theme of The world health report 2000, namely ''Health systems: improving performance". Delegates wishing to report on salient aspects of their health activities could make such reports in writing for inclusion in the record, as provided in resolution WНА20.2. Delegates wishing to participate in the debate are requested, ifthey have not done so already, to announce their intention to do so, together with the name of the speaker and the language in which the speech is to Ье delivered, to the officer responsiЬle for the list of speakers on the rostrum. Before we proceed, 1 wish to inform you that the speakers' list will Ье closed today at 17:30. Should а delegate wish to submit- in order to save time - а prepared statement for inclusion in extenso in the verbatim records, or whenever а written text exists of а speech which а delegate intends to deliver, copies should also Ье handed to the officer responsiЬle for the list of speakers in order to facilitate the interpretation and transcription of the proceedings. Delegates will speak from the rostrum. ln order to save time, whenever one delegate is invited to соте to the rostrum to make а statement the next delegate on the list of speakers will also Ье called to the rostrum, where he or she will sit until his or her time to speak has come. ln order to remind speakers of the desiraЬility of keeping their address to not more than five minutes, а system of lighting has been installed; the green light will change to amber on the fourth minute and finally to red on the fifth minute. Before giving the floor to the first speaker on my list, 1 wish to inform the AssemЬly that the General Committee has confirmed that the list of speakers should Ье strictly adhered to. The list of speakers will Ье puЬlished in the Journal. 1 would like to remind those delegates who have to leave Geneva and are not аЬlе to deliver their speech before they leave that they can ask for their text to Ье puЬlished in the records ofthe AssemЬly. The debate on item 3 is now open. The first speaker on the list is Bahrain, who will speak on behalf of the Member States of the Gulf Cooperation Council: Bahrain, Kuwait, Oman, Qatar, Saudi AraЬia, and United Arab Emirates. A53NR/2 page 26

Dr AL-MOUSA WI (Bahrain): A53NR/2 page 27

El Sr. GONZALEZ FERNANDEZ (Mexico):

Sefiora Presidenta, distinguida Directora General, estimados colegas, sefioras у sefiores delegados, sefioras у sefiores: Es un honor para mi participar en la AsamЬlea Mundial de la Salud. La creaci6n de la Organizaci6n Mundial de la Salud respondi6 а una idea en apariencia simple que se ha confirmado reiteradamente desde entonces: la salud no es un asunto de naciones particulares, ni siquiera de regiones geogпificas, sino asunto de orden mundial, una cuesti6n fundamentalmente de caпicter internacional. Muchos afios han pasado desde la creaci6n de la Organizaci6n que hoy nos congrega. El perfil epidemiol6gico у demogпifico de la poЬlaci6n es muy distinto al de hace 50 afios. Los paises del orbe hemos realizado esfuerzos para mejorar las condiciones de salud, tomando en cuenta las caracteristicas de cada regi6n, los estandares у la calidad de vida de nuestras poЬiaciones, у hemos logrado avanzar у elevar Ia esperanza de vida consideraЬlemente. Si aun queda mucho por hacer, las acciones que ha encaminado la Organizaci6n Mundial de la Salud, al igual que las organizaciones regionales de salud, como en el caso que corresponde а Mexico, la Organizaci6n Panamericana de la Salud, han favorecido un mundo mas sano у con mejores perspectivas para la vida de sus habitantes. En este sentido, es loaЬle у digno de encomio el esfuerzo que la OMS ha realizado con el fin de seguir dando pasos adelante para enfocar su acci6n este afio en mejorar el desempefio de los sistemas de salud. A53NR/2 page 28

Сото lo ha planteado la propia Dra. Gro Harlem Brundtland, Directora General de la Organizaci6n: los sistemas de salud de unos paises funcionan mejor que otros. No s6lo deЬido а diferencias en los ingresos fiscales о crediticios, о а los gastos destinados а la atenci6n de la sa\ud por los Estados, sino mas Ьien por la manera de conceЬir, gestionar, financiar у administrar \os sistemas nacionales con miras а servir mejor а \а poЬ\aci6n. En Mexico, gracias al esfuerzo de todos los mexicanos, hemos iniciado е\ afio 2000 con un sistema mas s6lido, extenso у eficiente. Contamos hoy con un sistema de salud con fortaleza у flexiЬilidad necesarias para atender con agilidad, suficiencia у oportunidad las enfermedades de la poЬ\aci6n, у particularmente con una mayor ponderaci6n de la prevenci6n sobre \а curaci6n. Tenemos un sistema mejor dotado para cumplir con \а seguridad social, а la que todos tienen derecho, asi como para llevar servicios sanitarios а cada vez mas personas, sobre todo en las comunidades de mas dificil acceso. La decisi6n politica del presidente de Mexico, Emesto Zedillo, de ampliar radicalmente la cobertura de \а poЬ\aci6n ha rendido frutos. Practicamente hemos alcanzado en estos cinco afios la cobertura universal del pais, es decir, de 100 millones de haЬitantes. En este esfuerzo debemos reconocer el ароуо solidario у efectivo que nos ha brindado la Organizaci6n Panamericana de la Salud. Hemos realizado una reforma del sector salud modemizando la operaci6n de las instituciones de salud у seguridad social, descentralizando recursos у compartiendo responsaЬilidades con los goЬiemos locales que integran nuestro sistema federal у fortaleciendo, de manera creciente, el financiamiento puЬ\ico а la salud у buscando siempre la mejoria en la calidad de los servicios. No hemos llegado а la meta, pero sabemos que recorremos la via correcta en tanto ha sido un trabajo que ha involucrado а todas las instancias de nuestra sociedad. La descentralizaci6n de los servicios de salud, la aplicaci6n de una politica rectora у un estricto control del gasto puЬlico, al tiempo que adoptamos medidas flexiЬ\es у oportunas en la materia, han propiciado un mejor у mas eficiente sistema de salud en mi pais. Mexico ha tenido recientemente una intensa actividad а favor de la salud de su poЬ\aci6n. El Congreso de la Uni6n aprob6 hace unos dias diversas leyes sobre temas de salud. Una de el\as modific6 el marco juridico en materia de trasplante de 6rganos у tejidos, lo que moviliz6 а nuestra sociedad civil, asi como а las instituciones sociales у politicas. En efecto, la nueva ley modific6 el sistema de donaci6n positiva de 6rganos por un sistema de donaci6n presunta о tacita, en el que se da participaci6n а los familiares de las personas fallecidas. El nuevo sistema recoge algunas experiencias mundiales у propone medidas penales severas para impedir el trafico о comercio de 6rganos у estaЬlece un sistema nacional de trasplantes basado en organizaciones publicas de control de listas, con la participaci6n de comites de etica medica у el ароуо de la ciudadania. De igual manera, se ha legislado recientemente sobre un nuevo marco de investigaci6n, organizaci6n de la prestaci6n de servicios medicos у formaci6n de recursos para la salud, asi como en relaci6n para las adicciones, particularmente en la prevenci6n de enfermedades por el uso del tabaco. Somos conscientes de la necesidad de promover la salud. En ese sentido, Mexico, en colaboraci6n con la Organizaci6n Mundial de la Salud у la Organizaci6n Panamericana de la Salud, ha preparado у esta listo para celebrar en unos dias la Quinta Conferencia Mundial de Promoci6n de la Salud. Esta reuni6n centrara su atenci6n en demostrar la manera en que las estrategias de promoci6n de la salud afiaden valor а la eficacia de las politicas, \os programas у los proyectos de salud. Basandose en los logros de las anteriores conferencias, esta Quinta Conferencia en Mexico abundara en е\ desarrollo de las cinco prioridades emanadas de У akarta. Durante \а Conferencia se pretende promover la responsaЬilidad social por la salud, ampliar la capacidad de \as comunidades у promover la participaci6n ciudadana en \а salud. Sefioras у sefiores: Mexico desea contribuir а la promoci6n de \а sa\ud en todo е\ mundo у esperamos que !а Quinta Conferencia Mundial de Promoci6n de \а Sa\ud у \а Declaraci6n de Mexico se conviertan en un hito en \а materia. Deseo expresar а todos ustedes el reconocimiento de mi pais а las aportaciones en la elaboraci6n de dicha Declaraci6n, asi como por su adopci6n. Estamos convencidos de que !а proЬ\ematica que se abordara sera una continuaci6n 16gica de las conclusiones que se alcancen en esta AsamЬ\ea. Mexico los espera а todos ustedes en junio. Deseo, para concluir, ratificar la invitaci6n de Mexico para que esten con nosotros. En Mexico tenemos un dicho proverЬial, у es desear а quienes nos visitan que se sientan como en su propia casa. A53NR/2 page 29

Espero por ello tener la oportunidad de reciЬirlos а todos ustedes en su casa, en la Ciudad de Mexico, en junio pr6ximo. Mexico seпi su casa. Muchas gracias.

Mme ARCANJO (Portugal) (interpretation du portugais) :1

Madame le President, Madame le Directeur general, Mesdames et Messieurs, selon une tradition desormais Ьien etaЫie, j'ai l'honneur de prendre la parole au nom de l'Union europeenne, dont le Portugal assure actuellement la presidence du Conseil. Je voudrais profiter de l'occasion qui m'est donnee de m'adresser а cette AssemЫee pour vous faire part des initiatives en cours et des futurs projets dans le cadre de la politique de l'Union europeenne dans le domaine de la sante. Je voudrais egalement dire quelques mots des progres accomplis quant а la poursuite du renforcement des relations entre l'Union europeenne et l'OMS. А и cours de l' annee ecoulee, une importance particuliere а ete accordee aux questions relatives а la sante, qui figurent desormais au premier plan des preoccupations politiques de l'Union europeenne. L'entree en vigueur du Traite d' Amsterdam il у а environ un an et, en particulier, l'inquietude qu'ont suscitee aupres des citoyens les divers problemes graves lies а la surete alimentaire ont contribue а faire en sorte que soient reunies aujourd'hui les conditions permettant а l'Union europeenne de progresser rapidement dans la definition d'une nouvelle strategie en matiere de sante publique. La creation, dans le cadre de la restructuration de la Commission europeenne, d'un nouveau portefeuille consacre а la sante et а la protection du consommateur et confie а М. David Byrne, membre de la Commission, temoigne de la priorite accordee а се domaine. La presidence portugaise а decide de faire porter les efforts en la matiere sur un certain nombre de domaines d'une importance critique. 11 s'agit notamment de restaurer la confiance du public dans la securite sanitaire des aliments, de trouver des moyens efficaces d'aborder les principaux facteurs determinants de la sante tels que le tabagisme, de s'occuper de la question des produits pharmaceutiques et de la sante publique, de lancer une importante initiative en се qui concerne la telematique et la sante, d' examiner les repercussions sur la sante de l'elargissement de l'Union europeenne et de faire progresser la definition de la nouvelle strategie ainsi que d'un nouveau programme-cadre de l'Union europeenne en matiere de sante publique. C'est la une liste de themes dont je ne pouпai aborder aujourd'hui que les plus importants dans le cadre de la cooperation avec l'OMS. Prenons pour commencer la question si importante du tabagisme, qui est Ьien sur une des priorites essentielles de cette Assemblee. Etant donne l'importance du tabagisme en tant que facteur determinant negatif de la sante et le niveau de priorite que lui а toujours accorde la Communaute, la presidence est amenee а concentrer particulierement les travaux sur l' examen de la proposition de refonte des directives concernant l' etiquetage des produits du tabac et la teneur maximale en goudron des cigarettes, proposition qui est destinee а couvrir l'ensemble des dispositions relatives а la fabrication, la presentation et la vente des produits du tabac. La proposition а l'etude, qui s'inscrit­ comme les directives existantes - dans le cadre des normes applicables au marche interieur, vise а la fois а renforcer et а etendre la portee des dispositions existantes. Comme les directives adoptees en 1998 en matiere de publicite en faveur des produits du tabac, cette proposition contribuera а l'integration dans les politiques communautaires des exigences relatives а la protection de la sante. 11 va de soi que, pour la protection contre les effets nocifs du tabagisme, l'action de la Communaute s'exerce а differents niveaux etje rappellerai а се propos que le Conseil de la Sante, lors de sa session de novembre 1999, а defini une strategie globale pour les futures actions dans се domaine qui prevoit un ensemble de dispositions legislatives et de mesures d'encouragement et d'information. En се qui conceme la lutte antitabac, je voudrais evoquer egalement les travaux menes dans le cadre plus large de l'OMS relatifs а l'elaboration et а la negociation d'une convention-cadre. La phase preliminaire qui а precede le debut des negociations officielles etant achevee, je tiens а souligner comЬien je souhaite que ces negociations soient fructueuses et qu'elles recueillent le soutien de la majorite des Etats Membres de cette Organisation. Les progres deja accomplis au niveau de la

1 Conformement а l'article 89 du Reglement interieur. A53NR/2 page 30

Communaute contribueront dans une large mesure а la mise en place de normes intemationales dans le cadre de cette convention. Le tabagisme figurait aussi parmi les points inscrits а l' ordre du jour d'une conference importante, qui s' est tenue les 15 et 16 mars demier а Evora (Portugal) sur le theme des facteurs determinants de la sante. Cette conference а aborde certains themes specifiques ayant trait aux activites en cours ou aux perspectives de developpement de ces activites dans le cadre de la strategie de l'Union europeenne en maШ:re de sante. On peut citer notamment la sante mentale, question а laquelle la Finlande - qui nous а precedes а la presidence de l'Union europeenne- а accorde une grande attention, ainsi que les jeunes et la sante, la nutrition et l'alcoolisme. La conference а egalement souligne un des messages essentiels de l'OMS, а savoir que pour obtenir un gain reel en matiere de sante pour les populations, il faut adopter une approche intersectorielle large. Il ne faut donc pas hesiter а aborder les questions de l'inegalite et de l'injustice, mais s'efforcer de faire en sorte que les politiques suivies dans tous les domaines aillent dans le sens des objectifs de la sante puЬlique. La necessite de mettre en place des synergies entre les differentes politiques et d'y integrer les exigences relatives а la sante etait aussi un point important de l'ordre du jour d'une deuxieme conference, tenue а Lisbonne en avril, sur le theme « Medicaments et sante puЬlique ». Cette conference visait а souligner le fait que les considerations de sante puЬlique doivent toujours prendre le pas sur d'autres considerations. А cette fin, les participants ont examine les moyens d'ameliorer le systeme actuel d'autorisation des produits pharmaceutiques dans l'Union europeenne, ainsi que d'assurer la rentabilite optimale de l'utilisation des produits pharmaceutiques et d'ameliorer l'information existante en la matiere. Les conclusions de cette conference seront prises en consideration lors du processus de revision du systeme centralise d'autorisation qui commencera prochainement, et, d'une maniere plus generale, contribueront а l'elaboration de la strategie de l'Union europeenne dans le domaine de la sante. Presente recemment par la Commission, le livre Ьlanc sur la securite alimentaire constitue une initiative majeure. Son but est de repondre а l'inquietude largement repandue dans l'opinion puЬlique au sujet de l'innocuite des aliments. Il propose la creation d'une autorite alimentaire europeenne independante, chargee notamment de donner des avis scientifiques, de collecter, d'analyser et de diffuser des informations sur les risques pouvant resulter de la consommation d 'aliments en се qui conceme tout се qui peut avoir un effet direct ou indirect sur la sante des consommateurs et leur securite. Cette initiative constitue donc un autre exemple particulierement significatif de la necessite de definir une approche interdisciplinaire pour aborder utilement les proЬlemes auxquels nous sommes confrontes. Pour се qui est de l'elaboration d'une politique globale de la Communaute europeenne dans le domaine de la sante puЬlique, nous nous trouvons maintenant а un carrefour. Le Traite d' Amsterdam montre la voie а suivre en conferant а la Communaute de nouvelles competences en matiere de sante puЬlique, lui permettant ainsi de repondre avec davantage d'efficacite aux nouveaux defis qu'elle doit relever, notamment celui de l'elargissement de l'Union europeenne. L'elargissement est un defi qui exige de revoir et de redefinir pour l'avenir une strategie claire et coherente en matiere de sante. Le 29 juin prochain, le Conseil des Ministres de la Sante aura l'occasion de proceder а un debat important sur les priorites de la politique а inscrire а l'ordre du jour de l'Union europeenne pour les annees а venir, sur la base des propositions que la Commission formulera prochainement en vue d'un nouveau programme-cadre en matiere de sante publique. Un autre changement important а ete la reconnaissance toujours plus evidente du rбle central du developpement de la sante dans la lutte contre la pauvrete et l'exclusion. La communaute intemationale, au sein de laquelle l'OMS joue un rбle tres important, reconnait que pour pouvoir garantir une croissance duraЬle et la reduction de la pauvrete, le fait d'avoir une population en bonne sante constitue une condition essentielle. La prise de conscience du lien existant entre la pauvrete, la croissance economique, la sante, la population et le proЬleme du VIН/SIDA exige une conception large du developpement social de l'homme. Une approche fondee exclusivement sur les progres de la medecine, ou une perspective exclusivement economique centree sur la protection des secteurs sociaux, ne suffisent plus. Le bien-fonde du renforcement et d'un recentrage des investissements dans les domaines lies а la sante, au VIН/SIDA et au Ьien-etre des populations apparait maintenant а l'evidence, d'ou la necessite de definir de nouvelles approches operationnelles visant а investir dans A53NR/2 page 31 ces domaines de maniere croissante et continue en faveur des couches defavorisees de !а population. Je dois а cet egard rappeler le travail accompli par l'ONUSIDA et saluer les mesures deja annoncees par l'industrie pharmaceutique. La Communaute europeenne s'efforce effectivement de mettre au point de nouvelles strategies globales en matiere de sante et developpement, en les axant sur des domaines prioritaires et complementaires du developpement social et humaiн, au niveau macroeconomique, et en encourageant !е developpement sectoriel et l'acquisition de connaissances et de capacites appropriees. 11 est· crucial que !а Commission europeenne et les organismes intemationaux de developpement agissent de maniere а tirer !е plus de profit des synergies au niveau de !а mise en oeuvre. А cet egard, je voudrais aborder brievement la question du renforcement des relations entre l'Union europeenne et l'OMS. Dans le domaine de l'environnement et de !а sante, !а Communaute et ses Etats Membres ont coopere etroitement avec l'Organisation а l'etude des effets possibles des champs electromagnetiques sur la sante et aux travaux preparatoires а !а Conference ministerielle sur l'environnement et !а sante, qui а eu lieu l'annee demiere а Londres. La Communaute met actuellement au point les instruments et supports juridiques fondes sur les conclusions de cette Conference. La resistance aux antiЬiotiques constituera un autre secteur de cooperation а explorer. Dans се domaine, !а Communaute а accompli un travail important. Etant donne les problemes de sante auxquels nous devons aujourd'hui faire face au niveau mondial, il importe plus que jamais que nos deux institutions cooperent et coordonnent leurs efforts. А cet egard, les travaux relatifs а un nouvel echange de lettres entre l'Union europeenne et l'OMS constitueront une base solide en vue du developpement et du renforcement de leur cooperation а l'avenir. Се nouveau partenariat permettra d'instaurer un dialogue mieux structure entre l'Organisation et !а Commission europeenne. Je salue les efforts personnels que !е Dr Brundtland, Directeur general de l'OMS, а deployes pour faire progresser се processus, qui se trouve deja а un stade avance et qui,je n'en doute pas, aboutira Ьientбt.

Mr НАКЕТА (Japan):

Madam President, honourable ministers and secretaries, Director-General, Regional Directors, distinguished delegates, ladies and gentlemen, on behalf of the Govemment of Japan it is my pleasure to have this opportunity to address you on the issue of pursuit of better health systems. First of all, we would like to express our support and appreciation for the efforts made Ьу Dr Brundtland who has actively striven to make WHO more efficient and has developed the Roll Back Malaria project. As concems tuberculosis, we highly appreciate the vigorous efforts and great achievements which WHO has made ever since the declaration on tuberculosis as а global emergency was adopted in 1993 followed Ьу measures to control the disease under the strategy of directly observed treatment Ьу short­ term chemotherapy. Tuberculosis, however, is currently resurging in Japan as well and, therefore, we will take up its control both nationally and globally in collaboration with WHO. In addition to such efforts we are convinced that now is the time for WНО to promote feasible and important projects such as the eradication of poliomyelitis and the elimination of leprosy. With regard to the poliomyelitis eradication project in the Westem Pacific Region, many people have been involved in this effort, including the former Regional Director for the Western Pacific, and the present Regional Director. We would like to inform you that we are planning to hold in autumn this year an intemational conference for making the Westem Pacific Region а poliomyelitis-free area. This July, Japan will host the G8 summit in Kyushu-Okinawa, and 1 would like to mention that health issues, especially infectious disease control and prevention, will Ье taken up during the summit. As the host country, Japan will Ье making its utmost effort to facilitate active discussions on the control of HIV1 AIDS, tuberculosis and malaria, especially in developing countries. Although average life expectancy in Japan has lengthened owing to the improvement of environmental health and medical science and technologies, there still exist many serious social problems such as lifestyle­ oriented diseases, dementia and an increasing number of elderly people who require long-term nursing care. In the twenty-first century, ageing of populations will become а global issue. In the year 2025, it is expected that developing countries will Ье home to more than 70% of the world's population of A53NR/2 page 32 people over the age of 60 years. Jарап has lauпched two пеw health systems iп respoпse to these proЬlems, пamely: "Health Jарап 21 ", апd "Loпg-term care iпsuraпce system for the elderly". First, it is importaпt to carry out policies that stress health promotioп or primary preveпtioп, that is to promote пatioпal health coпditioпs апd to preveпt diseases iп order to соре with the issues of ageiпg апd chaпges iп disease treпds. J арап has lauпched "Health J арап 21" as а пatioпal health promotioп movemeпt for the tweпty-first ceпtury. This iпitiative sets out 54 evideпce-based iпdices of lifestyle-improvemeпt targets to Ье reached Ьу the year 2010, coveriпg such areas as food апd пutritioп, physical exercise, rest апd meпtal health, smokiпg апd alcohol coпsumptioп. The aim is to preveпt the so-called lifestyle-orieпted diseases, such as сапсеr, heart diseases, strokes апd diabetes. We will appeal to the private sector апd other groups that support the promotioп of the health of our citizeпs, апd actively create а social eпviroпmeпt that effectively supports health promotioп. Secoпdly, iп April this year, the loпg-term care iпsuraпce system came iпto force. This is а mechaпism eпsuriпg full пatioпal support for elderly people iп difficult situatioпs, such as bed coпfiпemeпt апd demeпtia. The aim is to estaЫish а system that provides compreheпsive services, comprised of health care, medical care and welfare services, апd that will also coпtribute to the stabllizatioп апd improvemeпt ofthe health system. Jарап pledges its coпtributioп to the global society iп the field of measures to соре with the ageiпg апd to the improvemeпt of health systems Ьу shariпg the knowledge апd experieпce we will gaiп through this large-scale project with Member States. lп additioп to these two major. health challeпges which have Ьееп lauпched this year, 1 would like to meпtioп that the Japaпese Governmeпt is takiпg оп а compreheпsive reform of major health systems. Опе area of exteпsive discussioп coпcerns what medical services for the elderly should coпsist of апd how they should Ье performed.

Ms КING (New Zealaпd):

Madam Presideпt, Madam Director-Geпeral, 1 welcome the opportuпity to speak here today after the 10-year аЬsепсе ofNew Zealaпd miпisters ofhealth from this sigпificaпt meetiпg. 1 waпt to give а brief report оп what has Ьееп happeпiпg to our health system duriпg that time апd meпtioп some of the sigпificaпt challeпges we face. lп New Zealaпd the puЬlic health system has chaпged almost Ьеуопd recogпitioп iп the past decade; throughout the 1990s, the previous Governmeпt attempted to impose а market model оп the puЫic health system, turniпg hospitals iпto compaпies, patieпts iпto customers апd а cooperative eпviroпmeпt iпto а competitive опе. The result has Ьееп growiпg health disparities betweeп New Zealaпders across socioecoпomic апd ethпic groups, апd betweeп differeпt geographical locatioпs; а loss of а populatioп-health апd puЫic-health focus; а waste of precious health resources (mопеу апd people ); fragmeпted services; апd а loss of coпfideпce Ьу people iп the abllity of our public health system to deliver health services wheп they пееd them. The market model is а failure. Ап emphasis оп а Ьаlапсе sheet at the ехрепsе of quality health care has led to а growiпg пumber of system failures iп New Zealaпd. But good people iп а bad system сап still make а differeпce. The пеw Governmeпt iп New Zealaпd is buildiпg оп the streпgths that have emerged, despite the system of the past, particularly iп the growth of service provisioп апd decisioп­ makiпg Ьу Maori for Maori (the iпdigeпous people ofNew Zealaпd). Our priorities iпclude: restoriпg а cooperative апd collaborative approach betweeп health providers, iпcludiпg the public sector, пoпgovernmeпtal orgaпizatioпs апd the private sector; reduciпg iпequities of access to health care; iпvolviпg the commuпities iп decisioп-makiпg iп health; апd developiпg the New Zealaпd health strategy which will Ье the Ыuepriпt that sets out the priпciples, objectives апd goals we waпt to achieve over the пехt decade. The strategy recogпizes the пееd to address the social, cultural апd ecoпomic determiпaпts of health, iпcludiпg housiпg, employmeпt, poverty, educatioп апd eпviroпmeпtal issues. Natioпwide health goals are to Ье re-estaЬlished, settiпg out the areas that we пееd to focus оп to develop healthy commuпities апd to improve the health status of our people. Мапу of them are попсоmmuпiсаЫе disease priorities, such as reduciпg the impact of diabetes, reduciпg the iпcideпce of coroпary heart disease апd caпcers, апd improviпg oral health status. Other health goals iпclude iпcreasiпg immuпizatioп of childreп, reduciпg the prevaleпce of smokiпg, апd reduciпg the growiпg health disparities betweeп Maori апd Pacific people апd other New Zealaпders. A53NR/2 page 33

One of the major challenges we face is to improve the health outcomes for our indigenous people. Health status for Maori people has improved over the last 20 years but Maori life expectancy at birth is eight years less than non-Maori. Maori experience а higher prevalence of most diseases. The rate of sudden infant death syndrome is five times higher for Maori than for non-Maori and only 45% of Maori children are immunized. The new Govemment has launched а major policy initiative, led Ьу the Prime Minister, called "Closing the gaps" which concentrates on improving the social and economic outcomes for Maori and Pacific people. lt requires an intersectoral approach with all the major govemmental agencies required to participate in and to identify how they can make а difference over the next three years. One area that needs urgent attention is reducing the prevalence of smoking amongst Maori: 22% • of the general population smoke; 46% of Maori smoke. There has been general concem for young Maori and Maori women, а target for the tobacco companies. New Zealand has been а leader in tobacco control. While consumption of tobacco products has declined, the prevalence of smoking has remained static in recent years. There is а need to increase policy initiatives around smoking in New Zealand and а three-pronged approach is under way: first, to increase the excise tax on tobacco - last week the Govemment increased the cost of а packet of 20 cigarettes Ьу NZ$ 1, taking the percentage of tax on cigarettes to the high end ot' WHO recommended levels; secondly, new legislation is before parliament which builds on gains made in the past; and thirdly, increased smoking-cessation programmes, with additional funding in our next budget. Smoking-related diseases kill around 4700 New Zealanders every year in а population of 3.8 million people. lf HIV/AIDS is the epidemic of the moment, smoking-related diseases have the potential to Ье the disaster of the next two decades. WHO predicts that 1О million people will die of smoking-related diseases Ьу the year 2020; two-thirds will Ье people who live in developing nations, and most of them are smoking now. This is the challenge we all face. We will fight this epidemic with vigour. We must do it with courage, and we support the development of an intemational ffamework convention on tobacco control. We must, as 1 said, have courage and conviction to сапу it through. As ministers ofhealth we owe it to our people.

Dr SНALALA (United States of America):

Madam President, Madam Director-General, Dr Alleyne, distinguished delegates, it is an honour once again to address the Health Assembly. As we witness the dawn of the twenty-first century, 1 am reminded of the words of the United States President Theodore Roosevelt nearly 100 years ago. Не said а new century is а time for both celebration and reflection. We certainly have much to celebrate. Led Ьу WHO, over the past decades we have consigned smallpox to the history books. We have eradicated poliomyelitis from most ofthe world and we have put health firmly on the global agenda. And now, thanks to its dedicated staff and its able, dynamic Director-General, Dr Gro Harlem Brundtland, WHO has become the pre-eminent global force for health. 1 also find myself reflective because today marks my eighth, and final, speech to this body as Secretary of Health and Human Services of the United States. 1 will leave with President Clinton at the end of his term in January 200 1. Last year 1 said that we can only guarantee а future of health for all if we address the challenges of infectious disease, noncommunicable disease and emerging public health threats. Reflecting on that, 1 want to discuss with you the five commitments that we, the intemational health community, must make to meet those challenges in the new century. First, we must vigorously fight infectious disease. That is especially important as we near our goal of eradicating poliomyelitis. Finishing the job will not Ье easy. We cannot become complacent. Donor nations must do more to overcome the financial, the political, the security and other baпiers to poliomyelitis eradication. Let me Ье very clear. No nation is free of poliomyelitis until every nation is free of poliomyelitis. As we continue to battle infectious disease we must always pursue new, more effective weapons. That is the second commitment, and that is why President Clinton has proposed а one billion dollar tax credit for pharmaceutical and Ьiotechnology companies to accelerate vaccine development. This powerful incentive will help move vaccines out of the halls of science into the hands of those who need them, including those with tuberculosis, malaria and AIDS. Confronting the global epidemic of AIDS must Ье our third commitment. Up to one quarter of southem Affica's population may die of AIDS, and the potential for A53NR/2 page 34 explosive epidemics in Asia and Eastern Europe is just as threatening. Besides the toll in human lives and human suffering, these numbers endanger fragile democracies, fragile economies, fragile health systems and international political staЬility. That is why the President of the United States considers AIDS а threat to our regional and global security, why we are supporting а significant increase in funding to combat the AIDS epidemic around the world and why we as а body must reaffirm our support of UNAIDS and of WHO's new energy in this area. We must all recognize that AIDS is а threat to every Member State and act accordingly. Our fourth commitment is clear. We must protect our children from а very different epidemic­ tobacco. As we approach the tenth anniversary of the World Summit for Children, which challenged all of us to reduce child and infant mortality, let us pit our wits and our wills to this task. Ву the middle ofthis century, tobacco is predicted to Ье the leading global cause of noncommunicaЬle death and disaЬility, responsiЬle for one in eight deaths. We have а tremendous opportunity to prevent many of these deaths Ьу supporting WHO's ТоЬассо Free Initiative. 1 also believe that the proposed framework convention on tobacco control can Ье the strongest multinational effort ever against tobacco. The debate on the convention must Ье open, transparent, and inclusive, and we urge that the framework itself Ье sufficiently broad to permit universal signing Ьу Member States. The only way to defeat the tobacco epidemic is through global cooperation. That brings me to our fifth and final commitment. We must continue to work together for positive change. WНО must lead the way, but it is not а job for WHO alone ..World health proЬlems require world health solutions. It is up to all of us to expand worldwide access to immunizations, to safe Ьlood, to safe food and health services, including mental health services, for all; to support partnerships like WНO's Roll Back Malaria and Stop Tuberculosis and the new Global Alliance for Vaccines and Immunization; to ensure that women and girls share equally in health and education services; to vigorously pursue prevention strategies for all of our citizens, women, men and children; to develop the evidence base for health systems so that we know how to deal effectively with the major causes of death and disaЬility; and to escalate our global fight against infectious disease, noncommunicaЬle disease and emerging puЬlic health threats. If we truly want to reach the goal of ensuring health for all we must continue to form global partnerships, to strengthen global systems, to harness global communications and, above all, to chart а common course in our common cause.

Dr STUART (United Кingdom ofGreat Britain and Northern Ireland):

Madam President, Director-General, ladies and gentlemen, the United Кingdom would like to congratulate the Director-General on her statement on health systems and fully endorse what she has said about the importance globally of the fight against НIV and AIDS, tuberculosis, malaria and other major diseases. The United Kingdom will continue supporting her efforts. We also welcome the joint statement of intent on HIV and AIDS made Ьу а number of pharmaceutical companies and United Nations agencies as а positive step forward. Fighting disease and tackling health inequalities effectively relies in part on improving the performance of health systems. That is why the United Kingdom Government has committed itself to modernizing the national health care system. With modernization comes systematic improvement in performance and true puЬlic accountaЬility for delivery. Comparisons of the performance of the National Health Service over time show that the deficiency has improved and continues to do so. But а narrow approach to efficiency runs the risk of resulting in low-quality services, poor health outcomes and ultimately higher costs. Efficiency cannot Ье considered in isolation from other aspects of performance, such as clinical quality, patient experience and access. Our approach also brings into the spotlight action to improve the level of health in populations, narrowing health inequalities, ensuring parity of access to services for all. The United Kingdom Government recently announced а four-year package of additional funding for the National Health Service, giving it the Ьiggest ever increase in resources and the most sustained. W е expect this step change in resources to Ье matched Ьу step change in performance. The Prime Minister laid down five major challenges for improving the national health service: partnership, making all parts of the health and social care system work better together; performance, improving both clinical performance and health service productivity; professions and the wider National Health Service work force, that means increasing flexiЬility in training and working A53NR/2 page 35 practices, and removing demarcations in the context of major expansions of the health care work force; patient care, which has two components, ensuring fast and convenient access to services but also empowering and informing patients so that they can Ье more involved in their own care; last but not least, prevention, tackling inequalities and focusing the health system on its contribution to tackling the causes of avoidaЬle ill health. We shall meet these challenges Ьу ensuring clarity of purpose in the service and involvement at the !оса! level. We shall develop the National Health Service's capacity to deliver, and we are evolving national service frameworks for key areas such as coronary heart disease, cancer and mental health services, estaЬ!ishing evidence-based guidance for clinicians through the National lnstitute of Clinical Excellence and spreading best practice quickly and consistently. Performance monitoring and management will Ье based around а set of performance indicators and there will Ье incentives for the service to improve its performance year on year. Regulation and inspection will ensure secure compliance with minimum standards of service and promote improvement. А Commission for Health lmprovement has recently began its work to monitor national protocols and standards and to ensure quality of access across the whole of the National Health Service. The United Kingdom's National Health Service will remain true to the aims estaЬlished on its foundation more than 50 years ago. Health service provided on the basis of need alone, free at the point of delivery. The modem National Health System in the United Kingdom will provide fast and convenient access for everyone to services of а consistently high quality and we shall work with all the other Govemment departments to ensure that the influence of their policies on health will Ье fully taken into account. Finally 1 recognize and welcome the important work which the World Health Organization undertakes in this area, from which we can all leam. 1 would also like particularly to endorse the comment in the statement made Ьу Portugal, which acknowledges the personal efforts of Dr Brundtland to bring about closer working between the European Union and the World Health Organization, and 1 look forward to continuing our own close collaboration with WНО. Thank you.

The PRESIDENT:

1 thank the delegate of the United Kingdom. 1 now give the floor to the delegate of Swaziland who will speak on behalf of the Southem African Development Community: Angola, Botswana, Democratic Republic of Congo, Lesotho, Malawi, Mauritius, MozamЬique, NamiЬia, Seychelles, South Africa, Swaziland, United Republic ofTanzania, ZamЬia and Zimbabwe.

Dr DLAMINI (Swaziland):

Madam President, Vice-Presidents, Madam Director-General Dr Brundtland, honouraЬle ministers, ladies and gentlemen, this statement, as the President has said, is presented on behalf of the 14 Member States she mentioned. The Member States of the Southem African Development Community (SADC) congratulate you, Madam, on your election to the Presidency, as well as your Vice-Presidents. lt gives our region, and all African women, pleasure and pride to have you as President for the first AssemЬly in the new millennium. Let me thank WHO for the human and financial support afforded to our region in the last fiscal year. The challenges have increased, however, outstripping the resources from national budgets. Whilst the SADC Member States would wish for the health budgets to Ье more than 12% of the total national budget, the economic difficulties that many of our countries face have made it difficult for us to achieve this. The population of the SADC region is 190 million. Sadly, the resources are disproportionately much less because of the weakened economies, conflicts, disease and natural disasters. Despite the poverty alleviation programmes, poverty is still consideraЬ!e in the SADC Member States. This is due to high unemployment rates, retrenchments, the disease burden including HIV 1AIDS, tuberculosis and malaria, as well as the heavy deЬt burden in the majority of the Member States. Poverty negatively impacts on the standard of health as well as the quality of care afforded to our people. Significant gains achieved in the last few decades are being rapidly negated Ьу the increase in poverty. We appeal to the developed countries and financial institutions to consider A53NR/2 page 36 cancelling these debts, and free the resources that are spent on repaying the debts for providing quality health care. RegrettaЬiy, there are still areas of conflict in the SADC region, making health provision quite а challenge. The ongoing war and conflict in our region is cause for concern. lt is becoming difficult in these countries to work towards eliminating poliomyelitis, when communities cannot Ье reached to conduct vaccinations. Health care in times of conflict is indeed difficult since people get displaced continuously. It is our hope that the intervention and mediation of some SADC and intemational leaders will result in the restoration of реасе, to avoid further deaths, displacement and maiming in our region. Such maiming places а burden of managing the acute cases as well as rehabilitation of chronic cases. Several countries which still have а significant number of landmine victims can testify to this. The anxiety that the whole world had about the У2К compliance, specially in the health sector, was justified. However, it was with great relief that the SADC Member States experienced few proЬiems, if any, around the transition period. SADC has, however, resolved not to Ье altogether complacent, since there may Ье minor hiccups in the health institutions. We appeal to WHO and other collaborating partners to assist our region in capacity-building for the advancement of health information technology so that we can offer our citizens quality care, as you heard the Director­ General say, and we find the theme for this year appropriate. HIV1 AIDS and tuberculosis epidemics still rage in the SADC regions, with some national prevalence rates well over the 20% mark. The HIV subtype С found in the subregion seems to have а short latent phase, so many of our young people are dying in numbers. This is resulting in the weakening of economies, and the loss of academic and professional people as well as the general population. There is need for assistance in planning for the ongoing huge human resource loss to the graves. The challenges that have arisen for the countries include а massive number of orphans and excess burden on the health sector. Our economies are negatively affected as the work force is lost after long absences from work and eventually death. Some orphans are living in deploraЬie conditions. Some are living with helpless, elderly grandparents and others alone in child-headed families. Many of these children are missing out on their schooling. There is need for assistance in the region in strengthening the social safety net. The health institutions are also overwhelmed with numbers, and severity of illness. The 100% to 3 00% осеираnсу rate in some of the adult medical wards results in the quality of care delivered deteriorating to sometimes very unacceptaЬie levels. lt is for this reason then that we appeal for assistance in expanding the home-based care programmes, so that we can provide а continuum of care and empower our communities. The issue of antiretroviral therapy and support for HIV -related pathology is creating challenges for our Member States, especially since it has been politicized. They are unaffordaЬie, inaccessiЬle to the general population. Whilst we applaud, and 1 emphasize applaud, the recently announced negotiations on improved access and reduction in prices, there is cause for concem. We take note that it was the initiative of the policy-makers of the developing countries, who kept requesting price reductions for drugs. The SADC Member States feel that WHO, UNAIDS and all concerned should involve policy-makers in the negotiating process from now on. The negotiations should have been not only for price reductions but for sustainaЬility, and concessions for parallel importing as well as manufacturing some of these drugs in our developing countries. Treatment of opportunistic infections should not Ье excluded from these negotiated packages. We are finding it expensive to соре with the burden of related illnesses besides just antiretroviral therapy. Hopefully this recent breakthrough is not aimed at thwarting the efforts of being independent and developing our expertise, just to maintain market for the pharmaceutical giants on their own terms for as long as they feel suitaЬie. For this gesture to Ье crediЬie, it should look at capacity-building for the health workers that monitor this process, adequately equipped laboratories for testing and monitoring patients through CD4 and CD8 counts and viralloads, as well as infrastructural development and more. These tests, where availaЬle in our region, are extremely expensive and beyond the reach of the majority of the people in the developing countries. We cannot overemphasize the issue of nutrition, which needs to Ье improved, as well as the prevention of HIV1 AIDS, the hallmark of curtailing the epidemic. SADC Member States are keen to emphasize the issue of nutrition, including infant nutrition and breastfeeding, in relation to HIV1 AIDS, and of alternative therapies in improving the quality of life of people living with HIV. Assistance in ASЗNR/2 page 37 this regard and relevant research is urgently needed. We still believe that there are qualitative as well as quantitative advantages of breastfeeding as against the indiscriminate advertisement of formulas. We feel that the empowerment of communities is vitally important so as to make them соре with the epidemic and make informed decisions. The countries' support of the provision of home-based care kits Ьу the World Health Organization's Regional Office for Africa, is highly appreciated. There is need to closely look at the quality, effect and availability of the female condom in our communities at affordaЬle prices, as well as taking cultural sensitivity into account. Relevant research into anti-HIV vaccine and related issues needs to Ье encouraged in the region, preferaЬly Ьу local scientists in the region collaborating with intemational researchers. lt is hoped that such research will Ье transparent and aimed at benefiting our communities. Assistance from the developed countries is needed to have fully and properly equipped health centres so that proper voluntary counselling and testing can Ье done as people are motivated to do so. The issue of Ьlood safety, our theme for this year, is а priority and we feel that we need funds to develop the upgraded WHO collaborating centre in Zimbabwe which is training Ьlood transfusion officers in the region and for the region. Malaria still causes significant morbldity and mortality in our region and the recent floods have aggravated the proЬlem, causing economic loss as well as loss of lives. Our region is keen to roll back malaria, and we feel that the programme is empowering and strengthening the initial, earlier OAU resolution. Considering that there is resistance to some of the pyrethroids as well as some insecticides, and taking into account the results of operational research done in our region, the SADC region has decided that it will include the use of DDT in vector control. The doses, site and method of spraying do not significantly endanger any fauna and flora but are aimed at saving human lives. The WHO ТоЬассо Free Initiative is strongly supported Ьу our subregion and we need assistance in strengthening our legislations in this regard. Some Member States whose economies depend largely on tobacco growing need immediate and continued assistance in growing altemative cash crops, so as to decrease tobacco growing in their countries. Sadly, some developed countries still dump the cigarettes not permitted in their own countries in our region. Such tobacco ends up being smuggled across the borders to do harm to our people in local industries. Of concem is the escalating level of drug abuse and trafficking. The young tend to Ье more vulneraЬle in this regard and we feel this makes the fight against HIV difficult with the amount of alcohol and drug abuse that is going on. The 1999-2000 rainy season was ushered in in а rather dramatic way. The cyclones and the floods caused significant loss of lives in excess of 500 in our region, through drowning and mud huts falling on people. Most of the SADC Member States were affected, with Mozamblque more severely affected. Besides the severe infrastructual damage, famine and the threat of diseases like cholera and malaria have hit hard. This will no doubt aggravate the poverty level that exists. The Kingdom of Lesotho is also experiencing severe winter with excessive snow and we feel many people will Ье endangered Ьу exposure to cold. While we thank the neighbouring States as well as the intemational community for the assistance given, we appeal for more sustained support for the rehabllitation programme in the affected Member States. The role played Ьу the neighbouring States of Botswana, Malawi, Namibla, South Africa, Zambla, Zimbabwe, my own country Swaziland, and others is to Ье applauded. Such а spirit of collaboration in the subregions should Ье encouraged since it also conforms to our culture. The recent flood disasters also highlighted the need for emergency and disaster preparedness in the region. We hope that WНО as well as other collaborating partners will assist us in this. The Health Care Financing Programme continues to Ье а challenge in our countries, which have dwindling resources. We want to emphasize that there is political commitment at all levels in our countries, but the resources do not match the burden we face. We appeal therefore to collaborating partners to support programmes that reflect the national and regional priorities identified Ьу the countries themselves. The donor-driven programme priorities only cause fragmentation of services as well as wasted resources and time. We also feel that while technical assistance is important, it should Ье sought in the Member States as much as possiЬle. This will promote relevance and ownership as well as sustainabllity in the programmes. While nongovemmental organizations perform а commendaЬle job, it is cause for concem that donors sometimes marginalize national policy-makers in favour of nongovemmental organizations to implement donor programmes. We also appeal for A53NR/2 page 38 assistance to strengthen the adolescent reproductive health programme. Programme sensitivity to cultural diversity will Ье appreciated. We believe that our good cultural values need to Ье promoted to save youth from sexually transmitted diseases and HIV/AIDS. Human resource development is а priority in our subregion; we also thank WHO, which is assisting us with some fellowships. The distance leaming programme, а new initiative in our region, also needs support and we are pleased to note that it is benefiting our communities. The SADC Member States have also pledged to assist each other where possiЬle in capacity-building and this initiative, we hope, will Ье supported Ьу the intemational community. The persistently good health indicators in our Member States of Mauritius and Seychelles give us hope that we could take а leaf from their book. NoncommunicaЬle diseases pose challenges in these two countries as well as other Member States and we will continue to fight them. We congratulate the Director-General for her initial enthusiasm and initiative to promote gender and racial balance at WHO headquarters. We are, however, concemed that with the recent departures and appointments, this trend is being reversed. While we recognize the need for management structures to Ье flexiЬle and adapt to changing needs, we however wish to place on record our conviction that such changes must always Ье guided Ьу а firm expression of the need to ensure adequate racial, gender, geographical representation at WHO. The 13th Biennial Intemational AIDS Conference will Ье held in Durban, South Africa, from 9 to 14 July 2000. We believe that the holding of this conference in our region, and in а developing country for the first time, provides an opportunity to reflect on all our НIV interventions and strategies. SADC Member States will work together with the host country South Africa to ensure а climate conducive to а healthy dialogue and а platform for the elaboration of actions that will help escalate our interventions. We look to the contribution and the success of this conference and we feel it will Ье а fitting tribute to all those across the globe who are battling to survive one ofthe most devastating scourges ever known in humanity. In conclusion, we believe that the challenge of the new millennium is to combat the НIV1 AIDS and tuberculosis epidemics, and to roll back malaria and other diseases. We still aspire to provide high quality, accessiЬle and affordaЬle care, with communities, for communities. They need to Ье the centre of our activities. The engagement and participation of the private sector is essential in improving the standard ofhealth of our community. lt is hoped that the deliberations ofthis Fifty-third World Health AssemЬly will give rise to resolutions that truly aim to strengthen our developing countries. We aim at improvement in the health indices as well as the quality of life. Let this AssemЬly assist us in achieving this ideal in this millennium in а participatory fashion. lt is hoped that our voiced concems will Ье heard and perceived in а positive, rational and constructive way, as was meant. For the benefit of our communities we want health for all, Ьу all, and with all. 1 thank you, Madam President.

М. CНARВONNEAU (Canada) :

Madame la Presidente, Madame le Directeur general, Excellences Mesdames et Messieurs les Ministres de la Sante, Mesdames, Messieurs. C'est pour moi un grand honneur et un vif plaisir de m'adresser а cette Cinquante-Troisieme AssemЬlee mondiale de la Sante, particulierement lorsqu'il s'agit d'un theme aussi actuel, aussi important, aussi central que nos systemes de sante.

(L'orateur poursuit en anglais.) (The speaker continued in English.)

At а time in history when health services everywhere are subjected to immense pressures arising from advances in technology, raised expectations on the part of the providers and the consumers, and funding limits, we have to commend the Director-General of WHO for having proposed to focus this year's world health report, as well as this AssemЬly's round taЬle on health systems.

(The speaker continued in French.) (L'orateur poursuit en fraщais.) A53NR/2 page 39

Les gouvemements ont un rбle с !е а jouer au niveau des politiques dt:; sante et des systemes de sante, comme l'indique le resume du Rapport sur la sante dans le monde, 2000; je cite: « La responsabilite de la performance du systeme de sante incombe en demiere analyse au gouvemement. La sante des gens constitue toujours une priorite nationale et c'est au gouvemement de veiller а се qu'elle soit assuree en permanence. ». Au Canada, nous retrouvons се concept au coeur meme de la loi canadienne sur la sante. Cette loi definit les principes constituant l'assise du systeme de sante canadien, soit l'universalite, l'integralite, I'accessiЬilite, la transferaЬilite et la gestion puЬlique. Nous sommes aujourd'hui invites а reflechir sur le theme du rapport sur la sante dans le monde de cette annee, а savoir l'amelioration du rendement de nos systemes de sante nationaux, tout autant que du rendement du systeme de sante mondial.

(L'orateur poursuit en anglais.) (The speaker continued in English.)

А few months ago, the Director-General reported to the Executive Board the progress made in reforming WHO and she shared with the Board the elements of her strategic agenda for the Organization. We took note with immense satisfaction of the strategic directions adopted and the programme priorities proposed Ьу the Director-General. Canada is pleased to recognize that Dr Brundtland has given the highest priority to improving the performance of WHO as the directing and coordinating authority on intemational health and as а primary source of technical advice and cooperation for its Member States. Ву estaЬlishing а strong unit for evidence and information, the Director-General has greatly improved the Organization's capacity to set short- and long-term programme priorities. The special initiatives for malaria, tuberculosis and tobacco control are good examples of the attention given Ьу WHO to health proЬlems that represent the greatest human and economic burden. We are particularly impressed Ьу the progress made in developing а framework convention on tobacco control and we look forward to the negotiation and adoption of а strong and comprehensive intemational convention.

(The speaker continued in French.) (L'orateur poursuit en fraщais.)

Dans le passe, !а communaute intemationale s'est souvent contentee de solutions simples pour des proЬlemes de sante generalement complexes. Il у а une vingtaine d'annees, par exemple, dans !е contexte de l'initiative pour la survie des enfants, la vaccination est apparue comme !а bonne solution au proЬleme des infections de l'enfance souvent mortelles. Apres quelques annees de vaccination massive, nous avons du reconna'itre que, sans la mise en place et le renforcement d'une infi"astructure correspondante, la couverture vaccinale ne pouvait etre soutenue. Le Dr Brundtland nous а rappele que les programmes dits verticaux n'ont une efficacite optimale que s'ils sont offerts dans le contexte de systemes de sante complets et duraЬles. C'est donc avec joie que nous accueillons le renforcement des ressources de secretariat dans les domaines du developpement et de l'evaluation des systemes de sante. On ne peut demander а I'OMS de repondre seule а !а demande croissante de cooperation technique pour le soutien des systemes de sante. C'est pourquoi !е Directeur general а fonde son programme strategique sur des partenariats intemationaux d'importance qu'il convient de reproduire et de prolonger dans nos pays.

(L'orateur poursuit en anglais.) (The speaker continued in English.)

In closing, 1 would like to reaffirm Canada's commitment to an effective global health system. The progress achieved so far permits us to Ье optimistic. No doubt our discussions during this conference will Ье an important contribution towards our goals. We need increasing solidarity efforts on the part of the intemational community and we need better coordination within the multilateral system. We need а strong and effective WHO. A53NR/2 page 40

(The speaker continued in French.) (L'orateur poursuit en fraш;ais.)

Nous avons besoin d'une OMS vigoureuse et efficace et nous saluons le travail entrepris dans cette direction.

The PRESIDENT:

Before we adjoum, may 1 remind you that the next plenary meeting will Ье held on Tuesday, tomoпow, at 9:00. The following Members were on the list today and unfortunately could not speak due to the time constraints; more than half of the delegates who took the floor drove through the red light, so tomoпow 1 hope we will reduce the percentage. Tomoпow's speakers are the Russian Federation, China, Republic of Korea, Chile, Brunei Darussalam, and Sweden. The plenary will first of all hear the invited speaker, Professor William Foege and then we shall break. At 14:30 we shall commence with the countries mentioned and then continue with the other speakers on the list. So please let us try and keep to the traffic lights so that we can finish on time. 1 thank you very much for your help today. Go and rest and we will see each other tomoпow at 13:00 in the plenary. The meeting is adjoumed.

The meeting rose at 17:50. La seance est levee а 17h50. A53NR/3 page 41

THIRD PLENARY MEETING

Tuesday, 16 Мау 2000, at 9:00

President: Dr L. АМАТНILА (NamiЬia)

TROISIEME SEANCE PLENIERE

Mardi 16 mai 2000,9 heures

President: Dr L. АМАТНILА (NamiЬie)

INVITED SPEAКER INTERVENANT INVITE

The President:

The AssemЬly is called to order. Before entering into the subject of our meeting, 1 wou1d 1ike to remind you that the round taЬles on "Addressing the major health system challenges" will take place at 10:00 in Rooms VII, XII, XVII and XVIII. ln the aftemoon, at 14:30, we will convene again for our fourth plenary, while the Committee on Credentials and Committee А will simultaneously hold their first meetings. We can now proceed with item 4 ofthe agenda, "lnvited speaker". lt is а great honour for me to welcome, on beha1f of this AssemЬly, Presidential Distinguished Professor William Foege, Rollins Schoo1 ofPuЬlic Health ofEmory University, At1anta, Georgia, and Senior Advisor, Bill and Melinda Gates Foundation. Professor Foege has very kindly agreed, in spite of his very heavy schedule, to address this AssemЬly on "Health ministers as good ancestors", and it is with pleasure that 1 now give the floor to Professor Foege.

Professor FOEGE (Senior Advisor, Bill and Melinda Gates Foundation):

Thank you for this wonderful opportunity. Му wife taught four-year olds for many years, so this has become а source of wisdom and stories for me. One of my favourite stories is the first day of schoo1. The teacher is explaining to these four-year olds what the rules will Ье for this, the first time they have ever been in school. The teacher says at the end, "lf you need to go to the bathroom, raise your hand". А very perplexed four-year-old Ьоу asks, "But how does that help?". How does it help that we are all involved with global health? One year 1 hadjust completed my presentation to that class offour-year olds on how to stay healthy, and 1 asked ifthere were any questions. А girl asked me, "Do doctors have bosses?", and 1 thought to myse1f, "1 would like to follow the career of this girl". Му answer was, "The good ones do - their patients are their bosses". Do ministers of health have bosses? У ou might all say immediately that you answer to such-and-such а person, but the good ministers find that every person in their country is their boss. lt does not end there. У ou are building а foundation which means that every person who will ever Ье bom in the future in your country is your boss. Amold Toynbee was wrong when he wrote, "The twentieth century will Ье remembered chiefly, not as an age of political conflicts and technica1 inventions, but as an age in which human society dared to think ofthe hea1th ofthe who1e human race as а practical objective". lt was instead, as we know, an A53NR/3 page 42 age of political conflict and technical inventions. In addition, we ended the twentieth century with gaps and discrepancies and differences in health that simply make us embaпassed. We meet this week, not just to improve global health govemance, not only to network, not simply to review the progress of our health programmes. We gather to figure out how to close those gaps, and to reaffirm the very essence of our philosophy as puЬlic health professionals. That essence rests on our oЬligation to use the knowledge and experience gathered over the years to improve the quality of life for everyone. Our work foundation, our professional creed, our reason for holding the position oftrust that brings us to this meeting, is to seek socialjustice in health. But we come here also to dream - to dream about а world we will never see, but а world that we will create. Over half а century ago, your professional ancestors began these annual meetings. Could they have believed what would happen in 53 years? People often make the statement that life expectancy has improved more in those 53 years than in the previous 4000 years. And that is true in many places, but not in every place. One disease, smallpox, has disappeared, infant mortality rates have declined Ьу 50% to 90% in most countries, but not for all groups. The measles virus is no longer the single most lethal agent in the world. That simultaneously shows the power of an inexpensive vaccine, but, at the same time, the hesitancy of the puЬlic health estaЬlishment to use that power fully. How else can we explain that almost 3000 children die each day of measles, а disease which is so readily preventaЬle? Would they have believed that poliomyelitis and guinea worm were about to join the ranks of historical footnotes? We acknowledge all these. accomplishments while facing the inevitaЬle truth, which is that the proЬlems you face are daunting. No ministers of health have ever faced more difficult times. AIDS is а more formidaЬle opponent than even the Black Death. That plague came and went. lt caused wholesale deaths; it reorganized society; and in 1348 and 1349 perhaps а quarter of the population of Europe died. Govemment workers, landowners, merchants, church officials died; in one year over 50% of the Ьishops of the Catholic Church died. But then, as with an earthquake or а natural disaster, the population could regroup. But not with AIDS. The proЬlem goes on, day after day. There is never а chance to regroup, as health workers and teachers and govemment workers in some places die faster than they can Ье replaced, weakening the social fabric. Grandmothers struggle to keep their grandchildren together, faced with the impossiЬle task of providing food and clothes and school fees. Many of you have known for а long time that AIDS in your country is а national security issue. Now that is being recognized globally. And if AIDS is not challenge enough, just add to that mix tuberculosis, malaria, malnutrition, onchocerciasis, lymphatic filariasis, intestinal helminths, the toll of injuries and violence, mental health proЬlems, poverty and illiteracy. And if that is still not enough to make health officers suпender, add а proЬlem causing more deaths than tuberculosis. Not the work of nature, but of people willing to cause suffering in order to make а profit promoting tobacco. У о и end up with а disease proЬlem complex that few in the world can even comprehend. У о и are the heroes of our time. Are you overwhelmed? Of course you are, but you are not defeated. The writer F. Scott Fitzgerald once wrote, "The mark of а first class intellect is the aЬility to keep two conflicting ideas in mind at the same time, such as this is an impossiЬle situation and here is how we will solve it". And so, in the midst ofthis impossiЬle situation, you evaluate the assets and tools at your disposal and conclude that never has this AssemЬly as а group faced such an impossiЬle proЬlem and at the same time never have you had so much power to change forever the future health of the world. As we look at the road ahead, what gives you hope? The positive signs are positive indeed. The first positive sign is that we have better tools. Could we have believed, when we started our professional careers, that we would have an inexpensive vaccine against poliomyelitis and the chance to spare every future generation? Some of us still remember that day, 45 years ago last month when it was announced that the Salk vaccine protected against poliomyelitis. Could we have believed the measles vaccine saving children Ьу the millions each year, the hepatitis В vaccine, the first of what will Ье а group of anti-cancer vaccines? Haemophilus injluenzae type В is а magical vaccine in removing meningitis and pneumonia from the lives of children. Now, soon, through the Global Alliance for Vaccines and Immunization, it can Ье made availaЬle to countries that were excluded in the past because of the vaccine price. Did we envision simple effective impregnated bednets, or an integrated management system for childhood illnesses? Could we have understood at that point that we would Ье dealing with powerful inexpensive micronutrients to decrease infant mortality, improve A53NR/3 page 43 strength, improve IQs? Did we even dream of а time when pharmaceutical ~ompanies would join the battle of diseases in developing countries Ьу making some tools availaЬle free? Did we envision Merck Drug Company, over the past 12 years, giving US$ 400 million worth of Mectizan for onchocerciasis? Or Glaxo-Wellcome providing up to US$ 30 million per year of Malarone, а new antimalarial drug, to discover how to get this most effectively to the people who need it, whether or not they сап рау? Or SmithКline Beecham providing Albendazole in an effort to do something finally about lymphatic filariasis? Or Pfizer providing Zithromax in the fight against trachoma? Now five pharmaceutical companies have agreed to provide major discounts for drugs useful against AIDS. А second very positive sign is better organization. We are here because we know we сап do better together than we сап separately. We help our own countries Ьу becoming globalists. Einstein reminded us that Nationalism is an infantile disease. Не called it the "measles of mankind". We have learned that strengthening our aЬility to solve disease proЬlems brings in the paradox involved in strengthening ourselves- that is- our independence, both as people and countries, is achieved through consenting to interdependence. As Gandhi said, if we understand that, we will pursue interdependence with the same zeal that we pursue self-reliance. After 50 years we are beginning to understand how to organize globally in order to increase our collective aЬility to improve health. For example, the last time WHO organized to contain malaria, most of Africa was excluded because it seemed "too hard". But we learn and this time Dr Brundtland and Dr NаЬапо did not take the position that any place was too difficult. Indeed "Roll Back Malaria" was launched in Africa with the Heads of State meeting in Nigeria and declaring, "We are committed". This leads us to the third positive sign: increased political interest. It is not just Roll Back Malaria which is attracting interest. Heads of State are supporting AIDS, guinea-worm eradication, child health, onchocerciasis, а host ofhealth proЬlems. Former heads of State are actually working for guinea-worm eradication in Mali and Nigeria. This is а new resource. Use that power. А former Head of State, Jimmy Carter, has spent countless hours pursuing health improvements in Africa, raising funds, visiting programmes, and hiring people. So, around the world, political leaders are demonstrating а new interest in health. This in turn gives us new power. А fourth positive sign: а new understanding of the role of health in development. The World Development Report issued Ьу the World Bank in 1993 outlined the role of health in development. Now we see articles on that theme every week. This in turn will put а new challenge before us to show what outcomes provide the best results per dollar spent. Ministers of finance are beginning to speak about the value of investing in health. In the United States, the Secretary of Health and the Secretary of the Treasury together are promoting global immunization efforts. As health workers we have made this point for some time but we have lacked an authoritative voice. Now the economic world has discovered the relationship and we need to use their voice. А fifth positive sign: the coalitions. WНО is becoming stronger Ьу participating in and sometimes sponsoring coalitions outside its usual structure. Mectizan distribution, for example, has brought dozens of nongovernmental organizations, medical mission groups, foundations, ministries of health, WHO, UNICEF, the World Bank, Merck Drug Сотраnу together in а new coalition held together Ьу а common goal to treat those infected with onchocerciasis. This coalition provided Mectizan to 33 million people last year alone. Lymphatic filariasis is inspiring а similar organization involving both Merck and SmithKline Beecham. The Global Alliance for Vaccines and lmmunization is organized around immunization of children. The Global Alliance for Tuberculosis Drug Development is forming in order to develop new drugs against this old disease proЬlem. The list goes on, with medicines for malaria. The point is that the future of public health will no longer Ье based on just the organizational lines of WHO, but WHO is becoming stronger Ьу supporting those who сап gather coalitions around а shared goal. There is а sculpture at the WНО building of а Ьоу leading а Ьlind man Ьу means of а stick; this sculpture is rich in symbolism: the symbolism of а disease, onchocerciasis, but also the symbolism of the social fabric that gives us hope. The man shows the impairment of Ьlindness, but for those who have worked with this proЬlem it takes little imagination to see the thickened and altered skin, and you сап feel the itching that is his first thought in the morning and his last thought at night. The Ьоу, at the front of the stick, is demonstrating the social fabric that holds that community together. Не is investing ASЗNR/3 page 44 in the future of the community but also his own future. Не already has microfilaria coursing through his body. Не is already itching and he knows that some day he will Ье at the other end of that stick. But now, because of this coalition, he will not Ье at the other end of the stick. The sculpture is not limited to WHO; there is an identical sculpture at the Carter Center, making clear that the coalition involves, and is dependent on, the nongovemmental community. А third sculpture is in the lobby of the World Bank. Of all the things that the World Bank could put in their lobby, they put that sculpture, because of the symbol of their investment in health, their investment in а coalition. It does not stop there. The fourth and last сору of that sculpture is in the lobby at the headquarters of Merck. lt was the first of the four to Ье erected. It means that visitors to Merck are confronted with а sculpture to commemorate а drug from which they are making no money when it is used in humans; а symbol of а new way of doing things in global health. А sixth positive sign: the successes. These are not just the global successes of disease eradication or child survival but the national successes of Uganda and Thailand, for example, as they tumed the tide in НIV transmission rates, giving hope to their country and giving hope to the world. These national successes make the point that every global programme that we have is the outgrowth of something that has worked nationally or locally. This is true of smallpox eradication, poliomyelitis eradication, malaria control, river Ьlindness control, immunization, and diarrhoeal disease control. Finally sign number seven: the increased resources. We have become accustomed to the traditional sources. National contributions to WHO and UNICEF, Ьilateral programmes, the Rockefeller Foundation, medical mission groups, service organizations such as CARE, Plan Intemational, Save the Children, World Vision and so forth. And for those we are continually grateful. The traditional sources now have new and welcome company, such as countless nongovemmental organizations; Rotary Intemational, with over US$ 400 million raised to date for poliomyelitis eradication; George Soros has hundreds of millions of dollars invested in health; the United Nations Foundation has provided US$ 100 million а year for а decade; Merck, Glaxo-Wellcome, SmithKline Beecham, Pfizer and other pharmaceutical companies are providing major resources, and now Bill and Melinda Gates are providing something that поnе of us in global health had ever dared hope for - а foundation of significant size dedicated to global health equity. They are prepared to invest over US$ 500 million а year to make sure that children everywhere have the benefit of the science now protecting children in developed countries. In addition, they are investing to stimulate research into health tools and health solutions for the proЬlems of poor people in poor countries. This comЬination of resources from public and private sources is absolutely unprecedented in global health. We ask the question: how has the world used accumulated wealth in the past? Well, several millennia ago, Alexander the Great used accumulated resources to increase military might. Then we saw, throughout the world, great fortunes invested in forts and fortresses. One thousand years ago, as tools improved, as building materials improved, we saw new creativity in architecture. At that point, resources from churches, from royal families, from communities were invested to build cathedrals, some taking hundreds of years to complete. Artisans were assemЬled who knew that they would never see the cathedral completed and yet there is no evidence that it decreased the quality of their work. Likewise, you and 1 are investing in а work for the future. Over the centuries, we have seen the use of resources to build the great universities of the world. Then accumulated resources helped to fuel the age of commerce, with ships and trading companies and multinational companies. More recently, wealth has built the modem cathedrals, that is the medical centres of the industrialized countries. But now, for the first time ever, we see significant resources being invested in global health, and we have the chance for а cathedral, а virtual cathedral dedicated to global health. The tools, the organization and resources are improving. Will the architects and builders and managers and labourers in this room Ье equal to that task? Will you provide such leadership that it becomes logical for others to follow the example ofBill and Melinda Gates? Will you form а movement so strong? Will you rally behind Dr Bruпdtland with а WHO so сараЬlе, а health structure so powerful that the story of this collective health movement will Ье recounted in schools of medicine and schools of puЬlic health for centuries to come? Repeatedly people say, it is the ministers of finance that we should talk to, they are the key. But it is you, the ministers ofhealth who tum that key. Ifhealth is to improve, it is up to you. The world cannot Ье allowed to exist half-healthy and half-sick. There is а point in every movement where the line is crossed. There is а drop of water that finally causes а glass to overflow. There is а A53NR/3 page 45

тотепt when а friendship Ьесотеs permanent. There is а тinute when а vaccine actually provides protection. And there will Ье а тотепt when the phrase: "the world cannot Ье allowed to exist half­ healthy and half-sick" goes froт being а nice stateтent to an actual coттitтent, when there is no tuming back and the world, in the words ofToynbee, "dares to think ofthe health ofthe whole huтan race as а practical objective". That тотепt could соте at any tiтe in the future. lt тight just as well соте today with the World Health AsseтЬly of 2000. II will require us to give new attention to тeasureтent, to identify gaps, to evaluate interventions and to eтphasize outcoтes over and over again. 1 tell students about а таn who was told Ьу а fortune-teller that he would Ье very poor and very unhappy until he was 45. The таn grasped at that straw and asked the fortune-teller what would happen when he was 45. The fortune-teller said, "You're going to get used to it". Your job as health leaders is to Ье sure that no one ever gets used to the gap in health, never gets used to unnecessary suffering, preтature death, poverty and illiteracy. То he sure that heads of State, тinisters of finance, those in leadership positions and those who are trusting you to таkе things better have no chance to get used to pessiтisт, cynicisт or fatalisт. Ве professional health workers but also Ье professional optiтists. 1 tell ту students that there тау Ье а need for cynicisт and when you need cynicisт, contract for it. Do not spoil your office Ьу hiring cynics. ln 1932, Lincoln Steffens said, "What is true of business and politics is gloriously true of the professions, the arts and crafts, the sciences; the best picture has not yet been painted, the greatest роет is still unsung, and the тightiest novel reтains to Ье \vritten". We echo today that the тost spectacular health contributions are still uniтagined to this day. The finest solutions are still before us. Gandhi said people often Ьесоте what they believe theтselves to Ье. lf we believe ourselves to Ье the deliverers ofthis new health day for the future, that is what we will Ьесоте. ln closing, let те ask you: would you have prefeпed being one of those health тinisters starting this health organization 53 years ago, without polioтyelitis vaccine, without тeasles vaccine, without oral rehydration therapy? Or, with all of our proЬleтs, would you rather Ье sitting here today? Would you even have prefeпed being part ofthe World Health AsseтЬly of 1980, so pleased at announcing that sтallpox was eradicated and yet lacking Mectizan for onchocerciasis, an integrated approach to childhood illnesses and having achieved less than 10% iттunization coverage for the world? Or would you prefer to Ье sitting here today? Would you even have prefeпed being part of the World Health AsseтЬly of 1990, about to participate in the Children's Suттit, but without widespread use of hepatitis В vaccine, fragтentary approaches to тicronutrients and no ехатрlе, as yet, of а reversal in AIDS transтission rates in any African country, no proтising treatтent for lyтphatic filariasis, no тajor involveтent of pharmaceutical coтpanies in solving these public health proЬleтs, and no United Nations Foundation, no Bill and Melinda Gates Foundation? Or would you prefer sitting here today? There has never been а better tiтe. The ingredients are in place, coalitions, leadership inspiration, optiтisт are required. Hard work will Ье the order ofthe day, but ifyou are willing, your bosses, the people you serve, тost of theт still unbom, will judge you as great cathedral builders and great ancestors. Thank you.

The PRESIDENT:

Thank you Professor Foege for а very stiтulating and inspiring presentation. On behalf ofthe World Health AsseтЬly, 1 wish to thank you warmly for having honoured us with your presence and for the beautifullecture you have given us. The тeeting is adjoumed until 14:30 this aftemoon.

The meeting rose at 9:40. La seance est levee а 9h40. A53NR/4 page 46

FOURTH PLENARY MEETING

Tuesday, 16 Мау 2000, at 14:30

President: Dr L. АМАТНILА (Namibia) later: Professor F.G. NAZIROV (Uzbekistan)

QUATRIEME SEANCE PLENIERE

Mardi 16 mai 2000, 14h30

President: Dr L. АМА TНILA (NamiЬie) puis: Professeur F.G. NAZIROV (Ouzhekistan)

ADDRESS ВУ ТНЕ DIRECTOR-GENERAL (INCLUDING OVERVIEW OF ТНЕ WORLD HEALTH REPORT 2000) (continued) ALLOCUTION DU DIRECTEUR GENERAL (У COМPRIS UN APERCU DU RAPPORT SUR LA SANTE DANS LE MONDE, 2000) (suite)

The PRESIDENT:

The AssemЬly is called to order. This afternoon, we shall continue with item 3. Before we start our discussion, 1 would like to inform you that at 16:00 1 have to hand over the presidency to Professor Nazirov, the first Vice-President, due to an unavoidaЬle engagement. Мау 1 remind you once again that, in accordance with resolution WНА50.18, delegates should limit their statements to five minutes. lf you are speaking on behalf of many countries, you can go а little over five minutes, between five and 1О. lf we do not comp1y with this rule, we might not Ье аЬlе to finish our work on time. The next two speakers on my list are the delegates of the RepuЬlic of Korea and the Russian Federation. 1 now give the floor to the delegate ofthe RepuЬlic ofKorea.

Mr СНА (RepuЬlic ofKorea):

Thank you Madam President. First of all, let me congratulate you on your election as President ofthis World Health AssemЬly. Му sincere appreciation goes to Mrs Maria de Belem Roseira for her excellent work as President for the last year. ln addition, let me congratulate the Director-General, Dr Gro Harlem Brundtland, for her strong and innovative leadership ofthe work ofWHO. Madam President, Madam Director-General, distinguished delegates, ladies and gentlemen, during the last half century, we have endeavoured to invest all the resources availaЬle for various health projects in order to reach the goal of health for all. However, we are now facing the new challenges of the twenty-first century. Many health services still need improving, and economic and social changes make it necessary to meet а new type of health demand. 1 agree with the points made Ьу the Director-General in her report that the effective measurement and assessment of performance in the health sector are important; that the benefits of health systems reform should Ье felt Ьу those who are living in poverty; and that the burden on them ofthe cost ofmedical care should Ье reduced. ln the RepuЬlic of Korea, we are progressing in the same direction in the reform of our health care system. ASЗNR/4 page 47

As а developing country, we have so far focused our efforts on the development of health systems. Many hea\th facilities have been estaЬ\ished and thousands of hea\th care workers fostered every year so that we can have an adequate level of health resources. As for hea\th care financing, we started our national health care system in 1977 and accomplished universal coverage for all in the very short period of 12 years, Ьу 1989. Now we are focusing efforts on promoting activity in health care services and enhancing the efficiency of this first health care infrastructure. То use health care resources more efficiently, we are improving the health care delivery system and reforming the distribution of drugs and the consumption behaviour. Promoting active health care systems is the main principle of our initiative of integrating the various systems of financing health insurance, which we believe will reduce the burden for the poor and increase the share of contributions for the rich. 1 sincerely welcome WHO's efforts to measure performance outcomes Ьу developing performance indexes. These efforts are very appropriate and timely, and 1 believe these indexes will Ье of great use to Korea and various other Member States in their efforts to evaluate and reform their health care systems. W е are now living in the age of knowledge and information. New information technology may widen the gap between the rich and the poor within and among nations. 1 hope that WHO will play the main role in estaЬ\ishing health as а global puЬlic good Ьу accumulating social assets, and will act as the foca\ point in providing all people with equitaЬle access to health-related information through the lntemet. 1 should like to take this opportunity to introduce the Intemational Vaccine lnstitution (IVI), newly estaЬ\ished in Seoul. Since its selection as the host country of this institution Ьу UNDP in 1994, the RepuЬ\ic of Korea has been at the forefront of the venture to construct the not-for-profit humanitarian vaccine institution. Now, 32 countries, Members of WHO, have joined as members of this institution. We believe that IVI will act as а focal point for vaccine-related cooperation in research and development, and contribute to the enhancement of human security. The Govemment of the RepuЬ\ic of Korea will continue to support the institution and would like to invite many countries to join the IVI as members so that it can achieve its goal more successfully. This is the first World Health AssemЬly in the new millennium. 1 am sure that Ьу working closely together, within an innovative WHO framework and with improved health systems performance, we can meet the challenges ofthis century.

Professor SHEVTCНENKO (Russian Federation): Проф. ШЕВЧЕНКО (Российская Федерация):

Уважаемая г-жа Председатель, дорогие дамы и господа, дорогие коллеги. Российская делегация признательна Генеральному директору и Секретариату нашей Организации за тематику доклада и заседаний Круглого стола для министров здравоохранения. Несомненно, это призвано упрочить глобальное лидерство Всемирной организации здравоохранения в вопросах охраны и улучшения здоровья народов нашей планеты. Но при этом я хотел бы оросить Генерального директора предпринять необходимые усилия, с тем чтобы ее доклад Ассамблее был доступен государствам-членам заблаговременно. Это будет способствовать более живой и глубокой дискуссии. Мы поддерживаем внедрение в практику более широкого подхода ВОЗ к вопросам здравоохранения в их тесной связи с экономической и социальной сферой, с политикой по проблемам развития окружающей среды. Я глубоко убежден, здравоохранение это система и каждодневная реальность жизнеобеспечения нации и каждого конкретного человека, это важнейший институт безопасности нации и всего человечества, это высший приоритет цивилизованного государства. Здоровье - показатель национального престижа, стабилизирующий фактор доверия ко всем ветвям власти, органам управления и политико-экономической системе любого государства в целом, ибо речь идет воистину о самом бесценном в мироздании - жизни человека. Проблемы здравоохранения должны быть главной заботой каждого государства, а ответственность за

здоровье населения должна лежать на правительствах стран, а не только на министерствах здравоохранения. Все это не может быть обеспечено без стабильного функционирования систем общественного здравоохранения. Это - адекватное финансирование отрасли, это - гарантия оказания качественной медицинской помощи, прежде всего социально незащищенным слоям населения, это - приоритет профилактики во всех сферах медицинской A53NR/4 page 48

деятельности, это - настойчивая (если угодно, агрессивная) работа по санитарному просвещению населения, воспитанию ответственности людей за собственное здоровье. Никакие системы общественного здравоохранения не будут эффективными без усилий самого общества, самих людей по сохранению и укреплению здоровья. Мы поддерживаем идею доклада о важности государственного регулирования в системах здравоохранения при использовании как общественных, так и частных структур в развитии отрасли. Заслуживает одобрения высказанное намерение направлять ресурсы в те секторы и системы здравоохранения, которые могут дать эффективную отдачу в более короткие сроки. Российские делегаты всегда выступали против распыления сил и средств Организации на малозначимые проекты и превращение Всемирной организации здравоохранения в некое агентство по снабжению. Мы настаиваем на сосредоточении внимания на более узком круге актуальных, реально выполнимых и отвечающих функциям ВОЗ задач. Важнейшим сектором деятельности ВОЗ является ее работа в странах и совместно со странами с учетом региональных приоритетов, усилия по разработке национальных стратегий развития систем здравоохранения, техническая и гуманитарная помощь. Мы просим Генерального директора сохранить быстрое реагирование на кризисы в системах здравоохранения в качестве приоритетного направления деятельности нашей Организации. И еще одна мысль. Я прошу вашей поддержки: пришло время для Всемирной организации здравоохранения открыто и твердо встать на защиту медицинских работников. Во многих странах, и у нас в том числе, они работают с колоссальным напряжением сил, часто бедствуют материально, нередко буквально лишены уважения, эксплуатируются их гуманистические качества, они подвержены риску различных инфекционных и неинфекционных заболеваний, чаще умирают, и особенно жертвуют собой при исполнении профессиональных обязанностей в районах военных конфликтов. Пора признать применение оружия против медицинского работника, всякое насилие над ним преступлением против человечности. Наша обязанность - призвать правительства стран к бережному отношению к медицинским работникам и всемерной их защите. Спасибо за внимание, и пусть Бог хранит вас всех в здоровье и мире.

Dr ZНANG Wenkang (China): 7*x~Pf.± с~ оо ):

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La Dra. BACHELET (Chile):

Sefiora Presidenta de la 53" AsamЫea Mundial de la Salud, sefiora Directora General, distinguidos Ministras у Ministros, distinguidos Representantes de los GoЬiernos de los Estados Miembros, sefioras у sefiores: Traigo un saludo muy especial а todos los presentes del Presidente de Chile, Don Ricardo Lagos Escobar, у de su GoЬierno recien asumido en marzo de este afio. El informe de la Directora General Mejorar е/ desempeiio de los sistemas de salud plantea orientaciones estrategicas centrales que compartimos: lograr incrementar la eficacia de los servicios, disminuir la mortalidad de los grupos pobres у marginados, hacer frente con decisi6n у sapiencia а los factores de riesgo antiguos у nuevos у situar la salud en el centro del desarrollo de los pafses. V aloramos de manera especial que el informe proponga un nuevo concepto de sistema de salud, mucho mas amplio е integral, el cual traspasa las fronteras del sector salud у del sistema de atenci6n de salud у que, junto con integrar а todos los otros sectores de la vida nacional у asf garantizar el accionar sobre el conjunto de los determinantes de la salud, otorga un importante rol al liderazgo polftico en la constituci6n de las metas, al hacer recaer la conducci6n en el goЬierno de cada pafs. Asimismo, el informe aporta certeros criterios para que los goЬiernos fijen sus polfticas de salud у definan sus metas а largo plazo у las funciones de direcci6n у acci6n que competen а los servicios publicos de salud. Valoramos el enfasis en la evaluaci6n de los desempefios del sistema como un instrumento para la mejorfa de las condiciones de salud, la respuesta а las demandas ciudadanas en materia de dignidad у calidad de la atenci6n у financiamiento justo. А este respecto, quisiera compartir con ustedes algunas reflexiones у experiencias. Un adecuado у legitimado proceso de evaluaci6n del desempefio permitira no s6lo las necesarias у adecuadas correcciones, sino tamЬien la cooperaci6n у el aprendizaje entre los pafses. Sin embargo, deseo llamar la atenci6n sobre la necesidad de asegurar una consensuada у adecuada implementaci6n de este proceso. Caben frente а esto numerosas preguntas: l,que rol juegan los pafses? Es decir, l,C6mo se construye este proceso? l,Cual es la metodologfa а seguir? l,Cuales son los indicadores utilizados mas adecuados para medir efectivamente el desempefio? l,Cuales son las fuentes de datos а utilizar? l,Son estas comparaЬles en los paises? El ideal es poder concordar objetivos, metodologfa е instrumentos para que luego los propios actores involucrados los apliquen у los lleven а саЬо. Son todos temas en los que es necesario profundizar para que, а nuestro juicio, esta iniciativa tenga el exito у las repercusiones buscadas. A53NR/4 page 51

Chile ha intentado desde hace aproximadamente cuatro afios medir с\ desempefio а traves del desarrollo de los denominados compromisos de gesti6n. De este proceso aprendimos una serie de lecciones, algunas de \as cuales me parece pertinente compartir en esta ocasi6n: 1) un elemento que determina fuertemente el exito es c6mo este es validado por el sistema. De allf la necesidad de que sea participativo desde su inicio, desde \а propia definici6n de \а meta, de los indicadores а usar. Con esto, no s6lo se logra el compromiso de los actores involucrados, sino que, ademas, ello constituye un factor fundamental para que esta mejoria del desempefio sea sustentaЫe en el tiempo; 2) el numero de indicadores no puede ser muy limitado, dada la alta complejidad del quehacer de los servicios de salud. Una sobresimplificaci6n о una sobreagregaci6n de indicadores puede ser una importante fuente de error de apreciaci6n у cualificaci6n; 3) debe existir un adecuado у necesario equilibrio entre los indicadores intermedios у de procesos у los de resultados, de manera que aporten sefiales claras sobre d6nde у c6mo intervenir para mejorar el desempefio. Frente а todos estos nuevos conceptos que el informe plantea habra que concordat· nuevas tecnologias de indicadores que garanticen el logro de su enfasis, asi como su implementaci6n, у desde уа manifestamos nuestra voluntad de contribuir а este necesario proceso. Sefioras у sefiores, el GoЬiemo del Presidente Ricardo Lagos esta implementando un nuevo papel del Estado en nuestra sociedad, con el fin de regular los mercados para lograr simultaneamente crecimiento econ6mico у equidad social. Una de las medidas principales es colocar los proЫemas de salud como prioridad en la agenda publica. Su primera sefial ha sido reasignar recursos del presupuesto nacional para enfrentar dos tareas en los primeros 100 dias de goЬiemo: е\ reforzamiento de la atenci6n primaria para facilitar el acceso oportuno а ella у mejorar su capacidad de resoluci6n, у la prevenci6n efectiva de las enfermedades respiratorias agudas en los nifios, adultos mayores у enfermos cr6nicos en el pr6ximo periodo invemal. А la vez, en el mediano у largo plazo, sentar definitivamente \as bases de la reforma de salud para resolver las inequidades que aun, pese а todos los avances de la democracia, persisten. Para enfrentar esta situaci6n, el GoЬiemo de Chile ha propuesto varias tareas principales para transformar estas politicas en ellogro del derecho а una salud digna para todos: 1) un plan nacional de equidad en salud, que identifique las brechas que separan la salud de unos pocos de la salud de la mayoria de los trabajadores у los pobres; 2) una reforma solidaria del sistema de financiamiento; 3) un nuevo modelo de atenci6n de la salud, que rearticule los niveles, priorice la atenci6n primaria, la promoci6n, el fomento у protecci6n de la salud, у una atenci6n oportuna eficiente, eficaz у humana en toda nuestra poЫaci6n; 4) е\ fortalecimiento del papel de conducci6n у rectoria del Estado; у 5) relevar muy fuertemente los derechos de las personas en salud у la participaci6n у el control social de su ejercicio. Aspiramos, en definitiva, para el Ьicentenario de nuestra independencia nacional, en 201 О, concretar un sistema de salud mas equitativo у una salud mas igualitaria. Chile tiene la voluntad de seguir aportando а la comunidad nacional е intemacional con su practica que coloca los derechos humanos у el derecho а la salud en el centro del quehacer de toda la sociedad. Muchas gracias.

Mr PEHIN ABDUL AZIZ UМAR (Brunei Darussalam):

Madam President, Madam Director-General, excellencies, ladies and gentlemen, health systems all over the world face the challenges ofthe prevailing conditions of ever-increasing health care costs and declining rates of economic growth. The puЫic increasingly expects higher quality health care and greater satisfaction from service providers. At the same time, there are concems that health care development does not place adequate emphasis on the principles of equity, effectiveness, efficiency, quality of service and consumer satisfaction. Thus my Govemment fully supports the initiative taken Ьу the Director-General and WHO to focus on assessing and improving health systems performance in The world health report 2000 ofthis Fifty-third World Health AssemЬly. Brunei Darussalam has taken а holistic approach to its socioeconomic development in order to enhance the quality of life of its people through а series of five-year nationally drawn plans. Significant progress has been made in its infi-astructure development, including the development of roads and housing, the provision of safe A53NR/4 page 52 water and electricity, and of proper sewage facilities and modem telecommunications services. At the same time, there has been а consideraЬle investment in infrastructure services in the form of health, education, welfare and religious facilities. The overall progress made, comЬined with sound puЬlic health programmes, has raised the living standards of our people, especially in health. Thus the country has achieved almost all the global health indicators set Ьу WHO. In addition, health care is provided free to all its citizens and permanent residents, including overseas specialized care not availaЬle in the country. However, Brunei Darussalam is now facing new challenges for the next millennium. Among others, major challenges include the escalating cost of health care, changing disease pattems from infectious diseases to the cuпent chronic and noncommunicaЬle diseases related to changes in lifestyles, changing population demography, increased puЬlic expectations for better quality health care, and the continued over-dependence of the people on govemmental welfare, including for health. The Ministry of Health has therefore embarked on several health care reforms. Among others, these will transfer some of the responsiЬility for health to the individual, including shifting part of the burden of health care costs to consumers, promoting health, and implementing its 10-year national health care plan for 2000-2010. The Govemment will continue to ensure that the people of Brunei Darussalam, especially disadvantaged and vulneraЬle groups, will always enjoy quality health care which is accessiЬle, equitaЬle and affordaЬle. Speaking regionally, 8runei Darussalam is one of the 10 Member countries of the Association of South-East Asian Nations (ASEAN). While progress in health development varies from one country to another, ASEAN countries also share some health needs, proЬlems and issues of common concem such as, in the prevention and control of communicaЬle diseases, notaЬly malaria, tuberculosis and HIV/AIDS; cost containment of drugs; strengthening development oftraditional medicine; and issues related to the impact of globalization and trade on health services in the region. Concerted and unified efforts are needed from all Member countries to address these issues and to achieve the identified соттоn goals for the health and well-being of the peoples of ASEAN. I believe cooperation, collaboration and the exchange of health information among the 1О ASEAN Member countries will Ье further enhanced and strengthened if all ofthem were in the same regional grouping of WHO. Subject therefore to the views from our ASEAN Member countries, we would like to propose that WHO study the possiЬility of including all the ASEAN Member countries in the same WHO regional grouping. Before concluding, 1 would like to take this opportunity to recognize the hard work and tireless efforts of the Director-General, Dr Brundtland, and her leadership in steering global action for health. Му country fully supports WHO's initiatives in the areas of tobacco control, tuberculosis, poliomyelitis eradication, malaria, НIV1 AIDS and others. 1 wish also to put on record my Govemment's sincere thanks and high appreciation to the Regional Director for the Westem Pacific and his stafffor their tireless efforts on all aspects ofhealth in the Region.

Mr ENGQVIST (Sweden):

Madam President, Dr Brundtland, distinguished delegates, all of us are well aware of the fact that action must take place also outside the health sector in order to build healthy populations and communities and to increase the health and social capital of people. То this end, а clear puЬlic health policy is necessary nationally and intemationally. The Fifth Global Conference on Health Promotion in Mexico City, in June this year, is а very important opportunity to debate how to go forward on these issues. То improve health determinants is а long-term job. We need to pursue action based on evidence that can put health right at the heart of economic policy-making. Thus, the new WHO Commission on Macroeconomics and Health has а very important task. I would like to illustrate Ьу the following why it is important to have а puЬlic health policy that addresses determinants of ill-health. In the 1990s, Sweden had to make significant cutbacks in the social protection system. There were increases in open unemployment, early retirement and long-term sick leaves. However, vital health statistics for this period paint an interesting picture: between 1980 and 1995, there was а reduction of about 20% in the overall mortality of both men and women and а 50% reduction in mortality among children from one to 15 years of age. Also, infant mortality went down from an already low level to today's 3.8 per thousand. The main explanation for the continued health improvements is to Ье found A53NR/4 page 53 in the strong tradition of investing in systematic puЫic health work in education, water, sanitation and sound environment; support to children and families; fight against alcohol, drugs and tobacco; occupational health; primary health care and reproductive health. Being healthy is one of the most important priorities in the life of all people; yet there are consideraЫe differences, between countries and between groups of people within countries. The best health status in any country is to Ье found among groups of people that are rich in opportunities to participate and influence, that have close interpersonal relations, social networks and control over their lives. The worst health status is to Ье found where powerlessness and social exclusion is higl1est: Therefore, national policies have to include measures which can meet the needs of underserved population groups with а pro-poor focus. One of the Director-General's proposed new priorities is mental health. 1 welcome this and would particularly emphasize the global proЫem of substance abuse. Many studies point to an overlap between proЫems with drinking or drug abuse and mental proЫems; both alcohol and drugs breed marginalization of people and deepen poverty. Associated with alcohol and drug use are а wide range of impairments both in health and the social context, such as employment, family life and everyday social interaction. Split families, spouse and child abuse and crime are among the well-known consequences. Drugs are also to Ье found as а significant factor at the macroeconomic level, as in some parts of the world the illicit drug economy poses а threat to · sound socioeconomic development. 1 am well aware that WНО has really not found its optimal contribution to the United Nations system-wide effort to counteract narcotics. This does not mean that the Organization does not have а role. On the contrary, WНО has а very important contribution to make in normative guidance based on evidence both with regard to demand reduction and treatment; advocacy is another important area. The message must Ье clear: narcotic drugs are wrong, illegal and deadly. With regard to alcohol, there is no other United Nations organization but WHO that can take the lead in guidance in intemational and national efforts. 1 am therefore very pleased that the WHO European Office, together with the Govemment of Sweden, will hold the second WHO European Ministerial Conference on Alcohol in Stockholm in February next year. ThP. theme of the Conference is "Young People and Alcohol". The Govemment of Sweden lends its full support to the continued work of the Organization.

Professor ST А VLJENIC-RUКA VINA (Croatia):

Madam President, Madam Director-General, dear colleagues and delegates. ln her announcement of The world health report 2000, Dr Brundtland reminded us of the significance of 19 June, а date that commemorates the opening ofthe lntemational Health Conference in New York in 1946, and the decision on the founding of our Organization. Professor Andrija Stampars, my compatriot, was also present at this Conference and was appointed President of the lnterim Committee; he had contributed to designing the Constitution of WHO. Nowadays, we are trying to incorporate the tenets of his puЫic health philosophy and policy into the modem health care system in Croatia. We have always considered Professor Stampars the father of Croatian as well as European social medicine and puЫic health in the twentieth century. The question is, ifhe came to join us today, would he understand а word of what we are ta1king about? Over half а century ago, the programmatic directions were optimistic, humanitarian and positive, proclaiming the enjoyment of the highest standard of health. Today, we talk about technology assessment, measuraЫe outcomes and output, health system management and health service reforms. The language has so profoundly changed that our ancestors would look at us in despair, barely understanding what we are talking about. Nevertheless, we are still faced with the same task oftrying to improve health and achieve а full health service as one of the fundamental rights of every human being, as stated in the Constitution. Challenge is the key word of our session this year, so 1 would like to say а few more words about it in respect of the new direction of our health policy in Croatia. М у country has а population of 4.5 million entering the third epidemiological transition with an ageing population, high adult mortality especially among males, dominated Ьу lifestyle-related noncommunicaЫe diseases. The good message is that infant mortality rates are on the decline. Already in the third decade of the twentieth century, some elements in our health care systems were in many respects designed for the A53NR/4 page 54

next century. However, for different reasons, accentuated Ьу the enormous development of high technology medicine and demographic changes resulting in growing needs of populations, the gap between financial resources and the potential of health care providers for the Croatian system has reached а critically unstaЫe point. Croatia, like many central European countries, has an extensive health care infrastructure, а comprehensive network of health care institutions and numerous well educated personnel, but the quality of care delivered and of health care conditions still lag behind European best practices. The greatest challenge is how to increase quality and reorient the system within existing financial resources. Since the needs and demands are constantly growing and the resources appear to Ье ever less adequate to meet them, we believe that the principle of priority-setting is an appropriate method. As far as the subjects are concerned, our priority is given to those in greatest need, children, mothers, the elderly, the physically and mentally disaЫed. As far as needs are concemed, priority status is awarded to those whose lives are in danger and where medical intervention can prevent more damage or save а life. In the area of programmes, priority is given to health promotion and health protection programmes. The process involves expert support Ьу the World Bank and WHO. The priority in the allocation of financial resources is given to emergency services and primary health care. As far as investments are concemed, our primary goal is the reconstruction of health care facilities destroyed Ьу war; in the human resources area, our priority is the education of primary health care providers. The hospital.sector will Ье reconstructed in Croatia in such а way that priority will Ье given to alternative levels of care. Quality assurance, technology assessment and health information highway development are planned to become the neural network of а new system together with new payment mechanisms in а kind of Ыосk system that will match patient, quality and performance-oriented services. But what is the priority for me, as Minister of Health? How do 1 manage the transition process in а new way Ьу daily revision and updating of the above-mentioned priorities with one ultimate goal in mind: removing the heavy burden of disease from the shoulders of our children, partners and parents?

Dr SALLAM (Egypt):

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Mr KORN DABBARANSI (Thailand):

Thank you, Madam President, Madam Director-General, your excellencies. Мау 1 first commend the Secretariat under the leadership of the Director-General, Dr Brundtland, for preparing such an innovative puЬlication as The world health report 2000. The Secretariat is very courageous and progressive in proposing, for the first time, an index for health system performance. 1 do agree that the measurement of how well each health system carries out the four main functions is а good index. Nevertheless, it is а good index only ofhealth care system performance, not ofthe total health system performance. Health systems relate to complex socioeconomic, environmental and other factors. The health care system is one of its components. Measuring the performance of health care systems thus inadequately reflects the performance of the overall health system. Other important measurements of the health system should include income level and distribution; level of, and equity in, educational attainment; political commitment towards health as measured Ьу healthy puЬlic policies; and the proportion of the national budget dedicated to health. А country with а health саге system that performs well, as measured Ьу the proposed index, may Ье а country with high levels of income inequity and social disparity, а very polluted environment, widespread exploitation of national resources and an absence of definite puЬlic health policies. On the issue of health care systems, the pluralistic health system in Thailand is characterized Ьу inefficiencies, fragmentation of service delivery and financing mechanisms, and inequitaЬle access to care Ьу different sections of the population. Over-expansion of the private hospital sector in the past two decades went on under а weak regulatory environment and an inadequate national policy towards the private health sector. As а result, key consequences have been intemal brain drain ot' well-trained professionals from the puЬlic to the private sector at the expense of societal costs and an accumulation of high-cost medical technology such as Magnetic Resonance lmaging and СТ scanners, with A53NR/4 page 56 suboptimal uses. The doctor-patient relationship is deteriorating and is gradually being replaced Ьу commercial arrangements, and there are increasing accusations and lawsuits. The situation definitely requires а total health system reform. Within the next two years, а comprehensive national health act will Ье promulgated through а continua\ process of social movement; this act will Ье the basis of the future Thai health system; this movement of total health system reform focuses on building rather than repairing health. We will also put more emphasis on manipulating socioeconomic and other environmental factors conducive to health. Thus healthy puЬlic policies will Ье the main focus of the reform, apart from the component of health care reform. ln this process of total hea\th system reform in Thailand, some achievements are being seen. А bill to estaЬlish а hea\th promotion fund is being considered in Parliament; this fund will Ье financed from 2% of the excise tax on tobacco and alcoholic beverages. The striking point is that this bill is sponsored Ьу the Ministry of Finance supported, of course, Ьу myself as Minister of PuЬlic Health. More importantly, the fund will Ье managed not Ьу the Ministry of Public Health bureaucracy, but under an independent health promotion office. No smoking scenes on television were also approved Ьу the CaЬinet of Thailand \ast month for those productions made in the country. Another example of this reform is the protection of social safety nets for underprivileged groups. These social safety nets include free education, health services and subsidized housing. We were аЬlе to maintain these social safety nets in spite of our nation's worst economic crisis over the past three years. То further strengthen the index proposed Ьу WHO and to sustain its progress, 1 should like to propose the following: (1) further broaden the index to measure the total health system rather than just the health care system; (2) work closely with Member countries to further develop and test the index; (3) support the development of а system to continuously monitor the movement of this index in Member countries and report annually to the World Health AssemЬly as part of The world health report; ( 4) WHO uses the level of achievement of the index in working together with other intemational development agencies and Member countries on developing appropriate health development programmes at the national, regional and global levels. While focusing on the development of the health system index, WHO should continue to support priority health programmes such as HIV 1AIDS, malaria, and tobacco control. The regional arrangements of WHO, which hinder Ьilateral or cross-border health initiatives, should Ье corrected. lf necessary, new altematives should Ье explored to address the common proЬlems of puЬlic health significance among our own countries. Thailand considers it а great privilege to Ье given the honour of hosting the visit of the Director-General around the end of this month; WHO and Thailand will announce the World No ТоЬассо Day in Bangkok on 31 Мау of the year 2000. Мау 1 once again express my sincere appreciation for the work done Ьу the Secretariat. On behalf of the Royal Thai Govemment, 1 should also like to express our full support and commitment to the future development and application of this index. We in Thailand will Ье pleased to work closely with the Secretariat on this endeavour in years to come.

El Dr LOMBARDO (Argentina):

Sefiora Presidenta, sefiora Directora General: Es un privilegio muy particular poder estar en esta AsamЬlea retlexionando acerca de un tema tan importante como el cuidado de la salud. Насе a\go mas de dos decadas esbozaba esperanzado el mundo aquella frase que se acufi6 en Alma-Ata expresando que este afio Salud para Todos en el Afio 2000 era la consigna. Ноу estamos cerca, viviendo el 2000 у muy distantes de la salud para todos. lndudaЬlemente que tenemos que modificar el funcionamiento de los sistemas de salud para que podamos avanzar en esta propuesta que tiene validez у que fue realmente un estimulo permanente у un acicate permanente para lograr е\ objetivo deseado de \а salud para todos. Vivimos en un tiempo de avances tecnol6gicos que nos sorprenden. La humanidad ha ido desarrollando avances cientificos que solamente formaban parte de la mentalidad de algun ilusorio о de algun fantasioso, que pensaba que el adelanto cientifico podia llegar а proveemos las posibllidades que hoy tenemos de servicio а \а gente. Pero lo cierto es que de nada valen los avances tecnol6gicos si а su vez no se e\aboran \as propuestas que hagan que estos avances lleguen а todos. У esto es precisamente un hecho fundamental del cual tenemos que partir. A53/YR/4 page 57

Muchas veces usamos datos estadisticos у haЫamos de variaЫes estadisticas у tenemos que tener absoluto cuidado de no caer desde el area de la salud al error en el cual incurren а veces \os que manejan \as cifras econбmicas. Cuando haЫamos de porcentuales, de deficit, de mortalidad, en muclюs casos haЫamos de alguien que en la unidad es el universo total, у de alguien а quien impedimos la posiЬilidad de mejorar realmente sus condiciones de vida у de mejorar su posiЬilidad de desarrollo. Es por eso que tenemos que humanizar: humanizar el adelanto cientifico у tecno\бgico; humanizar \а economia, у llevar los principios de una concientizaciбn clara del derecho inalienaЫe а la salud que tiene que ser ejercido por todos los haЬitantes de este planeta а una realidad practica у раlраЫе en nuestro mundo actual. Es е\ tiempo de \а inclusiбn. Vivimos en exclusiбn. Нау sectores privilegiados que manejan grandes recursos у otros que no tienen acceso а las posiЬilidades de la supervivencia. Es por eso que todo el camino que se ha desarrol\ado debe l\evamos а un proceso de inclusiбn. Para esto en Alma­ Ata se fijaban, en el area de salud, estrategias que no fueron Ьien entendidas, porque algunos entendieron que era la atenciбn primitiva о primera. La estrategia de atenciбn primaria de salud hаЫаЬа de un proceso de desarrollo de atenciбn у cuidado de la salud en redes de servicios que, а traves de niveles de complejidad creciente, iban haciendo una mejor utilizaciбn de los recursos de \а a\ta tecnologia, pero fortificaban el primer nivel de atenciбn, donde se resuelve el 85% de las patologias que presenta nuestra humanidad. Es por eso que hay que fortificar ese primer nivel. Нау que desinstitucionalizar la atenciбn у el cuidado de la salud. No hay que pensar que el elemento tecnolбgico es el que resuelve el proЫema. El contacto entre dos seres humanos, uno que puede ayudar а traves del conocimiento у otro que tiene necesidad de ayuda, no necesariamente se debe hacer а traves de un aparato. Нау una relaciбn personal, humana, que califica esta relaciбn у que debe contener en cada acto medico la posiЬilidad de desarrollar estrategias de atenciбn у de prevenciбn, de prevenciбn primaria, secundaria у terciaria, que tienen que apoyar cada acto de desarrollo. Es por eso que tenemos que hacer una saЬia utilizaciбn de los recursos. La sobreoferta de elementos tecnolбgicos, el enfrentamiento puЬiico/privado, el tratar de no integrar los recursos destinados al area de la salud nos hicieron cometer muchas torpezas, у en ese aspecto fuimos dispensadores de recursos que no llegaron а una racional у exacta utilizaciбn. Un parrafo para la corrupciбn. La corrupciбn es algo detestaЬle en cualquiera de los aspectos de la vida del ser humano, pero cuando la corrupciбn se instala en el area de la salud у los recursos no llegan ni а la cama del enfermo, ni а la vacuna preventiva, ni al salario del equipo de salud, estamos frente а un hecho de delito de lesa humanidad. Porque cuando alguien incorpora а su bolsillo recursos que estaban destinados para el cuidado de la salud, lo que puso en su bolsillo es la vida de algun nifio que no tuvo el cuidado necesario, la consulta que una madre no tuvo en el momento adecuado antes de tener un parto feliz, о aquellas acciones preventivas que deЬieron ser desarrolladas para que no suframos enfermedades que hoy pueden ser evitaЫes. La diferenciaciбn entre los paises desarrollados у los del subdesarrollo pasa а traves de la investigaciбn, у por eso creemos que tenemos que hacer enfasis profundo los paises que estamos en las vias de desarrollo en el proceso de avanzar en la investigaciбn para poder entrar en el juego de la historia con las posiЬilidades ciertas de tener algo que discutir у que ofrecer en el primero de los mundos, donde la ciencia se desarrolla. La posiЬilidad de avanzar en Ias estrategias de prevenciбn, la posiЬilidad de hacer un uso racional de los medicamentos, utilizar saЬiamente los recursos de los antiЬiбticos que puedan llevamos si no lo hacemos а una era preantiЬiбtica, en la cual el proceso de atenciбn del cuidado de la salud distaba mucho de las posibilidades ciertas que hoy tenemos. Atender los proЬlemas que hoy nos presentan el desarrollo del cuidado de Ios medicamentos antivirales, que tamЬien nos pueden llevar а un mecanismo de irracional utilizaciбn; el cuidado de la salud mental, patologia frecuente en el siglo en el que estamos entrando, hacen necesario que retlexionemos. El desafio es humanizar la ciencia, humanizar el conocimiento, humanizar la economia, avanzar en el sentido de que todos estos elementos tienen que estar al servicio de la gente, у asi indudaЬlemente habremos apostado por la vida, que es aquello que se opone а la muerte у а la destrucciбn para que la enfermedad no se apodere de quien no deЬiera apoderarse у de quien debiera A53NR/4 page 58

estar protegido por los avances de la ciencia que en estos momentos podemos brindar а cada uno de los habitantes de nuestra humanidad. Muchas gracias.

Mr BENIZRI (lsrael):

Madam President, distinguished delegates, it is with pleasure that 1 thank you, and the Director-General, Dr Brundtland, for the opportunity which is given to те to address this nоЫе AssemЬly. ln terms of population and size, lsrael is considered to Ье а small country. However, she is one ofthe leading States in the field ofhealth. 1 am delighted to Ье here, to head the delegation oflsrael, to learn from others and to share with you all the knowledge and experience we have gained over the years. The principles of health for all which were estaЫished Ьу WHO have been adopted Ьу the lsraeli Ministry of Health. ln lsrael, emphasis is put on the upgrading of primary health care, including health promotion, health protection and disease prevention, with special attention devoted to the enhancement of collaboration between the primary care and hospital sectors. Reorientation towards primary health care should bring about the restructuring and reorganization of the secondary and tertiary care systems. lt is well known that those secondary and tertiary care systems absorb а consideraЫe part of the financial resources, mainly due to the introduction of new medical technologies. The health reform in lsrael is made up ofthree main components: implementation ofthe National Health lnsurance Law; decentralization of hospitals; and turning the Ministry of Health from а ministry that provides service into а ministry that determines policy. The National Health lnsurance Law aims at giving equal access to health services for the entire population. The Ministry of Health fosters puЫic participation and intersectoral cooperation in order to promote а healthy lifestyle through cessation of smoking, healthy nutrition and physical activity. ln the field of health promotion, top priorities are: women's health, health status ofthe elderly and mental health. The reorganization of health services for the elderly includes two major elements: strengthening community geriatric services and improving the health services basket provided for the elderly. Concerning mental health care, we would like to highlight the transfer of services from the mental health hospitals to the community and the inclusion of а basket of services for psychosocial rehaЬilitation. Israel strongly supports the Director-General's efforts to allot mental health its deserved place in WHO policies and calls upon the Organization and its Member States to devote the World Health Day in 2001 to mental health. 1 chose as my top priority the fight against smoking because it is an important issue of common concern. 1 am actively involved in taking legal actions against tobacco companies operating in lsrael for the damage they are causing to health and to our society as а whole, and 1 want to make use of the fines imposed on the companies Ьу court rulings for this important cause. 1 also implemented а new approach and appointed а puЫic committee with а judge at its helm, to investigate the damages caused Ьу smoking. 1 am sure that after we have left the AssemЬly, we shall continue to closely work together to make the world, through our joint efforts, а healthier and а better place for all.

Mr DE SIL V А (Sri Lanka):

Madam President, excellencies and distinguished delegates, Sri Lanka had а flourishing indigenous system of medicine for at least 20 centuries, until it began to suffer under the colonial rule. ln 1948, when Sri Lanka earned independence, we were left а western system of medicine, which was essentially а heavily bureaucratic, centralized and "top down" command system. Since independence, successive govemments have continued to maintain а system of free education and estaЫished а system of free health care at the point of delivery for all her citizens. As а result, Sri Lanka has been аЫе to accomplish impressive gains in national health indicators. Му Ministry has to deal with several compelling challenges in this new millennium. First, Sri Lanka is in the throes of an epidemiological transition, in which the infirmities characteristic of newly industrializing countries, such as noncommunicaЫe diseases, accidents, suicide and cancer are on the increase. This is at а time when malaria and other infectious diseases, and childhood and maternal malnutrition are yet to Ье reduced to more ассерtаЫе levels. Secondly, my country is confronted with а dramatic demographic transition, with one of the fastest ageing populations in the A53NR/4 page 59 world, and al\ the consequences of such а transition. Post-traumatic stress and other mental health proЬ\ems are on the increase, and the fearful spectre of НIV 1AIDS is \urking in the background. However, this threat is much less than in many other Member States of WHO, including those in our Region. 1 am happy to note that my Govemment has allocated 24 Ьillion rupees for the health sector for the year 2000 to overcome these challenges. Incidentally, this is an increase of 100% compared to \ast year. This is despite the increased defence expenditure the Govemment has to incur to combat terrorism. Realizing that the al\ocation of increased funds alone will not achieve the envisaged result, Her Excellency Madam Chandrika Bandaranaike Kumaratunga appointed а presidential task force in early 1996 in order to submit comprehensive recommendations on health policy and implementation. This task force functioned under my chairmanship and comprised distinguished clinicians, academics, medical educationalists, economists and representatives of other relevant agencies. This task force functioned in 15 committees, with over 100 members co-opted as advisers, and submitted its recommendations Ьу mid-1997. The key recommendations of the presidential task force addresses а comprehensive range of issues in the health sector. А crucial consideration is that al\ aspects of the system of indigenous medicine have been integrated into these proposals in tandem with the western system. Appraisal of performance of individuals and institutions and regular audit of systems and processes are fundamental requirements for objective measurement of performance and improvement of efficacy and quality. EstaЬ\ishing the need, conceptual basis and operational guidelines for audit have to overcome the resistance to change and ingrained inertia of а bureaucratic administration. lt has long been accustomed to a\most automatic promotion and salary increments, as well as an attitude of noncooperation or overt antagonism of trade unions of powerful health professionals. We have realized that without estaЬ\ishing а benchmark to assess performance, one can hardly address the task of improving it. Му Ministry has already initiated appropriate measures to implement, monitor and evaluate recommendations of the presidential task force on а step-by-step process. For the first time, we have introduced а system of appraisal of performance linked to incentives. Although the Government of Sri Lanka perceives the many inequities and fiscal burdens of а health care system which is free of cost for all at the point of delivery, а more equitaЬ\e system incorporating cost sharing may not Ье political\y conducive at this juncture. However, we were exploring the possiЬility of improving and expanding the existing schemes of health insurance. We will also facilitate the development of а vibrant and high quality private health sector. This is in addition to the improvement of free health care facilities provided Ьу the State. lt must also Ье appreciated that we need to implement these changes Ьу using dialogue, persuasion and negotiation as our key instruments. This has to Ье achieved within the context of а democratic policy. ln conclusion, 1 wish to express my appreciation to the World Health Organization, the World Bank and other intemationa\ agencies for the direction, guidance and \eadership extended to us, especially with regard to Roll Back Malaria and the ТоЬассо Free lnitiative, and look forward to continuous cooperation, guidance and support.

Dr DURМUS (Turkey):

Madam President, Madam Director-General, excellencies, ladies and gentlemen, it is indeed а privilege and an honour for me to address the Fifty-third session ofthe World Health AssemЬ\y. lt also gives me great pleasure to congratulate you, Madam President, upon your election as the President of this eminent body. Му congratulations also go to the other distinguished officers to whom 1 wish every success in their important work. We have studied the introductory document to The world health report 2000 with due attention. The report brings а new dimension in the assessment of health systems as govemments seek to improve the quality of health services. 1 wish to рау tribute to the Director-General and her team for preparing this report. The world health report of this year is being prepared with а new approach, taking а wide range of views into account. We hope that this report will Ье finalized subsequent to the AssemЬ\y to reflect the ideas and experiences of many countries that are voiced here. As the extent of participation is widened, the report will Ье enriched Ьу the adoption and implementation of its ideas and strategies. The world hea/th report 2000 focuses on the capacity of Member States to improve health systems. ln this regard, there is а need to develop certain methods to assist countries in A53NR/4 page 60 improving the quality of their health systems, as well as to maximize their capaЬility to respond to the demands oftheir people. We are pleased to see the World Health Organization being fully involved in an area where its leadership is most required. Our country will finalize its national health policy development study in line with the Health 21 targets Ьу the end of2000. We intend to make full use of and implement efficiently this national health policy. Health should Ье the centrepiece of all development policies. 1 would like to affirm the commitment of my Govemment to this. Considering the wide social, cultural and economic diversity of different countries, it is appropriate for each country to develop а health system that responds to its own needs. However, 1 believe that dissemination of facts, based on the experiences of different countries, Ьу WHO could empower national govemments to benefit from best practices in other countries. UndouЬtedly, an effective partnership at national and globallevel is а prerequisite for this purpose. Turkey has initiated а comprehensive health care reform process including the introduction of incentives for service providers. Our priority is to ensure quality and accessiЬility of primary health care services throughout the country. We strongly believe in the importance of preventive services which will decrease health expenditures and in tum will lead to the effective use of limited resources. Today, as in all other service sectors, the health service should Ье tailored according to customer satisfaction. Health services should Ье аЫе to meet the puЫic demand. For this purpose, objective criteria should Ье developed to analyse the various demands of the population. ln addition, national policy-makers should Ье equipped with adequate tools and Ье empowered to redesign new strategies to attain better health levels. Madam President, the first step of the health system's improvement is an evidence-based assessment of the existing situation. The world health report 2000 will encourage the countries to take further steps in this direction. We expect the World Health Organization to prepare guidelines and provide technical assistance to realize the objectives of this report. We find it valuable to integrate health systems evaluation in the world health reports. This approach will allow countries to evaluate their performance in а global context and encourage them to make further progress. Health is а complex issue requiring the efforts of many sectors. The characteristics of different countries, their socioeconomic status and other multidimensional factors should Ье taken into consideration in the comparative analysis of health systems. The World Health Organization should work with govemments more closely to support them in their efforts as they improve their data collection systems. ln this regard, the increasiпg level of cooperation between govemments and regional offices has significant importance. 1 take this opportunity to congratulate the new Regional Director for the European Region on his appointment to this important task. Our efforts at global and national levels are all dedicated to achieving the best possiЫe level of health for every human being. We are committed to the common goals of alleviating poverty, improving the quality of life and reducing the burden of disease.

Professor F.G. Nazirov (Uzbekistan), Vice-President, took the presidential chair. Le Professeur F.G. Nazirov (Ouzblkistan), Vice-President, assume la presidence.

The PRESIDENT: ПРЕДСЕДА ТЕЛЪ:

В отсутствие Председателя имею честь продолжить.

Dr SUJUDI (Indonesia):

Mr President, Madam Director-General, excellencies, ladies and gentlemen, allow me to congratulate you, Madam President, on your election to preside over this Fifty-third session of the World Health Assembly. 1 am confident that, under your able guidance, this important forum will conduct а relevant debate leading to the important decisions required Ьу the substantial health issues confronting the world today. 1 should also like to take this opportunity to congratulate the Director-General of WHO, who has brought new ideas to and infused enthusiasm in this Organization, A53NR/4 page 61 while at the same time confronting many challenges in а period of just two }ears. She has also pointed the way to tackling the difficult task of making the world а healthier and safer place for all. We have stepped into а new millennium. This is а time for us to both celebrate our success and ponder over the problems still confronting us. Tuming to my own country, Indonesia, great strides have been made over the last three decades, notably with regard to infant and matemal mortality, which have diminished dramatically whilst life ехресtапсу as а whole has increased. Health is provided to а population of some 21 О million people spread over thousands of islands Ьу more than 7000 health centres and 50 000 midwives. We have successfully conquered diseases such as smallpox and we are on our way to overcoming poliomyelitis and leprosy. Yet we still have а long way to go. Emerging and re-emerging communicable diseases still remain а great challenge. Tuberculosis, malaria and dengue haemoпhagic fever are still major problems and show а worrying increase in morЬidity trends and parasite rates. Respiratory infections and diaпhoea continue to take а rapid toll, especially among children. Many women continue to die needlessly in childЬirth. Coupled with this is the added burden of noncommunicable diseases, which are increasing at а fast расе, especially among old people. The use of tobacco, alcohol and narcotics is an area of concem, while appropriate human resources and the provision of good-quality drugs are still deficient. In providing services, finding or training an adequate number of quality personnel with the right expertise and technical skill is а priority. Although some 162 pharmaceutical companies are registered as applying good manufacturing practice, the availaЬility of affordable drugs under WTO rules is fraught with problems which have significant consequences on health. The issue of health financing is also а major problem affecting the poorest families, who have to meet expenses out of their own pockets and thus spend а disproportionate amount of their income on health. The last two years have witnessed great social and political changes in Indonesia. Indeed, the monetary crisis which hit the country in 1997 left а large number of people unable to afford even the most basic health services. These changes have had an impact on almost every aspect of life in Indonesia. One of the effects of the monetary crisis on the health sector has been the formulation of social safety net schemes, although this particular issue still constitutes а considerable task for the Govemment. Developing countries like Indonesia cannot ignore the needs of the poor, and providing sufficient health care for all must remain а top priority of the Govemment. These challenges have led us to revise the vision and mission of the Ministry of Health. We have set ourselves а goal entitled "Healthy Indonesia 201 О", with four basic strategies to support it, namely: incorporating health care into the mainstream of national development; professionalism; better managed health care; decentralization. One of the Ьiggest challenges facing us is posed Ьу decentralization. Indeed, we are trying to bring the health system closer to the people and are empowering the districts to this end. We are now engaged in remodelling the entire health system, а process which involves major changes in function and operation at every level. In practical terms, this entails the upgrading of human resources at the district level while providing centralized standards and guidance. The goal is to place health at the very heart of development in order to promote а healthy civil society, pursuing economic development to achieve better living standards. We must provide advice to all sections of society, as well as to all other sectors, to ensure that health is not viewed as purely ministry ofhealth matter. From 26 to 29 April 2000 the health ministers of the ASEAN countries met in У ogyakarta and discussed this topic as part of their agenda. The summit closed with the ASEAN health ministers declaring that their next common goal would Ье to achieve а "healthy ASEAN Ьу the year 2020". То this end, they resolved to meet annually to achieve better cooperation in the field of health development in the region. It is very important that such regional initiatives are recognized and encouraged. These are our priorities for the future and we therefore look forward to the active participation of WHO in all these areas.

Professor FISER (Czech Republic):

Mr President, Madam Director-General, ladies and gentlemen. lt is а very special honour for me to speak to this Fifty-third World Health Assembly on behalf ofthe Czech Govemment as the Minister of Health of the Czech Republic. Thank you very much, Director-General, for the work you and your A53NR/4 page 62 team have done during the last two years for the health of the world's population. Health is an important puЬlic value. То preserve and develop health is а major priority of both individuals and society. Although care for personal health rests primarily with individual citizens, some of its aspects are beyond their possiЬilities. The State has to step in with its health policy to provide the necessary conditions. In the last decade, the health of the population of the Czech RepuЬlic has improved. The infant mortality rate has been decreasing continuously. It was reported to Ье 5.2 per 1000 live Ьirths in 1998 and 4.6 per 1000 live Ьirths in 1999. Life expectancy at Ьirth has shown а faster increasing trend, but it is still about four years below the European Union average. In 1997, life expectancy at Ьirth increased to 70.6 years for men and to 77.6 for women and, in 1998, it reached 71.1 for men and 78.1 for women. The National Environment and Health Action Plan (NЕНАР) is one of the areas of major concem to the Czech RepuЬlic. The NЕНАР is related to other documents approved Ьу the Czech Govemment, in particular the State Environment Policy and National Health Programme. The implementation of NЕНАР in the Czech RepuЬlic is ensured Ьу the Council for Health and Environment estaЬlished Ьу the Govemment of the Czech RepuЬlic and chaired Ьу the Minister of Health. Health 21, on health for all in the twenty-first century, is understood in the Czech RepuЬlic to Ье one of the principal documents of the World Health Organization, and а basic tool of the Czech health policy in the period 2000-2005. Globally, the achievement ofindividual targets ofthe Health 21 strategy will reduce the differences in health and its accessiЬility in different countries. The achievement of individual targets of Health 21 strategy in the Czech RepuЬiic at the national, regional and local levels is also important for the process of enlarging access to health. Health is one of the priorities for the European Commission. Preparing for accession to the European Union is а key element for the Czech Govemment, and а main issue of the accession process is preparing for changes in Czech legislation. 1 believe the World Health Organization, especially its Regional Office for Europe, will play an important role in this enlargement process in Europe. WHO should Ье а key player in health policies throughout the world and each of its Member States to reflect their special needs. 1 would like to conclude Ьу expressing the hope that "One WHO" will meet the challenges of the next century in wor1d health.

Dr АL-СНА ТТI (Syrian Arab RepuЬiic ):

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Е! Sr. FERNANDEZ AMEGLIO (Uruguay):

La delegaciбn del Uruguay felicita а !а sefiora Presidenta por su elecciбn у confia en su competencia para llevar а buen termino nuestros trabajos. TamЬien desea felicitar а !а sefiora Directora General por е! Informe sobre /а salud en е/ mundo 2000. Sin lugar а dudas, seпi un gran aporte para las reformas de los sistemas de salud а las que nos vemos enfrentados. El mensaje transmitido en е! informe nos deja varias reflexiones que deseamos transmitir а !а AsamЫea. (,Cшil es !а razбn por !а que estando en los comienzos del siglo XXI е! mundo no ha podido aun encontrar una soluciбn а !а atenciбn de !а salud de su роЫасiбn? Consideramos que parcialmente una posiЫe respuesta а esta pregunta es que no se puede haЬ!ar de salud sin haЬ!ar de economfa у polftica de Estado. En general, todos consideramos que е! mundo avanza hacia una economfa globalizada, con integraciбn de sus economfas, alianzas entre grupos de pafses, economfa sin fronteras, !о que harfa pensar en una mejor distribuciбn de los Ьienes globales. Pero no es menos cierto que los paises desarrollados continuan practicando polfticas econбmicas proteccionistas en defensa de sus producciones ineficientes, que impiden que las naciones menos desarrolladas puedan crecer econбmicamente у obtener mayores ingresos para distribuir entre sus haЬitantes. Definimos que es imposiЫe haЬ!ar de salud у pobreza а! mismo tiempo. (,De que sirve realizar una polftica para е! nifio lactante о para !а embarazada si luego no va а tener alimentaciбn apropiada para su desarrollo? (,Сбmо es posiЫe planificar un programa de prevenciбn sanitaria cuando una vacuna tiene un coste promedio de 12 dбlares у una inmensa роЬ!асiбn mundial recibe un ingreso inferior а los 20 dбlares por mes? Son derechos, desde nuestro punto de vista, naturales del ser humano е! acceso а !а alimentaciбn у а !а salud. Si falta alguno de ellos consideramos que no existen condiciones de vida. Los goЬiemos mas ricos materialmente del mundo deberfan reaccionar frente а esta proЫematica у realizar acciones у formular polfticas que posiЬiliten una mejor distribuciбn de !а riqueza, de forma tal que !а situaciбn mejore paulatinamente. TamЬien consideramos que !а OMS debe asumir un papel protagбnico frente а !а industria farmaceutica para buscar un fuerte abatimiento de los costos de los medicamentos. A53NR/4 page 64

Nuestro pais, la RepuЫica Oriental del Uruguay, con 3 200 000 haЬitantes, debe enfrentarse а los proЬlemas sanitarios que surgen de haber completado la transici6n demogпlfica у epidemiol6gica. Las enfermedades prevalentes у de mayor importancia desde el punto de vista sanitario son las enfermedades cr6nicas no transmisiЫes. Los accidentes, las consecuencias de la violencia у los haЬitos t6xicos. А modo de ejemplo, algunos indicadores son: la tasa bruta de mortalidad tiene un valor del l 0%; la mortalidad infantil, de 14,5 por 1000 nacidos vivos; у la esperanza de vida al nacer, de 73 afios. Tenemos una cobertura de inmunizaci6n superior al 90%, у un gasto en salud de aproximadamente el 10% del РIВ. Los retos que motivan el proceso de mejorar el funcionamiento del sistema de salud de nuestro pais son, entre otros: la ejecuci6n de la rectoria о funci6n del GoЬiemo en la salud; la mayor eficiencia у eficacia de los servicios; la complementaci6n de lo puЫico con lo privado; el mejoramiento de la accesiЬilidad de los servicios de salud; el fomento del desaпollo de los recursos humanos; la contenci6n de los costos incrementales у, por ultimo, pero no menos importante, el trato del sistema hacia los usuarios о, lo que es lo mismo, una atenci6n humanizada hacia el paciente, уа que la solidaridad en la atenci6n de la salud desde nuestro concepto no es un mero acto de carid::td, sino que es un deber de quien la ejerce. Nuestra propuesta, encuadrada dentro de la reforma del Estado, procura ciertos desplazamientos de las actuales politicas de salud hacia otras que contribuyen allogro de los objetivos que pretendemos alcanzar. Estos desplazamientos son: desde un enfoque sectorial, а uno que contenga la acci6n intersectorial; desde un Estado deficiente, omnipotente у omiso, а un Estado promotor, equilibradamente regulador у eficiente; desde una gesti6n centralizada, а una descentralizada у aut6noma; desde un gasto puЫico sin control у mecanico, а otro controlado у que priorice las necesidades de los mas pobres; desde acciones cuyos efectos se desconocen, а planes у programas adecuadamente evaluados segun metodologias que relacionen los costos con los resultados obtenidos. No debemos olvidar que la verdadera riqueza de una naci6n esta en su gente у sus valores, уа sean intelectuales о morales. En el umbral del nuevo milenio, nuestro deber, hoy mas que nunca, es ser instrumentos canalizadores de esta inmensa fuerza generadora del mundo de mafiana que es el progreso у su impresionante desaпollo tecnol6gico, sin olvidamos de que todos nuestros esfuerzos de aplicaci6n de recursos humanos у econ6micos deben tener como objetivo basico la mejora de la calidad de vida del ser humano, у de esta manera articular el desaпollo con la justicia social, en la construcci6n de un mundo mas libre, mas igualitario para todos quienes tenemos el privilegio у el orgullo de ser sus haЬitantes.

Mr СНUА Jui Meng (Malaysia):

Mr President, Madam Director-General, distinguished ministers, ladies and gentlemen, first of all may 1, on behalf of the Govemment of Malaysia, extend our warmest congratulations on the election of the President. Allow me this aftemoon to make а personal observation: this moming, 1 went to one of the cafeterias in this building, the Palace of Nations and next to the cafeteria was а large lounge. 1 noticed that there was cigarette smoke in that lounge; 1 looked around and 1 said this is not possiЫe, this building is the Palace ofNations, but there is an entire row dedicated to people who smoke. Now 1 know that smoking is not an easy haЬit to give up. As one Prime Minister of Thailand said: "Giving up smoking is easy; I've already given it up 100 times". What 1 am trying to say is this: if we want to roll back tobacco in the world, let us begin in the Palace of Nations at the United Nations; let it Ье а place that is smoke free. We support the view of the Director-General that the three main goals in assessing national health systems performance are: number 1, health improvement; number 2, responsiveness to the legitimate expectations of the population; and number 3, faimess of financial contribution. We also agree that progress towards achieving these goals depends on how well systems carry out the four vital functions of service provision, resource generation, financing and stewardship. ln relation to responsiveness to the legitimate expectations of the population, may l say а few words on the question of the promise held out Ьу five drugs companies to the Director-General of the World Health Organization and to UNAIDS that they are going to consider reducing the price of drugs for HIV; we welcome this statement: it is а positive development after several years of constant battling between A53NR/4 page 65 developing nations and drug companies, and we congratulate Dr Brundtland for having effected this breakthrough. At the same time we also recognize the fact that the Agreement on Trade-Related Aspects oflntellectual Property Rights (TRIPS) ofthe World Trade Organization permits countries in situations such as that of poor countries that cannot afford expensive drugs for HIV, which is life-threatening and а major latter-day plague, to undertake what we call compulsory licensing and parallel importing. We know, for example, that Brazil, which produces AZT on its own, sells it at а price 90% cheaper than that for which it is sold in the United States of America. Therefore, developing countries should Ье allowed to do manufacturing under compulsory licensing and even to do parallel importing. 1 hope that the Director-General, UNAIDS and the World Health Organization will take this up on behalf of the developing nations of the world and make sure that no sanctions are imposed on developing countries for taking initiatives to save their populations from this latter-day plague. We realize that if we do not enhance responsiveness to the population and if we do not bring about health improvements, this situation may even undermine the political stabllity of nations and greatly influence the choice of govemment. As for financing of the health system, like many other countries in the world, Malaysia is committed to addressing the issue of sustainaЬility and securing more resources for continuous improvement of health. Malaysia for one believes and advocates that healtl1 expenditure should Ье regarded as а long-term investment, which brings retums in allowing citizens to realize their health potential to the fullest, thus enaЬling them to contribute towards nation-building. Health services in Malaysia are provided mainly Ьу the Govemment, although over the years the private sector's contribution to health care has been increasing. The health services in the puЬlic sector are highly integrated into the preventive, promotive, curative and rehabllitative systems. But we realize that for а truly integrated national health system we have to bring in the private sector, which is now fragmented and has disintegrated. How do we plan to do this in the next five years? Simply, first Ьу cooperating with the private sector; secondly, through health care planning and development, doing it together; thirdly, Ьу the utilization of puЬlic health care facilities Ьу private doctors and vice versa; fourthly, Ьу training and education; fifthly, Ьу collection and sharing of health data across the board; and sixthly, Ьу а commitment Ьу both sectors to our social responsibllity to the population in terms of health care. Before ending, may 1 just say that we have shared at the round taЬles views about health systems around the world, 1 hope that the World Health Organization will Ье аЬlе to collate all this information, giving the strengths and weaknesses of each system, because we have to continuously improve our health systems to deliver better health care and we have to leam from each other. We need to do so bearing in mind the words of George Bemard Shaw as 1 conclude: "success does not consist in never making mistakes, but never making the same one а second time".

Dr SERRA (Brazil):

Mr President, Madam Director-General, delegates, in order to guarantee universal, equitaЬle and full access to health services, which are а constitutional right of Brazilians, our efforts have been focused on two essential vectors. First, alteration of the management model; and second, transformation ofthe mechanisms used to provide health services. In the case of health system management, it is worth stressing that, at the same speed at which we have sought to increase the funding availaЬle to health, we have taken measures to overcome emergency proЬlems, reduce mortality rates, attenuate the pain and suffering of the population, and reduce the inequalities that, unfortunately, still scar our nation. We have decentralized management and financial resources according to the size of the population to Ье served: today, 97% of municipalities in Brazil are fully responsiЬle for managing basic health care. The results have been highly positive, since municipal administrators are much better informed with regard to expanding local needs. In the rendering of health services, we reorganized basic health services through the Family Health Programme and Community Health Agent Programme, where doctors, nurses, nursing aids and community agents are prepared to provide health care for families in their own homes, transferring only those patients in need ofmore complex forms oftreatment to hospitals or health centres. We have already organized 7300 teams of doctors, nurses and community agents, providing services in more than 2000 cities and taking care of 28 million people. Ву 2002, our target is to form, train and field A53NR/4 page 66 another 14 000 teams, extending these services to at least half of the Brazilian population. Simultaneously, more than 100 000 community agents are active in more than 80% of Brazilian municipalities. The results already achieved have been highly positive. Between 1994 and 1999, we reduced the mortality rate of children under one year of age from about 40 to 35 per thousand live births, and all the new evidence shows that this downward trend will continue and accelerate. 1 would further re­ emphasize the hard work we have done to control the quality of the Ыооd supply. Ву 2003, Brazil intends to achieve а quality level of 100% for the Ыооd supply. Dr Brundtland said recently, and 1 quote: "ln the last five years, Brazil has achieved impressive results in improving its Ыооd transfusion services and in many respects can Ье considered an example for other countries". Finally, 1 would like to touch upon two points of importance to Brazil and to WHO: combating tuberculosis and tobacco use. ln the case of tuberculosis, Brazil has adopted the DOTS strategy and is distributing financial bonuses to municipal health secretariats for cases cured. With regard to tobacco, 1 would like to emphasize before this AssemЫy that Brazil, though it is the world's fourth largest producer of tobacco and the largest exporter of tobacco leaf on the planet, will play а vanguard role in the process of elaborating the future framework convention on tobacco control and its protocols. 1 should like to close my remarks Ьу refeпing to the "lndex of national health system performance". Some academic exercises have been tried recently Ьу two United Nations agencies and, at least in the Brazilian c.ase, both studies, unfortunately, were not comprehensive, contained inaccurate and stale data and were based on improper research. This could have been avoided if those academic exercises had been the subject of prior debate with Member States; 1 do not mean the results, but the methodology and the recorded data sources. These weaknesses lead to misleading conclusions and to inadequate policy recommendations. Evaluation exercises, including WHO's, should always Ье the result of а prior discussion of methodology between govemments and WHO and should always Ье based on recent data provided Ьу reliaЫe sources. We do favour wide-ranging polemics on ideas and concepts about health policies, but not on scientific technique and numbers presented as а fait accompli. Brazil has introduced two draft resolutions in Committee А on infant and young child nutrition and on the revised drug strategy as well as an amendment to the draft resolution on HIV1 AIDS. Brazil hopes to count on the support of other Member States to approve them.

Mr NGEDUP (Bhutan):

Mr President, Madam Director-General, distinguished delegates, ladies and gentlemen, on behalf of the Bhutanese delegation and on ту own behalf 1 should like to extend to the President and to the officers of the Bureau our warmest congratulations upon their election. Dr Brundtland promised us а new vision for WHO when she assumed leadership; it brought fresh hopes and expectations of а vibrant and dynamic Organization. Two years later, we are proud to witness her dreams slowly taking concrete shape: The world health reports for 1999 and 2000 are testimonies of words being transformed into decisive action. We salute you, Dr Brundtland and your аЫе team. The world health report 1999 said that the yardstick of genuine development is the filtering down of development to the poorest of nations and the poorest of people; The world health report 2000 follows up with the theme of improving health systems performance, а decisive move to realize the aims and objectives enunciated in the earlier report. Му delegation would like to commend the Director-General and WHO staff for this excellent report. We believe these proposals will provoke positive changes in the health care delivery systems of Member countries. The implementation of the report at country level, however, must Ье carefully analysed in the context of national capacities and capaЬilities. Country-specific needs must Ье assessed before promoting uniform application. Here 1 cannot emphasize enough the importance of human resource development, particularly in the more disadvantaged countries; 1 should like to therefore urge WHO to invest more into capacity-building in these countries. Му delegation would also like to express our appreciation to the Director-General for extending her energies beyond the confines of WHO to generate more active and realistic puЬlic-private partnerships. lt is my belief that her leadership in new initiatives such as the Global Alliance for Vaccines and lmmunization (GAVI) will ensure а healthy outcome for millions of children around the A53NR/4 page 67 world; GA Vl provides an excellent opportunity to strengthen existing immunization programmes through its supportive and catalytic role. 1 am confident of GAVI's will to put smiles on the faces of children of the world in the not-too-distant future. Health care development in Bhutan is just four decades old, yet today over 90% of our people have adequate access to primary health care services. ln the last decade alone, we have experienced dramatic reductions in mortality and а significant increase in life expectancy. We are close to realizing many of our health for all targets. Today 14 out of 20 districts in the country are tobacco-free through community initiatives. The health of children and women features high on our agenda: for the Royal Government, quality assurance, sustainability and alternative financing mechanisms have emerged as the new challenges. lmproving health management information systems, research capacity, communication facilities, multisector partnership, targeted advocacy and social moЬilization have become important strategies to meet these challenges. The Bhutan Health Trust Fund, an innovative approach to health systems sustainaЬility and the recent introduction of telemedicine will further reinforce our dreams of providing better health care for our people. As WHO is becoming more vibrant and responsive to the needs of Member countries so also are many far-reaching changes taking shape in my country. ln 1998, his Majesty the King voluntarily devolved his own powers to the Legislative AssemЬly to empower the Bhutanese to determine their own destinies. ln 1999, the newly elected Council of Ministers undertook а major restructuring of Government ministries to promote the three pillars of efficiency, accountaЬility and transparency. 1 believe these historical changes in my own country Ьlend harmoniously with the changing visions in WHO. Our Government has consistently over the years firmly believed that investment in the social sectors must Ье accorded the highest priority. We will continue to strive hard to realize the objective of both WHO and our own, which 1 believe is to bring health and happiness to our people.

Mr SAVVIDES (Cyprus):

Mr President, Madam Director-General, dear colleagues, distinguished delegates, ladies and gentlemen, on behalf of the Government of Cyprus 1 should like to congratulate the President on her election as President of the Fifty-third World Health AssemЬly. 1 should also like to take this opportunity to express our strong support for the initiatives undertaken Ьу the Director-General and to acknowledge the hard work and dedication of the WHO headquarters staff. Once more we should like to express our gratitude and appreciation to the Director and staff of the Regional Office for the Eastern Mediterranean for their continued support and for all their ongoing collaborative activities. The realization of the Declaration of Alma-Ata in terms of rapid and sustained progress towards universally accessiЬle basic health care remains а dream for millions of people. The global picture is uneven and equalities in health between the poorest and best-off groups have widened while health systems in general are unprepared to face the challenges of the twenty-first century. Policy-makers need to respond immediately to new challenges such as emerging epidemics of noncommunicaЬle diseases and of major infectious diseases which outlived the twentieth century. There is the burden of demographic changes; diseases arising from environmental changes and hazards in the workplace; the rising demands and expectations of people concerning their health; and the growing demand for costly new technology. All these changes place mounting pressure on service provision at а time when puЬlic spending is under tight constraints. As not all services can Ье provided, it is obvious that the most cost­ effective services should Ье provided first. This new approach, the so-called "new universalism", recognizes governments' limits, but retains governments' responsiЬility for leadership and financing of health systems. Experience gained in the 1950s and 1960s has shown that national health insurance can lead to dramatic improvements in health, while maintaining total public spending on health at moderate levels. This year's theme- "Health systems: improving performance"- gives us а golden opportunity to review once again the strengths and weaknesses of our health systems, and to enhance our efforts for а better outcome. Cyprus, like many other countries worldwide, in an effort to achieve better health for its entire population, is at the crossroads of reforming its health care system, which is now characterized Ьу а rapidly developing puЬlic sector, along with а growth in the private sector which is not fully controlled. A53NR/4 page 68

The Govemmeпt of Cyprus, haviпg carefully studied national conditioпs, апd takiпg iпto accouпt iпtemational experience and trends iп the field, has decided to put forward proposals for а natioпal health iпsurance system. These proposals have been the subject of ап exteпsive consultation with our social partпers, health care providers, orgaпizatioпs and other interested parties. The maiп objectives of our natioпal health scheme are: equity iп the financing and provisioп of comprehensive health care, largely free at the point of delivery for all our people; efficieпcy iп the delivery of health care, iп particular high standards of quality at reasoпaЬle cost; coпtaiпment of cost iпflation caused Ьу demographic changes, techпological advances апd adverse incentives. The bill for the production of the scheme is поw before parliameпt, and is expected to become law this year. We believe that the introductioп of the пatioпal health insuraпce system will help us fiпd ап efficieпt апd equitaЬle solution to our health proЬlems which will meet the critical challeпges ofthe twenty-first ceпtury.

El Sr. COMENDEIRO НERNANDEZ (Cuba):

Quisiera felicitar а la Presideпta у а los Vicepresidentes seleccioпados, asi como а la Dra. Gro Harlem Brundtland, Directora General de la Orgaпizaciбп Mundial de la Salud, por ellnforme sobre la salud en el mundo 2000. Sefior Presidente, la delegaciбп de Cuba tieпe а Ьien recoпocer la calidad у profundidad del Jnforme sobre la salud en .el mundo 2000 ofrecido por la Directora General de la Orgaпizaciбп Muпdial de la Salud соп el fiп de facilitar los preparativos de las delegaciones asistentes а la preseпte AsamЬlea, у al respecto me permito hacer las siguieпtes consideraciones. Ме parece adecuado que el informe este eпcamiпado а mejorar el desempefio de todas las accioпes de salud у по sбlo las referidas а los servicios. En relaciбп соп la aseveraciбп de ese mismo iпforme « ... ellogro de uп alto пivel medio de atenciбn по es suficieпte, уа que una de las metas del sistema de salud ha de ser tamblen la de reducir las desigualdades... », estamos plenamente de acuerdo соп aquella у hacemos refereпcia al respecto а una de las recomeпdacioпes hecha а los Jefes de Estado у Goblemos еп la Declaraciбn Final de la Primera Reuпiбn de Ministros de Salud de lberoamerica, celebrada en La НаЬапа еп octubre de 1999: «Las reformas del sector salud, los modelos de соореrасiбп у los programas para la оЬtепсiбn de salud para todos deben estar basados еп priпcipios de solidaridad, soberania, dignidad, equidad у sustentabllidad.» Podemos afiadir como ejemplo que еп el caso especifico de nuestro pais la equidad social alcanzada en el по ha permitido пi cercaпameпte la pobreza extrema. Pero, por otra parte, а Cuba la equidad еп el acceso а las fueпtes de finaпciamieпto le ha sido continuamente vedada como coпsecueпcia del criminal Ьloqueo del que ha sido victima por mas de cuatro decadas. De igual forma, respaldamos absolutameпte los criterios vertidos en el informe acerca de la respoпsabllidad coпtiпua у permanente de los gobiemos, ademas indelegaЬle еп el desempefio del sistema de salud de cada pais, como uпа prioridad пасiопаl, еп el contexto de sus respectivos arreglos sociales. Sin duda, respecto а este puпto, el escollo mas graпde que епfrепtап los goblemos еп la actualidad para cumplir con este deber es la acciбn sistematica de debllitamieпto del Estado que geпera el neoliberalismo соп la privatizaciбп absoluta у descoпtrolada. Еп la meпcionada Declaraciбп Final de la Primera Rеuпiбп de Miпistros de Salud de lberoamerica se recomendaba al respecto: «Las reformas del sector salud dеЬеп coпstituir una politica de Estado que las coпvierta en un proceso enriquecido de sus propias experiencias у de las que surjan del intercamblo, en un marco adecuado у sistematico de aпalisis, de decisiones constructivas у de cooperaciбn». Еп ellnforme sobre la salud en el mundo 2000 se definen ademas cuatro funciones clave para la mediciбn del desempefio: prestaciбп de servicios; generaciбn de recursos humanos у fisicos; recursos para pagar la аtепсiбп sanitaria; у la rectoria, como funciбn que estaЬlece las reglas de juego para impoпer su cumplimieпto у proporcionar orieпtaciбп estrategica а los distintos actores implicados. Fortalecer la rectoria es algo importante para el goblemo, que geпeralmeпte delega esta funciбп а los miпisterios de salud puЬlica de los paises, у еп Cuba, Salud PuЬlica es quien asume el encargo de su Goblemo. El informe plaпtea tamblen que esta funciбп entrafia еп el plano intemacional: « ... la movilizaciбn de la acciбn colectiva de los paises para producir Ьienes puЬlicos de iпteres mundial, por ejemplo investigaciones, fomeпtaпdo al mismo tiempo una visiбn comuп еп pro de uп desarrollo mas equitativo eпtre los paises у еп los paises». А los que sugerimos afi.adir como ejemplo el desarrollo de A53NR/4 page 69 la docencia medica у la cooperaciбn, acciones en las que nuestro pais ha hecho decisivos aportes, como es el caso de la Escuela Latinoamericana de Medicina, que cuenta con 3385 becados de 20 paises, а lo que se suma el ofrecimiento reciente de nuestro Presidente, Comandante Fidel Castro, de 3000 medicos de forma gratuita, durante la Primera Cumbre Sur de los Jefes de Estado у GoЬiemos de los 77, para trabajar en los paises de ese grupo, sin contar con mas de 25 000 medicos cubanos que han prestado servicio en decenas de paises del Tercer Mundo, у en la actualidad, 1632 especialistas de la salud lo hacen de forma absolutamente gratuita en 13 paises de Centroamerica, Haiti у el Atrica subsahariana. Resulta ademas importante para los sistemas de salud la mejoria del desempefio como objetivo fundamental, expresiбn clave у razбn de ser del informe que se analiza. Al respecto creemos relevante sefialar la iniciativa que los sistemas у servicios de salud de Las Americas han iniciado en relaciбn con los procesos de reforma del sector sobre las funciones у responsaЬilidades de los actores envueltos en la prestaciбn de atenciбn de la salud con el nombre de La Salud PuЬlica en Las Americas, en la que ademas de promover una definiciбn comun de ella у de sus funciones, propicia el desarrollo de un marco para la evaluaciбn del desempefio en sus paises, elaborando al respecto un plan de acciбn continental para fortalecer la infraestructura de la salud puЬlica у mejorar la practica de esta. Quisieramos finalizar ratificando nuestra convicciбn у consecuentemente todo nuestro ароуо а cuanta acciбn vaya dirigida al desarrollo de nuestros pueЬlos, que debe centrarse en los seres humanos, en la erradicaciбn de la pobreza у en la satisfacciбn de las necesidades basicas de todas las personas, para alcanzar los cuales la inversiбn en la salud resulta una premisa decisiva е imprescindiЬle. Muchas gracias.

Dr У ADA V (Nepal):

Mr President, Director-General of WНО, excellencies, distinguished delegates, ladies and gentlemen, 1 should like to offer my most sincere congratulations to the President on her unanimous election to the presidency of the Fifty-third World Health AssemЬly. Congratulations are also extended to the vice-presidents, chairpersons of the main committees and the other officials who have been elected to lead this AssemЬly. At the outset 1 wish to congratulate Dr Brundtland, Director-General of WНО, for presenting the summary of our annual report in an excellent manner. 1 also appreciate the work she has done to create dynamism within this prestigious Organization, thus enhancing the image of WНО as а leading agency for world health. Many of the issues faced Ьу the health sector in Nepal are the same as those confronted Ьу all low-income countries, namely, an under-resourced public sector limited in its aЬility to meet health needs, and а rapidly expanding, poorly regulated private sector. ln addressing these issues and ensuring that the health system will Ье аЬlе adequately to meet the needs of the most vulneraЬle groups - women and children, the rural population, the poor, the disadvantaged and marginalized people- Nepal has adopted а health policy framework which will result in improved performance of the health system. This is being accomplished through strengthening health service delivery, decentralization, improving the public-private mix and strengthening health sector management. Нis Majesty's Govemment ofNepal has estaЬlished policies and is developing mechanisms to ensure the effective and efficient delivery of priority puЬlic health measures, and essential curative services based оп the guiding principle of primary health care. Recognizing the role of the private sector and nongovemmental organizations (NGOs) in this effort, Нis Majesty's Govemment is encouraging their participation and exploring mechanisms Ьу which this may Ье achieved. While emphasizing the provision of essential services, His Majesty's Govemment has recognized that referral services should Ье improved. Towards this end, strategies are being developed to ensure the quality and cost effectiveness of such services, to encourage the private sector to play а major role in their funding and provision, and to estaЬlish а safety net to ensure that the needy and underprivileged will not Ье deprived of necessary services because of their inaЬility to рау. То achieve these ends, Нis Majesty's Govemment has recognized the need to make better use of existing resources and to develop altemative sources of financing. То address the former, strategies are being developed to encourage а more effective public/private/NGO collaboration at the central and service delivery levels, including contracting and targeted subsidies. Special emphasis has been placed on extending the management A53NR/4 page 70 system for human resources, financial information, quality assurance, drugs, medical supplies, logistics and physical assets management. In developing altemative sources of financing, user fees and community financing schemes are being expanded and may Ье supplemented Ьу the broader introduction of health insurance and health cooperative systems. Critical to improving health sector performance are decentralization and increased community participation. In implementing decentralizatioп, His Majesty's Govemmeпt is strikiпg the пecessary Ьаlапсе betweeп devolutioп of authority and responsibility, buildiпg the пecessary capacity to effectively exercise authority апd take respoпsibility, апd eпsuriпg that the ceпtre сап eпsure the implemeпtation of пatioпal health policies. As is the case with other \east developed countries, Nepal requires support from its development partпers апd United Natioпs ageпcies. Тоо ofteп this support has Ьееп provided in а fragmeпted fashioп which leads to iпsufficieпt use of resources апd distortioп of sectoral priorities. То reverse this, His Majesty's Govemmeпt, with the support of its developmeпt partпers, is developing а medium-term strategic plan апd finaпcing framework as а basis for operatioпaliziпg Nepal' s approach to improving health sector performaпce апd thus the health of the Nepalese people. Finally, оп behalf of His Majesty's Govemmeпt of Nepal апd оп my оwп behalf, 1 should like to express my deep appreciatioп for the leadership, active support апd effective technical cooperatioп provided Ьу WHO iп this area. Thank you all for your kiпd attentioп.

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Mr КЕТ SEIN (Myanmar):

HonouraЬle Mr President, HonouraЬle Madam Director-General, excellencies, distinguished delegates, ladies and gentlemen, it is indeed а great honour for me to have this opportunity to address the Fifty-third World Health AssemЬly. First of all 1 should like to congratulate the President and Vice-Presidents on their election and express my appreciation to the Director-General, Dr Brundtland, for her excellent report. Life in the twenty-first century will continue to Ье influenced Ьу а variety of factors, including epidemiological, demographic, socioeconomic, political, technological, environmental and global developments. One of our main tasks in this century is the development of efficient and effective health care services responsive to the emerging health needs of our communities. "Health systems: improving performance", the theme of our discussion, is very thought-provoking and highly relevant to those of us who are responsiЬle for health development in our countries. Especially at this juncture, when our Region is recovering from an economic slump, it is imperative that the resources allocated to the health sector are most judiciously utilized to attain maximum benefits. Health systems should respond to the needs of the community both in terms of quality and quantity. While striving to improve performance, we should also ensure that there is equity in improvements at various levels of health care delivery, both in urban and rural areas. Health systems are faced with а demand for sophisticated services requiring consideraЬle financial, technological and human resources. In the current economic circumstances throughout the world, health systems are struggling to do more with less. More attention needs to Ье given to how services are provided, organized, managed and financed. In Myanmar, efforts have been undertaken to enhance primary health care services at the grassroots level and to fund and upgrade health care delivery at the district level of health facility. This has been carried out through capacity-building of health personnel as well as institutional restructuring and upgrading of facilities and equipment at alllevels. Another innovative approach to ensuring equitaЬle access to quality health care for people in rural areas is the organization of these services so that specialists from central state divisions and district level health institutions go down to the grassroots level to provide special services. То meet A53NR/4 page 72 manpower requirements for the provision of quality services, on-the-job training programmes were introduced to enhance the capacity of health staff. The Govemment allocated consideraЫe resources for upgrading health institutions with modem technological equipment. However, cost-sharing schemes have been introduced to recover the recurrent expenditures necessary to operate and maintain the equipment. Another area of the health system whose performance requires close scrutiny is the private sector, which has emerged as an important player in delivering health care. Although Ьу substituting private resources the Government can reallocate puЬlic resources to the areas of greater priority, it should Ье noted that the private sector's objective is narrower and profit-driven; we need to ensure that services provided Ьу the private sector meet both the required medical and ethical standards. ln conclusion, 1 should like to repeat that health systems must have efficient organization and management.

Dr DEGUARA (Malta):

Mr President, Madam Director-General, fellow delegates, colleagues, Malta supports Dr Brundtland's changes in WНО aimed primarily at making it more relevant and efficient. Director-General, 1 am sure you are aware that my country has always taken а special interest in the reform of the United Nations and its agencies. We therefore note your improvements of the Organization with particular interest and hope that you use your influence and the example of WHO to encourage similar changes in other parts of the United Nations system, particularly the Administrative Committee on Coordination (АСС). АСС should also drastically change to exploit the positive advances you yourself have made at WHO. For its part, Malta will continue to push for this type of reform in the Economic and Social Council and the General AssemЫy ofthe United Nations. On the nationallevel, one ofthe main objectives ofthe ongoing reforms in the health sector that my Govemment has championed over the past few years has been an emphasis on improving the quality and performance of the nation's health services. For this purpose, we have made sure that structures and systems were in place to create an appropriate environment where performance could Ье evaluated and the results channelled back to those responsiЫe for implementing change. All present agree that health information is only really useful if it is readily availaЫe to key managers who are then empowered to change behaviour. Prior to our reforms, old-fashioned, over-bureaucratic civil service systems were the hallmark of our health services and most of the administration was based on historical data. There was no mechanism for "closing the loop" to show the key managers how well or otherwise they were achieving their targets. Therefore, one of the first remits of these extensive health sector reforms in the early 1990s was the estaЬlishment of two new govemment departments: one to serve as а think-tank and а change catalyst, the Department of Health Policy and Planning; while the other, the Department of Health lnformation Systems, undertook the task of introducing the most appropriate information technology in an integrated system throughout the various levels of our health care system. The Department of Health Policy and Planning immediately set to work on achieving multisectoral consensus and ownership of а new national health policy document, "Health Vision 2000". We made sure that this evidence-based puЬlic health policy document included achievaЫe targets set for all the agreed priority health areas. With this common mission, we could then proceed to implement several important policies in our Ьid to improve the quality of health services and their performance. The serious investment in information technology provided the knowledge to help informed decision-making become the norm. А strong commitment at the top to introduce only those new puЬlic health policies which were clearly evidence-based, though not necessarily popular or based on passionate appeals, ensured that scarce resources were allocated effectively to maximize positive health gains. Specifically, on the performance appraisal level, we are placing great emphasis on improving peer review and introducing objective monitoring systems, including outcome and process indicators in the various key areas encompassing client satisfaction, clinical processes, human resource utilization and the financial management sector. The challenge here is to avoid estaЫishing perverse incentives at the patient's expense. We estaЫished that one way of reducing this possiЬility was Ьу involving the key managers themselves at the earlier stages of the process of developing this vision, A53NR/4 page 73 and specifically in determining incentives and standards. One concern that is ever foremost in our mind during the standard-setting process is the danger of raising expectations beyond the service's ability to deliver. We must therefore constantly ensure that any patient or health charters must Ье doaЬle and achievaЬle within our limited existing resources. These actions, comЬined with the introduction of а strong modem management structure - especially within the hospital system - are now starting to рау back with visiЬle performance improvements. We plan that Ьу the time our new general acute hospital is commissioned in 2003, we shall have staked out the balance for our audit systems. We are notjust concentrating on improving the performance of hospital systems, we are concurrently and consciously promoting а shift away from concentrating our resources on treating disease to improving health and well-being; this Ьу focusing the indicators on health gains rather than on health repair achievements. We therefore welcome WHO's renewed interest in and directions on improving performance. Director-General, your emphasis on careful and responsiЬle management and on stewardship is not lost on us as we also recognize the vital role health ministries have to play in this regard. А small country like ours will always need to rely on an extemal and independent review element in order to maintain objectivity. In this regard the role of respected intemational organizations such as WНО cannot therefore Ье overemphasized. We sincerely wish the Director-General every success in this Ьid to focus discussions on the quality and performance elements of all our countries' health services for the benefit of our patients. Thankyou.

Mr SELIM (Bangladesh):

Mr President, 1 should like to felicitate members of the Bureau. The Director-General and her team are to Ье commended for their outline of The world health report 2000. The current trend of reduced public sector role in the social field in general and in health in particular has had some consequences. Costs have increased; lack of finance is а great proЬlem. The gap between the rich and the poor is expanding; globalization is resulting in marginalization of the poor. In tackling some of these issues, the private sector in many of our countries has become positively engaged. Despite their positive involvement, the state sector will need to fill any gaps. States indeed have а role in areas of puЬlic health goods, preventive care, emerging diseases, emergency health preparedness, technology purchase, etc. On the other hand, the private sector can play а most useful role in secondary and tertiary health care. We in Bangladesh have been trying to strike а balance between private and public sector involvement. The Govemment's focus has been broadly primary and basic health care: providing safe water and Ьlood, malnutrition and micronutrient deficiencies, and inadequate financial and human resources have been some of our main concems. We are striving to put into place а regulatory framework and oversight system so as to ensure better pertormance from professionals, private service providers and pharmaceutical industries. Under the dynamic leadership of our Prime Minister, Sheikh Hasina Wajed, we have initiated reforms in the health sector through the health and population sector programme. We have introduced а national health policy with focus on the health of the poor: the essential services package, а new for-the-poor programme, which covers limited curative care, child and reproductive health and communicaЬle disease. W е have also expanded the coverage of free vaccination under the Expanded Programme on Immunization. However, some proЬlems are tending to re-emerge. Malaria, especially in the Chittagong Hill Tracts, is а case in point. Among the new challenges, arsenic contamination in subsoil water in almost all parts of Bangladesh is the gravest; continued intake of such water is non-curaЬle. Providing arsenic-free surface water is the formidaЬle task we are facing; we are tackling this as best we can, but perhaps we will need assistance. Contemporary times pose certain challenges for us. Declining intemational assistance and tighter intellectual property rules are а few to nате. У et these must Ье met. We must try to develop mechanisms that would facilitate the evolution of consistent professional standards, the increased flow of health assistance and greater access to health technology and drugs. Global stewardship in these areas falls within the mandate of WHO. We have no doubt that under the leadership of Dr Brundtland, WHO will prove equal to the task. A53NR/4 page 74

Le Dr MORRI (Saint-Marin) (interpretation de l'italien) :1

Monsieur le President, je suis heureux d'adresser mes plus cordiales salutations а vous-meme, au Directeur general, le Dr Brundtland, aux honoraЬles coШ:gues et а tous les delegues qui participent а cette importante reunion. En се qui me concerne, c'est la premiere fois que je participe personnellement а cette session annuelle de l' Assemblee depuis ma recente nomination а un poste de grande responsaЬilite, puisqu'il s'agit pour moi d'assumer la direction du Ministere de la Sante et de la Securite sociale de mon pays. Je sens profondement le poids d'une telle responsaЬilite, car je suis en plein accord avec le Directeur general lorsqu'elle declare dans son message introductif а la synthese du Rapport sur la sante dans le monde, 2000 que la maniere dont les systemes de sante sont coщ:us, geres et finances exerce une influence sur la vie et les moyens d'existence des gens. Or се sont justement les gouvernements, et plus particulierement les ministres de la sante, qui sont charges d'effectuer les choix les plus fondamentaux dans се domaine. Ameliorer les systemes nationaux de sante et les rendre toujours plus efficaces, repondre aux exigences et aux attentes de la population, tel est le defi que nous avons а affronter dans tous les pays et а l'egard duquel nous nous sentons encourages, en raison meme du theme qui а ete choisi pour le rapport sur la sante dans le monde de cette annee. En effet, en depit des differences encore profondes qui existent entre les diverses realites regionales et nationales, nous sommes tous appeles а examiner nos propres systemes de sante et а 1es reviser, si necessaire, afin d'en augmenter les prestations et l'efficacite. La RepuЬlique de Saint-Marin а fait, depuis plusieurs annees deja, le choix d'un systeme de sante puЬlic et de services de sante gratuits pour la popu1ation. Nous considerons que ceci а ete et reste 1а voie 1а p1us sure pour donner un contenu concret au droit 1е p1us fondamental de tout etre humain, c'est-a-dire le droit а la sante. Mettre en oeuvre un systeme de sante public ne signifie nullement exc1ure d'autres apports ou synergies exterieurs, ni encore moins renoncer а la competitivite. En particu1ier, je souhaiterais sou1igner 1'apport des associations humanitaires et de volontaires aux prestations du systeme de sante а Saint-Marin et reconnaitre 1е rб1е determinant qu'elles ont exerce dans 1е contexte socia1 de notre petit pays. Un des themes auxque1s nous portons une attention toute particuliere est celui de la formation permanente et adequate du personne1 de sante, qui est 1'une des conditions fondamenta1es de 1а competitivite du systeme. Par formation, nous entendons aussi Ьien celle qui accompagne 1'agent de sante puЬlique tout au long de sa carriere professionnelle que toute autre formation specifique liee а des situations particu1ieres ou d'urgence. D'une formation adequate du personne1 depend ega1ement 1'efficacite dans l'utilisation de nouvelles techno1ogies et infrastructures, qui sont abso1ument essentielles pour que 1е systeme de sante soit en mesure de repondre aux exigences que posent а 1а fois le diagnostic et 1а therapie. Investir dans 1а techno1ogie et 1а formation, et par consequent regarder vers 1'avenir, constitue un des objectifs c1es de 1а po1itique de sante а Saint-Marin. Le pays que j'ai 1'honneur de representer est un pays dans 1eque1, а 1'instar d'autres regions, 1а duree moyenne de vie а consideraЬlement augmente au cours des dernieres decennies. De meme, le niveau de Ьien-etre et 1а sco1arisation se sont consideraЬlement eleves. La societe saint-marinaise а beaucoup evo1ue et, par voie de consequence, les proЬlemes qu'elle doit affronter aujourd'hui ont eux aussi beaucoup change, du point de vue tant des soins que de 1а prevention. Les donnees statistiques nous revelent que, а Saint-Marin, 1е rapport entre le chiffre de 1а popu1ation active et 1es retraites demeure eleve : en 1998, il etait de 4,1 О actifs pour 1 retraite. Le nombre de personnes ayant plus de 65 ans est en constante augmentation. Par consequent, 1а demande d'assistance medica1e geriatrique, de deve1oppement des services а destination des troisieme et quatrieme ages, d' ajustement des fonds de pension aux nouvelles rea1ites, cette demande est elle aussi en constante augmentation. Dans une societe qui connait desormais 1е superflu, on assiste а l'emergence ou а la recrudescence de certains dereg1ements et а des phenomenes de margina1isation comme 1'anorexie, la boulimie, 1'alcoo1isme ou 1а toxicomanie, qui exigent une reaction significative de 1а part du systeme sociosanitaire. Divers types d'interventions ont d'ores et deja ete mis en oeuvre pour reagir et p1us particulierement pour prevenir

1 Confonnement а l'article 89 du Reglement interieur. A53NR/4 page 75

се type de proЬlemes. La prevention est en effet un des aspects majeurs de notre politique dans tous les secteurs et а tous les niveaux. La campagne de prevention de maladies graves qui touchent de larges segments de la population s'avere particulierement importante. Je citerai а titre d'exemple le depistage du cancer du sein qui est effectue de maniere systematique sur toute la population feminine de Saint-Marin. Une politique de prevention, cela signifie egalement privilegier l'information, particulierement dans le contexte scolaire, au sujet de certaines pathologies et des formes de dereglements les plus graves. De plus, il s'agit de maintenir un haut niveau de vigilance en се qui concerne un certain nombre de maladies specifiques qui, on l'a vu dans le cas du SIDA, pouvaient diminuer dans une certaine mesure l'interet que leur portaient les medias et, de се fait, ont perdu egalement l'attention du grand puЬlic. Beaucoup de ces objectifs pourront etre atteints si la famille, qui constitue encore la cellule de base de notre societe, retrouve son r6le de moteur vital, de reservoir et de dispensateur d'amour, de solidarite et d'humanite. Ainsi que je l'ai dit en commeш;ant cette breve intervention, la responsaЬilite qui incombe а ceux qui ont la charge de decider et de mener а Ьien les politiques de sante au niveau national, particulierement les ministres de la sante, cette responsaЬilite, disais-je, est immense. Dans l'accomplissement de nos Hiches, nous pouvons cependant compter depuis plus de 50 ans sur la collaboration, le soutien et l'experience de l'Organisation mondiale de la Sante, а laquelle nous adressons toute notre reconnaissance et notre admiration pour le travail deja accompli et nos meilleurs voeux pour ses activites futures.

The PRESIDENT: ПРЕДСЕДА ТЕЛЪ:

Мы благодарим вас. На этом мы завершаем работу сегодняшнего пленарного заседания. Поскольку в списке ораторов остается еще достаточно много выступающих, мы продолжим нашу дискуссию завтра в первой половине дня, после доклада Комитета по проверке полномочий. Объявляю заседание закрытым.

The meeting rose at 17:45. La seance est levee а 17h45. A53NR/5 page 76

FIFTH PLENARY MEETING

Wednesday, 17 Мау 2000, at 9:00

President: Dr L. AMATHILA (NamiЬia) later: Dr М. AMED:EE-GEDEON (Haiti) Dr L. AMATHILA (NamiЬia)

CINQUIEME SEANCE PLENIERE

Mercredi 17 mai 2000, 9 heures

President: Dr L. АМА TНILA (NamiЬie) puis: Dr М. AMEDEE-GEПEON (Hai'ti) Dr L. AMATНILA (NamiЬie)

1. FIRST REPORT OF ТНЕ СОММIТТЕЕ ON CREDENTIALS1 PREMIER RAPPORT DE LA COMMISSION DE VERIFICATION DES POUVOIRS1

The PRESIDENT:

The AssemЬly is called to order. Today, the AssemЬly will consider the first report of the Committee on Credentials which held its meeting yesterday, Tuesday, 16 Мау, under the chairmanship ofMr Р.С. Goddard (Barbados). The report is contained in document А53/33 which you have all received. 1 have been informed Ьу the Secretariat that after yesterday's meeting of the Credentials Committee, а formal credential was received from Dominica. It has not been feasiЬle to contact all members of the Bureau of the Credentials Committee but, in accordance with previous practice in this regard, 1 have examined the credential of Dominica and found that it was in keeping with the Rules of Procedure. 1 would recommend to the AssemЬly that Dominica Ье accepted as having formal credentials. Does the AssemЬly agree with this procedure? The delegate of Pakistan has the floor.

Dr КASI (Pakistan):

Thank you, Madam President. We would like to make а statement before the adoption of the report of the Credentials Committee. 1 just wanted to clarify whether the acceptance of credentials Ьу Dominica also implies that we are adopting the report, or if not 1 would like to seek the floor before the adoption of the report. Thank you.

The PRESIDENT:

У ou can make the statement now.

1 See reports of committees in document WHASЗ/2000/REC/3. 1 Voir les rapports des commissions dans le document WHA53/2000/REC/3. ASЗNR/5 page 77

Dr КASI (Pakistan):

Madam President, the Pakistan delegation has read the report of the Credentials Committee and would like to draw attention to the factual and legal inaccнracy in it with regard to Afghanistan. The report proposes that the Health AssemЬly should recognize the validity of credentials presented Ьу Afghanistan among other countries. The issue of the credentials of Afghanistan was considered at length Ьу the Credentials Committee of the fifty-fourth session of the United Nations General AssemЬly; the Committee decided "to defer а decision on the credentials of representatives of Afghanistan on the same basis as taken at the fifty-second session". ln accordance with Articles 58 and 63(2) of the Charter of the United Nations, the United Nations shall "make recommendations for the coordination of the policies and activities of the specialized agencies". We had hoped that the Credentials Committee of the Fifty-third W orld Health AssemЬly ofthe World Health Organization, а specialized agency ofthe United Nations, would reflect the true situation prevailing in the United Nations General AssemЫy with regard to the question of credentials of Afghanistan. This would have brought the report in conformity with the position taken Ьу the Credentials Committee of the fifty-fourth session of the United Nations General AssemЬly. lt would also have made the report of the Credentials Committee of this AssemЬly factually and legally сопесt. As this has not been done, we are constrained to disagree with the Committee's proposal that we recognize the validity ofthe credentials presented Ьу Afghanistan. We would like, therefore, to enter а reservation on the report Ьу the Credentials Committee ofthe Fifty-third World Health AssemЬly with regard to Afghanistan. We request that this statement Ье incorporated in full in the records of this plenary session.

The PRESIDENT:

1 thank the delegate of Pakistan. Нis objection will Ье fully reflected in the report of this plenary. 1 see no other objection. The first report ofthe Committee on Credentials is therefore adopted. 1 would like to inform the AssemЬly that Committee А will now hold its second meeting, while Committee В will meet only after we have completed the discussion on item 3.

2. ADDRESS ВУ ТНЕ DIRECTOR-GENERAL (INCLUDING OVERVIEW OF ТНЕ WORLD HEALTH REPORT 2000) (continued) ALLOCUTION DU DIRECTEUR GENERAL (У COМPRIS UN APERCU DU RAPPORT SUR LA SANTE DANS LE MONDE, 2000) (suite)

The PRESIDENT:

1 shall now retum to item 3, as announced yesterday, and the next two speakers on the list are the delegates of lndia and Algeria. 1 give the floor to the delegate of lndia.

Mr SНANMUGAM (lndia):

lt is а privilege to Ье here today to participate in the Fifty-third World Health AssemЬly. Let me begin Ьу congratulating you, Madam President, on your well deserved election to the Presidency of the Health AssemЫy. Our sincere thanks are due to the AssemЬly for the honour bestowed on lndia in its election as one of its Vice-Presidents. Мау 1 also congratulate Dr Brundtland, Director-General, for her dynamic leadership in bringing about dramatic changes in the Organization and for giving it а direction and а long-term vision. The theme for this year's world health report- health systems- is extremely timely. Over the years, the definition of what constitutes а health system has been changing. lt is clear that а health A53NR/5 page 78 system is much more than the estaЬlishment of health facilities, or appointment of doctors. А health system has now соте to acquire а far broader definition, encompassing access to knowledge and information; food, water, sanitation and environment; social equality and democratic participation; and empowerment and speedy redress. А balanced mix of all these aspects seems to Ье а prerequisite for achieving health goals. ln the last five decades, lndia has made significant progress in improving the quality of life of the people. We have been able to achieve а measure of food security, contain communicable diseases, eradicate smallpox and control leprosy, reduce infant mortality, and double life expectancy with а great sense of responsibility. 1 wish to inform you that India's population crossed the one billion mark а week ago on 11 Мау 2000. То curtail the rise of population, our Government has framed the National Population Policy 2000 to reach the replacement rate Ьу 201 О and to have а stable popu1ation Ьу 2045. The policy is noncoercive. On account of lingering poverty and illiteracy, communicable diseases, namely, tuberculosis and malaria, continue to persist. Economic development has resulted in an increase in income, which in turn has brought about profound changes in lifestyles, eating haЬits, increased consumption of alcohol and tobacco due to stress, contributing to а perceptible increase in the number of noncommunicable diseases. However, most worrying of all, is the emergence of various infections such as hepatitis and HIV1 AIDS and the re-emergence of drug-resistant malaria and tuberculosis. The rapidity with which HIV1 AIDS is spreading is а cause of great concern, as the impact on the social and economic life of the country can Ье quite devastating. There is no doubt that in the coming years we will need to intensify public health promotion, as merely providing curative services will Ье expensive and difficult. Despite considerable development and progress achieved on several fronts, there still remains а huge and unnecessary burden of infectious diseases among the poor that need to Ье addressed as а priority in а cost-effective manner. Addressing this unfinished agenda is mostly а matter of political will and а reasonable commitment of resources. However, research and development can also help through operational and behavioural research and development of new tools, including improvements in vaccines, for facilitating а more focused implementation of health programmes for achieving better health outcomes. The advantages oftraditional medicine, such as Ayurveda, Unani, yoga, naturopathy and homeopathy, are efficacious, effective, affordable and well documented. The Government is to standardize and publish these systems so as to provide health саге to the people. The continually changing nature of microblal threats poses new challenges. These threats are not confined to any one country or region but are global in nature. New pathogens such as HIV and evolution of drug-resistant variants of familiar ones necessitate а comprehensive understanding of not only the Ьiomedical aspects and the systemic determinants of the spread of drug resistance, but also require sustained research in the development of new drugs and vaccines, etc. Research for countering these global health challenges needs to Ье funded collectively Ьу the global community, so that the results of such research сап Ье enjoyed Ьу all as а common good available at affordable prices. Since the developing countries which account for the larger proportion of the global disease burden have limited resources, the support of multilateral funding agencies and private foundations would Ье required in а substantial manner to enable these countries to undertake major research in predominant diseases. 1 would, therefore, urge WHO to take the lead to moЬilize and coordinate multilateral funding for undertaking the much-needed basic research in areas of priority concern. For me it has been а unique experience to Ье here today and share some experiences and concerns with ministers of health of other countries. 1 find that, in every country, there is concern and а desire to improve the health system to make it accessible and affordable to all people. 1 do hope that the round-table meetings will stimulate good discussions and generate innovative ideas. 1 look forward to such sharing and exchanging of views.

М. BENYOUNES (Algerie):

Madame le President, Madame le Directeur general, Mesdames et Messieurs les Ministres, Excellences, honorables delegues, Mesdames et Messieurs, permettez-moi tout d'abord, Madame le A53NR/5 page 79

President, au nom de !а delegation algerienne et en mon nom personnel, de vous feliciter pour votre election. Nos felicitations s'adressent egalement aux membres elus du bureau. C'est avec beaucoup d'interet que nous avons pris connaissance du rapport de Mme !е Directeur general sur !а sante dans !е monde. Се rapport traduit !а realite sanitaire et cerne les proЬlemes de sante puЬlique les plus cruciaux de notre epoque. C'est pourquoi, а titre d'illustration, je voudrais m'attacher de suite а decrire les resultats enregistres en Algerie, ou l'eradication de !а poliomyelite, l'elimination de !а rougeole et du tetanos neonatal, !а totale disparition du cholera depuis 1995 et !а reduction progressive des autres maladies а transmission hydrique ont marque des avancees significatives. Par contre, !а mortalite infantile, de l'ordre de 56 pour 1000, !а mortalite maternelle, de 140 pour 100 000 naissances, et !а resurgence de certaines maladies comme !а diphterie constituent une preoccupation majeure de sante puЬlique, qui nous а conduits а mettre en place avec les differents intervenants un dispositif de prevention et de prise en charge. Ces mesures devront nous permettre de ramener nos indicateurs de sante aux normes internationalement admises. Parmi ces axes prioritaires, un accent particulier est mis sur l'humanisation et l'amelioration de l'environnement. Malgre les nettes avancees enregistrees en matiere de lutte contre !а maladie, malgre !е developpement consideraЬ!e de 1а cooperation sanitaire а l'echelle de !а planete, realises sous l'egide de notre Organisation, !а realite sociosanitaire du globe en cette fin de millenaire nous interpelle tous. L'objectif annonce de la sante pour tous en l'an 2000 n'a pas ete atteint. Et il n'est pas pres de l'etre ! Nous avons le devoir et l'oЬligation morale de rechercher les causes de cet echec afin de pouvoir trouver des reponses alternatives plus appropriees, а meme d'assurer le plus elementaire des droits, !е droit а !а vie, а des pans entiers de l'humanite, notamment en Afrique. La mere africaine, le ьеье africain ainsi que toutes les Africaines et tous les Africains qui decedent chaque jour du SIDA et de maladies chroniques, faute de prevention et de soins adequats, ne comprennent pas les raisons de leur abandon. Comment faire pour qu' ils n 'aient pas l' impression d'etre abandonnes, d'etre а l'ecart des preoccupations de !а communaute internationale? Nous ne pouvons pas non plus ouЬ!ier que, chaque jour, des milliers d' Africaines et d' Africains meurent de maladies diverses et viennent s'ajouter aux milliers d'autres Africaines et Africains qui meurent de faim, de soif ou du fait de conflits armes. 11 est du devoir de la communaute des nations, et notamment des plus riches d'entre nous, d' oeuvrer а trouver les reponses multiformes aux proЬ!emes que connalt 1'Afrique. 11 est du devoir de la communaute internationale d'agir sur les veritaЬ!es facteurs а l'origine du sous-developpement sociosanitaire qui mine notre continent, comme precise dans le document « Appel d' Alger pour l'intensification de la lutte contre !е SIDA en Afrique », adopte lors de la vingt-troisieme session ordinaire de la Commission du Travail et des Affaires sociales de l'OUA, qui s'est tenue а A1ger du 16 au 21 avril dernier. Ces reponses ne peuvent etre qu'economiques et politiques, car il ne peut у avoir de developpement sanitaire lorsque le chбmage concerne une majorite de la population active, lorsque l'habltat precaire et insalubre est la regle, lorsque l'education et l'enseignement font defaut. 11 ne peut у avoir de developpement sanitaire sans developpement social, et il ne peut у avoir de developpement social sans essor economique fonde sur l'exploitation equitaЬ!e des richesses generees par notre continent. De surcrolt, seule une volonte politique reelle d'annuler totalement ou partiellement la dette qui frappe des pays de plus en plus pauperises offrirait aujourd'hui des perspectives de progres collectif. Le monde developpe doit aujourd'hui faire face aux oЬ!igations que l'histoire, la morale et, tout simplement, !а fraternite humaine lui rappellent dans cette oeuvre d'aide et de soutien effectifs pour ameliorer les conditions sociales, economiques et politiques de l' Afrique et vaincre la detresse sanitaire. А cet egard, la conference sur la lutte contre la pauvrete et l'exclusion, qui se tiendra а Alger en octobre prochain, offrira l'opportunite de mettre en exergue la relation dynamique qui existe entre le niveau de developpement socio-economique et le degre de satisfaction du droit а la sante. А 1' oree du troisieme millenaire, la sante pour tous en Afrique est irremediaЬ!ement liee au travail pour tous, а l'education pour tous, а un habltat decent pour tous. Toute autre approche serait inevitaЬlement vouee а l'echec. A53NR/5 page 80

Dr КASI (Pakistan):

Madam President, Madam Director-General, excellencies, distinguished guests, distinguished delegates, ladies and gentlemen, 1 would like to congratulate you and other officers on your election. Under your guidance we hope to take important decisions at this Health AssemЬly. This AssemЬly will address issues which we see as being critical for the future health and wellbeing of the world's peoples. Over the last hundred years, the world has made unprecedented progress in combating disease, improving health standards and enhancing knowledge and techniques to improve human health and the quality and longevity of life. But, even as we confront the technological and ethical barriers of dealing with the kernel of human health and life, we would do well to remember that first, the war against disease has not yet been completely won; secondly, that the benefits of the breakthrough in health technologies and а healthy environment have not been made availaЫe to all. The gap in health standards between the best and the worst is increasing in quality and quantity; and thirdly, new diseases are emerging which could devastate entire countries and continents unless timely action is taken Ьу the international community. The world health report 2000, the puЫication of which we welcome, should offer an objective and global overview of the present and prospective challenges in the way of realizing the goal of health for all. lt must project the disparity in global health conditions; the perspective of poor countries, struggling to prov.ide health to their peoples with extremely limited resources; competing domestic interests; inadequate external financing flows; heavy debt burdens; an unequal international trading system; strict control of technologies; and difficult security environments. In such circumstances, what is required is not another report confirming that developing countries spend too little on health, that their "indicators" are dismal, and that their governments should Ье compelled to give higher priority to health and related social sectors through "conditionalities", incentives and disincentives. What is required is а greater demonstration of global solidarity. We believe that The world health report should suggest measures at the international level to enhance equity in world health and to arrest the inequity in access to health care within and among nations. WHO has to assume its leadership role and focus attention on remedying maldistribution of resources, nationally as well as internationally. Solidarity requires that, as а general principle, health care at affordable costs should Ье availaЫe to а human being from any medical institution, irrespective of where it is located. The report should also suggest measures to increase investment for health development, especially in poor countries, through alliances between the public and private sectors. lt should propose ways to ensure that intellectual property rights do not become an impediment to the production and availaЬility of life-saving drugs at affordaЫe prices for all peoples. The report should also suggest models to develop alternate financing for health care, and suggest strategies for dealing with communicable and noncommunicable diseases that are increasingly emerging in the developing world. We would suggest that the report Ье finalized after the comments at this AssemЫy have been taken into account.

Le Dr Ponmek DALALOY (Republique democratique populaire lao) :

Madame la Presidente, Madame le Directeur general, honorables delegues, Mesdames et Messieurs, nous voudrions nous joindre aux autres orateurs pour exprimer nos chaleureuses felicitations а la Presidente et aux Vice-Presidents pour leur election. Nous sommes certains que, sous leur direction, notre Assemblee obtiendra un plein succes. Le theme « Pour un systeme de sante plus performant » choisi cette annee pour le rapport sur la sante dans le monde est particulierement opportun, car, avec le commencement du siecle, avec les nouvelles occasions et les nouveaux defis, il est d'une extreme importance de discuter sur les systemes de sante qui sont en fait les forces realisatrices. On peut dire qu'ils constituent les facteurs decisifs du succes ou de la defaite des activites de sante. Certes, les systemes de sante sont fonction des conditions historiques et du developpement de chaque pays. Dans се sens, ils sont differents, mais ils n'en possedent pas moins des buts et des objets communs. C'est pour cela que nous voudrions faire une breve synthese de notre experience, esperant par la echanger nos idees avec nos collegues. Dans notre pays, le systeme de sante est un systeme qui est bati depuis 25 ans. Notre point de depart fut tres bas, car c'est а partir de zero que nous avons debute dans les deux tiers du pays. En A53NR/5 page 81 effet, dans cette partie, tout а ete rase par 1а guerre. Dans \е tiers restant, 1е systeme datait du debut du siecle passe. Seuls quelques hбpitaux ont ete construits dans les annees 60, 70, 80 et 90. En се qui conceme les personnels, jusqu'en 1954 nous n'avions qu'un seul docteur en medecine. En 1975, а !а fin de !а guerre, nous n'en avions que 50. Maintenant, nous en avons plus de 1600. La quantite est suffisante, mais, face aux demandes de !а nouvelle periode, !а qualite reste а parfaire. C'est pour cela que l'elevation de !а qualite est devenue une priorite urgente а \aquelle nous allons consacrer \е plus gros de nos efforts. Paralle\ement а l'elevation de \а qualite des personnels, l'amelioration appropriee des equipements est aussi une necessite pressante, car c'est !а science et !а technique. Pour elever \а­ qualite des personnels, \'existence des techniques appropriees est une necessite inevitaЬ!e. Sans bases materielle et technique, !а formation et, en consequence, !а qualite ne peuvent etre que theoriques et incompletes. La science et !а technique sont les meres des competences des forces de !а sante. Cette force constituee, nous pensons etendre notre systeme de sante au niveau des districts et des villages. А travers nos experiences des annees passees, vu !е dispersement de !а population - car notre pays est un petit pays montagneux, peu peuple, mais compose de nombreuses ethnies -, vu les difficultes de transport surtout en saison de pluie, !а clef du proЬleme ne reside pas dans !а seule construction des dispensaires dans les villages ou dans un groupe de villages, car les villages sont trop petits et, dans !а pratique reelle, ceux qui у viennent ne sont que les habitants du village meme. C'est dire !е faiЬle taux d'utilisation. Autrement dit, l'obstacle, c'est l'isolement de !а population. Pour resoudre се proЬleme, c'est l'intendance sur place qu'il faut creer, autrement dit !а disponibllite du personnel de sante et des medicaments essentiels au niveau des villages memes. Cette precieuse le<;on nous а ete foumie par notre experience pendant !а liblration nationale. En effet, а се moment-la, l'isolement etait complet; on ne pouvait pas se deplacer. Non seulement on n'avait pas de moyens de transport, mais on n'avait pas les conditions permettant de se deplacer. De cette situation est ne l'esprit de compter sur ses propres forces sur place. Comme nous survivions dans l'absence presque totale de soutiens, nous devions adopter comme orientation !а prevention avant tout. Et comme nous manquons de medicaments, il nous faut compter sur les plantes medicinales et !а medecine traditionnelle heritee de nos ancetres. Dans les conditions reelles d'aujourd'hui, malgre les changements importants obtenus а travers les developpements socio-economiques, nous restons encore dans l'orЬite du sous-developpement ou de !а pauvrete, surtout dans les regions rurales eloignees des minorites ethniques. C'est pourquoi cette experience est plus que jamais actuelle et blnefique, car, avec les soutiens actuels qui existent, avec !е nouveau mecanisme etaЬli, l'utilite et l'efficacite de cette experience seront certainement decuplees. Dans notre cas, si nous utilisons des indices de performance pour mesurer notre systeme de sante, nous pourrons constater !а situation suivante. Concemant l'amelioration du niveau de !а sante, nous pouvons dire qu'il у а une amelioration continue appreciaЬle par l'elevation de !а qualite des soins aux niveaux central et provincial et dans certains districts, cela par un plus grand perfectionnement des connaissances et des capacites des cadres et par l'introduction des technologies appropriees nouvelles. Certes, beaucoup reste encore а faire, surtout aux niveaux de base des regions inaccessiЬ!es. Pour се qui est de !а distribution, je pense que nos efforts sont des plus louaЬ!es, meme aux niveaux de base, parce que, en cooperation avec !а Banque mondiale et !а Banque asiatique de Developpement, nous faisons tout notre possiЬ!e pour avoir \а couverture \а plus large possiЬle, visant les groupes les plus marginalises, autrement dit les pauvres, !а mere et l'enfant. 11 reste а faire dans les regions d'acces vraiment difficile. Pour се qui est de repondre aux attentes legitimes de !а population, nous pensons que nous avons fait !е necessaire par l'accroissement du budget, par !а participation du secteur prive, par !а participation de !а societe, par !а mobllisation des aides exterieures pour realiser се que !е peuple veut avoir, par exemple les centres de reference pour resoudre les cas qui depassent les capacites des echelons inferieurs. La construction de nouveaux hбpitaux ou !а renovation d'hбpitaux existants en sont les illustrations. Certes, nous avons du retard, car се qui nous manque се sont des fonds. Pour се qui est de l'equite nous avons aussi fait des efforts, en passant de !а prise en cl1arge complete par l'Etat а !а participation de tous les secteurs de l'economie, de !а collectivite et de !а societe. La mission de !а sante est !а шission de chaque individu, de !а collectivite comme celle de !а societe dans son ensemЬle. L'individu est considere comme !е pilier vertical qui va se solidariser avec A53NR/5 page 82 les autres individus dans la famille, dans les ecoles et sur les lieux de travail. L'equite passe par Ia participation de chaque individu, soit а travers les depenses directes, soit а travers les prepaiements а la caisse d'assurance-maladie. Dans la pratique, nous sommes encore dans la periode de transition. 11 nous reste encore beaucoup а faire. Malgre les difficultes, malgre les lacunes qui persistent, nous avons confiance dans l'avenir. Nous apprecions le rбle joue par I'OMS en foumissant des outils puissants pour aider les pays а renforcer leurs systemes de sante.

~ ~.1\ :l •• ·· ~Ы\ Mrs ESCHEIKH (Tunisia): :( (..}"J· _JJ ') (_--::--.. -е-:: У - ASЗNR/5 page 83

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Dr AL-DOURI (lraq): A53NR/5 page 84

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El Sr. VOTO-BERNALES (Peru):

Sefiora Presidenta, permitame ante todo felicitarla, asi como а los otros miembros de la Mesa, por su elecci6n para presidir los trabajos de esta 53 3 AsamЬlea Mundial de la Salud. El Peru es un pais que ha ingresado al tercer milenio con una poЬlaci6n que supera los 25 millones de habitantes. Nuestra proyecci6n para el afio 2005 es que los menores de 15 afios representen un declinante 33% de la poЬlaci6n у los mayores de 64 afios llegaпin aproximadamente al 7% de la poЬlaci6n, es decir, doЬlando su proporci6n dentro de la poЬlaci6n total con relaci6n а 20 afios atras. DeЬido а esta tendencia, que inicia la reducci6n de una alta fecundidad hist6rica, у al incremento de la esperanza de vida, nuestra poЬlaci6n se va haciendo de mayor edad. Este primer aspecto demografico marca uno de los desafios actuales del desarrollo de nuestro sistema de salud. Al mismo tiempo que mejorar у extender el sistema asistencial cuyo grupo prioritario continua siendo la poЬlaci6n matemoinfantil, debemos avanzar en el desarrollo de capacidades para atender en forma adecuada у creciente las necesidades de nuestra poЬlaci6n adulta у adulta mayor. En las decadas pasadas, у sobre todo en los ultimos 1О afios, hemos progresado notaЬlemente en la lucha contra las enfermedades infecciosas. La incidencia de la tuberculosis ha disminuido en un 40% entre 1990 у 1999. М е permito recordar que el Peru es el pais que mas eficazmente ha implementado la estrategia DOTS, recomendada por la OMS. Asimismo, hemos interrumpido la transmisi6n del virus de la poliomielitis, como ha sido certificado en 1994. TamЬien estamos en proceso de erradicar el sarampi6n у el tetanos neonatal. Ahora enfrentamos el desafio de las enfermedades no transmisiЬles, de las enfermedades cr6nicas у de las degenerativas. Los proЬlemas de violencia domestica у urbana у aquellos de salud mental vienen escalando posiciones rapidamente en nuestra agenda social. Estamos en un proceso de reorganizaci6n de nuestros programas de salud para hacer frente а este desafio. El concurso tecnico de los paises que уа han enfrentado exitosamente esta situaci6n sera un elemento de alto valor para nuestro GoЬiemo. Nuestro sistema de salud se ha desarrollado en forma hist6rica sobre la base de cuatro grandes agentes prestadores: el Ministerio de Salud, que administra el 81% de los estaЬlecimientos del pais; el A53NR/5 page 85 seguro social de salud, que admiпistra el 4%; el sector privado, que admiпistra el 9%; у la saпidad de policia у fuerzas armadas, que admiпistra el 6% de los estaЬlecimieпtos. El actual proceso de reforma del sector salud vieпe modificaпdo esa estructura tradicioпal. Teпemos еп proceso uп vigoroso programa de aseguramiento рбЬliсо, que se inicio con el seguro escolar en 1997 у el seguro matemoiпfantil en 1998. Hemos introducido un elemento de competitividad en el sistema asistencial mediante la creacion de entidades privadas que ofrecen planes de seguros complementarios а los de la seguridad social, dinamizando el sistema. En cuanto а la prestacion de servicios, tenemos en preparacion un proceso de transferencias de los centros у puestos de salud а los goЬiemos locales, con los cuales se dara uп mayor espacio а la participacion social еп la gestioп de salud. En este diпamico proceso de camЬios vemos con expectativa las posiЬilidades de cooperacioп de la OMS que contribuyan а ampliar la base de evidencias que sustenten пuestras politicas de salud у nos permitaп brindar mas у mejor salud а todos los peruanos. Consideramos, como Ьien sefialo la Dra. Brundtland en su alocucion ante este plenario, que la voluntad politica, apoyada en bases cientificas solidas, puede dar lugar а graпdes camЬios. En tal sentido, quisiera expresar el pleno ароуо de mi GoЬiemo а iniciativas como la lucha contra el tabaquismo, el SIDA, о la lucha contra la malaria, que son algunos ejemplos de la perspectiva sobre la labor de esta Organizacion con la que mi GoЬiemo coincide plenameпte. Muchas gracias.

The PRESIDENT:

1 thank the delegate of Peru. 1 now call the delegate of Barbados to take the floor; he is goiпg to speak on behalf of Bahamas, Barbados, Belize, Domiпica, Haiti, Jamaica, Surinatne, апd Trinidad and Tobago.

Mr GODDARD (Barbados):

Madam President, it gives те great pleasure to address this august AssemЬly оп behalf of the countries of the Caribbean Community represeпted here Ьу Bahamas, Barbados, Belize, Domiпica, Haiti, Jamaica, Suriпame, and Trinidad апd Tobago. We, the CARICOM countries, many ofwhich are small island States, are faced with many challenges iп our quest to secure the social and economic well-being of our citizens. Our vulneraЬility relates поt only to the delicate balance of the ecosystems iп relation to the environment and in particular to the Caribbean Sea, but also to the economic depeпdence on tourism and agro-industry iп the global marketplace. We are поw iп the process of transition to а new economy, with the development of global financial services, software development, апd the expansion of electronic busiпess. We appreciate the programmes ofWНO and the assistance given to the Region. ln particular the work done Ьу РАНО and the support given to our individual health ministries are invaluaЬle, welcomed and much appreciated. 1 might also add that we are most supportive of your commeпts relating to an initiative in mental health. This is an area that has Ьееп much neglected for far too long and your iпitiative coincides with recent actions of our own to improve and modemize our approach to mental health. The region has charted its health development plan for the next five years around eight priority areas, through the Caribbean Cooperatioп in Health initiative. The concept of Caribbean Cooperation in Health was introduced in 1984 as а mechanism for health development through increased collaboration and technical cooperation among the countries in the Caribbean. The initiative was redefined in 1996 to address health issues during the period 1999 to 2003. The goal is to improve and sustain the health of the people of the Caribbean; adding years to life and life to years for all. The goal reflects the Caribbeaп' s commitment to health Ьу increasiпg equity in and for health withiп and among countries. The priority areas of the initiative are health systems development, humaп resources development, family health, food and пutritioп, chroпic noncommunicaЬle diseases, communicaЬle diseases, meпtal health and environmeпtal health. Not only are these important areas of focus iп our Region, but are germane to the thrust of this AssemЬly which focuses on "Health systems: improving performance." lmproving performaпce iп health systems will impact positively оп the way we address A53NR/5 page 86 these priority health issues. As iпdividual пatioпs апd as а regioп, we share соттоп priority proЫems апd are cooperatiпg iп developiпg solutioпs to address them. Our peculiar epidemiological situatioп is typified Ьу the existeпce of а double burdeп of commuпicable diseases coexistiпg with а rapid growth of lifestyle-related пoпcommuпicable diseases. Over the past decade, the couпtries of the Caribbeaп have successfully eradicated poliomyelitis апd measles. lп 1998 the regioп set а goal of elimiпatiпg coпgeпital rubella syпdrome Ьу the епd of 2000. This is beiпg dопе Ьу immuпiziпg all mеп апd womeп betweeп the ages of 21 апd 35 years. The Caribbeaп is happy to report that we are well оп the way to achieviпg our goal. These gaiпs, however, are coпstaпtly beiпg threateпed Ьу emergiпg апd re-emergiпg problems such as malaria апd deпgue fever. This is facilitated Ьу the iпcreased mobility of populatioпs betweeп couпtries. The gaiпs iп life ехресtапсу as а result of improved health staпdards iп the regioп are beiпg threateпed Ьу the НIV/AIDS epidemic. UNAIDS has advised us that the Caribbeaп has the most rapidly growiпg HIV1 AIDS epidemic after sub-Saharaп Africa. lt is believed that over 500 000 people, approximately 2% of the regioп's populatioп, are iпfected with HIV. lп тапу of our couпtries, the spread of the epidemic has become geпeralized iп the populatioп. The transition in the есопоmу, to which 1 refeпed earlier, is heavily depeпdent оп the skills, ingenuity апd iппovation of the young people in our society - а group that is most vulnerable to the scourge of НIV1 AIDS. The threat of this disease to our economic апd social developmeпt is clear for all to see. The region is cuпently redoubliпg its efforts to combat НIV/AIDS and has developed а regional strategic plan which focuses on inteпuptioп of mother-to-child traпsmission; reductioп of new infectioп amoпg adolescents and vulneraЫe groups; апd improvement of care to those persoпs living with HIV and AIDS. We in the Caribbean look forward to full cooperatioп and support of WНО and relevant intematioпal bodies in obtainiпg techпical cooperatioп in the implemeпtatioп of our plans and also in benefiting from the reductioп in drug prices Ьу the pharmaceutical compaпies. The Caribbeaп is beset Ьу а comЬinatioп of chronic noпcommunicaЫe diseases such as diabetes mellitus, hypertension and сапсеr, as well as coпtemporary psychosocial proЫems of drug abuse, violence and accidents. These now contribute to the major causes of morЬidity and mortality iп our ageiпg populations. ln our efforts to deal with this wide spectrum of health proЫems with limited resources, it is clear that the priority strategy has to Ье health promotion iп order to achieve positive behavioural changes that would result in healthier lifestyles. The strategy must пecessarily include the buildiпg of strategic alliances with other govemment sectors, civil society and the private sector. The strategy should also iпclude empowerment of the iпdividual to take respoпsiЬility for his or her own health. There is а great пееd for acceleratioп of our efforts in this area and for iпcreased techпical cooperation апd assistance. lп seekiпg to address these multiple challeпges, many of our Caribbean countries are implemeпtiпg reforms of our health systems iп order to improve efficiency and to ensure greater seпsitivity to user participation. We are поt unmindful ofthe impact on our health goals ofthe policies of govemmeпt iп other areas, апd we coпtinue to highlight the health of our пations in other seemiпgly unrelated areas of policy formulation. These elements are critical for improving performance iп our health systems, and the health of our people.

The PRESIDENT:

1 thank the delegate of Barbados. 1 now give the floor to the delegate of Panama who is going to speak оп behalf of the central Americaп couпtries; Belize, Costa Rica, EI Salvador, Guatemala, Honduras, Nicaragua, Panama апd the Domiпicaп RepuЫic.

EI Dr. TEMN SIТTON (Panama):

3 НопоrаЫе seiiora Presideпta de la 53 AsamЫea Muпdial de Ia Salud, hопоrаЫе Directora Geпeral de Ia Orgaпizaci6n Mundial de Ia Salud, sus Excelencias Jefes de delegaciones у seiiores delegados, damas у caballeros: Constituye motivo de alto hoпor representar а Ios honoraЫes pueЫos у GoЬiemos de Belice, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, RepuЫica 3 Dominicana, у al nuestro, еп esta 53 AsamЬiea Mundial de Ia Salud. Reunidos en Ia RepuЫica de A53NR/5 page 87

Panama durante el 12° Consejo de Ministros de Salud de Centroamerica, Belice у RepuЬlica Dominicana, reconocimos la importancia que representa para la regi6n las consecuencias que en las poЫaciones indigenas tienen los estados nutricionales deficientes у la creciente incidencia en algunos de nuestros paises de los indices de tuberculosis. La Regi6n de Las Americas esta habitada aproximadamente por 43 millones de indigenas, agrupados en mas de 400 pueЫos diferentes, con una diversidad de lenguas, costumbres у creencias que enriquecen nuestra cultura. Sin embargo, estos pueЫos se han visto sometidos а siglos de abandono, lo que ha dado como resultado un alarmante deterioro de sus condiciones de salud у una baja cobertura de servicios sanitarios, lo que а su vez trae como consecuencia una pobre calidad en sus estandares de vida. Los altos indices de mortalidad, desnutrici6n, pobreza у analfabetismo, asi como la creciente incidencia de enfermedades tales como la tuberculosis у la malaria, instaron а los Estados Miembros а estaЫecer principios para el quehacer de las comunidades indigenas que fueron plasmados en las recomendaciones de Winnipeg (Canada) de 1993. Estos principios son: la necesidad de un enfoque integral а la salud; el derecho а la autodeterminaci6n de los pueЫos indigenas; el derecho а la participaci6n sistematica; el respaldo у la revitalizaci6n de las culturas indigenas; la reciprocidad en las acciones. Tomando como fundamento los principios antes mencionados, у en el marco del Decenio Intemacional de las PoЫaciones Indigenas del Mundo, 1994-2004, los Estados Miembros hemos priorizado la Ьйsqueda de soluciones а la proЫematica de salud de las poЬiaciones indigenas, en el marco del respeto а su cosmovisi6n у sistema de salud tradicionales. En algunos de los paises centroamericanos, la tuberculosis tiene una tendencia ascendente motivada por un conjunto de factores relacionados con el hecho de que quienes la adquieren forman parte de grupos de poЫaci6n cuya accesiЬilidad а los servicios eficientes у efectivos de atenci6n primaria es limitada. Podemos resumir el proЫema en cuatro aspectos hasicos: una deficiente organizaci6n de la red de laboratorios diagn6sticos; bajo numero de pacientes sometidos а tratamiento adecuadamente supervisados; el estado de extrema pobreza, у el aпaigo а tradiciones culturales de las poЬlaciones indigenas, que dificulta la adecuada inteпelaci6n entre el receptor у el proveedor de la atenci6n medica. Сото ejemplo del area, en 1999 Panama registr6 1387 casos de tuberculosis, lo cual represent6 una tasa de 48,57 por 100 000 haЬitantes. Esta cifra refleja una situaci6n grave, en concordancia con la clasificaci6n de la OMS. No tenemos la menor duda de que la situaci6n es aun peor considerando el subregistro existente, producto de las dificultades en la detecci6n de la enfermedad. Cada afio se registran en las Americas alrededor de medio mill6n de nuevos casos, de los cuales 50 000 fallecen, afectando primordialmente а nuestra poЫaci6n econ6micamente activa. Mujeres, especialmente embarazadas, у lactantes у nifios sufren las mayores repercusiones tanto а corto como а largo plazo por esta enfermedad, deЬido а las caracteristicas Ьiol6gicas de estos grupos. Recordemos tamЬien que la asociaci6n de la tuberculosis con el VIH у la aparici6n de bacilos resistentes ha contribuido а aumentar la incidencia у а complicar el cuadro clinico de la enfermedad. Por otro lado, nuestro pais, junto а Honduras, Haiti у Brasil, es uno de los cuatro paises latinoamericanos que presentan las tasas mas altas de SIDA, con un patr6n de transmisi6n principalmente heterosexual, que se propaga rapidamente en la misma franja de edad que el de la tuberculosis. Esto explica que alrededor del 20% de los casos de SIDA esten doЫemente infectados. La tuberculosis ha sido identificada como un proЫema sanitario principal, que constituye un reto para nuestro sistema nacional de salud en esta etapa de trabajo. En la lucha contra esta enfermedad, los paises centroamericanos necesitamos fortalecer las acciones у los programas nacionales en el marco de proyectos con colaboraci6n у asesoria tecnica, como seria el caso de la Fundaci6n Damian у la OPS. Lo antes expuesto tiene una relaci6n directa con el escaso acceso а los alimentos, у esto obedece especialmente а la carencia de ingresos familiares de amplios segmentos de la poЫaci6n, que hoy se encuentran sumidos en la pobreza у la pobreza extrema, donde el hambre у la desnutrici6n causan sus mayores estragos. La inseguridad alimentaria de los hogares se distingue en cr6nica у transitoria. La inseguridad alimentaria cr6nica se vincula а la persistencia de una dieta insuficiente deЬido а la incapacidad de los hogares para adquirir los alimentos necesarios, уа sea а traves del mercado о su propia producci6n. La inseguridad alimentaria transitoria deriva de una disminuci6n temporal del acceso а los alimentos por parte de la familia. Por eso debemos tener presente nuestra responsaЬilidad A53NR/5 page 88 de manera tal que logremos proporcionar а toda nuestra poЬlaci6n, especialmente infantil у mujeres en edad fertil, una alimentaci6n sana у nutritiva, para que puedan tener una vida activa у saludaЬle, intensificando las campafias de promoci6n у defensa de la lactancia matema у estaЬleciendo о extendiendo los programas de distribuci6n de alimentos. Ademas, fortaleciendo las politicas destinadas al suministro de micronutrientes у asegurando que los programas de fortificaci6n de alimentos con hieпo у los otros уа existentes, lleguen а los grupos vulneraЬles para disminuir la incidencia de anemia por deficiencia de estos minerales. Exigir el cumplimiento de leyes у normas que regulan la producci6n е importaci6n de alimentos, con miras а reducir el peligro de consumir alimentos en condiciones higienicas inadecuadas, de bajo valor nutritivo у en condiciones fito у zoosanitarias ilegales, que lastimen la salud de nuestra poЬlaci6n en general у а los infantes у mujeres en edad fertil en particular, es una necesidad impostergaЬle. La Regi6n Centroamericana se ha caracterizado por la buena voluntad para lograr acuerdos en foros Ьilaterales у multilaterales у asistencia humanitaria, у nos sumamos al convenio marco para la lucha antitablquica. Por ello, hacemos una cordial invitaci6n а los representantes de la Regi6n а participar en la 16а Reuni6n del Sector Salud de Centroamerica у Republica Dominicana, los dias 6 у 7 de septiembre, а realizarse en la hermana RepuЬlica de Honduras. Sefiora Presidenta, sefiora Directora General, sefiores delegados, coпespondera а la RepuЬlica de Panama reciЬir а los Jefes de Estado у de GoЬiemo de Iberoamerica en la Х Cumbre Iberoamericana el pr6ximo mes de noviembre. Invito а mis colegas de lberoamerica а unimos por la nifiez у la adolescencia, base de la justicia у la equidad en el nuevo milenio, que es precisamente el lema de la pr6xima cumbre. Muchisimas gracias.

El Dr. GARCfA МАТА (Ecuador):

Sefiora Presidenta, felicitaciones por su merecida elecci6n. Sefiora Directora General, felicitaciones por el exito de esta AsamЬlea. Sefiores у sefioras delegados en la 53а AsamЬlea Mundial de la Salud: El Ecuador, pais andino, situado al noroccidente de la America del Sur, cuenta con 12 millones de haЬitantes, un 70% de mestizos у un 30% entre Ьlancos, indios, negros у otras pequefias etnias. А finales del siglo ХХ, у como parte de un proceso de reforma del sector salud, que fuera discutido durante afios, aprob6 el plan nacional de salud, que fuera adoptado por primera vez como una politica de Estado. indices vergonzosos tengo que exponer ante este foro mundial, porque los esfuerzos que se encuentra realizando el nuevo GoЬiemo requieren no solamente del ароуо tecnico у orientador de los organismos intemacionales, sino tamЬien logistico, para poner en practica el nuevo Sistema Nacional de Salud, comprometiendonos а continuar en la lucha contra la coпupci6n, para asi garantizar la transparencia у buena utilizaci6n de los recursos. Los grandes proЬlemas de salud en nuestro pais se reflejan en que el 30% de la poЬlaci6n no tiene acceso а ningun tipo de prestaci6n en salud у apenas un 25% de la poЬlaci6n tiene algun tipo de seguro en salud. Los indices de mortalidad matemoinfantil son muy altos, а pesar de que en los ultimos afios hemos iniciado un programa de matemidad gratuita para garantizar una atenci6n mas adecuada а un 70% de las madres у los nifios que acuden а los centros de salud у hospitales que dependen del Ministerio de Salud Publica. La desnutrici6n toca al 65% de los nifios menores de cinco afios у la anemia al 50% de las madres embarazadas. А principios de este afio tuvimos una epidemia de malaria como consecuencia de una falta de prevenci6n adecuada, especialmente con un aumento de Plasmodium falciparum. La tuberculosis presenta cada vez mas pacientes resistentes а las drogas clasicas, isoniazida, PAS у rifampicina, agravandose el proЬlema por el alto costo de las nuevas drogas para su tratamiento. En 1998 se registraron 4175 casos, el 32% concluyeron su tratamiento, el 12% lo abandonaron, el 2,11% fallecieron у en un 0,48% fracas6 el tratamiento. Los indices de los pacientes VIH( +) han aumentado de forma importante у no disponemos de un programa para el diagn6stico oportuno, у el alto costo de su tratamiento hace imposiЬle que los pacientes sean tratados en forma adecuada. En 1984 se detect6 el primer caso en Ecuador. La tasa de portadores de VIН/SIDA aument6 del 0,4 por 1 000 000 haЬitantes en 1984 а 2,3 por 1 000 000 A53NR/5 page 89 haЬitantes en 1999. En 1os adolescentes, la proporci6n de portadores en relaci6n al total se increment6 del 9,9% en 1990 al 28,7% en 1999. Los programas de vacunaci6n realizados los ultimos afios nos han permitido casi eпadicar el sarampi6n у la poliomielitis, asi como tamЬien los estudios realizados para el diagn6stico у tratamiento de la oncocercosis nos han permitido constituimos en modelo para paises de la regi6n que en el mes de noviembre se reuniпin en Ecuador para compю1ir experiencias. Насе un mes fue aprobada en el Congreso Nacionalla ley de comercializaci6n de medicamentos esenciales у genericos. Esperamos que en los pr6ximos meses puedan ponerse al servicio de las clases mas pobres que acuden а los hospitales у centros de salud del Ministerio de Salud PuЬlica. Por lo demas el Ecuador esta comprometido en un nuevo marco juridico de protecci6n integral а las personas adultas mayores, personas discapacitadas у grupos vulneraЬles de la poЬlaci6n. La nueva ley del adulto mayor esta en via de aprobaci6n en el Congreso Nacional, asi como la nueva ley de discapacidades, у la reforma del sistema del seguro social, cuyo objetivo es alcanzar progresivamente la protecci6n universal del sistema provisional а todos sus haЬitantes mediante una administraci6n tripartita: Estado, patronos у sociedad civil. Hemos logrado un programa integra1 intersectorial que permite la participaci6n de 1а sociedad civil en el control у atenci6n de los adultos mayores а traves de los clubes aЬiertos de enfermedades no transmisiЬles. Queremos agradecer el ароуо que hemos reciЬido de la OMS а traves de la OPS, tanto para la reforma del sector salud como tamЬien para la lucha contra la epidemia del paludismo у el dengue, el combate а la morЬimortalidad matemoinfantil у la desnutrici6n, el progreso del VIH у la eпadicaci6n de la poliomielitis, el sarampi6n у la oncocercosis. Pero queremos decirles que la mortalidad infantil por diaпea у deshidrataci6n, por enfermedades respiratorias у por falta de un sistema sanitario preventivo adecuado sigue siendo importante en nuestros paises. Para terminar, sefiora Presidenta, deseo apoyar la solicitud de los paises pobres que han pedido una condonaci6n de las deudas en salud, porque а pesar de los sacrificios que en vidas humanas representa el pago de los intereses de la deuda extema, no hemos tenido respuesta positiva de algunos de los paises con recursos. Muchas gracias.

La Sra. МсСОУ SANCHEZ (Nicaragua):

HonoraЬle sefiora Presidenta de la 53 3 AsamЬlea Mundial de la Salud, honoraЬle Dra. Gro Harlem Brundtland, Directora General de la Organizaci6n Mundial de la Salud, honoraЬles sefioras у sefiores Vicepresidentes de esta AsamЬlea Mundial de la Salud, colegas у delegaciones de los Estados Miembros, sefioras у sefiores: Ме permito en primer lugar felicitar а la sefiora Presidenta por su elecci6n у а los Vicepresidentes de esta AsamЬlea Mundial de la Salud, deseandoles muchos exitos en las funciones encomendadas. Un saludo muy respetuoso а la honoraЬle sefiora Directora General. Desde 1997 el GoЬiemo de Nicaragua ha venido implementado un programa de reformas econ6micas у sociales profundas cuyo objetivo principal es la reducci6n de la pobreza en un contexto de crecimiento sosteniЬle. En septiembre de 1999, Nicaragua fue declarada elegiЬle para ingresar а la iniciativa de paises pobres altamente endeudados. De esta manera, los fondos destinados al pago de la deuda extema seran invertidos en salud у educaci6n como una estrategia de desaпollo humano sosteniЬle, que estara basada en tres pilares fundamentales: lograr un crecimiento econ6mico de base amplia con enfasis en el sector rural, en el que se concentra mayormente la pobreza; la inversi6n en capital humano que reduzca la vulneraЬilidad econ6mica, social у amЬiental aumentando la competitividad con base а mayores rendimientos de la fuerza laboral, la generaci6n de nuevos puestos de trabajo, у la mejoria de acceso а los servicios de salud у educaci6n; у fortalecer una red de protecci6n social localizada en grupos vulneraЬles у postergados para romper la transmisi6n intergeneracional de la pobreza. Desde la concepci6n de la salud como producto social queda clara la importante contribuci6n que la salud tiene en la lucha contra la pobreza. Por ello en nuestras politicas sociales hemos incluido la equidad, el enfoque de generos у una politica de poЬlaci6n congruente con la realidad que vive el pais. En los ultimos cincos afios Nicaragua entra en una senda de crecimiento econ6mico de forma sostenida, con un tasa promedio de crecimiento de alrededor de 5%, lo que ha A53NR/5 page 90 permitido, conjuntamente con el aumento en el gasto social, mejorar el ingreso por habltante у reducir los niveles de pobreza. Las intervenciones sanitarias desarrolladas nos han permitido incrementar en seis afios la esperanza de vida al nacer, reducir la tasa de fecundidad у disminuir de manera sostenida las tasas de mortalidad infantil, prenatal у matema. En los ultimos tres afios se han incorporado nuevas vacunas, como la pentavalente у la triple contra el sarampiбn, rubeola у parotiditis, lo que coloca а Nicaragua como el pais centroamericano con el esquema de inmunizaciбn mas amplio, protegiendo de esta manera а nuestra роЫасiбn infantil contra 1О enfermedades prevalentes de la infancia. Estas acciones nos han permitido tener ausentes la poliomielitis, el sarampiбn у el tetanos neonatal desde hace varios afios. El manejo de la tuberculosis con la estrategia DOTS ha sido altamente efectivo. En el campo de los micronutrientes se ha introducido el hierro en la harina de trigo, el yodo en la sal у recientemente la vitamina А en el azucar. El ejercicio de la rectoria se ha fortalecido con la promulgaciбn de diferentes leyes como la ley general de salud, la de lactancia matema, la de seguridad transfusional, у la del derecho de los no fumadores, entre otras. Recientemente se ha concluido un analisis sectorial, siendo el tercer pais de America Latina que lo realiza у el primero en hacerlo de manera prospectiva, lo que nos ha permitido tener un mejor conocimiento de las debllidades у fortalezas del sistema de salud nicaragiiense у los retos а enfrentar en las prбximas decadas. Tamblen se elaborб un plan de inversiones а corto plazo para permitir un mayor ordenamiento del proceso de inversiбn puЬlica. En las prбximas semanas iniciaremos la elaboraciбn del plan nacional de salud, un plan integral de reforma у modemizaciбn del sector salud у el plan maestro de inversiones, con la visiбn de que inversiбn es salud, es inversiбn social, es inversiбn en capital humano. Algunos de estos retos son comunes а muchos paises, como el enfrentar la transiciбn demografica у epidemiolбgica, mejorar la equidad, superar las limitaciones financieras у lograr un ejercicio adecuado de la rectoria. Esto plantea un dоЫе reto а los sistemas de salud: por un lado, se nos pide brindar mas у mejores servicios, у por otro lado se nos pide reducir los costos cuando debemos enfrentar patologias que requieren alta inversiбn en tecnologia у recursos especializados. Esto es tremendamente dificil para un pais cuyo РIВ no supera los 500 dбlares per capita anuales. Estamos cruzando el umbral del siglo XXI arrastrando una enorme у pesada deuda social acumulada durante muchos afios, у este enorme reto no debe hacemos desistir de nuestro empefio de mejorar la salud de nuestros pueЬlos. Es un derecho irrenunciaЫe у un deber indeclinaЫe. Los proЫemas de salud son demasiado importantes у la necesidad demasiado urgente para que elliderazgo siga siendo asumido sбlo por unos pocos, como ha sucedido tradicionalmente. Por estas у otras muchas razones estamos oЬligados а mejorar la eficiencia de nuestros sistemas de salud, incorporando а todos los actores sociales en la construcciбn de una nueva relaciбn entre el sector puЫico у privado у las agencias de cooperaciбn intemacional, у fortaleciendo la capacidad de gestiбn con estructuraciбn de redes locales intersectoriales. Esto requiere un liderazgo, una capacidad de conducciбn у un adecuado posicionamiento como rectores del sector salud. Se requiere que un organismo tan importante como la OMS, а traves de sus бrganos у oficinas regionales, disponga los maximos recursos para mejorar la disponibllidad de medicamentos para los mas pobres, para los enfermos de cancer у del VIНISIDA, los tuberculosos, entre otros, por medio del ароуо а la negociaciбn conjunta de medicamentos especiales, incluyendo los antineoplasicos у los antirretrovirales, proyecto presentado por los paises de la regiбn centroamericana en el grupo consultivo de Estocolmo у que aun no ha encontrado financiamiento entre las agencias у organismos de cooperaciбn, por lo que solicitamos el ароуо de esta AsamЬlea para que esta mociбn sea incluida entre las cuestiones relacionadas con estos proЬlemas de salud puЬlica. Tamblen es clave el ароуо en recursos materiales у humanos а traves de la asistencia tecnica regional para mejorar el rendimiento de nuestros sistemas de salud, su capacidad de regulaciбn у financiamiento, la prestaciбn de los servicios, la generaciбn de recursos у la articulaciбn intra е intersectorial. Queremos agradecer а traves de este medio el ароуо brindado por la OPS al desarrollo de las acciones sanitarias en nuestro pais у la invitamos а continuar con este esfuerzo para lograr la tan ansiada meta de salud para todos. Muchas gracias у que Dios nos bendiga. A53/VR/5 page 91

Dr AL-ZAANOUN (Palestine): : ( ~) иус. )1 ~Y.J .J_i!S.lll

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El Dr. CUENTAS У ANEZ (Bolivia):

Sefiora Presidenta, sefiora Directora General, sefiores delegados у delegadas: En diversos paises del mundo se realizan procesos de reforma de !а salud. V arios de ellos llevan adelante estos procesos con е! objetivo de reducir los costos. Algunos, para mejorar !а calidad de atenci6n. En Bolivia tenemos un proceso de reforma de !а salud que busca !а equidad. En е! marco de la equidad hemos implementado un seguro basico que tiende а mejorar las condiciones de vida de !а poЬlaci6n A53NR/5 page 92 maternoinfantil у al mismo tiempo hemos puesto en marcha un escudo epidemiol6gico para disminuir las principales enfermedades endemicas que afectan а muchos de nuestros paises. No voy а cansarles, sefiores delegados, dando los indicadores que tenemos en Bolivia, que son similares а los que se encuentran en varios de nuestros paises. Simplemente quiero compartir con ustedes una reflexi6n у hacer un planteamiento: si nosotros queremos de verdad mejorar las condiciones de salud de nuestros paises, debemos tener acceso а la tecnologia hasica. Los actuales indicadores, en muchos de los paises de America Latina о de Africa, nos sefialan que para continuar mejorando los indicadores es imprescindiЬle contar con acceso а la tecnologia hasica. Si en los afios ochenta у noventa se puso en marcha por iniciativa de la OMS un programa de medicamentos esenciales que permiti6 que cientos de miles de ciudadanos de escasos recursos pudieran acceder а un medicamento, los desafios de los pr6ximos afios en el siglo XXI hacen imprescindiЬle que la OMS tome la iniciativa de generar una politica global que permita а nuestros paises tener la posiЬilidad de acceder а la tecnologia basica para llevar adelante la construcci6n de nuestros sistemas de salud. No vamos а lograr los objetivos que todos perseguimos si el conocimiento, la tecnologia hasica, el medicamento у la informaci6n cientifica en la salud no se encuentran al alcance de los paises que requieren de estos instrumentos para crear sistemas de salud que mejoren la calidad de vida de sus haЬitantes. Bolivia forma parte de un programa de alivio а la deuda que permite que los recursos de la deuda externa puedan ser invertidos en salud у en educaci6n. No todos los paises tienen esta oportunidad. Sin embargo, es imprescindiЬle que todos podamos contar con la posiЬilidad de acceder а equipos, al conocimiento у al intercamЬio cientifico. Por ello tamЬien, junto а pedir а la OMS que sea el motor de esta iniciativa, compartimos la visi6n de enfocar una politica conjunta para disminuir algunas enfermedades endemicas que son comunes а todos nuestros paises. Compartimos la visi6n de la OMS de concentrar esfuerzos en los paises que tienen patologias endemicas como la malaria о la tuberculosis, у tamЬien haremos los esfuerzos conjuntos para llevar adelante una politica global de lucha contra el tabaquismo у el SIDA. Muchas gracias.

Mrs OМAROV А (Kazakhstan): Г-жа ОМАРОБА (Казахстан):

Г-н Председатель, уважаемый Генеральный директор, уважаемые делегаты, дамы и господа. Хочу поздравить Вас, уважаемый Председатель, и весь руководящий состав Ассамблеи с избранием на столь высокий пост. Мы заслушали содержательный доклад Генерального директора, который охватил наиболее важные и актуальные аспекты мирового здравоохранения и станет основой для проведения политики здравоохранения. Мы благодарны Всемирной организации здравоохранения, ее Европейскому бюро за рекомендации, использование которых в национальной системе здравоохранения способствовало улучшению ряда показателей. Благодаря политической воле главы государства повсеместно внедрена терапия КТНН, произошло снижение смертности от туберкулеза на 25% в результате обеспечения 90%-ного охвата прививками. В результате этого снизилась заболеваемость вакцинауправляемыми болезнями - заболеваемость дифтерией снизилась в 2, 7 раза, корью в 4 раза, эпидемическим паротитом на 14,4%, вирусными гепатитами на 5,3%. С 1995 г. в нашей стране не регистрируется полиомиелит. Говоря о реформах здравоохранения, нужно отметить, что реформы нужны не только ради реформ, а ради улучшения здоровья народа, обеспечения доступности медицинской помощи. Когда мы говорим о финансировании, то следует

определить механизмы, регулирующие затраты, определить цену медицинских услуг и, самое главное, - правильно распределить имеющиеся финансовые ресурсы. Памятуя это, мы пересмотрели существующую сеть медицинских учреждений в сторону сокращения дорогостоящей стационарной помощи и переноса центра тяжести в амбулаторно­ поликлиническую, с открытием дневных стационаров и стационаров на дому. Нами определены основные приоритетные направления развития здравоохранения до 2005 г. Согласно Алма-Атинской декларации 1978 г., первым приоритетом мы считаем первичную медико-санитарную помощь. Первичная медико-санитарная помощь должна быть доступна и A53NR/5 page 93

бесплатна для всего населения. В этом направлении мы изменяем и по.-штику образования, как высшего, так и среднего, оно будет адаптировано на первичную медико-санитарную помощь. Вторым основным приоритетом мы считаем туберкулез, третьим- иммунопрофилактику, далее следует охрана здоровья матери и ребенка, государственная лекарственная политика, для того чтобы каждый гражданин мог купить нужное ему лекарство. Вчера мы говорили о том, что

здоровье каждого - это его дело, и он также должен участвовать в охране своего здоровья, поэтому следующим приоритетом мы считаем формирование здорового образа жизни в нашем обществе. Получат развитие новые технологии диагностики и лечения, и еще основным приоритетом мы рассматриваем санитарное благополучие страны. Известно, что здоровье - это глобальная межотраслевая проблема. В нашей стране обеспечен процесс участия различных министерств в охране здоровья. Хотелось, чтобы Всемирная организация здравоохранения поддержала такой подход и способствовала бы ускорению этого процесса в

других странах. В заключение хочу отметить, что Казахстан поддерживает стратегию ВОЗ "Здоровье для всех в XXI веке". Я уверена, что наше сотрудничество получит дальнейшее развитие. Благодарю за внимание.

Dr LJUBIC (Bosnia and Herzegovina):

Madam Director-General, distinguished delegates, since the signing of the реасе agreement in Bosnia and Herzegovina important progress has been made towards the reconstruction and reform of the health care system and the development of an effective and efficient health sector. Unlike any other country, Bosnia and Herzegovina is passing through multiple transitions: from war to реасе, from humanitarian assistance to sustainaЬle development, &om centrally planned to market-oriented economy, from one constitutional system to another. Last but not least, the demographic transition is now taking place - the country nowadays has more people over 65 than children below six years. The new epidemiological pattem caused Ьу the recently finished war presents an additional challenge. Reform is а reality for developed countries; if reform and transition are а necessity for former socialist countries, then both, plus administrative reorganization and the restoration of war damages, are the challenges that my country has to face when it wants, and it does want, to enter the third millennium with similar chances and perspectives as the others from our Region. То face these unprecedented challenges two concepts gained importance among decision­ makers and health systems administrators in Bosnia and Herzegovina- effectiveness and efficiency. The concept of effectiveness concems vision - what our health care systems should look like in the future and what kind of services or products our systems have to deliver in order to meet the rising needs and expectations of our population. The concept of efficiency concems the knowledge, procedures, organizational structures and human and other resources needed to convert our vision into tangiЬle reality. Both ministries of health in Bosnia and Herzegovina, in collaboration with WНО, produced strategic plans for reform and reconstruction of the health care systems. These documents present the vision of effective and efficient, modem but affordaЬle, patient-oriented, health-promotion-driven health care systems. Our Govemment has а clear vision ofwhat it wants to achieve in the health sector in the mid-term and long-term period ofhealth system reform and reconstruction. The most important component of health care with regards to primary health care is based on the family doctor system. То support it, the family medicine departments have been introduced at the medical faculties in Bosnia and Herzegovina, as well as the specialization in family medicine. Accordingly, it is planned to reduce а number of hospital beds, reduce hospitalization, and improve diagnostics and therapeutic services for more efficient treatment and more effective support to the family doctor. The third significant component ofthe reform is health financing. All these changes are necessary to achieve the objective of building а rational and sustainaЬle health care system adjusted to realistic economic conditions in our country after the war and in Europe at the very beginning of the third millennium. If there are no capacities, knowledge and managerial skills, organizational structures, processes and procedures availaЬle in the country to implement а vision will remain а dream forever. То prevent A531VR/5 page 94 this scenario mш1stries of health, again with technical support from WHO, embarked on the preparation of operational plans that, together with the strategic plan represent the master plan for the reform and reconstruction of the health system. This exercise will significantly improve the efficiency of the health administration in Bosnia and Herzegovina. Post-war reform and reconstruction are taking place under extreme resource constraints. Therefore the key for putting into practice any effective system for implementation is to identify specific priority areas of activities and put these into а coherent framework that is linked to overall strategic objectives, focusing on critical areas and driving the health sector's strategy forward. However, achieving effectiveness and efficiency in the management of our system are not the only parts of good health system stewardship. We need to focus with equal energy and perseverance on safeguarding equity in access to services and protection of vulneraЬle populations in а currently turbulent economic and social environment.

Dr М. Amedee-Gedeon (Нaiti), Vice-President, took the presidential chair. Le Dr М. Amedee-Gedeon (Нai'ti), Vice-President, assume la presidence.

Le PRESIDENT :

La deleguee du Mali parlera au nom du Benin, du Burkina Faso, du Burundi, du Cameroun, du Congo, de la Сбtе d'Ivoire, du Gabon, de la Guinee, de la Guinee equatoriale, de Madagascar, de la Mauritanie, du Niger, de la RepuЬlique centrafricaine, de la RepuЬlique democratique du Congo, du Senegal, du Tchad, du Togo et au nom de son pays.

Mme TRAORE NAFO (Mali) :

Madame le President de seance, Mesdames, Messieurs les honoraЬles delegues, Madame le Directeur general, Mesdames, Messieurs, с' est pour moi un grand honneur et un plaisir de prendre la parole au nom des Ministres de la Sante des pays suivants pour vous presenter notre vision : Benin, Burkina Faso, Burundi, Cameroun, Congo, Сбtе d'lvoire, Gabon, Guinee, Guinee equatoriale, Madagascar, Mali, Mauritanie, Niger, RepuЬlique centrafricaine, RepuЬlique democratique du Congo, Senegal, Tchad et Togo. Permettez-moi tout d'abord de feliciter Mme le President pour son election а la tete de la cinquante-troisieme session de l' AssemЬlee mondiale de la Sante. Je felicite egalement les Vice­ Presidents et les autres membres du bureau, qui ont le privilege de l'assister dans la conduite des travaux de cette session. Nous avons examine avec interet le rapport du Directeur general sur la sante dans le monde en l'an 2000. Се rapport fera date pour avoir abandonne le schema classique de l'analyse des progres sanitaires enregistres dans le monde, au profit d'une demarche plus dynamique, plus en profondeur, visant l'amelioration de la performance des systemes de sante. Cela nous parait fondamental, d'autant plus que la plupart des progres accomplis ces demieres annees dans nos pays en developpement restent precaires parce que non accessiЬles au plus grand nombre. Or nous connaissons aujourd'hui le poids des risques en termes de maladies emergentes, de pathologies reemergentes et de regression de l'esperance de vie dans les pays en developpement. Il importe de souligner la situation difficile que traversent bon nombre de pays africains а cause des conflits armes, de la famine et d'autres catastrophes ayant des consequences dramatiques sur la sante des populations. Pour ces pays et leurs voisins immediats qui accueillent leurs refugies, plus que d'un renforcement, il s'agit de l'imperieuse necessite de retaЬlir leur systeme de sante. Nous devons accorder plus d'attention а ces situations afin d'y apporter des solutions adequates, sinon nous assisterons а des desequilibres sans precedent. C'est le lieu de rappeler la tenue de la revue de l'initiative de Bamako, en mars 1999 а Bamako, apres dix ans de mise en oeuvre. Cette revue а fait ressortir la necessite de la relance de l'initiative, qui constituera la plate-forme commune pour l'essentiel des interventions dans le cadre d'une approche globale, harmonieuse et coordonnee. Cette plate-forme commune permettra de saisir toutes les occasions pour l'offre d'un paquet de soins essentiels, accessiЬles et acceptaЬles pour les A53NR/5 page 95 communautes avec leur pleine participation. Les ressources pourront etrc davantage rationalisees, donnant ainsi l'opportunite de renforcer la dimension de l'equite. Dans la recherche de solutions pour le renforcement de nos systemes de sante, les principes de l'initiative de Bamako se justifient encore. C'est pourquoi les Etats, l'OMS, l'UNICEF et d'autres partenaires doivent apporter leur soutien sans faille а l'appel de Bamako. En plus de cette preoccupation de fond, quatre points specifiques meritent une attention particuliere. Le premier conceme le VIН/SIDA et le paludisme. Conformement aux resolutions prises а la Conference d' Atlanta sur le paludisme et le SIDA, а laquelle ont participe les ministres africains de la sante, au Sommet des chefs d'Etats africains sur le paludisme а Abuja (Nigeria) et а la reunion des ministres de la sante de l'OUA sur le \'IНISIDA а Ouagadougou (Burkina Faso), nos pays s'accordent а donner la meme importance а ces deux fblaux. Nous apprecions а leur juste valeur les efforts entrepris par l'OMS et l'ONUSIDA pour reduire les prix des medicaments contre le VIН/SIDA. Par la meme occasion, nous exhortons les pays concemes а plus d'implication en vue de la pleine satisfaction des interets des populations si durement touchees. Le partenariat au niveau sous­ regional doit etre renforce au meme titre que le partenariat intemational et local. Les responsaЬilites des organisations sous-regionales sont plus que jamais engagees. 11 est certain que la victoire sur le VIН/SIDA et le paludisme ne peut etre remportee sans un effort de solidarite. А cet egard, et dans le cadre du processus d' allegement ou d 'annulation de la dette des pays les plus lourdement endettes, l'OMS devra s'attacher а mettre au point les instruments de suivi et d'evaluation de l'impact des mesures adoptees par les pays sur la sante de leurs populations. Le deuxieme point conceme les vaccinations. Malgre les efforts deployes dans се domaine ces demieres annees, les resultats restent en deya de nos attentes. Мете dans les pays ou un bon niveau de couverture vaccinale а ete atteint, nous assistons а une diminution fort inquietante de celui-ci. Comme l'ont souligne d'autres intervenants avant moi, cela est du au fait que les interventions dans се domaine n' ont pas ete accompagnees par un renforcement concomitant de nos systemes de sante. Nous devons tirer tous les enseignements de cette situation et prendre de nouvelles initiatives en vue d'une approche plus globale et integree. L' Alliance mondiale pour les vaccins et la vaccination en constitue un exemple sur lequel nous fondons beaucoup d'espoir. Le troisieme point conceme une maladie specifique а notre continent. 11 s'agit de la trypanosomiase humaine africaine. Nous assistons actuellement а la reemergence de foyers de cette affection. 11 est urgent que des actions energiques soient engagees pour eviter qu'elle ne redevienne un autre grave proЫeme de sante puЫique. Le quatrieme et demier point conceme la lutte contre le tabagisme. La vigilance dans се domaine est plus que de rigueur, surtout а l'heure de la mondialisation, car les consequences de cette nouvelle epidemie sur la jeunesse de nos pays seront incalculaЫes. En la matiere, certains pays de la sous-region disposent deja d'un cadre reglementaire en cours d'application. lls s'inspireront des autres pays. Madame le President de seance, la pertinence des orientations contenues dans le rapport de Mme le Directeur general ainsi que la perspicacite des questionnements qui s'en degagent constituent, nous en sommes convaincus, une base prometteuse d'une reflexion qui permettra aux decideurs que nous sommes de faire des choixjudicieux pour l'amelioration de la sante dans le monde.

Professor NAZIROV (Uzbekistan): Проф. НАЗИРОВ (Узбекистан):

Уважаемая г-жа Председатель, уважаемый Генеральный директор, ваши превосходительства, дамы и господа. Разрешите поздравить нашего Председателя с ее назначением. Мы восхищены обзорным докладом Генерального директора, и мне хочется высказать особую признательность и чувство благодарности за то доверие, которое было оказано нашей стране Всемирной ассамблеей здравоохранения, избравшей ее представотеля на должность заместителя Председателя Ассамблеи. Дамы и господа, с первых дней обретения независимости Узбекистану, как и большинству стран Содружества, предстояло сделать выбор с учетом своих особенностей и разработать национальную модель. A53NR/5 page 96

Своеобразие демографической ситуации, задачи по развитию здорового человеческого потенциала, сложившаяся социальная инфраструктура населения с преимущественным проживанием населения в сельской местности, относительно высокая доля детей, - все это требовало соответствующих деловых подходов к формированию структурных преобразований

в системе здравоохранения. Не секрет, что мы все еще переживаем последствия перекосов семидесяти лет бывшего советского здравоохранения, являвшегося образцом затратной системы. Этот период

характеризовался наращиванием стационарных коек, по количеству которых раньше выделялся бюдЖет, при этом рост базы медицинских учреждений происходил не за счет нового строительства, а размещения их в неприспособленных, а порой просто непригодных помещениях. В самом худшем положении оказались учреждения родовспомогательных педиатрических служб, фельдшереко-акушерские пункты, сельские врачебные амбулатории и участковые больницы. Непомерное число коек в больничных учреждениях отвлекало значительные ресурсы на

вторичную стационарную медицинскую помощь, тогда как на первичную медико-санитарную помощь, амбулаторно-поликлинические учреждения приходились остатки от остаточного принципа финансирования здравоохранения в целом. Потребавались безотлагательные меры по изменению инфраструктуры с преимущественным развитием менее затратной и экономичной амбулаторной медицинской помощи и приведением коечного фонда к

санитарным нормам. Реформирование системы здравоохранения в условиях поэтапного перехода к рыночным

отношениям определило стратегические направления совершенствования: переход от экстенсивного пути развития медицинских учреждений к интенсификации их деятельности, создание новых финансовых механизмов в здравоохранении, создание и внедрение принципиально новой специализации - врача общей практики, реформа подготовки медицинских кадров. Приоритетное развитие получили: охрана здоровья матери и ребенка, борьба с инфекционными заболеваниями, борьба с социально значимыми заболеваниями, туберкулез, рак, наркомания, психические болезни, передающиеся половым путем инфекции, развитие первичного звена здравоохранения, обеспечение населения равнодоступной квалифицированной первичной медико-санитарной помощью, охрана окружающей среды. Учитывая, что в сельской местности проживает более 62% населения Республики, остро назрел вопрос совершенствования сельских медицинских учреждений. В мае 1996 г. правительство припяло Постановление о программе развития социальной инфраструктуры села на период до 2000 года. Это позволило организовать совершенно новую форму медицинского обслуживания жителей села - сельский врачебный пункт с работающим в нем врачом общей практики, как это принято в мировой практике. За прошедшие годы по специально разработанным проектам построено более 600 новых сельских врачебных пунктов. По Указу президента страны основу национальной модели здравоохранения составляет государственная система здравоохранения, обеспечивающая всем гражданам доступность и бесплатность медицинского обслуживания в рамках гарантированного государством объема медико­

санитарных услуг. Поэтапный переход страны к рыночным отношениям порождает предпосылки для создания новой многоукладной системы здравоохранения, медицинских учреждений различных форм собственности и источников финансирования. В Республике уже функционируют частные клиники, развивается система частнопрактикующих врачей. Продолжается разгосударствление и приватизация отдельных медицинских учреждений, передача их в аренду и коллективную собственность. Продолжает оставаться напряженной ситуация по заболеваемости туберкулезом, злокачественными образованиями, а также заболеваниями, передающимися половым путем. Из-за экологического бедствия в зоне Аральского моря ситуация с рядом заболеваний в этом регионе остается тревожной, что требует постоянного напряженного внимания и контроля руководством системы здравоохранения. Здесь уместно подчеркнуть, что в достигнутом огромная роль принадлежит Всемирной организации здравоохранения и Европейскому региональному бюро. По инициативе президента нашей Республики 2000 г. объявлен "Годом ASЗNR/5 page 97

здорового поколения". Приняты государственные про граммы, реализация которых позволит решить имеющиеся проблемы, поднять еще на более высокую качественную ступень охрану здоровья матери и ребенка. В заключение хочу сказать, что, отдавая должную дань роли и заслугам в развитии здравоохранения во всем мире, в том числе и в нашей Республике, мы твердо убеждены, что дальнейшее сотрудничество с ВОЗ будет еще более благотворным. Благодарю за внимание.

Mr ZELENKEVICH (Belarus): Г-н ЗЕЛЕНКЕБИЧ (Беларусь):

Уважаемая г-жа Председатель, уважаемая г-жа Генеральный директор, уважаемые дамы и господа. Прежде всего позвольте мне присоединиться к поздравлениям в адрес руководства настоящей Ассамблеи по случаю избрания и выразить надежду, что работа нашего форума будет плодотворной и окажет дальнейшее позитивное воздействие на развитие мирового

здравоохранения. Уважаемые делегаты, мы с большим вниманием выслушали доклад Генерального директора о состоянии здравоохранения в мире и выражаем благодарность ей и Секретариату за большую работу, проведеиную по его подготовке. Общая глобальная цель достижения здоровья для всех по сути является вневременной. Интенсивные усилия государств для обеспечения населению своих стран высокого уровня здоровья не должны ослабевать ни при каких условиях. Поэтому роль систем здравоохранения, оказывающих все большее воздействие на повседневную жизнь большинства людей, постоянно повышается, особенно в связи с возникшими проблемами эпидемического, демографического и экономического характера. На ситуацию в здравоохранении продолжают оказывать негативное влияние последствия аварии на Чернобыльекой атомной электростанции, которые затрагивают практически всех жителей нашей страны. Сохраняется беспрецедентный рост рака щитовидной железы среди населения в загрязненных районах, рост некоторых онкологических заболеваний среди населения. Я должен сегодня, к сожалению, констатировать, что с этой проблемой мы остались один на один, поэтому мы просим ВОЗ, мировое сообщество объединить усилия и помочь Республике в ликвидации медицинских последствий аварии на Чернобьmьской атомной

электростанции. В этой ситуации наибольшее значение имеет формирование государственной политики в области охраны здоровья как приоритетного направления социально-экономического развития, а также более рациональное использование и повышение эффективности инвестиций в здравоохранение. Мы на государственном уровне осуществили ряд важных мероприятий по

укреплению охраны здоровья, предусмотрено нормативное выделение доли внутреннего валового продукта для расходов на здравоохранение, принят закон Республики Беларусь о государственных минимальных социальных стандартах, определяющий социальные гарантии для населения, включая систему здравоохранения. Припята и реализуется государственная программа "Здоровье народа", которая регламентирует комплекс государственных межведомственных профилактических мер по укреплению здоровья белорусского народа с уделеннем основного внимания формированию здорового образа жизни. Приняты и реализуются целевые комплексные программы по социально значимым заболеваниям. Также припята государственная программа по укреплению материально-технической базы

здравоохранения, внедрена оперативная система управления отраслью по моделям конечных результатов, а также система управления качеством медицинской помощи. Основным механизмом реализации мер по реструктуризации медицинской помощи является изменение порядка финансирования, т.е. переход к нормативам бюджетной обеспеченности расходов на

здравоохранение на одного жителя, система договоров на предоставление определенного объема услуг под установленный объем финансирования, а также предоставление экономической самостоятельности учреждениям здравоохранения в использовании ресурсов. Все вышеуказанные меры в комплексе обеспечивают усиление государственного регулирования и социальных гарантий в области охраны здоровья населения. A53NR/5 page 98

Мы полагаем, что государственная бюджетная система здравоохранения позволяет обеспечить социальную справедливость, равенство и доступность получения населением необходимой медицинской помощи. Следуя по пути масштабных перемен, наша страна должна улучшить свои показатели здоровья и приблизиться к уровню развитых стран. На этом этапе Всемирная организации здравоохранения могла бы существенно повлиять на направление хода перемен, предостеречь от неизбежных ошибок, предоставляя анализ и оценки решений по важнейшим проблемам, одной из которых является улучшение деятельности систем здравоохранения. Благодарю за внимание.

Le PRESIDENT :

Je donne la parole au delegue des Iles Salomon qui parlera au nom de Fidji, des Iles Cook, des Iles Marshall, de Kiribati, des Etats federes de Micronesie, de Nauru, de Nioue, des Palaos, de la Papouasie-Nouvelle-Guinee, de Samoa, des Tonga, de Tuvalu, de Vanuatu et au nom de son pays.

Dr AUMANU (Solomon Islands):

Mr President, Madam Director-General, all distinguished delegates of the Fifty-third World Health AssemЬly, ladies and gentlemen, it gives me pleasure and honour to deliver this statement on behalf ofthe following small island States ofthe Westem Pacific, namely, Cook Islands, Fiji, Kiribati, Marshall Islands, Micronesia, Nauru, Niue, Palau, Papua New Guinea, Samoa, Solomon Islands, Tonga, Tuvalu and V anuatu. 1 would like to give а brief overview of the cuпent health status of the Pacific, the developments in the last five years, then our commitments to and challenges facing our health systems in the twenty-first century. The major extemal factors that affect the effectiveness of health service delivery on the islands are: demographic pattems, geography, and lower socioeconomic status of the people. Environmental, political and infrastructural factors are increasingly becoming а major concem. А young, growing population of up to 15 years of age characterizes the general health status of the Pacific islands. Women, children and other vulneraЬle groups continue to Ье the recipients ofthe health services. The islands have diverse population groups, and because of this there is diversity and complexity of health needs in the different social backgrounds. As such, interpretation of health needs varies, and calls for selective and strategic planning and resource distribution. The key health proЬlems are infectious diseases, like vector-bome malaria, dengue, acute viral and respiratory infections, matemal health proЬlems, tuberculosis, and small pockets of malnutrition. NoncommunicaЬle diseases are on the rise, with diabetes and mitotic and cardiovascular diseases showing an alarmingly upward prevalence. Our changes in diet and dietary haЬits and tobacco abuse are known attributing factors. The most significant and depressing experience in the last 1О years is the increasing number of people with НIV infection in the Pacific rim. The number seems low now, but the significance and impact is а threat to the Pacific's small population, with its limited resources. None the less, there are marginal but significant improvements of the health indices across the Member States at varying rates. There is some decline of matemal and infant mortality rates, and modest improvements in the fertility rate and life expectancy at Ьirth rate. Health developments in the last five years have given us experience and encouragement. Nearly all Pacific islands now have their national health policies and development plans. Their vision is to provide а better environment to foster productivity, happiness, healthy people and reduction of poverty. The future health directions focus on new horizons in health. The underpinning concept is that which was agreed upon in the Yanuca Island Declaration, namely the "healthy islands" concept. Subsequent meetings on the concept were held in Rarotonga and Palau. Health programmes are aimed at achieving goals through the cooperation of all stakeholders: our intemational development partners, churches, civil society and most importantly, the local communities. In relation to health systems, puЬlic sector reform is the agenda of the times. As part of this reform process, the health sector must also review and restructure its organizational structure and functions to refocus its efforts to Ье responsive to the people's need. A53NR/5 page 99

The ТоЬассо Free lnitiative is operational and supported. Pacific countries are continuously drafting and enforcing legislation to govem tobacco promotion and abuse, most notaЬly in women and younger age groups. Health promotion has been acknowledged as the way forward, and one of the priority policy issues within the region. ln short, our commitment is twofold: first, to improve national health outcomes, particularly health of mothers and children, and those disadvantaged because of their geographical remoteness. Secondly, to continue to support and evaluate institutional strengthening within the health systems, for the purpose of managing the changes envisaged, and strengthen primary health care. We reaffirm our support, commitment and partnership to this huge Organization for world health. Мау God give the world good health.

Dr L. Amathila (Namibla), President, resumed the presidential chair. Le Dr L. Amathila (Namible), President de 1' AssemЬlee, reprend la presidence.

Professor ONGERI (Kenya):

President of the Fifty-third World Health AssemЫy, Director-General, distinguished delegates from Member States and other collaborating institutions, ladies and gentlemen, on behalf of the Kenya delegation, 1 would like to congratulate you, Madam, on your election as President of the Fifty-third World Health AssemЫy, together with your very аЫе team of Vice-Presidents and the other officials who have been elected to lead the deliberations ofthe current World Health AssemЫy. We would also like to take this opportunity to register our sincere appreciation for the excellent work Dr Gro Harlem Brundtland, the Director-General, is doing with regard to finding solutions to major health proЫems facing countries. For instance, WHO's direct involvement, together with the rest of the intemational community, in supporting the meeting on malaria which was held recently in Abuja, Nigeria, raised the hopes of many of us in sub-Saharan Africa who are constantly faced with this endemic proЫem. The fact that the Director-General attended the meeting in person is а clear indication and testimony of her concem in forging global partnerships through the intemational community with а view to finding а lasting solution to the enormous medical and economic proЫems caused Ьу malaria. lt is our hope that this being the first meeting this century many technical and priority health matters listed in the provisional agenda of this AssemЬly will receive adequate funding and policy support in the years that lie ahead of us. Before 1 share the progress Kenya has made in some of the priority areas listed on the provisional agenda for this AssemЫy, may 1 take this opportunity to underscore some of the challenges we have, which may inhiblt our determination and enthusiasm in achieving the health-for­ all goal. Despite the significant improvements in the health status of the world population in the twentieth century, as set out in the document entitled Health for all in the twenty-first century/ Kenya, like many other developing countries, has suffered from severe macroeconomic constraints in the last decade. These constraints have manifested themselves in а variety of ways, including insufficient funding for health activities, difficulties in achieving intersectoral action for health, and marginalization of the operations and maintenance budgets in favour of personnel emoluments. Thus, macroeconomic constraints, coupled with а high incidence and prevalence of poverty, have over the years undermined our good intentions to finance fully some of the health priorities that we have in the past agreed upon to support in this AssemЫy. Another source of concem to us in Kenya is the high burden of disease, against а background of meagre resources to combat its various consequences. Мау 1 now tum to the provisional agenda for this Assembly. Drawing on our previous reports and submissions in this Assembly, 1 will confine my brief comments to the progress Kenya has made so far in the past one year on some of the items listed on the agenda. With regard to the Stop Tuberculosis lnitiative, Kenya fully endorses the outcome of the ministerial conference on tuberculosis and sustainable development which was held in Amsterdam in March 2000. Мау 1 assure

1 Document EBIOI/8. A53NR/5 page 100 this AssemЬly that we are fully committed to the imp1ementation of the Amsterdam Declaration. ln the context of the ongoing reforms in the health sector, our strategies for containing the spread of tuberculosis include minimizing diagnostic delays, strengthening diagnostic procedures at all levels, improving treatment compliance Ьу using short-course chemotherapy, strengthening specialized training in tuberculosis, as well as intensifying operational research activities, including surveillance. With regard to HIV/AIDS, which has been declared а national disaster, the Government of Kenya through an Act ofParliament has estaЬlished the National AIDS Council to coordinate and oversee the implementation of НIV1 AIDS activities in all sectors. Мау 1 emphasize the fact that the establishment of the National AIDS Council is consistent with the United Nations Economic and Social Council resolution 1999/36. With regard to the progress Kenya has made in the area of the WHO framework convention on tobacco control, 1 am happy to report that my Ministry has drafted and forwarded the ТоЬассо Control Bill to the Attorney-General for debate and enactment in parliament to become law. This is an ongoing process. ln connection with the progress made Ьу Kenya in strengthening its health system, may 1 mention that we are implementing а number of reform measures in the health sector. Kenya is restructuring the basic institutional aпangements to make them respond to the reform agenda which aims at improving the provision of health services. We are also undertaking а review of the existing health legislation to make it more responsive to our level. These reform measures are being pursued within the broad aims ofKeJ)ya's health policies which are to promote equity, enhance efficiency and improve the health status of the population. Finally, looking at the provisional agenda, it is obvious that we are dealing with broad and diverse issues. Similarly, as we seek solutions to these proЬlems, we need to broaden our strategies to include forging greater regional and international cooperation, and developing joint action against poverty and poor economic performance, among others. lt is through such collaborative effort, regardless of our country's level of socioeconomic development, that we сап make а real difference in the standard of living of our people at national, regional and internationallevels.

Mr RI Chol (Democratic People's RepuЬlic ofKorea):

Madam President, distinguished delegates, allow me, first of all, to congratulate you and other officers on your election as President and Vice-Presidents of the present AssemЬly. 1 would like to thank Dr Gro Harlem Brundtland, Director-General, for her presentation of а thought-provoking report which has presented а number of issues important for improving health systems .in the world. The delegation of the Democratic People's RepuЬlic of Korea recognizes that the report of the Director­ General is of great importance in that it reflects real proЬlems arising in the implementation of the goals and objectives of health for all in accordance with the present requirements at the beginning of the new millennium. lt is therefore necessary to рау deep attention, on the basis of the report of the Director-General, to finding realistic ways and means to соре with challenges in the process of developing health systems in the world and to estaЬlish health systems suitaЬle for the actual conditions of individual countries. ln this context, my delegation considers it important for WHO to further enhance its role and function as а directing and coordinating agency for world health and to cooperate closely with Member States. And it is also equally important to guard against the tendency of commercializing health work and to give priority to estaЬlishment of а health system in which State and legal control would Ье tightened in order to ensure health for all the people. Health is а prerequisite for human development and security, and it is impossiЬle to expect socioeconomic development without development ofthe health system. ln this sense, the primary health care system still remains а priority in individual countries, especially in developing countries. Му Government, whose supreme principle in its activities is to steadily improve the welfare of the people, has given priority to improving its primary health care system, embodying the Juche-oriented health policy so as to meet actual requirements. Since 1988 my Government has transformed the section-doctor system into а household-doctor system, under which а doctor should Ье absolutely accountaЬle for the health of given families, thus enaЬling the State to A53NR/5 page 101 fu1fil its ro1e and function to 1ook after its реор1е in every way. Му Goveшment will, in the future, too, adhere to its popular health policy whose advantages have been proved Ьу experience. Му delegation also holds that WHO and developed countries should рау due attention to providing deve1oping countries with financia1, materia1 and technica1 assistance, because it is impossiЬle for people to benefit from all the strategic plans and programmes to activate national hea1th systems without resources, even though they are properly estaЬlished. Мау 1 conc1ude my statement Ьу thanking WHO and other United Nations agencies, govemments of different countries and nongovemmental organizations for having provided my country with emergency assistance in the hea1th sector.

Le Dr MARQUES DE LIMA (Sao Tome-et-Principe):

Madame 1а Presidente, Madame 1а Directrice genera1e, illustres de1egues, Mesdames et Messieurs, au nom de !а de1egation de !а RepuЬlique democratique de Sao Tome-et-Principe et en mon nom propre, permettez-moi de vous feliciter, Madame !а Presidente, pour votre e1ection а 1а presidence de 1а Cinquante-Troisieme AssemЬlee mondia1e de !а Sante. Mes fe1icitations vont egalement aux Vice-Presidents de cette auguste AssemЬlee et а Mme !а Directrice genera1e de l'OMS pour l'excellent rapport qu'elle nous а presente sur !а situation de 1а sante dans 1е monde en 2000, dont 1е theme est: « Pour un systeme de sante p1us performant ». Се rapport traite d'un sujet d'actua1ite incontestaЬle dont 1'importance ne doit pas etre neg1igee. Cinquante ans apres !а creation de 1'0MS et l'adoption de sa Constitution, 1'augmentation de !а pauvrete dans p1usieurs pays du monde, particu1ierement dans 1es pays en developpement, et 1es millions de deces causes par des maladies telles que !е pa1udisme, 1е SIDA et 1а tuberculose sont des preuves evidentes que les systemes de sante de 1а plupart de nos pays ne sont pas encore en mesure d'accomplir 1es quatre fonctions vitales clairement definies dans 1е rapport, а savoir 1а prestation des services, !а production des ressources, 1е financement et 1'administration generale. Pour 1es differentes raisons susmentionnees, 1а question qui а ete posee est tout а fait 1ogique : que faut-il pour avoir un bon systeme de sante? 11 s'agit, sans 1'ombre d'un doute, d'une question appelant des reponses multip1es et comp1exes, se1on !е point de vue de 1а personne ainsi interpellee et aussi se1on 1е contexte social, economique et cu1turel du pays et de l'endroit ou elle se trouve. Les p1us pauvres repondront certainement qu'un bon systeme de sante serait celui qui permet d'acceder facilement aux soins de sante soit preventifs, soit curatifs et qui peut garantir 1' acces а 1' eau potaЬle et l'assainissement. Un bon systeme de sante serait ce1ui qui donne les informations necessaires pour adopter des comportements positifs vis-a-vis de 1а promotion de la sante. Le travai1 entrepris par 1'0MS en vue d'aider les Etats Membres а trouver des reponses adequates constitue un effort digne d' etre reconnu. Le succes du systeme de sante ne depend pas exc1usivement du montant du financement, bien que се soit 1а un e1ement important, particulierement dans les pays comme 1es nбtres, aux economies fragilisees, aux maigres ressources financieres et supportant en meme temps une lourde charge de dette exterieure. Le succes du systeme depend surtout de la capacite de gestion et de 1а fayon dont 1es gens sont appe1es а participer au processus de p1anification, de mise en oeuvre et d'eva1uation des interventions de sante. Ayant pris !е soin de faire reposer 1es recommandations sur des bases factuelles, et non pas seu1ement ideologiques, 1е rapport du Directeur genera1 nous apporte egalement des innovations qui contribuent а 1а c1arification et а 1а comprehension des objectifs du systeme de sante, et devient ainsi un precieux auxi1iaire d'eva1uation et d'amelioration de sa performance. Le soutien que ne cesse d'apporter 1'0MS, de concert avec nos pays, pour surmonter 1es difficu1tes et contribuer au Ьien-etre de nos populations se traduit par des strategies desormais c1airement definies dans се domaine aussi, се qui revient а augmenter encore 1es chances de succes de nos efforts communs. J'aimerais profiter de cette occasion pour remercier 1'0MS de 1'appui mu1tiforme qu'el\e foumit а Sao Tome-et-Principe depuis 1999, moment ou nous avons decide d'entamer un processus de reforme de notre systeme de sante. Apres que 1а po1itique nationa1e de sante eut ete definie au cours de l'annee demiere, tous 1es efforts sont maintenant concentres sur l'e1aboration du p1an nationa1 de A53NR/5 page 102 developpement sanitaire pour une periode de cinq ans ; nous escomptons que toute la documentation sera prete d'ici la fin de l'annee en cours. Dans le cadre de cette reforme, les obstacles sont analyses et etudies de fa<;on а trouver les moyens de les franchir. Les preoccupations majeures soulevees par le rapport du Directeur general sont et seront prises en consideration ; d'ailleurs, en guise d'exemple, le souci envers les plus pauvres se retrouve dans une des lignes de force du programme de notre Gouvemement, qui est justement ахе sur la lutte contre la pauvrete et l'exclusion sociale. Le Gouvemement de Sao Tome-et-Principe fera tout се qui est en son pouvoir pour assumer sa responsaЬilite d'ameliorer le systeme de sante, en tenant toujours compte de la pluralite des facteurs en jeu. Nous sommes persuades que, grace а notre determination а redresser la situation de la sante а Sao Tome-et-Principe et moyennant le soutien de l'OMS et d'autres partenaires du developpement, les resultats а venir iront dans le sens d'une meilleure sante et d'un plus grand Ьien-etre de la population du pays.

The PRESIDENT:

1 thank the delegate of Sao Tome and Principe. 1 now give the floor to the delegate of Liberia who is going to speak on behalf of GamЬia, Ghana, Nigeria, Sierra Leone, and his own country.

Dr COLEМAN (Liberia):

Madam President, honouraЬle ministers, Director-General, distinguished delegates, on behalf of the AssemЬly of Health Ministers of the West African Health Community, 1 wish to congratulate the President and the Vice-Presidents on their election to office and to express to you, Madam President, our full confidence in your distinguished leadership ofthe Fifty-third World Health AssemЬly. The health challenges of the countries of the West African subregion are similar and we have over the past 25 years tried to address them collectively. We continue to respond to the changing health needs of our people as а consequence of risk factors such as urban migration, changing population demography, and both intemal and extemal displacement ofpersons. ln our health policies, we remain focused on the basic health needs of our peoples, with the sole aim of improving the health indices of our countries. Therefore, our countries have formulated national strategies to tackle these challenges at affordaЬle cost. We continue to pursue community participation in planning and delivery ofhealth care services. Primary health care remains the centrepiece of the health care delivery services of Member countries, and our govemments are addressing the needs of the districts in terms of facilities and of logistic, technical and managerial support. We continue to share experiences and to leam from each other in order to achieve better health for the larger proportion of our populace with the shortest time possiЬle. W е lay emphasis on caring for vulneraЬle groups - women, children and the elderly - while improving accessiЬility and affordaЬility for the rural dwellers. Major endemic diseases such as malaria, poliomyelitis, guinea worm, and river Ьlindness continue to take their toll on the health of our people and they are being tackled vigorously. We commend the Roll Back Malaria initiative, in particular the African summit held recently in Abuja. We as а subregion pledge entire support for full implementation ofthe Abuja declaration. We wish to acknowledge and commend all our partners and collaborators (both govemmental and nongovemmental agencies) in our fight against communicaЬle diseases. The resurgence of preventaЬle epidemics such as cerebrospinal meningitis, tuberculosis, yellow fever and cholera continue to cause concem and challenge our disease surveillance and our preparedness for epidemics. Efforts are afoot towards subregional cooperation and collaboration in the management and control of these epidemics. The pandemic of НIV1 AIDS continues to have а devastating effect on the social fabric of our population and has the potential to deplete our future workforce of the young and the аЬlе. Member countries have intensified their campaign for prevention of the disease through changes in social haЬits while investing more in diagnosis ofthe infection and safer Ьlood transfusion. We are supporting these A53NR/5 page 103 efforts with political commitmeпt at the highest level iп our couпtries. We аге committed to iпstitutiпg measures to reduce stigmatizatioп апd to improve the lives ofthose liviпg with HIV/AIDS. Rapid urbaпizatioп апd chaпges iп lifestyle have iпcreased the risk of noncommunicaЬle ailments such as cardiovascular diseases, diabetes, mental disorders, road traffic accidents апd urbaп violeпce. We are uпdertakiпg commuпity awareпess programmes to prevent or limit these conditions. Industrializatioп brings iп its wake environmental degradatioп and pollution. We are trying to Ieam from the experiences of the older iпdustrialized nations оп how to institute measures to protect our enviroпment and preserve our greenery. This сап опlу Ье achieved though intersectoral cooperation, which would also guaraпtee potaЬie water апd good saпitatioп for our peoples. Our subregion has recently experienced the devastating effect of civil strife and wars оп the health of our people and our health care delivery system. Existing health facilities and infrastructures have been decimated апd health manpower depleted. Now that реасе has retumed to these countries, we are making efforts to rebuild the manpower and rehaЬilitate health iпfrastructure in the affected areas. We пееd the support ofthe iпtematioпal community апd well-meaning friends ofthe subregioп to support our efforts in strengthening traiпing institutioпs and upgrading the diagnostic facilities in health institutions, particularly iп Liberia and Sierra Leone. Human resource is quiпtessential to effective health care delivery services еvеп in the twenty­ first century. Over the past half а century, countries ofthe West African subregion have iпvested iп the trainiпg of doctors, nurses, pharmacists and other allied health workers. In the past 25 years, the West African Health Community, through its specialized agencies, has trained а large пumber of postgraduate and postbasic health personnel. However, we still lack many of these today as betweeп 40% and 60% of the products of our traiпing iпstitutioпs have been attracted to the richer ecoпomies of the North, the Middle East and, lately, the southem hemisphere. While we do not thiпk it appropriate to ask for reparation at this time, we believe that the beneficiary couпtries should support our training efforts through grants, supply of leamiпg materials and equipmeпt, and award of fellowships so that we сап continue to produce more to fill the vacuum left Ьу those in their service. Health is wealth iпasmuch as wealth is dependeпt оп health. There canпot Ье ecoпomic growth ifthe population is iпfirm and incapacitated Ьу perennial ill-health. While we agree that our ecoпomies require restructuring to make them more productive апd have poteпtial for coпsisteпt growth, this should not Ье at the expense of а healthy populatioп. We would like to use this forum to appeal to the major fiпancial iпstitutioпs - World Bank апd Intematioпal Monetary Fund - to eпsure that their prescriptions for our economies support and encourage increased accessiЬility and affordaЬility of health services to our peoples, especially the vulneraЬie women and children апd the deprived rural dwellers. In this regard, we commend the intematioпal community for the heavily iпdebted poor countries iпitiative оп debt relief. We hope this will Ье expaпded to include other poor couпtries iп our subregion as soon as possiЬle. When implemented, we assure you that the dividends will Ье invested in health and other social services. Some of our couпtries have adopted the sector-wide approach in the development oftheir health services. The advantage of this iпnovative approach to health care development has not yet Ьееп fully realized, as both we and our partпers remain locked iп the mentality of the old parallel programmes. We continue to use the old yardsticks iп assessing needs and executiпg plans under this new system. There is а need for coпtiпuous dialogue and fine-tuniпg iп order to ensure that the benefits of this new approach are felt Ьу the population it was meaпt to serve. We would also like to thank all govemments, govemmental agencies, intergovemmeпtal agencies and nongovemmental development agencies which have supported апd are contiпuiпg to support our health care delivery programmes and services. We are very appreciative of their efforts, but we would Ье happier if all graпts апd donatioпs are disclosed for coordinatioп Ьу the appropriate govemmeпtal ageпcies of our countries. As the saying goes, diseases know по geographical boundaries. We, the Member countries of the West African Health Commuпity, are interspersed among our fraпcophoпe neighbours. The lack of а forum for direct commuпication оп health matters has hampered our efforts at disease surveillance and coпtrol. We are happy to anпounce that after mапу years of discussioп, the Member couпtries of the Economic Commuпity of West African States have established а single health commuпity Ьу the merger ofthe West African Health Community and Organisation de Coordination et de Cooperation A53NR/5 page 104 pour la Lutte contre les Grandes Endemies with headquarters in Bobo-Dioulasso, Burkina Faso. Once fully operational, we expect that the activities of this new organization would complement rather than compete with the activities of WHO in our subregion. We in the West African Health Community and indeed the West African Health Organization have full confidence in WHO and wish the Organization success in the years ahead.

М. DАМА УЕ (Tchad) :

Madame le President, je profite de l'occasion pour joindre ma voix а celle de ceux qui m'ont precede pour vous adresser mes vives felicitations pour votre brillante election а la tete de cette auguste Assemblee. Je vous souhaite plein succes dans la conduite de nos travaux. Madame le President, Mesdames, Messieurs, il est fort rejouissant pour nous de constater que le systeme de sante interesse au plus haut point les responsaЬles de notre Organisation, car c'est de sa fonctionnalite et de sa viabilite que depend la qualite de la prestation des soins aux populations, facteurs essentiels de la reduction de la mortalite et de la morbldite observees dans la plupart de nos pays. Aussi apprecions-nous avec un interet particulier les differents proЬlemes lies au systeme de sante souleves par Mme le Directeur general dans son rapport sur la sante dans le monde en 2000. Mon pays, le Tchad, а commence la reorganisation de son systeme de sante des 1990. Une des preoccupations majeures du.Ministere de la Sante publique etait d'offrir а toutes les populations des soins de base de qualite et de rapprocher le plus possiЬle des beneficiaires les services de soins. C'est ainsi qu'une declaration de la politique nationale de sante а ete faite, qu'une profonde structuration а ete operee selon le scenario de developpement sanitaire de l'OMS а trois niveaux, et qu'une douzaine d' orientations strategiques ont ete definies en termes de priorites et presentees aux partenaires au developpement sanitaire lors de la reunion sectorielle de la sante en mars 1999. Le systeme est renforce а tous les niveaux. Cependant, l'insuffisance des ressources, notamment des ressources humaines, а gravement entrave sa performance. Aussi, il me plait de dire qu'en termes d'equite, de solidarite et de couverture sanitaire du pays, nous avons mis en place un partenariat auquel participent tous les acteurs de la sante : les communautes par l'entremise de l'initiative de Bamako, les institutions etatiques et les organisations non gouvemementales. Mais се partenariat est presque informel et les mandats des intervenants n'etaient pas clairement definis. C'est pourquoi il nous а semЬle bon de mettre en place un cadre de concertation, d'information, d'orientation et d'encadrement des acteurs qui aboutit а un contrat d'intervention appele « contractualisation ». Au cours de la negociation de la contractualisation, chacun definit ses prerogatives par rapport а celles des autres. Le Ministere de la Sante se rejouit de la fac;on dont se deroule cette operation sur le terrain et souhaite que cela se passe aussi Ьien dans les autres Etats Membres de l'OMS. Concemant les maladies transmissiЬles, il у а lieu de noter qu' elles constituent un lourd fardeau pour les pays les moins avances. Le Tchad, mon pays, vient d'etre durement frappe par une epidemie de meningite. Il s'en est sorti grace а la mobllisation sans faille des communautes locales, des pays amis et des organisations intemationales. Le soutien de l'OMS а ete ferme et sans reserve, се qui lui а permis de juguler sans delai cette epidemie. Je voudrais, au nom du Gouvemement de la RepuЬlique du Tchad, temoigner notre profonde gratitude а tous ceux qui nous ont soutenus dans cette lutte contre l'epidemie. Il est triste de constater que certaines maladies, comme le paludisme, la tuberculose et le VIНISIDA, continuent de peser lourdement sur nos Etats. Elles font tous les jours de nombreuses victimes, surtout parmi les enfants et les adultes jeunes, et pourtant les moyens de les combattre existent. C'est pourquoi nous insistons aupres de l'OMS et de la communaute intemationale pour qu'une action immediate et concertee soit entreprise en faveur des pays africains en general et de mon pays en particulier. En се qui conceme la lutte contre les maladies endemiques et epidemiques, je voudrais souligner que, dans le cadre de la Communaute des Etats sahelo-sahariens, dont mon pays а l'honneur d'assurer la presidence, nous avons un programme de concertation et des projets avec la Jamahiriya arabe libyenne, le Niger, le Soudan, le Mali, le Burkina Faso, la Gamble et l'Erythree. Nous notons A53NR/5 page 105

egalement avec satisfaction les progres accomplis dans le processus d'eradication de la poliomyelite du globe terrestre. Pour finir, je voudrais presenter mes compliments а Mme le Dr Gro Harlem Brundtland, Directeur general de l'OMS. Qu'elle trouve ici l'expression de notre profonde gratitude pour les efforts soutenus qu'elle ne cesse de deployer afin de resoudre les proЬlemes de sante dans la Region africaine en general et au Tchad en particulier, et aussi pour l'impulsion qu'elle а su donner а notre Organisation depuis sa brillante election а la direction generale.

Dr RYS (Poland):

Madam President, Madam Director-General, distinguished delegates, for years our country has been experiencing improvements in some key areas of puЬlic health. One example is а continuous decrease in the infant mortality achieved mainly Ьу improving matemal care. Another is reduction of many communicaЬle diseases, mainly achieved Ьу the successful programme of vaccinations and wide access to antiblotics. However, some infectious diseases still remain а proЬlem. For example, hepatitis В has а decreasing but still high incidence rate, and HIV infection, although less prevalent than in many countries of the world, is not controlled enough Ьу sufficient tools to prevent the spread of the disease. The successes in controlling infectious diseases and reducing infant mortality resulted, at the beginning of the decade of the 1970s, in а life expectancy in Poland similar to that observed in countries with an estaЬlished market economy. Later in the decade of the 1970s and in the 1980s, growing mortality due to cardiovascular disease and cancer contributed to the appearance of the life­ expectancy gap. In the last decade Poland went through major transition in its political and economic system. Present efforts of the Polish strategy for health are well in accordance with Target No. 1 of the WHO strategy, Health for All 21, which is to decrease the existing life-expectancy gap between the countries. NoncommunicaЬle diseases, which are the major proЬlem in Poland, are preventaЬle Ьу intervention on risk factors and Ьу modification of the lifestyle. There is an estimation that only one factor - smoking - contributes to 50% of the life-expectancy gap between Poland and countries with an estaЬlished market economy. The antismoking campaign is а focus of the Polish Govemment. The most important means of intervention was introduction of а law putting special taxation on tobacco products and limitations, followed Ьу а ban, on tobacco advertising. Signs of а decrease in smoking rates in Poland, which have already been observed, prove that it is not "Ьу chance" that Poland is hosting the Second European Ministerial Conference on ТоЬассо or Health ofthe European Region. At the time of undergoing socioeconomic transition, we observed also а significant decrease in alcohol consumption and а change of the style of alcohol consumption for less hazardous types. We are looking forward to seeing the effect on the accident and violence rates. After two decades of increase in mortality due to cardiovascular disease, the trend was reversed in 1992. The coincidence with political and economic transformation is evident. However, the direct causes are still not fully understood. We would like to strengthen the favouraЬle trend Ьу active intervention on known risk factors of cardiovascular disease. The Polish health care system has been attempting to assure equity of access to health services of all citizens, no matter such characteristics as sex, ethnicity, level of disabllity, etc. However, it appears that it is poorly educated men who contributed most to the life-expectancy gap. Some unfavouraЬle aspects of economic transition, such as appearance of unemployment and а within­ country gap in living standards between the social groups and geographical regions, require more focus on observation ofthe socioeconomic factors and conditions which contribute to poor health. We do hope that understanding the effect of social factors would facilitate health policy planning to create а more solid basis to strengthen the decline of noncommunicaЬle diseases. The increasing life expectancy experienced in our country for the past six years requires more focus on proЬlems which are typical of old age. We are happy to find also the appropriate targets in the strategy Health for All21. Representing the Polish Govemment, 1 would like to echo the words of the Director-General, Dr Brundtland, that health is now at the heart of the development agenda. Reform of the health care A53NR/5 page 106 system is one ofthe four key reforms undertaken Ьу the present Government ofthe Polish RepuЬlic. ln the past Poland experienced great international solidarity and humanitarian aid from other countries and international organizations. We would like to thank again warmly all those who contributed. Today we are joining countries which provide help to others in major disasters. We would like to continue this service wherever we are аЬlе to Ье helpful. Our country is ready to collaborate with WНО. We are ready to provide help and expertise in many areas in which our country has been successful. We are also looking forward to participating in the attempts to create а global strategy to fight noncommunicaЬle diseases, which remain the major health proЬlem in our country.

Mr ABDULLAH (Maldives):

Madam President, Director-General Dr Brundtland, distinguished delegates, ladies and gentlemen, while congratulating you, Madam President, on your election, 1 wish to commend the initiative of the Director-General, Dr Brundtland, to reform WHO in response to the needs of the new century. 1 also wish to thank our Regional Director, for his valuaЬle support and guidance. Unprecedented advances have been made during the past century, ensuring а healthier and happier human civilization. We have won many battles against diseases. Humanity has never enjoyed better health, as а result of our technological advancement and socioeconomic strides. У et, we cannot Ье complacent and rest on our laurels. There are many new proЬlems; alarming health challenges face us. Widespread poverty, а polluted environment, the global emergence of AIDS, resistance of microorganisms to antiЬiotics, а more virulent form of malaria, the increasing use of tobacco, an explosive situation of noncommunicaЬle diseases, and an ageing population are but а few that call for holistic new action in the face of dwindling resources. At the dawn of а new century and а new millennium, we share а great responsibility to ensure а healthier life for future generations. The time is now ripe to resolve our total commitment for addressing these proЬlems urgently and effectively. Reforming and strengthening our health systems must remain our top priority in order to succeed in this Herculean task. 1 warmly congratulate Dr Brundtland for her landmark reform initiatives and for placing on our agenda the crucial issue of strengthening health systems for better performance. Health is а fundamental human right. lt is our responsibllity to provide the best of it to our people. We must strive to design and implement а sustainaЬle health system that ensures equitaЬle, accessiЬle, and affordaЬle health care to all. On one side, health budgets are skyrocketing, while on the other, health care is becoming increasingly unaffordaЬle and inaccessiЬle to а larger majority of people. Medical care and pharmaceuticals have become overcommercialized. This inequity and gap can Ье mainly bridged through better planning, organization and performance of the health systems in our countries. Resource management and economics, as well as capacity-building, are crucial. The present initiative will hopefully lead to а historic breakthrough, which will help WHO to launch а long-range strategy to strengthen global health systems. Efficient organization and management of the health systems are vital in this process. Therefore, 1 would hope that there could Ье а regular WHO mechanism for developing the human resources vital for health sector planning and management. Reviewing educationallevel and curricula of the medical and health professions to make them more relevant and responsive to changing needs also requires our attention. Regular WHO monitoring and assessment of the performance of health systems is also essential. Guided Ьу the visionary leadership of President Maumoon Abdul Gayoom, we in the Maldives are also in the process of reforming the health system with the support and guidance of WHO, aiming for sustainabllity. We have embraced а community multisectoral approach involving nongovernmental oragnizations, with emphasis on prevention and cost sharing. Health education, healthy settings, and inculcating healthy behaviour are key policy elements. We are currently implementing а 10-year health master plan, and have launched Maldives' "Vision 2020" on the same basis. 1 am happy to say that these strategies and policies are reaping fruit. Tobacco-related diseases have become а major source of mortality and morbldity. Therefore, while endorsing WHO's framework convention 1 hope it will become an effective tool to save our children, women and men from this killer epidemic. We introduced no-tobacco legislation in the Maldives in 1953, but at the time it was premature, and did not work. But with the passage oftime and A53NR/5 page 107 people becomiпg more health coпscious day Ьу day, those practical legislative апd other coпtrol measures are поw workiпg. These iпclude Ьаппiпg smokiпg iп public places, Ьаппiпg all forms of advertisiпg, iпcreasiпg taxatioп оп tobacco, declariпg two voluпtary islaпds as по-tоЬассо islaпds, апd iпtroduciпg по-tоЬассо homes. 1 siпcerely hope that the deliberatioпs here will shed light оп пеw апd pragmatic approaches, recommeпdatioпs апd activities that will provide пеw directioп апd motivatioп for reformiпg апd streпgtheпiпg health systems iп order to achieve better performaпce апd sustaiпaЬility. 1 саппоt but give my wholehearted support to this most importaпt ageпda of WHO. We leaders iп health сап make it work Ьу joiпiпg haпds with our perseveriпg Director-Geпeral. The highest level of political will is also critical поw. 1 wish the Director-Geпeral апd our colleagues every success iп this great task of shapiпg а healthier world iп the tweпty-first ceпtury.

La Dra. OSORIO (Veпezuela):

Sefiora Presideпta de la AsamЬlea, sefiora Directora Geпeral, Miпistros, Miпistras, distiпguidos delegados у delegadas: Еп primer 1ugar deseo felicitar а la sefiora Presideпta por su elecci6п у maпifestarle 1а satisfacci6п у orgullo de пosotras, las mujeres, por su пombramieпto. Veпezuela, а partir de la gesti6п del Presideпte Hugo Chavez Frias hace 15 meses, ha iпiciado uп proceso de coпtraпeforma еп пuestro sistema saпitario, que tieпe por Norte el Ьieпestar colectivo у la prestaci6п de servicios de salud, bajo los priпcipios de iпtegralidad, equidad, uпiversalidad у eficieпcia, proceso doпde lo mas importaпte, despues de la geпte, sоп los programas de salud. Podemos expresar соп orgullo que еп este momeпto пuestro pais cueпta соп uпа пueva Coпstituci6п, lograda а traves de uп proceso coпstituyeпte que еп su prefacio dice asi: «El Estado tieпe como sus fiпes eseпciales la defeпsa у е1 desaпollo de la persoпa у el respeto а su digпidad, el ejercicio democratico de la voluпtad popular, la construcci6n de uпа sociedad justa у amante de la paz, la promoci6n de la prosperidad у Ьienestar del pueЬlo». Es asi como en nuestro proceso de reforma estamos fortaleciendo la salud puЬlica у nos estamos eпfreпtaпdo а la coпiente пeoliberal que уа en mi pais, Venezuela, haЬia aprobado еп 1998 leyes que nos conduciaп directamente al mercantilismo у а la profundizaci6n de 1а inequidad еп los servicios sanitarios, so pretexto de superar el eпorme deterioro que el sector publico de la salud sufri6 en las ultimas dos decadas. En пuestra Constituci6n Bolivariaпa se estaЬlece que la salud es uп derecho social у el Estado su garante. Ademas, incorpora la participaci6n comunitaria у el contro1 social en la planificaci6n, gesti6n у evaluaci6п, el fiпanciamiento publico de la salud у la integraci6n con la seguridad social, mandatos constitucioпales que siп duda nos plaпtean una serie de retos. Durante este ultimo afio hemos avaпzado еп el rescate de la fuпci6n publica у del ejercicio de la rectoria а traves de la conformaci6п de uп пuevo Ministerio de Salud у Desaпollo Social, que nos permite enfocar las interveпciones sanitarias en una пueva dimensi6n que incorpora lo social. lgualmente, estamos avanzando еп la creaci6n de uп sistema intergubemamental de salud con responsaЬilidades compartidas entre lo nacional, lo estatal у lo muпicipal. Еп materia de prestaci6n de servicios у en coпcordancia con la importancia de avanzar en la mejora del desempefio еп el sistema de salud, nuestro pais esta desaпollando е implantaпdo un modelo de atenci6п iпtegral en toda nuestra red ambulatoria, que privilegia las accioпes preventivas у de fomento de la salud у que supera la fragmentaci6п que tradicionalmeпte existia еп los servicios у que definitivamente mejora el acceso de la роЬlасi6п а la prestaci6n de servicios de salud integrales у de calidad. Apoyamos las iniciativas que contribuyeп а elevar la eficieпcia para la equidad, у que combateп la excesiva burocracia у la corrupci6n de los sistemas de salud. Еп Venezuela recientemeпte eпtr6 en vigencia la ley organica de protecci6n al пifio у al adolescente, ordenamiento juridico que estaЬlece el iпteres superior de nifios у nifias, asi como su prioridad absoluta еп todas las intervenciones del Estado. Esta ley ha sido coпsiderada por el UNICEF un instrumento de avanzada, que otros paises pudieraп considerar. Es en este sentido que пuestra gesti6n ha decidido estaЬlecer como meta prioritaria la reducci6п de la mortalidad infantil у matema, mediante accioпes intersectoriales, el relanzamieпto de la lactancia matema у el modelo de atenci6n integral en los servicios de salud. A53NR/5 page 108

La 1ucha contra е1 VIН/SIDA en nuestro pafs incorpora desde este afio una acci6n decidida а reducir la transmisi6n vertical, mediante el despistaje rutinario del VIH en Jas consultas prenatales у el tratamiento antirretroviral а Jas mujeres embarazadas у madres seropositivas. En Ja lucha contra el paludismo hemos reorientado Ja estrategia de combate contra esta endemia, centrando nuestras acciones en el fortalecimiento de los equipos Jocales de salud у el entrenamiento de las comunidades en la detecci6n, diagn6stico у tratamiento precoz del paludismo, у menos utilizaci6n de fumigaciones. Con este camЬio de estrategia, hemos logrado reducir Ja incidencia de esta endemia en un 25% en el ultimo afio. Sefiora Presidenta, no quiero terminar sin antes expresar el profundo agradecimiento en nombre de mi GoЬiemo у de todo el pueЬio venezolano por Ias manifestaciones de solidaridad у la ayuda humanitaria prestadas por una enorme cantidad de pafses de todo el mundo у de organismos intemacionales, ante las inundaciones у deslaves que enlutaron tпigicamente а Venezuela en diciembre de 1999. Muchas gracias.

Mr IВRAHIM (Sudan):

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Dr НABTEMARIAM (Ethiopia):

Madam President, 1 should like to join others in congratulating you on your election and thank you for giving me this opportunity to make а brief intervention. 1 would like to start Ьу thanking and commending the Director-General, Dr Brundtland, for her comprehensive report, and visionary and efficient guidance of this important institution. 1 am confident that with this management we will Ье аЬlе to take steps forward in achieving better health for our people. Ethiopia shoulders an unacceptaЬly high burden of morЬidity and mortality; recognition of this unacceptaЬle health status led to а critical examination of the nature, severity, magnitude and root causes of prevailing health probiems. This was followed Ьу formulation of the health sector development programme that has а 20-year perspective, and of а five-year rolling development plan. Му country firmly believes that the sector-wide approach is the right one to solving the complex health proЬlems that are prevalent. The health sector development programme was initiated Ьу bringing together all the major stakeholders, including the federal and regional governments, administrative councils, international and Ьilateral bodies and, to а lesser extent, the private sector in examination of the proЬlems, development of plans, implementation of programmes, and monitoring outputs and outcomes. This sector-wide health development programme has helped us remove the inefficiencies associated with inequitaЬle urban-Ьiased health services and vertical projects. The new initiative emphasizes priority on rural population, preventive services, and the provision of essential basic health services, with appropriate emphasis on gender equity. These objectives are realized through aid programme components. Those include improvement of service delivery and quality of care; rehaЬilitation of health facilities; expansion of access and coverage; development of appropriate type of human resources; strengthening of the pharmaceutical services, including ensuring the availaЬility of essential drugs in а sustainaЬle manner; launching of innovative strategies for information, education and communication; ensuring good management and а health information system; and development of appropriate mechanisms and indicators for monitoring and evaluating the changes. The last component is а critical assessment of the need for а sustainaЬle health care financing mechanism that includes the exploration of prepayment, health insurance, а revolving drug fund and а review of user charges. lmplementation of our health sector development programme in Ethiopia is now in its third year. During this period, useful experiences have been gained with regard to coordination, support and implementation at all critical levels of federal structures. While this experience has prepared us for better implementation in the future, some very important arguments have also been recorded in terms of expanding access, developing standards and guidelines, and human resources, and especially giving priority attention to important health programmes. Among these important programmes, malaria, HIV1 AIDS, tuberculosis, poliomyelitis eradication, reproductive health, including maternal and child health, immunization, control of important communicaЬle diseases, and cross-border health development may Ье singled out. The Roll Back Malaria initiative is well under way, with the aim of reducing the burden of malaria through symptom surveillance, early detection and containment of epidemics, human resources development, operational studies, integration of the programme within health sector activities, community involvement and provisional resources. We recently estaЬlished the National AIDS Council under the chairmanship of the President of Ethiopia, Dr Negasso Gidada, that reflects the multisectoral nature ofthe infection and addresses the control strategy. Tuberculosis, poliomyelitis eradication, control of onchocerciasis and guinea worm are given due emphasis. ln conclusion 1 would like to reiterate that Ethiopia is striving to increase access to health care, integrate services with appropriate emphasis on important health programmes, with а high level of decentralization and democratization. ln view of the high burden of morЬidity and mortality, the need for resources is immense. This is further exacerbated Ьу recent drought and famine. We would therefore draw attention to the situation and request WНО, international institutions, and all other partners to соте forward with the necessary resources to assist the people of Ethiopia to enjoy health in the not very far future. A53NR/5 page 110

М. LAKOE (RepuЬlique centrafricaine) :

Madame la Presidente de la Cinquante-Troisieme AssemЬlee mondiale de la Sante, Madame la Directrice generale de l'OMS, honoraЬles delegues et invites, Mesdames et Messieurs, la presente declaration ne s'inscrit pas en dehors de la ligne globale tracee par le Mali au nom de tous les Etats de la zone franc, mais il s'agit, pour la delegation centrafricaine que je conduis, de revenir sur certains points specifiques а la RepuЬlique centrafricaine qui meritent une attention particuliere. La delegation centrafricaine felicite la Directrice generale de l'OMS pour la bonne qualite du rapport produit et la profondeur du discours tres inspirateur qu'elle а prononce а l'ouverture des presentes assises. Les autorites centrafricaines louent particulierement les efforts que deploie le Dr Gro Harlem Brundtland, Directrice generale de l'OMS, qui, depuis sa prise de fonction, а place l' Afrique au centre de ses preoccupations. Les multiples initiatives en cours, comme le projet Faire reculer le paludisme, l'initiative Halte а la tuberculose, l' Alliance mondiale pour les vaccins et la vaccination, l'initiative Pour un monde sans tabac, le renforcement de la lutte contre le SIDA, l'accroissement de l'allocation extrabudgetaire en faveur de la Region africaine et la promotion de la matemite sans risque, representent autant de preuves de cette volonte affichee d'aider le continent africain, berceau historique de l 'humanite et, malheureusement, berceau actuel de toutes les souffrances humaines а cause du fardeau de la maladie et de la pauvrete. Madame la Presidente, je voudrais attirer votre attention, ainsi que celle de l'opinion intemationale, sur la situation sanitaire de la Republique centrafricaine. En effet, cette situation est caracterisee surtout par une montee en puissance de l'epidemie de SIDA, avec un taux moyen d'occupation des lits dans un des hбpitaux centraux de la capitale de 65,7% sur trois ans (1996-1998) et des taux de seropositivite chez les femmes enceintes qui sont passes d'environ 12 а 50% entre 1997 et 1999. Des chiffres aussi inquietants ont ete observes dans les autres categories de sujets soumis а la surveillance. 11 s'agit des malades de la tuberculose, des sujets souffrant de maladies sexuellement transmissiЬles et des donneurs henevoles de sang. Face а се drame, un conclave а ete organise а l'intention des decideurs sous la tres haute presidence de S. Е. Ange-Felix Patasse, President de la Republique, Chef de l'Etat, en date du 2 juillet 1999. А cette occasion, le Chef de l'Etat а reaffirme sa volonte politique de s'engager personnellement dans la lutte contre се fleau. Cette volonte politique s'est traduite par la remise de 300 Ьicyclettes pour des actions de proximite et par l'augmentation des credits destines а la lutte contre le SIDA, qui sont passes de 200 000 dollars en 1999 а 500 000 en 2000. Un projet de prevention de la transmission mere-enfant, avec possiЬilite de traitement de la mere seropositive et de l'enfant, sera Ьientбt operationnel а Bangui avec le concours financier et technique de l'ONUSIDA et de la Cooperation fraщ:aise. L'appui strategique de l'OMS pour le developpement de la reponse nationale а l'epidemie de SIDA а ete tres determinant; nous souhaitons qu'il soit renforce. En plus du SIDA, des maladies endemiques comme la trypanosomiase et des epidemies de meningite ont ete enregistrees en tres grand nombre dans le pays. Ces demieres annees, le nombre de trypanosomes depistes ne cesse d'augmenter alors que les medicaments specifiques se font rares. 11 у а eu, au cours des quatre premiers mois de l'an 2000, 2344 cas de meningite declares, dont 388 deces. Grace а une coalition nationale composee de l'OMS, de l'UNICEF, de l'Institut Pasteur, de Medecins sans Frontieres et de la Croix-Rouge, la vaccination contre la meningite dans les prefectures touchees а ete pratiquee. Des epidemies de rougeole sont actuellement signalees dans le pays. А се taЬleau deja sombre, s'ajoutent les consequences des inondations de 1999 dans plusieurs villes du pays; ces inondations ont occasionne des destructions de maisons et des deplacements de populations. Bref, la Republique centrafricaine est un pays sinistre qui а besoin d'une assistance. C'est pourquoi je lance un appel au nom du Gouvemement pour que la communaute des bailleurs de fonds, par le Ьiais de l'OMS, puisse comprendre les proЬlemes poses et prendre les mesures necessaires d'assistance au peuple centrafricain au nom des principes d'equite, de justice sociale et de solidarite intemationale. A53NR/5 page 111

Mr КIYONGA (Uganda):

President of the Fifty-third World Health AssemЬly, honouraЬle mш1sters and heads of delegations, Director-General of WHO, distinguished delegates, ladies and gentlemen, the Ugandan delegation wishes to thank Dr Brundtland for the commendaЬle efforts made to bring health issues to the forefront of the world's development agenda. In the recent past we have witnessed discussion of malaria and НIV/AIDS at the G7 and United Nations meetings. There is no doubt that the Director­ General 's efforts have contributed to this development. Every effort should Ье made to ensure that health finds its natural place at the centre of all economic policy and planning. This is particularly important in developing countries where diseases such as malaria, HIV/AIDS and tuberculosis are not only causing deaths and high morЬidity but are in addition retarding and in some cases reversing the process of development. lt is our expectation that this trend of heightened discussion of health issues willlead to more resource flows to poor countries to help fight the unfair imbalance that is so clear in the quality of life between countries in the North and in the South. The summit on malaria held in Abuja last month was а very important event. The African leaders were very clear in expressing their determination to fight malaria. The donor countries pledged close to US$ 750 million to support the fight against this disease. lt is very important that special instruments are created to ensure that the disbursement ofthese funds is not unduly delayed. President Clinton of the United States of America has put in place an initiative that is aimed at strengthening research and development for vaccines and other drugs against НIV/AIDS, malaria and tuberculosis. This is а move that we expect to Ье strongly supported Ьу other rich countries. The timely implementation of this initiative will go а long way in assisting effectively to tackle these diseases. 1 have the pleasure to report that Uganda has begun to benefit from the debt relief under the highly indebted poor countries initiative. The health sector in Uganda is to Ьenefit from this debt relief. lt is our expectation that other countries that are heavily in debt wiН access this facility as soon as possiЬle. Despite debt relief, Uganda still finds it difficult to find adequate funding for its development effort. Particular mention of НIV/AIDS must Ье made here again. About one-and-a-half years ago U ganda joined the UNAIDS pilot scheme to make availaЬle antiretroviral drugs to the victims ofthe pandemic of AIDS. Before this initiative, 500 of our people had access to these drugs. lt is disappointing to note that after the initiative only 900 more people have had access to the drugs. U ganda was therefore happy to hear that some pharmaceutical companies were considering giving significant reductions in the drug prices as part of а comprehensive programme to assist in the fight against HIV1 AIDS. Our calculation shows that even if а 75% reduction is awarded in prices, the price of the drugs would still Ье out of reach of the vast majority of our people who are affected Ьу this condition. We strongly feel that the pharmaceutical companies should enter into serious dialogue with the countries most affected Ьу the pandemic ofНIV/AIDS. We look forward to serious and significant developments following this announcement Ьу the drug companies. Whatever the results of this announcement will turn out to Ье, Uganda urges the pharmaceutical companies to work more closely with the countries most affected Ьу the pandemic in developing а vaccine and other drugs more appropriate for developing countries in order to fight this terriЬle condition. Uganda has, over the past 1О years, developed some capacity for research in some aspects of НIV 1AIDS, including in vaccine trials. We welcome other researchers to соте and work with our scientists. lndeed, with further support to U gandan scientists а lot of progress can Ье made in this area. Turning to health systems, the subject for this year's discussion, 1 am glad to report that Uganda has now developed а new policy and strategic plan for the next five years, which will Ье launched in July this year. The main elements in the plan and policy include: increasing access of the population to basic health services; and а defined minimum package of health care services that should reach all the people in Uganda. This has been developed in line with the burden of disease in the country. This package therefore covers such areas as malaria, HIV1 AIDS, tuberculosis, reproductive health, immunization, integrated management of childhood illnesses, mental health and other basic clinical services. А third element is stronger collaboration among the different organizations involved in health care services, which include the nongovernmental organizations mostly based on the main religions in the country, private enterprises and traditional health care practitioners. This collaboration is intended A53NR/5 page 112 to remove duplication and avoid unnecessary competition. We expect this approach to lead to more equity in access to health services Ьу the population. А fourth element is decentralization. In line with our Constitution, health care delivery will Ье the primary responsiЬility of the district authorities. The Ministry of Health will therefore Ье concerned with policy formulation, standard-setting, quality assurance and technical assistance to the districts. А fifth element is use of the sector-wide approach, which willlead to stronger donor coordination and equitaЬle service delivery in the country. Practical and comprehensive indicators for monitoring implementation of the plan have been developed. This new policy and plan, we believe, will lead to improved health outcomes for the population. In conclusion, Uganda welcomes the new trend that is bringing health to the centre of development planning and we call for stronger international action and solidarity to fight disease in poor countries, with particular reference to НIV/AIDS, malaria and tuberculosis.

Mons. LOZANO BARRAGAN (Santa Sede ):

Ilustre Presidenta, sefiora Directora General, distinguidos delegados: Un saludo muy afectuoso а las delegaciones de los Estados у de las instituciones presentes en la 53а AsamЬlea Mundial de la OMS. En este inicio del siglo XXI les auguramos paz у toda clase de Ьienestar а los pueЬlos que representan. El Ьien que es objeto de nuestras discusiones у deliberaciones en estos dias se llama salud. La salud, escribe Juan РаЬlо 11 en su mensaje para la Jornada Mundial del Enfermo del 11 de febrero pasado, fundada en una antropologia respetuosa de la persona en su integralidad, lejos de identificarse con la simple ausencia de enfermedades se propone como una tensi6n hacia la mas plena armonia у sano equilibrio en los niveles fisico, psiquico, espiritual у social. En esta perspectiva, la misma persona es llamada а movilizar todas las energias disponiЬles para realizar la propia vocaci6n у el Ьien de los demas. Precisamente porque la salud no se limita а la perfecci6n Ьiol6gica, continua Juan РаЬlо 11, tamЬien la vida en е1 sufrimiento ofrece espacios de crecimiento у autorrealizaci6n у abre caminos hacia el descubrimiento de nuevos valores. Esta misma tensi6n hacia la armonia exige el compromiso de la comunidad politica nacional е internacional de subvenir а las necesidades medicosanitarias de la poЬlaci6n mediante una politica у un sistema sanitario que tutele el derecho universal al cuidado de la salud у rompa el circulo vicioso pobrezalenfermedad, enfermedad/pobreza. La Iglesia cat6lica siempre ha participado en este compromiso а traves de una compleja у diversificada red de instituciones caritativas sanitarias dispersas por todo el mundo. Segun datos estadisticos, trabajan en la Iglesia cat6lica 5215 hospitales; 16 428 dispensarios; 823 leprosarios; 12 605 casas para minusvalidos у enfermos cr6nicos; 8147 orfanatorios; 10 666 guarderias; 10 556 centros para educaci6n о reeducaci6n sociosanitarias, у 37 234 otras instituciones sanitarias. El total de las instituciones es de 113 747. Нау 37 facultades de medicina en las universidades cat6licas. En nuestro Pontificio Consejo para la Salud, en el Vaticano, promovemos continuamente estudios, congresos у simposios sobre temas como el SIDA, la lepra, la toxicodependencia, los ancianos, los minusvalidos, los hospitales cat6licos, la economia у la salud, etc. En estos estudios hemos tenido siempre estrecha colaboraci6n de expertos у peritos en varias disciplinas de todo el mundo у de diversas instituciones, entre las cuales la OMS nos ha dado su muy eficaz contribuci6n. Sefialamos en especial nuestra Conferencia Internacional, que este afio versara sobre sociedad у salud. У son exactamente las sociedades del asi llamado Tercer Mundo que mas nos interpelan en su pobreza en la linea de las prioridades de la OMS, уа que tantos paises pobres no pueden dedicar lo deЬido del gasto а resolver sus proЬlemas sanitarios por tener que pagar la pesada deuda externa que en muchas naciones superan los gastos totales de los servicios relativos а la instrucci6n у salud en su conjunto. Proponemos que en este afio del 2000, que Juan РаЬlо 11 ha proclamado como afio juЬilar de indulgencia у perd6n, se continue con el estudio у la aplicaci6n de la mejor manera de ayudar а estos paises, уа sea con la condonaci6n total de la deuda, уа con formas suavizadas de pagos, destinando las sumas asi ahorradas а inversiones que hagan posiЬle en estos pueЬlos su derecho impostergaЬle al cuidado de la salud у а las investigaciones cientificas para combatir las enfermedades que nos golpean. A53NR/5 page 113 _

Estamos convencidos de que los sistemas sanitarios nacionales е inteшacionales no pueden ser determinados exclusivamente por las urgencias financieras о por las posiЬilidades tecnol6gicas, sino por una referencia а la centralidad de las personas у de las comunidades en las cuales se vive. El fen6meno de la mundializacion que incide sobre la salud s6lo tendпi una soluci6n aceptaЬle si es respetada la absoluta dignidad de la persoпa humaпa у las culturas de los pueЬlos у ese respeto es traducido еп una auteпtica solidaridad que en el ramo sanitario debera afirmar como primacia la salud para todos, lo que pudieramos llamar, parangonado соп el Ьien comun, la salud comun internacional. Muchas gracias.

Mr BERМEJO (International Federation ofRed Cross and Red Crescent Societies):

Madam Presideпt, Madam Director-General, distiпguished ladies and gentlemen, the Iпternatioпal Federatioп of Red Cross and Red Crescent Societies welcomes the focus ofthis World Health AssemЬly оп health systems. Ultimately it is the role of governments to ensure that health systems meet the пeeds of their populatioпs, particularly of the most vulneraЬle people. However, today тапу couпtries are falling short of providiпg basic health services which are universally accessiЬle. Moreover, пational health systems are findiпg it difficult to make effective use of the private sector providers and nongovernmeпtal orgaпizatioпs from which the poor receive much of their care. New partпerships and пеw ways of doiпg business are needed. Dr Bruпdtland and Dr Foege both highlighted iп their speeches the leap forward that пеw partnerships developed with the private sector have represented. The next leap forward depends on finding meaпingful ways to partner with civil society at the iпternational апd nationallevels. Governments апd пatioпal societies participating а few moпths ago iп а Red Cross and Red Crescent iпternatioпal coпference agreed to study in greater depth the working relationship between States and national societies iп service provision. Performiпg health systems must build оп the comparative advantages of civil society organizations. National Red Cross апd Red Cresceпt societies can play ап importaпt role in health апd care iп the commuпity. HIV/AIDS, for iпstaпce, has reminded us iп the most dramatic way that there is ап important health battle needing to Ье waged at а very persoпal level. lt is at the very iппеr level of the human persoп. lt coпcerns iпdividuals апd the circumstaпces of our intimate relatioпships, our families, our workplaces and our local commuпities. That is where the differeпce must Ье made. Civil society organizatioпs сап help fill the gap between vulпeraЬle people апd the formal health delivery system. With пetworks of voluпteers working with vulneraЬle commuпities, the Red Cross and Red Cresceпt сап put kпowledge апd tools iп the haпds of ordinary people. lt сап support processes that reduce vulneraЬility апd that build cariпg communities. Red Cross апd Red Cresceпt voluпteers have demoпstrated their capacity to provide care апd support to individuals and family members and communities iп many countries. The Iпternational Federatioп is eпtering а пеw phase of collaboration with WНО, as highlighted in the preparatory documeпt on collaboratioп with the Uпited Nations system апd with other intergovernmeпtal orgaпizations. In this пеw phase we will focus on buildiпg strong partnerships arouпd Red Cross апd Red Cresceпt efforts to scale up community awareness апd moЬilizatioп. This is the focus, for example, of our African Red Cross/Red Crescent health iпitiative, RT 2010, whereby Red Cross and Red Crescent пational societies are committed to workiпg with partners оп priority puЬlic health proЬlems, usiпg the Red Cross апd Red Crescent networks of community voluпteers. Other examples iпclude our partпering with WHO апd miпistries of health for the global campaigп for Ьlood safety, or partneriпg iп the Americas for the integrated maпagement of childhood illпess, or for control of poliomyelitis, tuberculosis and malaria in selected countries. In this пеw phase, we will not, however, lose our traditional focus оп emergency and humanitariaп actioп. Conflict and пatural disasters cause in many cases many major public health crises and collapse of health systems. But the reverse is also true. As this year' s world disaster report will show, puЬlic health crises are, in many cases, а major coпtributing factor to disasters. National Red Cross and Red Crescent society volunteers are consisteпtly in the ffont liпe of initial response to disasters. They are also increasiпgly availaЬle to contribute through partпerships to bridgiпg the gap between formal health delivery systems апd vulпeraЬle households. A53NR/5 page 114

Dr КATSAROV (Bulgaria): 1

Madam Presideпt, Vice-Presideпts, Dr Bruпdtlaпd, ladies and geпtlemeп, 1 would like to avail myself of this opportuпity to coпgratulate the Presideпt апd the Vice-Presideпts of the Fifty-third World Health AssemЬly оп their electioп апd to wish them every success iп fulfilliпg their importaпt tasks. 1 would like to express our coпfideпce that this AssemЬly is of special importaпce апd we сап expect а serious impact from the decisioпs to Ье takeп here. This coпfidence is based both on the agenda of the AssemЬly and on the ideas delineated in The world health report 2000. The creative conteпt of the Director-General' s message is а synthesis of tremendous efforts made to analyse the numerous facts, ideas and perspectives for health development. Formulation ofthe three overall health policy goals, the four core functions of health systems, as well as the clear strategic mission of the World Health Orgaпization will Ье the milestones in the further development of health systems and health policies in the twenty-first century. On behalf of the Bulgarian delegatioп, 1 would like to emphasize that we fully support the ideas and statements in the Director-General' s message and firmly believe that Bulgaria has all the prerequisites to implement them, notwithstaпding the severe economic difficulties experienced Ьу our country. lп this context, 1 would like to share with you the maiп parameters and characteristics of the health care reform in Bulgaria. After years of partial and indecisive change, health care reform was finally launched three years ago. lt is а serious iпitiative, creating the preconditions for estaЬlishment of а truly new health system. Any radical reform requires а staЬle legislative base and this was created through gradual developmeпt and approval Ьу parliament. Planning and implementation of health care reform has been supported Ьу the Government of Bulgaria, which fully realizes its responsibility for the health and well-being of the nation. The philosophy of the health care reform combines liberal views on the freedom of choices and responsibilities with deceпtralization апd market-oriented approaches, preserving the equal rights of public апd private sectors. The system is oriented towards the needs of individuals and communities, and encourages the participation of nongovernmental organizations апd iпitiatives, and civil society. The main parameters of the reform comprise chaпge in health care financing, as well as in the structure and administration of the health system. ln order to distribute financial risk, а social health iпsurance system will Ье iпtroduced through estaЬlishment of а national health insurance fund and its regional and local branches. The new financing system, based on contractiпg services between the health iпsurance fuпd and health care providers will Ье launched оп 1 July 2000 in primary health care and one year later iп the hospital sector. The free choice of а health estaЬlishment alongside the contracting mechanism will create competition in the health care market and will reduce the "shadow economy" in this field. The structural reform envisages - alongside the restructuring of the health care institutions and establishment of new ones- а serious extension of their autonomy. The health care estaЬlishments will enjoy administrative, fiпancial, and professional independence. PuЬlic participation and control would Ье increased through establishment of hospital supervisory boards. Health admiпistration reform follows а new managerial paradigm, based on decentralization and restriction of hierarchical and administrative interventions. This trend is in line with the overall economic reform and introductioп of contracting in health care. ln this way, conditions for universal апd effective coverage of health care consumers with quality services will Ье provided, with full observation of patients' rights. ln addition, the health care reform gives high priority to health promotion and prevention of diseases. Different proЬlem-oriented programmes are carried out, such as the Countrywide integrated noпcommunicaЬie diseases intervention programme (CINDI) on chronic noncommunicaЬle diseases, reform of the mental health services, control of tuberculosis and sexually transmitted diseases, iпcluding AIDS, programmes targeting the health needs of the Roma minority in the country, etc. At national level, programmes on suicide prevention, control of drugs and alcohol abuse, tobacco consumption, etc., are under way. Our aspiration is that health care reform should Ье

1 The text that follows was submitted Ьу the delegation ofBulgaria for inclusion in the verbatim records in accordance with resolution WHA20.2. A53NR/5 page 115 iтpleтented оп а broad intersectoral platform, ensuring support of the health professionals, as well as professional organizations, and the general puЬlic. ln conclusion, 1 would like to eтphasize that health care reform in ту country has been strongly supported Ьу WHO, especially Ьу the Regional Office for Europe. Likewise, the European Union and the World Bank have provided substantial assistance. 1 would like also to тention the assistance received froт the intemational aid agencies of Spain and Switzerland. Extending our sincere gratitude to all who have supported us, 1 would like to underline not only the iтportance of the тaterial and information resources provided, but also the тoral value of their support, which has contributed to reducing the risks associated with radical reforms and gives us confidence and sustains us in our way ahead.

М. ВАМВА (Guinee-Bissau) :1

Маdате la Presidente, Madame la Directrice generale, chers collegues Ministres, Mesdaтes et Messieurs, au nот de тоn Gouvemeтent et en тоn nот personnel, je voudrais saluer tres chaleureuseтent cette auguste AsseтЬlee reunie en un тотеnt tres particulier pour la Guinee-Bissau. J'aiтerais ensuite feliciter la Directrice generale pour la qualite du rapport produit, dont le theтe « Pour un systeтe de sante plus performant » est tres pertinent. Permettez-тoi de vous presenter brieveтent la politique sanitaire actuelle de тоn pays, qui а connu deux grandes guerres: la preтiere, de 1963 а 1974, qui а aЬouti а l'independance il у а 25 ans; l 'autre, de 11 тois, allant du 7 juin 1998 au 7 таi 1999. Cette demiere а detruit le peu d'infrastructures existantes, en particulier dans le secteur cle de la sante, ayant provoque la fuite de Ьеансоuр de cadres de la sante et ayant interroтpu une serie d'activites de reforme en cours, notaттent dans le doтaine des ressources huтaines. Je те re:fere а la formation des тedecins, des infirmiers, des sages-feттes et d'autres cadres techniques de la sante. Ceci а encore affaiЬJi la situation deja precaire du secteur de la sante de la Guinee-Bissau. Сотте vous le savez certaineтent, le pays avait elabore, avec l'appui de l'OMS et d'autres partenaires du developpeтent, le plan national de developpeтent sanitaire (PNDS) pour la periode 1998-2002, dont la тise en oeuvre а ete interroтpue а cause du conflit arme du 7 juin 1998. En се тотеnt, le Ministere de la Sante, avec l'appui des institutions deja citees, у coтpris la Banque тondiale, теnе un processus d'adaptation du PNDS en conformite avec les conditions actuelles du pays. Le present Gouvemeтent, issu des elections deтocratiques du 28 noveтbre 1999, а defini сотте grandes priorites les doтaines de la sante et de 1' education, entre autres. Се Gouvemeтent а herite de 25 annees de destruction totale du pays dans tout le secteur social. 11 а egaleтent herite notaттent de la corruption, d'une dette exterieure elevee et de la destruction du reseau d'entreprises et de l'econoтie du pays. De nos jours, les grands proЬleтes de sante publique auxquels тоn pays doit faire face sont le paludisтe, les тaladies diarrheiques aiguёs, les infections respiratoires aiguёs, le VIН/SIDA, la tuberculose et la lepre. La тortalite infantile est tres elevee ( elle est estiтee а 140 pour 1000 enfants nes vivants), de тете que la тortalite тatemelle. Cette demiere est estiтee а 900 pour 100 000 fеттеs. Les causes profondes de cette situation sont Ьien connues : bas niveau de scolarisation et d'education qui, d'une тaniere ou d'une autre, provoque la pauvrete. 11 у а une insuffisance en се qui conceme les sages-feттes, tant en quantite qu'en qualite. Au niveau de quelques laboratoires peripheriques existants, les conditions ne permettent pas de faire les tests. Une grande partie de l'hбpital national de reference а ete detruite. La pediatrie а ete forteтent atteinte, de sorte que trois ou quatre enfants doivent partager le тете lit. 11 est donc urgent de recuperer la pediatrie. 11 existe deja un cadre d'intervention clair, тais les тoyens тanquent pour des aтeliorations. L'une des conditions essentielles est la тise en valeur des ressources huтaines, тais les salaires pratiques dans тоn pays coтproтettent la qualite de la prestation des services.

1 Le texte qui suit а ete remis par Ia delegation de !а Guinee-Bissau pour insertion dans le compte rendu, conformement а !а resolution WHA20.2. A53NR/5 page 116

Devant cette situation, nonobstant les aides consideraЬles que le pays recevait de la communaute intemationale et en raison de la mauvaise utilisation de ces aides, l'appui de l'OMS et d'autres partenaires du developpement continue d'etre extremement important pour permettre le developpement harmonieux de notre systeme de sante, en conformite avec les plans prevus. En conc1uant тоn intervention, j 'aimerais insister sur le point suivant : le nouveau Gouvemement de la Guinee-Bissau est attache aux principes de la democratie, de la transparence et de la responsabilite dans la gestion des choses puЬliques et l' administration de tous les secteurs de la societe, avec l'homme comme centre de reference. La cooperation technique dans le cadre de l' integration regionale est importante, ainsi que dans le contexte geographique et linguistique. Le renforcement de се type de cooperation entre les pays en developpement et les pays developpes permettra, sans doute, une execution plus efficace des programmes de sante et une utilisation plus judicieuse des faiЬles ressources mises а notre disposition pour ameliorer la sante et le Ьien-etre de nos populations. La nouvelle Guinee-Bissau que nous voulons construire а besoin de votre total appui technique et financier pour pouvoir apporter la sante а tous les villages du pays.

Dr FARНADI (Islamic RepuЬlic oflran):1

In the name of God, the Compassionate, the Merciful, Madam President, Madam Director-General, excellencies, ladies and gentlemen, as we all are aware, the World Health Organization since its inception has played а significant role in devising model health care systems which have been adapted Ьу various countries according to their own epidemiological, technological and socioeconomic situation. The primary health care system as а key to the attainment of health for all was а novel strategy initiated Ьу WHO and globally approved Ьу the Alma-Ata conference in 1978. The system was based on equity and social justice, aiming at provision of the eight elements of primary health care to the totality of population, with emphasis on community involvement, intersectoral collaboration, use of appropriate technology and considering health as an integral part of socioeconomic development. Although most of the Member States accepted the policy of health for all and many of them tried to develop their own health systems based on primary health care, the outcome was much less than expected. Countries suffering from war, intemal conflict, political instaЬility and economic crises were particularly unsuccessful in developing effective primary health care services for their populations. On the other hand, health systems in general are still facing many challenges, such as the epidemiological and demographic transition, financial constraints, and growth of the private sector. Lack of proper community involvement, weak intersectoral collaboration, managerial weaknesses, shortage of trained manpower, coupled with rapid tumover, brain drain, and scarcity of essential drugs, basic supplies and equipment are among the serious proЬlems facing developing countries, where the needs for effective and comprehensive health systems are greatest. Despite these gloomy pictures, there are many examples of success stories in almost all parts of the world. In other words, there are always solutions to most of the proЬlems and there is light after darkness. In recent decades, health systems already contributed enormously to better health for most of the global population. As the new century begins, health systems have the potential to achieve further improvement in human well-being, especially for the poor. This calls for global solidarity, including financial support from affluent countries to the poor countries of the world. Needless to say, WHO should continue to provide technical support and guidance to the countries undertaking health system reform in order to make sure that the reformed health systems are сараЬlе of meeting the legitimate expectations of populations.

1 Тhе text that follows was submitted Ьу the delegation ofthe Islamic RepuЬ!ic oflran for inclusion in the verbatim records in accordance with resolution WHA20.2. ASЗNR/5 page 117

The primary health care system in the Islamic RepuЬlic of Iran was lnitiated as а pilot project before the Alma-Ata Conference. The system was fully revised and expanded after the revolution, based on the social, economic and political situation of the country. More than а decade has passed since medical education was integrated into the Ministry of Health, resulting in close cooperation and coordination between the producers and the users of health manpower, and their joint involvement in health care delivery. At present there are 15 604 health houses, 2335 rural health centres, 2210 urban health centres, and 245 delivery facilities providing primary health care to 90% of the population. lnpatient care is provided Ьу 434 general hospitals with 43 744 beds, and 260 training hospitals with 54 925 beds. More than 40 000 female community health volunteers are involved in health education and family planning activities in semiurban areas, liasing between the families and health services. Strengthening community involvement, development of partnerships between the private and puЬlic sectors, strengthening refeпal systems, and improving the quality of health services are the main challenges to Ье met in the future. Madam President, 1 have great hopes that we all will Ье аЬlе to work together with our WHO in bringing more and more improvements to health systems, hence ensuring the health and happiness of people everywhere on our globe.

М. BENJELLOUN-TOUIMI (Maroc) :1

Madame le President, Madame le Directeur general, Mesdames et Messieurs les Ministres, Mesdames et Messieurs les chefs et membres des delegations, Mesdames et Messieurs, c'est pour moi un grand plaisir de vous presenter, Madame le President, au nom de la delegation du Royaume du Maroc, mes vives felicitations а l'occasion de votre election, ainsi qu'aux Vice-Presidents, en vous souhaitant pleine reussite dans la conduite des travaux de cette session. De meme, il m'est agreaЬle de souligner les efforts entrepris par l'OMS sous la direction de Mme le Directeur general dans le but d'atteindre les objectifs traces et auxquels nous tendons tous en vue d'amcbliorer l'etat de sante dans tous les pays du monde. Je voudrais aussi feliciter Mme le Directeur general pour la qualite du Rapport sur /а sante dans /е monde, 2000, dans la mesure ou il aide а comprendre les objectifs des systemes de sante et que ces demiers ont un grand impact sur la sante des populations durant toute leur vie. Le developpement des systemes de sante est un facteur essentiel qui contribue au changement des situations. Et si les preoccupations de ces systemes ne se limitent pas а l'amelioration de la sante de la population mais visent aussi leur protection contre les couts financiers engendres par la maladie, cela constitue un veritaЬle defi pour tous les gouvemements, dans la mesure ou le but de l'OMS est d'amener tous les peuples au niveau de sante le plus eleve possiЬle. Dans le contexte actuel, on peut dire que le systeme de sante est en crise. De fait, toute crise oЬlige а faire des choix, а redefinir les priorites, а concentrer tous les efforts et toutes les ressources en consequence. Comme il а ete demontre par ailleurs, les systemes puЬlics actuels encouragent trop peu la creativite et les talents et gaspillent l'energie. Aussi, dans се nouveau contexte, le Ministere de la Sante doit se consacrer aux fonctions dans lesquelles il excelle et ne peut etre remplace ; il doit se delester de certaines responsabilites en les confiant а des partenaires, puЬlics ou prives, devenir plus transparent, plus decentralise et sensiЬle aux besoins des citoyens. Le Ministere de la Sante doit accroitre sa responsaЬilite puЬlique en introduisant une plus grande flexiЬilite de gestion et en mettant l'accent sur les resultats plutбt que sur les procedes. Nous avons prepare au cours de l'annee precedente le Plan de developpement sanitaire pour la periode 2000-2004 et, а partir des analyses et orientations economiques et sociales definies, il est apparu que le systeme de sante doit prendre en consideration un certain nombre de conditions definies par la societe : satisfaction des besoins, accessiЬilite du plus grand nombre aux soins, solidarite, respect des equilibres financiers, equite, regles ethiques. Се systeme doit etre organise autour de ses missions fondamentales avec un processus de decision et d'execution rapide, plus proche des citoyens et se preoccupant davantage de la qualite de ses relations avec les usagers, transparent dans sa gestion

1 Le texte qui suit а ete remis par !а delegation du Maroc pour insertion dans !е compte rendu, conformement а !а resolution WHA20.2. A53NR/5 page 118 et econome des deniers puЬlics. Le modele futur des services de sante essaie de pallier les insuffisances du modele actuel tout en essayant d'incorporer la dynamique de la regionalisation. Tout d'abord, le modele projete integre la reforme du financement qui tente de remedier aux faiЬlesses actuelles de mobilisation des ressources financieres en elargissant la couverture de l'assurance­ maladie а pres de 30% de la population et en mettant en place un mecanisme adapte et plus juste d'assistance medicale aux economiquement faiЬles. Ensuite, le rбle de coordination du Ministere de la Sante dans le contrбle et l'organisation doit etre renforce dans le cadre d'un partenariat. Се partenariat sera elargi а la region, qui insufflera au secteur de la sante puЬlique un dynamisme certain au niveau local. La region peut constituer une source additionnelle et importante de mobilisation des ressources financieres. C'est l'une des raisons qui poussent le Ministere de la Sante а entreprendre une politique de decentralisation/deconcentration, aussi progressive que forte. En corollaire, il parait indispensaЬle de separer la fonction de financement de celle de prestation de services afin de permettre aux hбpitaux puЬlics de jouir d'une pleine autonomie, necessaire а l'amelioration de leur gestion, de leurs performances et de la qualite des soins qu'ils offrent. Cette autonomie permettra de reallouer une partie des subventions destinees aux hбpitaux et aux СНU vers les soins de sante de base. Le projet futur des services de sante vise а pallier les insuffisances du schema actuel par l'extension de l'assurance-maladie, la mise en place d'un mecanisme pour la prise en charge des economiquement faiЬles, la reforme du systeme hospitalier pour le rendre plus efficace, la revision du systeme d'allocation des ressources, l'augmentation du budget alloue aux soins de sante de base, le developpement du partenariat et la coordination avec les autres secteurs et ONG pour les activites sanitaires. Tous ces elements deviendront efficaces apres la mise en place des structures regionales. En resume, се modele cherchera а assurer : le renforcement institutionnel en developpant le rбle de garant de l'equite de la distribution des structures sanitaires, en reglementant et regulant le rбle joue par les services centraux du Ministere de la Sante et en mettant en place des structures regionales avec devolution des fonctions de planification et de gestion aux services de sante ( decentralisation/ deconcentration); l'efficience economique, qui vise l'amelioration de la gestion des ressources d'une maniere generale et la gestion financiere dans les hбpitaux en particulier ; 1' equite inteпegionale et а tous les niveaux du systeme de sante en coпigeant les disparites inteпegionales en termes de disponiЬilite des ressources puЬliques de sante et en orientant les services de sante de base. Les objectifs operationnels definis dans le Plan de developpement economique et social 2000-2004 supposent la realisation et l'application, en plus des programmes sanitaires et des projets, des reformes institutionnelles а entreprendre а partir des axes exposes. Се qui necessite avant tout l'integration de tous les acteurs et la moЬilisation des ressources humaines et financieres et des instruments juridiques. Si l'OMS а realise d'enormes efforts en vue de renforcer les soins de sante, grace aux changements introduits dans ses methodes de travail, nous esperons encore atteindre tous les objectifs definis dans le cadre de la strategie adoptee pour un meilleur niveau de sante des populations de toutes les nations. Je souhaite plein succes а vos travaux.

The PRESIDENT:

This completes the list of speakers in our review of item 3. Having heard the comments of the ministers and heads of delegations, 1 suggest that the AssemЬly might now wish to express its appreciation of the address of the Director-General of the work done Ьу the Organization. All the speeches will, of course, Ье duly recorded in the records of the AssemЬly. Before adjouming this plenary, 1 would like to remind the AssemЬly ofthe programme ofwork for the remainder of today. At 14:30, Committee А and Committee В will hold their third and their first meetings respectively, while the General Committee will meet for the second time at 17:30. A53/VR/5 page 119

We have now conc1uded our work for today. The next p1enary шeeting will Ье he1d on Thursday, 18 Мау, at 17:00. The meeting is adjourned.

The meeting rose at 12:50. La seance est levee а 12h50. A53NR/6 page 120

SIXTH PLENARY MEETING

Thursday, 18 Мау 2000, at 17:00

President: Dr L. АМА THILA (NamiЬia)

SIXIEME SEANCE PLENIERE

Jeudi 18 mai 2000, 17 heures

President: Dr L. AMATHILA (NamiЬie)

AWARDS DISTINCTIONS

The PRESIDENT:

The AssemЬly is called to order. We shall now take up item 7, Awards. Excellencies, distinguished delegates, ladies and gentlemen, we are assemЬled here today for the presentation ofthe Sasakawa Health Prize and the United Arab Emirates Health Foundation Prize. 1 have much pleasure in welcoming among us the distinguished winners of these prestigious prizes: Dr Yoav Hom; Dr Oviemo Otu Ovadje; Mrs Sonia Oliveros, representing the Family Planning Association (PLAFAM) (Venezuela); Professor Roemwerdiniadi Soedoko; and Mr Ket Sein, Minister ofHealth ofMyanmar, receiving the award on behalf ofthe lnstitute ofNursing. 1 am also very pleased to greet Professor Kenzo Kiikuni, representing the Sasakawa Memorial Health Foundation, and Dr Mahmood Fikri, representing the founder of the United Arab Emirates Health Foundation.

Presentation of the Sasakawa Health Prize Remise du Prix Sasakawa pour la Sante

The PRESIDENT:

We shall start with the presentation of the Sasakawa Health Prize. This Prize is awarded to individuals or institutions for outstanding, innovative work in health development, and aims at encouraging the further development of such work. lt is with pleasure that 1 announce that the 2000 Sasakawa Health Prize has been jointly awarded to: Dr У oav Hom of Israel; Dr Oviemo Otu Ovadje ofNigeria; and the Family Planning Association (PLAFAM) ofVenezuela. Dr Hom's career, spanning over 30 years, has been entirely devoted to cancer research and treatment of cancer patients in Israel and the W est Bank. In 1978, Dr Нот estaЬlished, in collaboration with Palestinian doctors, an oncology programme in the West Bank, at the time in urgent need of modem oncological services. Thanks to this programme, cancer patients can receive most of their medical care locally without having to travel to Israel. Dr Hom is well known not only for his highly competent work as а researcher, doctor and teacher, but also for his passionate devotion to his patients and their families The award will Ье used to create а West Bank Cancer Association directed Ьу Dr Hom himself. The Association will focus essentially on educational activities related to cancer ASЗNR/6 page 121

prevention, early detection and treatment; training programmes for doctors, nurses and cancer-related professionals; and on setting up new facilities in hospitals, c1inics, laboratories and rehabilitation centres for prevention, early detection, treatment and follow-up of cancer patients. Dr Oviemo Otu Ovadje is а consultant anaesthesiologist at lkoyi military hospital. While training as а medical doctor in Nigeria, Dr Ovadje observed that many pregnant women died of intemal haemorrhaging from ruptured ectopic pregnancies, а common, often fatal condition in developing countries. Dr Ovadje invented а very simple Ыood-saving device known as ЕА Т SET (Emergency Auto-Transfusion Set) designed to replace the gauze filtration technique used in developing countries. The device has been used successfully on а number of patients with ruptured ectopic pregnancies and life-threatening intraperitoneal Ыeeding. The prize money will Ье used to increase the scope of current clinica1 trials of the ЕАТ SET, and to conduct parallel studies in hospitals in lndia, South Africa, Zimbabwe, and any other interested developing countries. Dr Ovadje will use part of the funds to acquire portaЫe clean-room facilities in his effort to manufacture the ЕАТ SET and promote local manufacturing of medical devices in Nigeria. The Family Planning Association (PLAF АМ) was founded in 1986 to promote fami1y p1anning in Venezuela and to improve sexua1 and reproductive health, particu1ar1y among the poor, Ьу developing medical and educational programmes. PLAF АМ recent1y started an innovative programme dealing with gender-based vio1ence, а major proЫem conceming main1y women in Venezue1a. The services offered Ьу the Association focus on prevention, inc1uding awareness-raising activities to draw attention to gender-based violence and have it treated as а puЬlic health issue; and on assistance, through medical care, counselling, socia1 work and psycho1ogical help for the victims of violence. The Association has also been working on the 1egal aspect of gender-based vio1ence. lts commitment 1ed to the approval, in 1998, of а law on violence against women and the fami1y, which came into force in January 1999. The Association intends to use the award to set up а legal aid service for victims of gender-based violence; to offer them group therapy and to develop research in areas linked to gender-based violence. Before presenting the prize, 1 invite Professor Кiikuni to address the AssemЬly on behalf of the Sasakawa Memorial Hea1th F oundation.

Professor KIIKUNI:

Madam President ofthe AssemЬly, distinguished winners ofthis year's Sasakawa Health Prize, Madam Director-General, Dr Brundt1and, excellencies, distinguished delegates and friends, first of all let me express my most sincere esteem and appreciation to all my colleagues gathered here today for your tireless efforts for the advancement of the health and welfare of the people of the world. On behalf of the Nippon Foundation and the Sasakawa Memorial Health Foundation, 1 shou1d like to congratulate Dr Hom of lsrael, Dr Ovadje of Nigeria, and the Family Planning Association of Venezuela, the recipients of this year's Sasakawa Hea1th Prize, for their innovative work and 1eadership, which have inspired all of us whose concem is enhancement of the health of the people of the world. The Sasakawa Health Prize was estaЬlished in 1984 Ьу virtue of an agreement between two unique leaders in health: Dr Halfdan Mahler, then Director-Genera1 of WHO, and the late Mr Ryoichi Sasakawa, the founder of the prize and then chair of the Nippon Foundation. The prize was estaЫished to demonstrate the strong commitment ofthe two leaders to improve the health ofthe people of the wor1d Ьу recognizing and encouraging individua1 and group efforts in primary health care. Mr Ryoichi Sasakawa had а deep persona1 concern about the lives of people affected Ьу leprosy, the disease dreaded Ьу humanity throughout history in every continent of the world. Leprosy was prevalent even in the early twentieth century in Japan. Persons diagnosed with leprosy were generally banished to remote islands or p1aces to 1ive out their lives far from their fami1ies and ffiends and indeed any ordinary реор1е in the society. The misery and suffering of the patients and fami1ies in those days left some people with а strong feeling of injustice and concem; among them was the 1ate Ryoichi Sasakawa, the founder of the Nippon Foundation. Не began his personal mission to relieve A53NR/6 page 122 the suffering of patients in Japan and abroad and, when а medica1 cure became availaЬle, he was determined that the cure should reach people in leprosy-endemic countries as widely as possiЬle. This conviction led to the estaЬ!ishment of the Sasakawa Memorial Health Foundation in 1974 (1 am the chairperson of the Foundation) and support towards the WHO leprosy control programme in the late 1970s. No other disease brings such agony and distress to the afflicted and their families as leprosy. WHO's definition of health, being the physical, mental, social and now the spiritual well-being of people, it was very timely and appropriate that WHO decided to strengthen its leprosy programme. 1 should like to make а special acknowledgement of WHO's courageous decision to tackle this age-old disease systematically and with determination. Based on years of field research in many parts of the world, the WНО Expert Committee on Leprosy in 1982 recommended а multidrug regimen for leprosy. This was а countermeasure, to overcome the drug resistance that was increasingly threatening leprosy field control. Following the recommendation, WHO and the scientific committee standardized treatment regimens, created calendar Ьlister packs and simplified diagnosis, which brought hope that, for the first time in history, the world had а tool to conquer leprosy. The 1991 World Health AssemЬly marked another milestone. The Forty-fourth World Health AssemЬly declared "WHO's commitment to ... promote the use of all control measures including multidrug therapy together with case-finding in order to attain the global elimination of leprosy as а puЬlic health proЬlem Ьу the year 2000" and urged Member States in which leprosy is endemic to "further increase or maintain their political committee and give high priority to leprosy control so that the global elimination of leprosy as а puЬlic proЬ!em is achieved Ьу the year 2000". The Health AssemЬly also requested the Director-General to continue strengthening the effort in various ways to achieve the goal. On behalf of the Nippon Foundation and its founder Mr Ryoichi Sasakawa, it would Ье dishonest not to express my disappointment that WHO was not аЬ!е to report the elimination of leprosy to this World Health AssemЬ!y in the year 2000. At the same time, 1 am aware that not only WHO but also Member States and supporting nongovemmental organizations have made unprecedented efforts over the past 1О years in diagnosing and curing patients. Over the past 25 years the Nippon Foundation has contributed US$ 200 million towards leprosy control work through WHO and through the Sasakawa Memorial Health Foundation. This includes US$ 50 million for free multidrug therapy coverage in almost allleprosy-endemic countries of the world. Today leprosy remains а puЬlic health proЬlem in some 20 countries, but more countries are expected to achieve leprosy elimination Ьу the end ofthis year. We have to accelerate the process so that as many patients as possiЬ!e are treated and cured at an early stage. We have to tell the world that we have an effective cure and that the cure is availaЬ!e free of charge. ln this respect, 1 acknowledge WНO's efforts to continue assuming а leading role in keeping up the momentum, in the form of the Global Alliance for Elimination ofLeprosy, till the year 2005 so that the remaining countries will also achieve the global goal. The Nippon Foundation will continue to Ье WНO's partner to see elimination achieved in the nearest possiЬle future. Leprosy is the disease that stigmatized patients to an extent that destroyed human integrity and dignity. More than the disease itself, the prejudice and stigmatization have damaged the people and families who suffer. lfthe world can successfully consign this disease to history, through the strong joint efforts in а partnership of Member States, WHO and the supporting nongovemmental organizations, it will Ье а triumph of humanity and of the fundamental philosophy of health for all. We urge WHO to continue pushing forward leprosy elimination until each and every country achieves the goal. Let us also confirm the commitment of all of us here today to continue giving priority to the leprosy programme. This is the challenge to and responsiЬility of all of us for future generations: WHO as an organization responsiЬle for giving technical guidance and direction to improve the health of the people; Member States which are directly responsiЬle for their people's better health; and nongovemmental organizations, whose primary concem is to Ье а part of the effort to realize fulfilment in terms of the quality of life of each and every individual. ASЗNR/6 page 123

The PRESIDENT:

Thank you, Professor Kiikuni. It is now my privi1ege to present the Sasakawa Hea1th Prize to our distinguished laureates. Dr Horn, may 1 ask you to come to the podium.

Amid applause, the President handed the Sasakawa Health Prize to Dr Horn. Le President remet le Prix Sasakawa pour la Sante au Dr Horn. (Applaudissements)

The PRESIDENT:

1 now invite Dr Horn to address the AssemЬ!y.

DrHORN:

Madam President, Madam Director-General, ministers, ambassadors, other distinguished guests, ту first entry into the Beit-Jala Hospita1 near Bethlehem took place on 8 June 1967, а few hours after the Six-Day War ended. With my governmental tasks over, 1 sought interesting new places to visit on the W est Bank - which at that time 1 had only heard of. 1 suddenly found myse1f in front of а hospital, and the thought саше to ту mind that there might Ье а need for assistance. The director of the hospital was seated at his desk, concerned, as I was, about meeting an individual who hours before had been an enemy. As it happened, 1 was the first lsraeli to enter that Palestinian hospital, а move that started а relationship which would last for over 25 years. The director and 1 became very good friends, both professionally as well as personally. On that day, it became clear to те that those living across our borders are human beings with whom we have much in common and much to share. lt also became clear to те that medicine should not recognize borders and that coexistence between diverse people is possiЬie and must Ье encouraged. Му continuous personal and professional activities with the Palestinians since then have been driven Ьу the insights gained on that first day. ln 1967, Arab cancer patients, especially those who could not personally afford the cost of care, had no oncology services on the West Bank. Most patients returned home after being diagnosed, to die without receiving the benefit of any further oncological assistance. Fatalism with regard to cancer added another factor, with patients not willing to follow medical advice. Having these facts in mind, it became obvious to те that my professional know-how and my personal enthusiasm could make а difference, and that needy individuals could benefit from ту involvement. lt took а while, but approximately 1О years later, in 1978, 1 opened the first oncology service on the West Bank. lt was not а simple task for an Israeli to practise medicine within an Arab community. lt could Ье accomplished only with the intervention of the local Medical Director, the late Dr Shehadeh, who was brave enough to invite an lsraeli physician to wear а white coat and work in а Palestinian hospital. This was the start of а long-standing, very close relationship between myself, many Arab doctors, other health care personnel, patients and families. Our humanitarian oncological services developed and progressed despite local unrest, stone-throwing, shooting and much violence around us. We never discontinued taking care of our Palestinian cancer patients, first at the Beit-Jala Hospital, which serves the southern part of the West Bank, and later in NaЬ!us, where we opened а second clinic for the people of the northern part of the region. Our joint lsraeli-Palestinian oncology service developed into а major operation which, over the years, treated many thousands of patients, providing them with modern modes of chemotherapy and radiation therapy, diagnostic services, and more. Other undertakings included the training of Arab physicians, who would become the next generation of oncologists, educating the population with regard to the importance of early diagnosis and follow-up, and trying to diminish the fatalistic approach to cancer that was endemic in the population. The bottom line is that we succeeded in making significant progress towards our goals for 18 years, during which time we acted like human beings lacking any prejudices. lt is my beliefthat our profession is stronger than, and stands above, any hatred between people. A53/VR/6 page 124

lt is indeed а great honour to receive the Sasakawa Award for the huтanitarian project in which 1 was involved. 1 want to thank the Sasakawa Health Prize organizers, with special thanks to those distinguished тетЬеrs of the WHO Coттittee who recognized this huтanitarian project and honoured те as one of the Sasakawa Health Prize awardees for the year 2000. Му congratulations to the other awardees, in whose сотраnу 1 proudly stand. Last, but not least, 1 want to thank all those who were involved in our project, Palestinian and lsraeli, patients and care providers; and ту faтily, whose support and understanding throughout the years allows те to Ье here today.

The PRESIDENT:

Thank you, Dr Hom. Мау 1 now ask Dr Ovadje to соте to the podiuт.

Amid applause, the President handed the Sasakawa Health Prize to Dr Ovadje Le President remet le Prix Sasakawa pour la Sante au Dr Ovadje. (Applaudissements)

The PRESIDENT:

1 now invite Dr Ovadje to address the AsseтЬly.

DrOVADJE:

Маdат President, Director-General, heads of United Nations agencies, тinisters and representatives of МетЬеr States, ladies and gentleтen, 1 wish to thank this august body and the donors of the Sasakawa Award for this very encouraging prize. 1 ат extreтely grateful and 1 should like to thank everybody. Now the ЕАТ SET concept calls especially for appropriate тedical technology in developing countries. We have sent а docuтent on our findings to show that over 95% ofтedical equipтent froт the developed world coтing to the developing world Ьесотеs unserviceaЬle and gets duтped in а record tiтe of two years. And this leads to а loss of foreign exchange, which is spent on this equipтent. The reason is that we do not have the technological core of тaintainers back in the developing world; we do not have the expertise to sustain these highly sophisticated devices; and of course our electrical supply in developing countries is erratic, and this leads to the breakdown of these systeтs. We do not fault the developed world for their sophistication but we are saying that we really need some tiтe to Ье аЬlе to bridge the technological gap, the technological тissing link between the developing world and the developed world. So the ЕА Т SET device and project, which is sponsored Ьу the Govemтent of Nigeria and the United Nations Developтent Prograттe with technical support froт the World Health Organization, is designed actually to provide appropriate technologies that are relevant to the needs of developing countries. 1 dedicate the Sasakawa Award to the proтotion of appropriate тedical technologies which are relevant to the needs of: the Nigerian Army, the Nigerian Nation, the United Nations Developтent Prograттe, the World Health Organization, the Biosafe Сотраnу, which is а Swiss сотраnу that таdе sоте contributions to our efforts here in Geneva, the tеат froт the Cantonal University Hospital, Geneva, which conducted the clinical trials that justify what we are doing and confirm that what we have done and what we are doing is worthwhile. And of course back hоте we have started clinical trials in which about 40 woтen who suffer froт internal Ьleeding have had their lives saved Ьу eтploying the ЕАТ SET. The Sasakawa Award will Ье used to proтote this work and to enhance the scope. 1 would like to thank this great body and the organizers and donors of the Sasakawa Award for this very, very encouraging award. A53NR/6 page 125

The PRESIDENT:

Thank you, Dr Ovadje. Мау 1 ask Mrs Oliveros to come to the podium.

Amid applause, the President handed the Sasakawa Health Prize to Mrs Oliveros. Le President remet le Prix Sasakawa pour la Sante а Mme Oliveros. (Applaudissements)

The PRESIDENT:

1 now invite Mrs Oliveros to address the AssemЬly on behalf of the Family Planning Association (PLAF АМ).

La Sra. OLIVEROS:

Sefiora Presidenta de la 53а AsamЬlea Mundial de la Salud, sefiora Directora General, sefior Director Ejecutivo de la Fundaci6n Conmemorativa Sasakawa para la Salud, sefiores delegados, sefioras у sefiores: En nombre de la RepuЬlica Bolivariana de Venezuela у de la Asociaci6n Venezolana de Planificaci6n Familiar (PLAF АМ), quiero agradecer а la OMS у а la Fundaci6n Conmemorativa Sasakawa para la Salud el haber otorgado а la asociaci6n que represento el Premio Sasakawa para la Salud correspondiente al afio 2000 por el desarrollo de sus programas en salud sexual у reproductiva, у en especial por el proyecto de atenci6n de la violencia basada en genero. Nos llena de orgullo у honor haber sido honrados con tan alto galard6n у estar presentes en esta AsamЬlea Mundial. De esta manera, la Asociaci6n Venezolana de Planificaci6n Familiar se ve confirmada en su misi6n, cual es la promoci6n de la planificaci6n familiar en nuestro pais у el mejoramiento de la salud sexual у reproductiva, en especial la de la poЬlaci6n de escasos recursos, mediante el desarrollo de programas medicoeducativos, respondiendo asi а la creciente demanda no satisfecha de dichos servicios у, dentro de tales programas, el de la atenci6n de la violencia basada en genero. Dicho programa plantea el logro de sus metas desde dos perspectivas: la preventiva у la asistencial. Desde el area preventiva se trabaja en la sensibilizaci6n de la poЬlaci6n adulta у juvenil en cuanto а lo que implica la violencia, sus formas de enfrentarla у manejarla, у la necesidad de romper el silencio у dejar atras el esquema de observar la violencia intrafamiliar como natural. Desde el area asistencial se trabaja en la atenci6n medica, de orientaci6n, de trabajo social, de ароуо psicol6gico у legal. Las estadisticas en Venezuela refieren que el 82% de las consultas en las emergencias de los hospitales de la ciudad de Caracas realizadas en mujeres corresponden а violencia domestica. Las consecuencias de vivir en situaciones de violencia deprimen toda intervenci6n que pretenda impactar favoraЬlemente en la salud у en la calidad de vida de las personas. Es por ello que PLAF АМ ha participado activamente en la elaboraci6n у discusi6n de propuestas ante los organismos gubernamentales, entre las que destaca la categ6rica necesidad de asumir la violencia como un proЬlema de salud puЬlica, por la cual el Estado debe asegurar la protecci6n, prevenci6n у asistencia especializada а las victimas. Asi, conjuntamente con otras organizaciones no gubernamentales, particip6 activamente en actividades puЬlicas para la aprobaci6n de la ley sobre la violencia hacia la mujer у la familia que entr6 en vigencia en el mes de enero de 1999. Nuestra asociaci6n es una organizaci6n no gubernamental sin fines de lucro, fundada hace 14 afios, afiliada а la Federaci6n Internacional de Planificaci6n Familiar (IPPF), que cuenta con el ароуо del Ministerio de Salud у Desarrollo Social, que no solamente ha desarrollado los programas antes mencionados, sino que ha promovido politicas gubernamentales а los fines de velar por el derecho del individuo а tomar decisiones libres е informadas con respecto а su salud sexual у reproductiva. De esta manera, en el texto de la Constituci6n Nacional de la RepuЬlica Bolivariana de Venezuela, que entr6 en vigencia este afio, fue incluido en su articulado el derecho de todo individuo а la planificaci6n familiar como un derecho fundamental. A53NR/6 page 126

En nombre de PLAF АМ traigo un mensaje de compromiso para el mejoramiento de la salud sexual у reproductiva у tal premiaci6n es un aliciente para continuar con el desarrollo de nuestros programas de salud, que s6lo ha sido posiЬle por la mistica у vocaci6n de servicio de su equipo. Queremos reiterar nuestro agradecimiento а la OMS у а la Fundaci6n Conmemorativa Sasakawa para la Salud por el importante ароуо que brindan а asociaciones como la nuestra.

The PRESIDENT:

Thank you, Mrs Oliveros.

Presentation ofthe United Arab Emirates Health Foundation Prize Remise du Prix de la Fondation des Emirats arabes unis pour la Sante

The PRESIDENT:

Ladies and gentlemen, 1 now come to the presentation of the United Arab Emirates Health Foundation Prize. The prize is awarded for outstanding contribution to health development, and this year it is awarded jointly to: Professor Roemwerdiniadi Soedoko of Indonesia; and The Institute of Nursing ofMyanmar. Dr Soedoko's career, spanning over 30 years, has been devoted to cancer research and community education, particularly women's education, considered an essential element in the fight against the disease. Besides her educational activities, both in medical schools and in the community at large, she has developed the Sidoarjo model, а community-based, integrated cancer-control model, which is now being applied nationally in Indonesia. Dr Soedoko has written several puЬlications on cancer and the role of Indonesian women in national development. The Institute of Nursing of Myanmar was estaЬlished in 1991 to build up the competence and skills required to practise safe and high-quality nursing care in preventive, creative and rehabilitative health services. The Institute has developed а community-based curriculum designed to deliver nursing services at the grass-roots level and to encourage community participation. А prominent aspect of the Institute's activities is the self-care programme, aimed at enhancing community participation in health activities and to encourage people to take responsiЬility for their own well-being. The Institute of Nursing is not only the main estaЬlishment for the training of nursing professionals, but also а national resource centre providing expertise and leaming material for the strengthening of nursing and midwifery education for in-service nurses under the Ministry of Health and those in general practice. Before presenting the prize to the distinguished laureates, 1 call upon the representative of the Founder ofthe United Arab Emirates Health Foundation Prize, Dr Fikri, to address the AssemЬly.

Dr FIKRI (United Arab Emirates):

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The PRESIDENT:

Thank you, Dr Fikri. lt is now my pleasure to present the United Arab Emirates Health Foundation Prize to our laureates. Professor Soedoko, may 1 ask you to come to the podium. A53NR/6 page 128

Amid applause, the President handed the United Arab Emirates Health Foundation Prize to Professor Soedoko. Le President remet au Professeur Soedoko le Prix de la Fondation des Emirats arabes unis pour la Sante. (Applaudissements)

The PRESIDENT:

1 поw iпvite Professor Soedoko to address the AsseтЬly.

Professor SOEDOKO:

Маdат Presideпt, the Presideпt of the Uпited Arab Eтirates Health Fouпdatioп, hoпouraЬle guests, ladies апd gепtlетеп, it is а great hoпour for те to receive this uпexpected award. 1 пever dreaтed of it. 1 соте froт lпdoпesia, а developiпg couпtry. For decades the ultiтate goals iп health тапаgетепt have Ьееп to coпtrol соттuпiсаЬlе diseases and to overcoтe пutritioпal proЬleтs. А lot of work has Ьееп focused оп these fields. As а faculty тетЬеr, 1 work for Airlaпgga Uпiversity School of Mediciпe, iп the Departтeпt of Pathology, апd also at Dr Soetoтo Geпeral Hospital iп Surabaya, East Java. 1 have also worked voluпtarily at Wisпuwardhaпa Сапсеr Society for 30 years; today 1 hарреп to Ье the chairmaп of it. 1 fouпd that тоrе thaп 90% of сапсеr cases сате iп at а late stage. Bowiпg ту head deeply, 1 started to observe, to listeп carefully апd to watch, especially iп the siтple соттuпitу, to leam what they really пeeded, their aЬilities апd ways to епаЬlе theт to protect theтselves especially froт сапсеr. lп 1982 1 started to develop а pilot project патеd Cancer Coпtrol Ьу the Соттuпitу for the Соттuпitу, with the basic idea that сапсеr сап Ье coпtrolled well wheп all levels of the соттuпitу are actively iпvolved. There is а strikiпg differeпce betweeп сапсеr patieпts and patieпts sufferiпg froт other illпesses. Сапсеr patieпts will feel very poor iп their wealth, will feel loпely iп their Ьig faтily, will feel аЬапdопеd while all their relatives keep watchiпg them, апd тost of all will have а feeliпg of uпcertaiпty. They апd еvеп their doctors do поt kпow wheп they will die, апd how badly the feeliпg of раiп will attack theт. lt is really а desperate fee1iпg. All the desperatioп touched the deepest part of ту heart апd led те to do everythiпg 1 could to help to overcoтe the situatioп. Bowiпg ту head agaiп, 1 rea1ized that it took eight to 18 тoпths for сапсеr patieпts either to Ье still alive or to die after loпg sufferiпg. А siтple questioп arose: What shall we do iп the latter cases? Shall we do everythiпg? Shall we do пothiпg? Or shall we do soтethiпg? WHO aпswered with palliative care апd сапсеr раiп relief. То oтit trial апd error, our Govemтeпt decided to lauпch aпother pilot project suitaЬle for lпdoпesia, iп Sidoarjo. We chaпged the passive тodel iпto ап active опе. We call this тodel: Соттuпitу Based, Coтpreheпsive, lпtegrated Сапсеr Coпtrol or the "Sidoarjo тodel". То iпcrease соттuпitу participatioп, we use the Faтily Welfare Моvетепt, or РКК, which is well orgaпized, has ап educatioп prograттe, а good тoпitoriпg апd evaluatioп systeт that сап reach the sтallest uпit iп the соттuпitу, i.e. faтily, апd is availaЬle iп every part of lпdoпesia. Please do соте апd see our тodel, iп ту beautiful couпtry. Notwithstaпdiпg our respect for the world of тodem тediciпe, we are поw directiпg our coпceпtratioп оп aпother тethod of reduciпg the сапсеr patieпt's sufferiпg, i.e. altemative therapy. То fight сапсеr, let's таkе а world bridge with Geпeva as the ceпtral poiпt. Оп this woпderful occasioп let те express ту high appreciatioп to ту faтily, WHO, all ту teachers, ту frieпds, ту people апd the Govemтeпt of lndoпesia, for their uпderstaпdiпg апd cooperatioп. 1 also express ту gratitude to the Uпited Arab Eтirates Health Fouпdatioп, which chose те to Ье опе of the caпdidates to receive this award. Апd, last but поt least, тау 1 express ту gratitude to the forтer Chief ofWHO's cancer uпit, Dr Jап S~emsward, who, for тоrе thaп 15 years, eпcouraged ту ideas, the little steps that 1 took, just like а father watches the uпsteady steps of his little daughter. A53NR/6 page 129

The PRESIDENT:

Thank you, Professor Soedoko. Mr Ket Sein, may 1 ask you to соте to the podium.

Amid applause, the President handed the United Arab Emirates Health Foundation Prize to MrKet Sein. Le President remet а М. Ket Sein le Prix de la Fondation des Emirats arabes unis pour la Sante. (Applaudissements)

The PRESIDENT:

1 now invite Mr Ket Sein to address the AssemЬly on behalf ofthe Institute ofNursing.

MrKET SEIN:

Madam President, Madam Director-General, distinguished delegates, it is indeed an honour and а privilege to Ье аЫе to stand here and give the words ofthanks. On behalf ofthe Institute ofNursing (Myanmar), 1 should like to express my profound thanks for being awarded the prestigious United Arab Emirates Health Foundation Prize for 2000. In Myanmar nursing education was first undertaken in the late nineteenth century in the hospital environment. After Myanmar gained independence in 1948, there were five training schools for nurses conducting diploma courses in nursing; now we have 40 nursing and midwifery training schools all over Myanmar. In 1991 came the first establishment of а university to confer Bachelor of Nursing Sciences degrees on the nurses who had а diploma in nursing. Recently, the Institute of Nursing (Upper Myanmar) was opened to serve the upper Myanmar region. The general objective of the Institute of Nursing (Myanmar) is to provide opportunities for the development of competencies and skills required for the practice of safe and quality nursing care in promotive, preventive, curative and rehaЬilitative health services. lt is a1so the objective of the Institute ofNursing to promote self-directed lifelong leaming to еnаЫе nursing personnel to respond appropriately to changing health needs and advances, and to develop well qualified nursing professionals сараЫе of exercising leadership in the continued development of the nursing profession. In addition to formal nursing education programmes such as the Diploma in Nursing and the Bachelor of Nursing Sciences, postbasic speciality nursing training were also given for both bridge and generic courses. Continuing education programmes for in-service personnel are also among the training programmes offered Ьу the Institute of Nursing (Myanmar). The Institute of Nursing (Myanmar) will work in collaboration with govemmental and nongovemmental organizations, 1ocally and globally, to upgrade and strengthen existing nursing education programmes. Through training of nursing professionals, including managers, educators, health service providers and researchers, the Institute ofNursing (Myanmar) will make appropriate use ofthe award funds to contribute towards the health development of the people of Myanmar and of mankind as а whole. In conclusion, 1 should like again to convey my heartfelt thanks for the United Arab Emirates Health F oundation Prize, which will Ье an inspiration for all the health personnel of our country to strive for attainment of health for all.

The PRESIDENT:

Thank you, Mr Ket Sein. We have now completed item 7. The next plenary meeting will Ье held tomoпow, Friday, 19 Мау, at 9:00. The meeting is now adjoumed.

The meeting rose at 18:05. La seance est levee а 18h05. A53NR/7 page 130

SEVENTH PLENARY MEETING

Friday, 19 Мау 2000, at 9:00

President: Dr L. AМATHILA (NamiЬia)

SEPTIEME SEANCE PLENIERE

Vendredi 19 mai 2000, 9 heures

President: Dr L. AМATHILA (NamiЬie)

1. SECOND REPORT OF ТНЕ СОММIТТЕЕ ON CREDENTIALS1 DEUXIEME RAPPORT DE LA COММISSION DE VERIFICATION DES POUVOIRS1

The PRESIDENT:

The AssemЬly is called to order. Today, the AssemЬly will consider the second report of the Committee on Credentials. The report is contained in document А53/38, which you have all received. Delegates will note that it was the Bureau of the Committee on Credentials that examined the credentials of the Member States named in the report. Since the meeting of the Bureau, а formal credential was received from Saint Vincent and the Grenadines, а Member State that had previously submitted а provisional credential. ln addition, 1 have been informed Ьу the Secretariat that since the last meeting of the Committee on Credentials, а formal credential was received from Guinea-Bissau, а Member State that had previously not submitted а credential. lt has not been feasiЬle to convene the Committee on Credentials to examine the credentials of Guinea-Bissau, or the Bureau to examine the credentials of Saint Vincent and the Grenadines, but, in accordance with previous practice, 1 have examined both these credentials and have found them to Ье in keeping with the AssemЬly's Rules ofProcedure. 1 therefore recommend to the AssemЬly that Guinea-Bissau and Saint Vincent and the Grenadines Ье accepted as having formal credentials. Does the AssemЬly agree with this procedure? 1 see no objection. Does the AssemЬly wish to comment on the report? 1 see no requests. ln the absence of any comments, does the AssemЬly agree with the report being adopted, along with the addition of the credentials 1 have just mentioned? 1 see no objection. lt is so decided.

1 See reports of committees in document WHA53/2000/REC/3. 1 Voir les rapports des commissions dans le document WHA53/2000/REC/3. ASЗNR/7 page 131

2. ANNOUNCEMENT COMMUNICATION

The PRESIDENT:

When the Genera1 Committee met on Wednesday, 17 Мау, it drew up the list for the annual election of members entitled to designate а person to serve on the Executive Board and it considered the programme ofwork for the remainder ofthe AssemЫy, giving me the authority to consu1t with the chairpersons of the main committees to review the progress of their work and revise their programme accordingly, if necessary. After consideration of the progress of work in the main committees, the General Committee recommended that this plenary should meet this morning at 9:00 to consider agenda item 6, Executive Board: election, and agenda item 8, Reports of the main committees. ln accordance with the programme of work drawn up Ьу the General Committee, Committee А and Committee В will meet immediately after the plenary adjourns. ln the afternoon, Committee А and Committee В will meet again. On Saturday, tomoпow, 20 Мау, at 9:00, Committees А and В will hold their last meeting. The eighth plenary will convene at 11 :30 to continue with the reports of the main committees and to hear the report of the round taЫes. The ninth plenary will meet at 12:00 for the closure ofthe AssemЬly.

3. EXECUTIVE BOARD: ELECTION [OF МЕМВЕRS ENTITLED ТО DESIGNATE А PERSON ТО SERVE ON) ELECTION DE MEMBRES НABILITES А DESIGNER UN REPRESENTANT AU CONSEIL EXECUTIF

The PRESIDENT:

W е shall now consider agenda item 6, Executive Board: election. 1 draw your attention to the list of 1О members contained in document А53/34 drawn up Ьу the General Committee in accordance with Rule 102 of the Rules of Procedure. In the General Committee' s opinion these 1О Members would provide, if elected, а balanced distribution of the Board as а whole. These members are, in the English alphabetical order: Brazil, Democratic People's RepuЫic of Korea, Equatorial Guinea, lslamic RepuЫic of lran, Italy, Japan, Jordan, Lithuania, Sweden, Venezuela. ls the AssemЬly prepared, in accordance with Rule 80 of the Rules of Procedure, to elect these 1О Members as proposed Ьу the General Committee? 1 see no objection. 1 therefore declare the 1О Members elected. This election will Ье duly recorded in the records of the AssemЬly. Мау 1 take this opportunity to invite Members to рау due regard to the provision of Article 24 of the Constitution when appointing а person to serve on the Executive Board. We can now proceed to item 8 Reports of the main committees.

4. FIRST REPORT OF СОММIТТЕЕ А 1 PREMIER RAPPORT DE LA COMMISSION А 1

The PRESIDENT:

We shall now consider the first report of Committee А. This is contained in document А53/35. Please disregard the word "draft" as the Committee approved the report without amendments.

1 See reports of committees in document WHA53/2000/REC/3. 1 Voir les rapports des commissions dans le document WHA53/2000/REC/3. A53NR/7 page 132

The report contains one resolution which is entitled "Stop Tuberculosis lnitiative". ls the AssemЫy willing to adopt this resolution? 1 see no objection. The resolution is adopted and the first report of Committee А is therefore approved.

5. FIRST REPORT OF СОММIТТЕЕ В 1 PREMIER RAPPORT DE LA COMMISSION В 1

The PRESIDENT:

You now have before you the first report of Committee В contained in document А53/36. The report contains seven resolutions and one decision which we shall proceed to adopt one Ьу one. Let us now consider the first resolution entitled "Members in arrears in the payment of their contributions to an extent that would justify invoking Article 7 of the Constitution". ls the AssemЫy willing to adopt this resolution? 1 see no objection. The resolution is therefore adopted. The second resolution is entitled "Financial report on the accounts of WHO for 1998 and 1999, report of the External Auditor, and comments thereon, made on behalf of the Executive Board: report of the Internal Auditor". ls.the AssemЬly willing to adopt this resolution? 1 see no objection. The resolution is therefore adopted. The third resolution is entitled "Real Estate Fund". ls the AssemЬly willing to adopt this resolution? The delegate of Congo has the floor.

М. MENGA (Congo) :

Merci, Madame la Presidente. Concernant la resolution sur le fonds immoЬilier de l'OMS, je voudrais faire une tres breve declaration compte tenu du fait que ma delegation а trouve de nombreuses objections, dont une objection principale. Le Congo s'etonne de се que le texte annexe а la resolution sur le fonds immoЬilier ne reflete pas les conclusions des debats et n'ait pas tenu compte des amendements faits par le Conseil executif lors de sa cent cinquieme session en janvier 2000, tenue ici а Geneve. En effet, dans la section 2.2, page 3, le paragraphe 1 avait ete retire pour illegalite de la demarche. Dans la mesure ou le Comite regional OMS de l' Afrique, seul organe directeur competent, а solennellement confirme le maintien du siege regional de l'OMS/AFRO а Brazzaville au cours de ses dernieres sessions de 1998 а Harare (Zimbabwe) et de 1999 а Windhoek (NamiЬie), la Direction regionale de l'Afrique, qui assure le secretariat de cet organe deliberant, n'a pas qualite ni pouvoir de prendre une decision contraire а celle dudit Comite. А l'evidence, quand on parle de siege officiel, il s'agit du siege de Brazzaville, Harare n'etant que le siege provisoire. Par ailleurs, il est de notoriete puЬlique que les travaux de refection du siege а Brazzaville sont actuellement en cours et а un niveau tres avance. Des missions de contrбle et d'evaluation ont meme ete effectuees par des equipes de la Direction regionale. Le rapport circonstancie sera presente en tout etat de cause lors de la prochaine session du Comite regional а Ouagadougou (Burkina Faso ). En outre, si des refections sont necessaires au niveau du siege provisoire а Harare, il etait indispensaЬle de \е mentionner clairement en son temps dans le texte propose au Conseil executif en annexe au projet de resolution en vue de son adoption prealaЬle par cet organe directeur. Or ceci n'a pas ete le cas. А la lumiere de се qui precede, il у а lieu de respecter la Iegalite et, naturellement, de ne pas violer les usages consacres par notre prestigieuse institution en matiere d'adoption de resolutions. C'est pourquoi \е texte adopte par le Conseil executif et propose а notre examen pour approbation presentement ne peut plus faire l'objet d'une quelconque modification. Il doit etre conforme а la decision du Conseil executif pour engager celui-ci, pas autrement. Transparence oЬlige. Enfin, cela а logiquement pour corollaire le retrait immediat de се texte de toutes les dispositions qui n'ont pas ete adoptees par le Conseil executif pour que la presente resolution soit

1 See reports ofcommittees in document WHA53/2000/REC/3. 1 Voir les rapports des commissions dans Ie document WHA53/2000/REC/3. A53NR/7 page 133 conforme. En conclusion, cette resolution doit etre adoptee sans le paragrapl1e 1 incrimine d'illegalite. Je vous remercie de votre bonne comprehension.

The PRESIDENT:

1 think that the objections of the delegate of Congo should Ье looked at if any coпections are needed. МауЬе the Lega1 Counse1 wants to say something. Legal Counse1, do you have something to say? The Legal Counse1 has the floor.

The LEGAL COUNSEL:

1 think 1 have to request the delegate of Congo for clarification. ls he objecting to а particular e1ement of expenditure that is comprised within the total sum indicated in paragraph 1? Paragraph 1 refers to а global amount and that is then composed ofvarious expenditures.

М. MENGA (Congo):

En се qui conceme l'adoption des resolutions, il у а quand meme un point а considerer en priorite, а savoir le respect des regles de procedure. Effectivement, au cours de la session de janvier du Conseil executif, ici meme а Geneve, il avait ete fait mention, dans le rapport relatif au fonds immoЬilier en се qui conceme le Bureau regional de 1' Afrique, du fait qu'il у avait necessite de proceder а la construction de Ыitiments а Harare. Au terme des debats tout а fait contradictoires et responsaЫes qui se sont produits consecutivement а l'examen de се point, i1 avait ete decide de son retrait pur et simple. Or, dans le projet de resolution approuve par la Commission В qui figure en annexe 4, page 3, on а repris in extenso се que le Conseil executif avait retire, donc n'avait pas adopte. D'un point de vue strictement procedural et en vertu de la legalite, nous pensons qu'il у а eu violation manifeste de la pensee et de l'esprit de се que le Conseil executif а eu а adopter. On ne pouvait donc point, ici, faire adopter un texte qui а ete amende ; dans се texte, on ne fait plus etat, en annexe, de la phrase que je cite : « Le Bureau regional de 1' Afrique а demande le financement par le fonds immoЬilier de la construction d'un blitiment de bureaux а Harare. On est encore en train d'etudier d'autres possiЬilites. » Et pour terminer mon propos, ii est entendu que le Conseil executif doit adopter un compte rendu qui sert de proces-verbal et nous pouvons etre surs que, dans le compte rendu provisoire, les conclusions pertinentes de cet organe directeur font etat du retrait de се paragraphe. La delegation congolaise exige donc tout simplement, sans aller au fond, parce que l'inscription ou la non-inscription dans les lignes budgetaires constitue un autre debat, le respect strict de се qui а ete adopte par le Conseil executif. Се qui а ete presente а la Commission В et approuve comme projet de resolution, et presentement soumis а notre adoption, necessite, et nous l'exigeons fermement, qu'on retire се paragraphe.

The PRESIDENT:

1 thank the delegate of Congo. 1 think now it has been explained. Would the Secretariat like to respond?

Mr AIТKEN (Senior Policy Adviser):

First, in clarification, the question is whether or not 1 agree with the delegate of Congo that there are expenditures refeпed to in this resolution which may relate to construction in Harare and not in Brazzaville. As you know, the Regional Office is temporarily relocated to Harare. 1 want to confirm for the record that this resolution only concems the purchase of а telephone switchboard for Harare, and that this switchboard is moveaЫe and can Ье moved to wherever the Regional Office is finally located. There is no construction provided for in the resolution relating to buildings or any other element in Harare. A53NR/7 page 134

The PRESIDENT:

1 thank the Secretariat and, now that а clear explanation has been given, does the delegate of Congo still want to respond, or shall we just take this objection as noted?

М. MENGA (Congo):

Reprenons се qu'a dit le representant du Secretariat : il parle des appareils ; or, dans le texte, on parle de la construction d'un batiment de bureaux. Се sont deux choses differentes. Nous sommes d'accord pour l'achat des appareils, mais, dans le texte, on parle de la construction d'un batiment de bureaux; c'est cette expression qu'il faut retirer.

The PRESIDENT:

Would the Secretariat please give the full answer to this issue so that we can move on?

Mr AIТKEN (Senior Policy Adviser):

1 think that what has. happened is that the delegate of Congo is thinking that the text of а document that was submitted to the Executive Board, which contains а paragraph about the possiЬilities of purchasing some accommodation in Harare, is also decided upon Ьу the AssemЬly resolution. Let me confirm for the record: the text of the document that was considered Ьу the Executive Board is not part of the resolution that we have now adopted or are about to adopt. The reference to accommodation in Harare is not included in the AssemЬly decision; it is only refeпed to in an Executive Board document for information, which has been included in the papers annexed to the resolutions and decisions of the Executive Board, but that is not part of the AssemЬly decision process.

The PRESIDENT:

1 think we have dwelt enough on this issue and clarifications have been given. lf there are further clarifications, 1 think it can Ье dealt with elsewhere. Мау 1 now ask the AssemЬly to adopt this resolution and, of course, note the objections and the discussions thereof, which took place now. ls the AssemЬly ready to adopt the resolution? lt is so decided. The fourth resolution is entitled "Casual income". ls the AssemЬly willing to adopt this resolution? 1 see no objection. Adopted. The fifth resolution is entitled "Amendments to the Financial Regulations". ls the AssemЬly willing to adopt this resolution? 1 see no objection. Adopted. The sixth resolution is entitled "Salaries of staff in ungraded posts and of the Director-General". ls the AssemЬly willing to adopt this resolution? The delegate ofThailand has the floor.

Dr WANCНAI SATTAУ А WUTНIPONG (Thailand):

Thank you Madam. As а newcomer to the World Health AssemЬly, 1 would like to ask some questions for clarification about the conduct of the meeting in this AssemЬly. Yesterday, in the meeting of Committee В, 1 was very confused over the way the meeting was conducted. 1 have two questions. First, 1 wonder which of the Rules of Procedure allowed Committee В not to discuss an agenda item which has been approved Ьу the plenary, as endorsed Ьу the General Committee. lfthis is сопесt, then 1 wonder whether any main committee can vote to discuss an agenda item which was deleted Ьу the plenary. lfthis can happen, it means that а main committee can overrule the decision Ьу the plenary. lf а main committee discussed this agenda item and felt that the agenda item should not Ье discussed Ьу the AssemЬly, it should report back for the opinion ofthe AssemЬly. However, we were recommended Ьу the Secretariat not to include this issue in the report. 1 think that this is а very risky way for the AssemЬly to go on. A53/VR/7 page 135

There is even тоrе risk related to ту second point. Yesterday, in Comтittee В, а point of order was raised that the agenda iteт on the scale of assessтents did not conform to Rule 98 of the Rules of Procedure. Rule 98 says that the discussion on the scale of assessтents requires one of two conditions. First, it has to Ье coттunicated to the Meтbers 90 days before the opening of the session. Second, it has to Ье recoттended Ьу the Executive Board. The two conditions are all factual conditions. For the first condition of 90 days, it was clear that we were informed less than 90 days beforehand. For the second condition, naтely the recoттendation Ьу the Executive Board, we received only а verbal explanation that it had been raised and discussed in the Executive Board. Two Executive Board тетЬеrs agreed, while one тетЬеr disagreed. Docuтentary support on the recoттendation Ьу the Executive Board was requested; however, the suттary record was not presented. This placed the тeeting in great confusion and forced the Chair to decide on the basis of the verbal suggestion Ьу the Secretariat. Finally, а vote was held and the decision of the Chair was overturned Ьу the тajority of the Members. This was definitely an unjustifiaЬle and unnecessary conflict, and placed at very high risk the conduct of the тeeting and the iтage of the Chair, including yourself. 1 would need а clear explanation on these two issues, so that the conduct of the meeting can go on with solidarity, transparency and efficiency.

The PRESIDENT:

1 thank the delegate of Thailand. 1 think this is what transpired in Coтmittee В yesterday but do we want to reopen the discussion? Could we round it up now? Legal Counsel, could you give us the final word on that?

The LEGAL COUNSEL:

The iteт, Scale of assessтents, was placed on the provisional agenda Ьу the Executive Board. That decision adopting the provisional agenda, as aтended during the discussion, is availaЬle in the official records of the Executive Board and the suттary records before the Health AsseтЬly. The question arose during Coтmittee В whether the requirements of Rule 98 had been adhered to with respect to the scale of assessтents. Rule 98 reads as follows: "No proposal for а review of the apportionтent of the contributions aтong Meтbers and Associate Members for the tiтe being in force shall Ье placed on the agenda unless it has been communicated to Meтbers and Associate Members at least ninety days before the opening of the session, or unless the Board has recoттended such review." There was consideraЬle discussion whether the last criterion, "unless the Board has recommended such review", was satisfied in the particular circuтstances. There was sоте question whether the Board had actually put it on the provisional agenda, and that had been clarified Ьу the interventions of the representatives of the Executive Board. As 1 say, that decision is also availaЬle in the official records. There was also а discussion on whether simply placing it on the agenda теt the intention of the rule, and that whether there should not Ье more of а substantive consideration Ьу the Board as to recomтending а revision. There was а point of order on this point; the delegate raising the point did not consider that the rule had been adhered to. 1 was requested to give an opinion as the Legal Counsel, and 1 gave my opinion that the rule had been adhered to. The Chairman upheld that opinion. There was then an appeal against that decision Ьу the Chairman; that appeal was successful - which had then the effect of the Committee deciding that Rule 98 had not been adhered to, and therefore the agenda iteт was not properly before the Coттittee. Now, as to whether the Coттittee has this authority: the Coттittee is а subsection of the AssemЬly as а whole, the plenary as а whole decided to put this iteт on the agenda. The Committee, when considering the iteт in тоrе detail, decided that it should not consider it- for the reasons 1 have just indicated. And so, using the Rules of Procedure, the Coттittee came to а conclusion, which it had the authority to соте to. As to the method of presenting reports to the plenary: over the years, we have developed а systeт whereby the substantive resolutions and decisions are the iteтs that are presented to the plenary. The Rapporteur indicated to те that he thought that there should Ье а text indicating how the Committee had acted on Rule 98 in relation to the iteт on the scale of assessтents. Му first reaction was that it is not done in this way. When he A53NR/7 page 136 added this reflected what had happened, 1 agreed with him that that was an appropriate way to proceed. 1 hope that answers all the questions.

The PRESIDENT:

The delegate ofThailand, you have the floor.

Dr W ANCНAI SA ТТ А У А WUTНIPONG (Thailand):

1 would like to thank the Legal Counsel for his explanation; however, 1 am not sure which ofthe Rules of Procedure of the Health AssemЬly allows the main committee to decide not to discuss an item on an agenda that had been adopted Ьу the plenary- this is the first question. Second, why did we vote on а factual issue if it is maintained that the official record shows that the Executive Board did recommend the inclusion of this agenda item in this AssemЬly? We should not have had to vote. ln addition, this was not а simple vote, it was а roll-call vote, whose nature may put at risk the solidarity of the Organization. So 1 think we need further clarification of these two issues.

The PRESIDENT:

The delegate of Uruguay has the floor.

La Dra. VIVAS (Uruguay):

En este punto del orden del dia "Escala de contribuciones", compartimos en terminos generales lo explicado por el Asesor Juridico sobre que es lo que sucedi6 en la Comisi6n В. Ahora Ьien, com­ prendemos las preocupaciones de la delegaci6n de Tailandia, en particular cuando vemos la versi6n en espafiol del primer informe de la Comisi6n В. А nuestra delegaci6n le surge una duda cuando en los informes lee: "La Comisi6n acord6 no debatir este punto del orden del dia por considerar que el ar­ ticulo 98 del Reglamento lnterior de la AsamЬlea de la Salud no se haЬia cumplido". Mi delegaci6n quiere volver а repetir algo que expres6 en el dia de ayer en la tarde en su primera intervenci6n sobre este tema. Entendemos que hubo debate sobre este punto, "Escala de contribuciones". Entendemos que en la Comisi6n В hubo debate. Luego vino una moci6n de orden. Una cosa es haber incluido "Escala de contribuciones" en el punto del orden del dia de la AsamЬlea, que si se cumpli6 у se deba­ ti6, у otra es lo que dice el articulo 98, que trata de la inclusi6n en el orden del dia bajo dos condicio­ nantes, para dos tipos de altemativas. No tengo аса conmigo el articulo pero se refiere а las propues­ tas de revisi6n de la escala de contribuciones. Lo que \а Comisi6n В hizo en el dia de ayer, а juicio de esta delegaci6n, que pide una clarificaci6n al respecto, es, en primer lugar, debatir е\ punto del orden del dia; en segundo lugar, como dijo el Asesor Juridico, hubo una moci6n de orden presentada por la delegaci6n de Cuba; el Presidente tom6 su decisi6n; la delegaci6n de Cuba recurri6 contra \а decisi6n tomada por el Presidente, se vot6 у \а moci6n de orden presentada por Cuba fue aprobada por una ma­ yoria importante. А lo que se refiere esa moci6n de orden а mi juicio, es а la propuesta concreta sus­ tantiva de c6mo vamos а modificar la Escala de contribuciones. Una cosa es el debate, que уо creo que lo hubo, у otra cosa es el articulo 98, con una propuesta sustantiva que estaba incorporada en un documento de la Secretaria de fecha 18 de abril. Ме gustaria una clarificaci6n sobre este punto porque no estoy tan segura de que sea exacto que la Comisi6n acordara no debatir este punto del orden del dia. Lo que acord6 la Comisi6n, а mi juicio, fue otra cosa.

The PRESIDENT:

Legal Counsel, could you explain why this item has not been included on the AssemЬly agenda today? The delegate of Cuba requests the floor before you give the final explanation. A53NR/7 page 137

El Sr. CASТILLO SANT ANA (Cuba):

Mi delegaciбn se suma а los criterios vertidos por la distinguida delegada del Uruguay, al res­ pecto de lo que ocurri6 en el dia de ayer en la Comisiбп В у para dar mas claridad а lo que ocurri6 у а los resultados de los debates de ayer. Repito, me sumo а los criterios vertidos por el Uruguay у puedo decir que la intenciбп de la delegaciбп de Cuba al preseпtar la mосiбп de ordeп era que по se tomara еп coпsideraciбп por la Comisiбп В uп proyecto de resoluciбп muy concreto que se preseпt6, que по cumplia con los requisitos del articulo 98 del Reglameпto lпterior de la Asamblea. Este articulo pres­ cribe сбmо dеЬеп preseпtarse los proyectos para camЬiar la escala de coпtribucioпes. У este proyecto de resoluciбп que se present6 qued6 fehacientemeпte demostrado que по cumplia estos criterios; por taпto, esa fue la rаzбп por la cual la delegaciбп сuЬапа preseпt6 esa mосiбп de ordeп. Pero ademas, despues de uп eпceпdido у coпtrovertido debate procesal, se llev6 а uпа votaciбп, у por uпа graп ma­ yoria, esa mосiбп de ordeп fue aprobada. Por taпto, mi delegaciбп coпsidera que по es correcto decir que el puпto "Escala de contribucioпes" se retir6 de los debates de la Comisiбn. У о те sumo а la de­ claraciбп del Uruguay еп el seпtido de que el puпto se discuti6, у se discuti6 соп creces. Ahora Ьiеп, tamЬien es correcto decir que еп virtud del articulo 98 по se coпsider6 uп proyecto de resoluciбп que, deпtro de este punto "Escala de coпtribucioпes" se preteпdi6 debatir еп la Comisiбп. Pieпso que asi debe eпteпderse lo que ocurri6 ayer еп la Comisiбп В у debe tomarse еп coпsideraciбп la decisiбn de la Comisiбп В de по examinar uп proyecto de resoluciбп que preteпdiera camЬiar la escala de coпtribucioпes siп que ese proyecto de resoluciбп meпcionado cumpliera los re­ quisitos del articulo 98, que prescribe la maпera еп que deben ser preseпtados este tipo de proyectos de resoluciбп.

The PRESIDENT:

Legal Couпsel, you have the floor.

The LEGAL COUNSEL:

1 thank the distinguished delegates of Cuba, Thailand апd Uruguay for their explanatioпs and queries; these are all valid. 1 thiпk the last iпterveпtioпs Ьу Cuba апd Uruguay brought out ап important point that the сопсеm of тапу who took the floor iп support of the origiпal poiпt of order was that the substaпtive requiremeпts of Rule 98, whether there should have Ьееп а proposal or а request Ьу the Executive Board for such а revisioп, were поt adhered to. ln that respect, there was а discussioп of the item апd they are correct that perhaps it would have Ьееп more accurate to say that the Committee decided поt to take а decision on the proposal for а revisioп. With regard to the authority of the Committee to take such actioп, а committee ofteп decides to take по actioп on ап ageпda item. This flows from the natural authority of апу parliameпtary body when coпfroпted with а particular questioп. So, 1 thiпk that these discussioпs have clarified the outcome of Committee В and 1 hope that we сап conclude this item.

The PRESIDENT:

After the delegates of Thailand апd of Uruguay have takeп the floor, 1 hope we сап go ahead.

Dr W ANCНAI SA ТТ А У ANUTНIPONG (Thailaпd):

Thaпk you for the explaпatioп, апd 1 also agree with the delegates of Cuba and Uruguay. However, my secoпd questioп has поt Ьееп answered. How сап we vote оп an issue of fact? What happeпs if today someoпe produces the documeпt to support the Secretariat's explaпation yesterday that the Board did discuss апd recommeпd this ageпda item? Would it mеап that Committee В decided coпtrary to Rule 98? The positioп of апу chair would Ье put at high risk if а committee voted agaiпst its decisioп. 1 thiпk the questioп is the quality of the suggestioп made Ьу the Secretariat, апd this is creatiпg unпecessary coпflict amoпg Member States. A53NR/7 page 138

La Dra. VIV AS (Uruguay):

Nada mas Jejos de nuestra intenci6n que prolongar este debate. Lo unico que quisieramos ver reflejado en el informe de la Comisi6n В es que la Comisi6n debati6 este punto del orden del dia, у como bien Jo expres6 el Asesor Juridico, у coincido con el, se puede considerar Ja redacci6n у el pleno puede decidir al respecto, con Jo que no seria necesario volver а la Comisi6n В con este tema. En primer lugar se debati6 este punto del orden del dia, porque este punto existe: Jo aprob6 primero la Mesa у luego la AsamЬlea; este punto esta en el orden del dia de Ja AsamЬlea. Pero no se tom6 una decisi6n sobre una propuesta, porque esa propuesta, desde el punto de vista procesal, no cumplia con el articulo 98 del Reglamento lnterior de la AsamЬlea, у asi fue sometido а votaci6n. Respecto de la observaci6n de la delegaci6n de Tailandia de que esto pone en una situaci6n difi­ cil al Presidente de Ja Comisi6n В, quisiera decir que respeto la opini6n del delegado de Tailandia, pero mas dificil fue Ja situaci6n que afrontamos los miembros de Ja Comisi6n В. Todo lo actuado en Ja Comisi6n В Jo fue dentro del Reglamento. Ciertamente no fue una situaci6n deseada, у no fue nuestra voluntad provocarla ni poner а nadie en situaciones dificiles. TamЬien nosotros estuvimos en una situaci6n dificil. Desearia que, si la AsamЬlea esta de acuerdo, el informe de Ja Comisi6n В re­ flejara lo que pas6 у dieramos por finalizado este asunto.

The PRESIDENT:

Мау 1 now ask the Legal Counsel to review this?

The LEGAL COUNSEL:

Thank you, Madam President. 1 would agree with the explanation ofthe delegate ofUruguay. ln response to the delegate of Thailand, 1 was not aware that Ьу the end of the discussion in Committee В there was still а concem whether the Executive Board had actually put the item on the agenda. Rather, the discussion centred more on whether Rule 98 required that there Ье an actual request Ьу the Executive Board for а revision and whether in merely placing the item on the Health AssemЬly agenda the Board satisfied that requirement. lt was that substantive issue that really was the basis of the point of order. ln response to the proposal Ьу the delegate of Uruguay, Madam President, you might wish to ask the plenary whether it would agree to the report of Committee В being revised on this point to read as follows: "The Committee discussed this agenda item, but as the Committee considered that Rule 98 of the Rules of Procedure of the Health AssemЬly had not been adhered to, no decision was taken on the proposal."

The PRESIDENT:

Does the AssemЬly accept this amendment? 1 see no objection to this. lt is so decided. Мау we now move further, 1 hope this time on items that we will all agree on? The sixth resolution was entitled "Salaries of staff in ungraded posts and of the Director-General". ls the AssemЬly willing to adopt this resolution? 1 see no objection. lt is agreed upon. The seventh resolution is "Regulations for expert advisory panels and committees". ls the AssemЬly willing to adopt this resolution? No objection. lt is so decided. Under agenda item 14.2 Staff development and support, the Committee decided to nominate Dr A.J.M. Sulaiman, member ofthe delegation ofOman, а member ofthe World Health Organization Staff Pension Committee, and to nominate Dr Е. Кrag, member of the delegation of Denmark, as an altemate member. Does the AssemЬly agree with this decision? 1 see no objection. lt is so agreed. The delegate ofthe United States of America requests the floor.

Ms BLACKWOOD (United States of America):

The delegation of the United States of America would like to make а brief statement on the issue ofthe WHO scale of assessment for the record. A53NR/7 page 139

The United States very much regrets that the reso1ution on the scale of assessments presented in the discussion paper could not Ье considered for а vote in Committee В. We regret even more that it could not Ье approved. Contrary to the statement in the report, the resolution represented no violation of Rule 98 or any other rule of the AssemЫy. The records of the meeting of the Executive Board in January, which are availaЫe to everyone, make clear that no rule was violated. Further, the legitimacy of this resolution was confirmed Ьу the Legal Counsel, the Chairman of Committee В, and the Chairman of the Executive Board. This AssemЬly has been replete with arguments that much more needs to Ье done on AIDS, malaria, tobacco and noncommunicaЫe diseases, if only more money were availaЫe. Developing countries are in serious need of assistance, and the United States wants very much to continue its long tradition of efforts to improve the health and developmental status of other countries. We see the decision in Committee В as а lost opportunity for WHO and its Members. lt remains the position of the United States of America that the WHO scale of assessments should Ье harmonized with that of the United Nations effective 1 January 2001.

The PRESIDENT:

1 thank the delegate of the United States of America for her explanation which will Ье duly recorded in the records of the AssemЬly. Does the AssemЬly agree and adopt the first report of Committee В as amended? 1 see no objections. lt is so adopted with the amendment. This completes our work for today. The next plenary will Ье held tomoпow at 11:30. Committees А and В will meet immediately on adjoumment ofthis meeting. The meeting is adjoumed.

The meeting rose at 10:05. La seance est levee а 10h05. A53NR/8 page 140

EIGHTH PLENARY MEETING

Saturday, 20 Мау 2000, at 11:30

President: Dr L. AМATHILA (Namibia)

ПUITIEME SEANCE PLENIERE

Samedi 20 mai 2000, llh30

President: Dr L. AMATHILA (NamiЬie)

1. SECOND REPORT OF СОММIТТЕЕ В 1 DEUXIEME RAPPORT DE LA COММISSION В 1

The PRESIDENT:

The AssemЬly is called to order. We shall continue today with approva1 of the reports from the main committees. We shall start with the second report of Committee В (document А53/37). Please disregard the word "Draft" as the Committee adopted the report without any amendments. It contains two resolutions. The first one is entitled "Participation Ьу WHO in the 1986 Vienna Convention on the Law of Treaties between States and lntemational Organizations or between Intemationa1 Organizations". ls the AssemЬly willing to adopt this resolution? 1 see no objection. The resolution is adopted. The second resolution is entitled "lntemational Decade of the World's lndigenous People". When the Committee adopted this resolution, it made certain editorial changes: it was recommended that lntemational Consultation on the Health of lndigenous Peoples should appear in inverted commas and, in paragraph 2, an "s" should Ье added to the word "People" which will read as "lntemational Consu1tation on the Health of lndigenous Peoples". These changes will Ье reflected in the final versюn. ls the AssemЬly willing to adopt this resolution, as amended? 1 see no objections, the resolution is adopted and the second report of Committee В is therefore approved.

1 See reports of committees in document WHA53/2000/REC/3. 1 Voir les rapports des commissions dans !е document WHA53/2000/REC/3. Л53NRJ8 page 141

2. THIRD REPORT OF COMMITTEE В 1 TROISIEME RAPPORT DE LЛ COMMISSION В 1

The PRESIDENT:

Let us now consider the third report of Committee В (document ЛSЗ/39). The report contains one reso1ution which is entit1ed "Hea1th conditions of, and assistance to, the ЛrаЬ popu1ation in the occupied ЛrаЬ teпitories, inc1uding Palestine". ls the AssemЬly willing to adopt this resolution? The delegate oflsrael has the floor.

Mr PELEG (lsrael):

Thank you, Madam President. 1 wish to express our regret about the adoption of political resolutions Ьу WНО. This resolution on the health situation in teпitories, and other resolutions regarding the participation of the Palestinians in the work of WHO, do not assist either the реасе process or the very important humanitarian role of WHO, including the promotion of the реасе process. W е hope that next year the Arab countries and the Palestinians, our partners in this important - реасе process, will not present such draft resolutions and will concentrate on professional cooperation with us in the framework and under the auspices of WHO.

The PRESIDENT:

1 thank the delegate of lsrael. У our remarks will Ье noted and will appear in the AssemЬly records. Any more objections or remarks? 1 see none. The resolution is adopted and the third report of Committee В is therefore approved.

3. FOURTH REPORT OF COMMITTEE В 1 QUЛTRIEME RAPPORT DE LЛ COMMISSION В 1

The PRESIDENT:

Let us continue with the fourth report of Committee В ( document АSЗ/40). Please disregard the word "Draft" as the Committee adopted the report without any amendments. The report contains two resolutions. The first one is entitled "Global Alliance for Vaccines and Immunization". ls the AssemЬly willing to adopt this resolution? 1 see no objection. The resolution is adopted. The second resolution is entitled "Aligning the participation of Palestine in the World Health Organization with its participation in the United Nations". ls the AssemЬly willing to adopt this resolution? 1 see no objection. The resolution is adopted.

4. SECOND REPORT OF СОММIТТЕЕ Л 1 DEUXIEME RAPPORT DE LЛ COММISSION Л 1

The PRESIDENT:

Let us now consider the second report of Committee А, which is contained in document АSЗ/41. The report contains four resolutions and one decision which we shall proceed to adopt one Ьу one.

1 See reports of committees in document WHA53/2000/REC/3. 1 Voir les rapports des commissions dans le document WHA53/2000/REC/3. ASЗNR/8 page 142

The first resolution is entitled "НIV/AIDS: confronting the epidemic". ln approving this report this morning, the Committee made editorial changes to operative paragraph 1(23) and amended operative paragraph 2(8) as follows: insert "as well as other programmes against HIV/AIDS in other Member States before, particularly at country level". Is the AssemЬly willing to adopt this resolution with the coпection made? ln the absence of any objections, the resolution is adopted, as coпected. The second resolution is entitled "Food safety". ls the AssemЬly willing to adopt this resolution? 1 see no objection. The resolution is adopted. Under agenda item 12.4, the Committee agreed on а decision entitled "lnfant and young child nutrition". Does the AssemЬly agree with this decision? 1 see no objection. lt is so decided. The third resolution is entitled "Framework convention on tobacco control". There is а clerical епоr in the text of the resolution attached to the report. ln operative paragraph 2, change the word "comprehensive" to "sound". With this coпection, is the AssemЬly now willing to adopt this resolution? 1 see no objection. The resolution is adopted with the change. The fourth resolution is entitled "Prevention and control of noncommunicaЫe diseases". ls the AssemЬly willing to adopt this resolution? 1 see no objection. ln the absence of any objection, the resolution is adopted and the second report of Committee А is therefore approved. Now that the main committees have finished their consideration of the Executive Board's reports, we are in а position formally to take note of these reports. From the comments which have been made, 1 take it that the AssemЬly wishes to commend the Board on the work performed and express its appreciation of the dedication with which the Board has caпied out the task entrusted to it. ln the absence of any comments, it is so decided.

5. SELECTION OF ТНЕ COUNTRY IN WHICH ТНЕ FIFTY-FOURTH WORLD HEALTH ASSEМВLY WILL ВЕ HELD CHOIX DU PAYS OU SE TIENDRA LA CINQUANTE-QUATRIEME ASSEMBLEE MONDIALE DE LA SANTE

The PRESIDENT:

1 should like to draw the AssemЬly's attention to the fact that, under the provisions of Article 14 of the Constitution, the Health AssemЬly, at each annual session, shall select the country or region in which the next annual session shall Ье held, the Executive Board subsequently fixing the date and place. 1 should also recall that the Thirty-eighth World Health AssemЬly concluded that it was in the interest of all Member States to maintain the practice of holding Health AssemЬlies at the site of the headquarters ofthe Organization. 1 therefore take it that the AssemЬly decides that the Fifty-fourth World Health AssemЬly will Ье held in Switzerland. ln the absence of any objections, it is therefore so decided. The meeting is adjourned.

The meeting rose at 12:20. La seance est levee а 12h20. A53NR/9 page 143

NINTH PLENARY MEETING

Saturday, 20 Мау 2000, at 12:20

President: Dr L. AMATHILA (NamiЬia)

NEUVIEME SEANCE PLENIERE

Samedi 20 mai 2000, 12h20

President: Dr L. AMATHILA (NamiЬie)

CLOSURE OF ТНЕ SESSION CLOTURE DE LA SESSION

The PRESIDENT:

The meeting is called to order. 1 should first like to ask Professor К waku Danso-Boafo, Minister of Health of Ghana, Chairrnan of one of the round taЬles on addressing the major health system challenges, to соте to the rostrum to present an oral report summarizing the discussions of the four round taЬles. Professor Danso-Boafo, you have the floor.

Professor DANSO-BOAFO (Ghana):

Madam President, Madam Director-General, distinguished delegates, ladies and gentlemen, 1 have the honour to present the report from the round taЬles held on Tuesday, 16 Мау, on behalf ofthe four chairpersons: Mrs Andrea Fischer of Gerrnany, Dr Ponmek Dalaloy of the Lao People's Democratic RepuЬlic, Seiior Jose Antonio Gonzalez Femandez ofMexico and myself. 1 wish to report first that the ministers appreciated the opportunity to debate these important issues during this AssemЬly. Overall, the ministers participating in the discussions welcomed the development Ьу WНО of а framework for assessing health systems, and they regarded it as а critically important tool for strengthening health systems. 1 will Ье summarizing other main points of the extensive discussions that took р1асе in the round taЬles in my remarks here this moming. 1 will begin Ьу outlining some general remarks. First, ministers found that whereas health indicators have improved in most countries, the distribution of good health, both between countries and between population groups within countries, is far from equal. ln some cases the inequality is growing. Second, they noted that because the major deterrninants of health - such as adequate housing, food supply and social security - are beyond the responsiЬility of ministries of health, strengthening health systems in order to address inequalities in health and improve health status should involve "partner" ministries and agencies, including donor agencies. Third, they recognized that а minimum set of intemational standards is needed against which the perforrnance of а country's health system can Ье measured, although, of course, the specific context of each country must Ье taken into account when assessing perforrnance. ASЗNR/9 page 144

Lastly, the development of indicators to measure health system performance does need to include а consultation process with countries. One key aspect to address in this process, especially in developing countries, is to consider sustainaЬility. 1 will now summarize the main points with respect to the stewardship role of govemments, faimess in financing, health service provision, and support from WHO, at bQth global and national level. With respect to the stewardship role of govemments, the ministers suggested that to take а central stewardship role - including leadership and coordination - а reliable health information system is needed that can help in setting priorities and measuring performance. The ministers also pointed out that each component of а health system should Ье held accountable - both intemally and also to the public it serves - for performing to consistently high standards, including standards of clinical care, and for continually striving to improve performance. They recognized that mechanisms for greater involvement ofthe public are required. With respect to faimess in financing, ministers agreed that financing is а major issue for developing countries, especially where the national budget is small, and there is little or no tlexibility in allocating the proportion to Ье spent on health. They pointed out that whereas many countries recognize the advantages of cost-sharing, the introduction of schemes for prepayment could face а number of obstacles. These obstacles are outlined in the more detailed summary record of the discussions. 1 With regard to health service provision, а major discussion centred on the desiraЬility of competition between health care providers. lt was pointed out that competition is not а panacea for improving health system performance, and that an effective health service requires collaboration between providers - both public and private - that is based on clearly defined priorities. Otherwise the situation can lead to fragmentation, friction and poor sharing of information. In this context, the need to develop human resources for health was consistently identified as ofvital importance, ifthe quality of health service delivery is to Ье improved. Hurdles to adequate development of human resources were seen to include difficulties in recruitment and retention of staff, suboptimal distribution of staff, poor skill mix, and inadequate staff training and education. The ministers recognized that а shortage of human resources can impede the aЬility of а country's health system to Ье responsive to its population's needs and expectations. lt was also pointed out that decentralization of service provision- including overall authority, budgetary control and personnel management- is а key factor in increasing access of the population to health care, particularly at district level. Ministers suggested that assessment of the responsiveness of а health system should take into account the extent of universal and equitable access to health care, community participation, and the prevention of medical accidents and health care errors. The major barrier to improving such responsiveness was noted to Ье lack of financial and other resources. On the question of support from WHO, in their discussions, the ministers identified ways in which WHO could support the development of health systems both globally and at а nationallevel. It was suggested that at the global level, WHO should engage in six supportive activities: - cooperate in identif)'ing priorities for changes that are required to improve health systems - support initiatives to reduce poverty - promote the exchange of experiences in health system development using а comprehensive framework - advise countries on the best models of health care financing - develop models for managing health systems after decentralization, and - reaffirm the benefit of health as an investment in development. With respect to support from WHO at the national level, it was suggested that WHO should collaborate: first, in strengthening the stewardship role of ministries of health, including the formulation of health policies and plans, and second, provide support to ministries of health in coordinating the actions of external partners.

1 See document WHA53/2000/REC/3, Part 11. A53NR/9 page 145

The PRESIDENT:

Thank you, Professor Danso-Boafo. 1 should also like to thank Dr Ponmek Dalaloy, Minister of Health, Lao People's Democratic RepuЬlic, Mr Jose Antonio Gonzalez Femandez, Minister of Health, Mexico, and Mrs Andrea Fischer, Minister ofHealth, Germany, for chairing the other round taЫes. The AssemЬly has now heard the summary report of the discussions on the round taЫes, and this will Ье included in the records of this AssemЬly. 1 wish to thank all the participants to this very interesting and stimulating experience. lt is gratifying to note that the round taЫes, included for the first time in the AssemЬly's agenda last year, continue to Ье а valuaЬle forum for the exchange of views and experience enriching us all. 1 would now Iike to invite Professor Ali, Chairman of Committee А, to соте to the rostrum and address the AssemЬly to give us an overview of the work of Committee А.

Professor ALI (Bangladesh) (Chairman, Committee А):

Madam President, Madam Director-General, ministers of health, fellow delegates, ladies and gentlemen, 1 have the pleasure of presenting my perceptions of the debates in Committee А, where we dealt with а heavy agenda which included some of the most pressing and challenging puЬlic health issues of our times. We considered the epidemics of HIV/AIDS, tuberculosis and tobacco-related diseases, the global spread of noncommunicaЬle diseases, the persistent proЬlem of malnutrition in infants and young children, and the vital need to ensure а safe food supply. As several delegates noted, many of these proЬlems are interrelated in а complex way that defy simple solutions. As Madam Director-General said in her opening speech on 15 Мау, "complex proЬlems rarely have simple solutions". Yet despite the complexity of these issues before us, 1 am pleased to report that our meetings were conducted in а spirit of consensus seeking and collaboration among the delegates who, throughout the deliberations, looked for ways to use the unique essence of WHO as а force for improving the health ofhumanity. Our Director-General, Dr Brundtland, put before us the challenge, in her opening address, of accepting risks and making some difficult decisions and commitments. ln а most positive way, delegates consistently showed their willingness to take up this challenge. Our main agenda item, on technical and health matters, initially included 14 suЬitems and seven resolutions. Because of our need to debate some very difficult issues with great care and thoroughness, we decided, with the agreement of our President and the Chairman of Committee В, to transfer five of these suЬitems to Committee В. Our debates began with а discussion of the Stop Tuberculosis Initiative, when we heard the views of close to 50 speakers. А resolution covering а series of measures to extend tuberculosis control was amended and approved Ьу consensus. PredictaЬly, the diverse situations caused Ьу the НIV/AIDS pandemic stimulated the greatest debate. Close to 70 speakers took the floor to discuss а host of issues, including the urgent need for greater access to affordaЬle drugs, preventive and palliative actions, research in medicines, and the timely reminder that we must never lose sight of the importance of prevention. Numerous proposals were made for strengthening the resolution, which was approved Ьу consensus after the hard and dedicated work of the drafting group. Our debate on food safety, which likewise involved а very large number of speakers, culminated in the approval of the Organization's first resolution on this important subject in more than two decades. Conceming infant and young child nutrition, we considered in great detail а draft resolution submitted Ьу the delegation of Brazil and heard several proposed amendments. Some speakers felt а need for more time to consider the many proposals in depth. Others wished to press forward with the draft resolution and amendments. ln the spirit of compromise seeking, which characterized all our deliberations, an open-ended working group was formed to discuss the procedures for responding to this draft resolution. Guided Ьу discussion, our Committee approved а decision that requested the Director-General to include in the agenda of the 107th session of the Executive Board an item on infant and young child nutrition and to include the draft resolution and amendments in the background documentation to Ье made availaЬle to the Board. During our debate on WHO's proposed framework convention on tobacco control, we again saw great willingness to tackle complex issues where the obstacles are consideraЬle and opponents are powerful. Numerous delegates, including those from countries heavily dependent on income from tobacco ASЗNR/9 page 146 growing, consistently expressed their full and unwavering support for the framework convention. 1 am pleased to report that we approved the resolution as amended, introducing several procedural measures designed to expedite work on this important convention, which has so much potential as а weapon in the fight against one of the major determinants of noncommunicaЬle diseases. ln а closely related matter, our Committee debated and approved а resolution mapping out а global strategy for the prevention and control of noncommunicable diseases which are now recognized as yet another predominant global health challenge. Lastly, we also heard the views of delegates on ways to strengthen health systems, on cloning in human health, and on health promotion. For health promotion, time simply did not allow us to discuss this important subject in adequate detail. Delegates thus requested that this item Ье included in the agenda ofthe Fifty-fourth World Health Assembly. As many speakers have noted, this has been а landmark Assembly: the first in the twenty-first century, occurring at а time when we are at а crossroads in public health. As we saw in Committee А, the problems before us are formidable, but we have many powerful tools: many dedicated partners, а strong leadership, clear direction and great determination. ln concluding, 1 would like to thank the distinguished delegates for the fine spirit of collaboration, the accommodation and global solidarity that was apparent as they searched for solutions to problems that threaten us all and unite us all. Although opinions differed on several issues, not а single vote was needed to resolve these differences. 1 would also like to thank the Vice-Chairmen, the Rapporteurs, and the secretariat of this Committee for its constant support, without which my task would have been impossible. Finally, 1 should like to say that it has been an honour for me personally, for our Region, South-East Asia, and for my country, Bangladesh, to have chaired this Committee.

The PRESIDENT:

Thank you, Professor Ali. 1 should like to congratulate you very warmly for your excellent presentation and also for the outstanding way in which you presided over the Committee. · The next speaker will Ье Dr Karam, Chairman of Committee В, whom 1 invite to the rostrum to report on the work of Committee В.

Dr КАRАМ (Lebanon) (Chairman, Committee В):

Madam President, distinguished delegates, Dr Brundtland, ladies and gentlemen, it is а pleasure for me to present to you the report of the work of Committee В during this year's World Health Assembly. 1 shall try to Ье brief and concentrate my remarks on the highlights of the Committee's work, as the details can Ье found in the report. The work of Committee В concentrated as usual on management and financial matters. Numerous suЬitems were dealt with under this main item, notably approval of the financial report and the amendments to the Financial Regulations. Also discussed under this item was the status of collection of assessed contributions including Members in arrears in the payment of their contributions to an extent that would justify invoking Article 7 of the Constitution. One resolution was approved. Other suЬitems included Casual lncome and the Real Estate Fund, both approved Ьу resolution. The lengthy discussion on the suЬitem, Scale of Assessments, led to а roll-call vote on an appeal Ьу а Member State. The appeal was carried and therefore the Committee took no decision on the proposed resolution. Other suЬitems included staff development and support. Dr Sulaiman, previously altemate member of the WHO Staff Pension Committee, was appointed as а member and Dr Krag was appointed as an altemate member. The Committee noted the annual report on human resources and approved the amendments. А resolution on participation Ьу WHO in the Vienna Convention on the Law of Treaties between States and lntemational Organizations or between lntemational Organizations was approved. А resolution on the health conditions of, and assistance to, the Arab population in the occupied Arab territories, including Palestine, was approved. Discussion ofthe item on collaboration within the United Nations system and with other intergovemmental organizations resulted in the approval of two resolutions: on the Intemational Decade ofthe World's lndigenous People, and on aligning the participation ofPalestine in the World Health Organization with its participation in the United Nations. Five suЬitems under the item dealing with technical and health matters were transferred from Committee А, namely, technical ASЗNR/9 page 147 cooperation among developing countries, on which the Committee noted the report; the Global Alliance for Vaccines and lmmunization, on which one resolution was approved; the revised drug strategy, on which the Committee noted the report; the eradication of poliomyelitis, on which the Committee noted the report; and smallpox eradication: temporary retention of variola virus stocks, on which the Committee noted the report. Conceming the work of the committees, we had good relations with Committee А. lt was so · friendly they even sent us а gift, five items from their agenda. With friends like that . . . . The secretariat was very helpful and informative, though it had to stay abreast of the incoming flights to Geneva to settle the nonreceivables. The ladies in the secretariat drenched my fury with their calm, smiles and promises of coffee, which you and 1 rarely had. У ou probaЬly noted the presence of three Karams on the podium; it was at least two too many! The Legal Counsel was of great assistance. There were tough moments when 1 wished 1 was not in his shoes and he wished he was not in mine. However, the sailing was smooth even in high waters, when some delegates were on the point of tears and others protested against the high-handed Chair. This did not prevent the Committee from oveпuling the Chair which 1 did not take personally. All in all, you could not say it was boring. Saturday moming was the tops; 1 have been told it was the nicest meeting; 1 wonder why? lt may Ье Saturday's secret. We were looking for delegates to take the floor. Some even suggested that the Director-General may consider holding the Committees on Saturdays from now on. So after а turbulent start and take-off, we landed smoothly, thanks to you. Madam President, distinguished delegates, Director-General and staff of WHO, it has been an honour and privilege for те and for my country to serve as the Chairman of Committee В. Vitally important management and financial methods were settled in а constructive spirit; 1 should like to thank warmly all the delegations who contributed. Deliberations were made possible thanks to the unfailing support and cooperation of the secretariat of Committee В. Lastly, 1 extend my thanks to you, Madam President, to the Vice-Presidents, and to the Director-General for taking such а strong interest in our work. We shall soon Ье leaving for our respective homes, and 1 should like to take this opportunity to wish you, Madam, all other officers, and delegates and your families, indeed your countries, continued good health during the coming year, safe joumey home, bon voyage, salama.

The PRESIDENT:

Thank you, Dr Karam. 1 wish to thank you for your comprehensive report and for conducting so well the work ofCommittee В. The Director-General would like to say а few words. Dr Brundtland, you have the floor.

The DIRECTOR-GENERAL:

Madam President, distinguished delegates, we have had an intensive and stimulating six days with debate on а wide range of health issues. As the Health AssemЬly started its work, it was again clear that health is big news. Indeed, it is. As we have seen this week, health issues are both central and highly complex. То resolve them, ministers and delegates invested time, energy and imagination. Ministers shared with each other their views and experiences on health systems. They told of the challenges they face in financing them, in responding to people's needs, in addressing priorities fairly and equitably. The challenges are enormous. The format of round tables that we started last year has engaged а large number of ministers. ln the discussions on health systems, there was extensive preparation Ьу all involved and the reportjust given to us Ьу Professor Danso-Boafo illustrated the key points that evolved. Remembering some different concems that were voiced last year, the feedback 1 have received this time from ministers is that there is а desire to have even more interactive and spontaneous discussions. Ву sharing ideas and experiences we will always Ье on the road to further improvement. Ministers are keen to improve the performance of national and local health systems. All countries can leam from each other; we have taken an important step this year in The world health report to develop а new approach to better assessment ofthe performance ofthese systems. We hope that this will assist countries to identif)r the best policy of options and derive the best possible health ASЗNR/9 page 148 outcomes from the scarce resources often availaЫe to health. ln the months and years ahead WHO will work with countries to further improve the tools for assessing the performance of health systems. All these efforts are aimed at transforming people's lives through better health. 1 am delighted with the progress of GAVI- the Global Alliance for Vaccines and lmmunization. Because we have seen the progress now during the Health AssemЬly which will make an important contribution in itself to health systems performance and indeed to the immunization of all children. We devoted much of our time to HIV/AIDS both in our formal and informal work. We have а resolution that gives us а new vision ofwhat we can do and therefore what we should do to counter HIV/AIDS. Ву enhancing care and strengthening its linkages for prevention we are about to give new directions and new energy to an expanded, revitalized response to the НIV/AIDS pandemic. We have rekindled а spirit of global solidarity and we will together work to take it forward. We had а rich and lively discussion on infant and young child nutrition. When opinions differ, it is even more essential that we use the best scientific evidence availaЬ!e to further guide our policies; this is what the Executive Board will do in January 2001. 1 appreciate the broad consensus and endorsement Ьу the Health AssemЬly to lay strong emphasis on food safety as а puЫic health priority. At the opening, 1 stressed the need to stay the course and get the job done. We are on track for certification of eradication of poliomyelitis Ьу 2005, but this means we must all work together in а dedicated, determined and effective way. The strategies are right, the vaccines will Ье availaЬ!e. 1 am grateful for the groundswell of solidarity, and we should all Ье reminded that we must manage this key effort together effectively to succeed. 1 think the renewed support we saw this week underlines for us the conviction we all share that Ьу staying the course we can rid the world of poliomyelitis. Committee В, as we just heard, also worked on many issues, and indeed gave us some new tools in terms of Financial Regulations to streamline further our work. So, finally, 1 would like to thank all delegations, and especially you, Madam President, the Vice-Presidents, the Chairmen ofthe committees and ofround taЫes and also all my colleagues on the staff of WHO, both at headquarters and in the regions, and our interpreters. All those whom 1 have mentioned have indeed worked very hard to help achieve the important steps for health that have been taken Ьу this AssemЬly.

The PRESIDENT:

HonouraЬle ministers, distinguished delegates, Director-General, ladies and gentlemen, we have reached the end of а very intensive week of hard work, during which you were аЫе to conclude the heavy agenda. 1 feel honoured and proud to have presided over this historical Fifty-third World Health AssemЬ!y, the first in the new millennium. This honour transcends me personally and encompasses my country, NamiЬia, as well as the countries ofthe African Region. There is an enormous task ahead of us, continuously to lower the burden of disease and to promote health and well-being throughout the world, paying special attention to countries and communities most in need. 1 am confident that through our collective commitment, action and cooperation, we can make health for all а reality. Our receptiveness to the new health, socioeconomic, and environmental challenges and the renewed framework for health all in the twenty-first century should inspire us in this endeavour. Dr William Foege, а special invitee of the Director-General, said to us that current challenges are complex and many, but then so are the availaЫe tools and opportunities to meet these challenges. The Chairmen of Committees А and В have just outlined the major health issues in our resolutions debated in their committees. 1 would like on my own behalf, and on behalf ofthe Vice-Presidents and the whole AssemЬly to thank the Chairmen, the Vice-Chairmen, the Rapporteurs and Secretaries of both committees for the excellent work done in а very limited time. 1 personally attended several sessions of Committee В and Committee А, and was greatly encouraged Ьу the lively and frank debate on health and health-related issues that are of importance to all of us, in both developed and developing countries. ln today' s world of globalization and ever-increasing interdependence, we need to dialogue and that is what happened in the committees. The round taЬles, an initiative started Ьу the Director-General last year, also provided an important forum for an exchange of ideas and views. The discussions outlined some fundamental issues related to the development of health systems at both global and national levels. A53NR/9 page 149

Lastly, 1 am glad to extend my sincere thanks to all those who have contributed to the work of the Fifty-third World Health AssemЬly, especially those behind the scenes, and the interpreters for their patience and willingness to соре with extended and often stressful hours of work. I wish you success in pursuing your health development action and becoming good ancestors. Now 1 must say while 1 would like to Ье а good ancestor, 1 would prefer to wait а couple of decades. I thank you for your support in enaЬ!ing me to preside over this AssemЬ!y, and wish you all bon voyage, safe joumey, and safe retum home. 1 formally declare the Fifty-third World Health AssemЬly closed.

The session closed at 13:00. La session est close а 13 heures.

ASЗNR page 151

COMPOSITION DE L'ASSEMBLEE DE LA SANTE MEMBERSHIP OF ТНЕ HEAL ТН ASSEMBL У

LISTE DES DELEGUES ЕТ AUTRES PARTICIPANTS LIST OF DELEGATES AND OTHER PARTICIPANTS

DELEGATIONS DES ЕТд TS MEMBRES DELEGATIONS OF MEMBER STATES

AFGHANISTAN- AFGHANISTAN ALBANIE - ALBANIA Chef de delegation - Chief delegate

Dr М. У. Barikzai Chef de delegation - Chief delegate Ministre de la Sante М. К. Krisafi Ambassadeur, Representant permanent, Geneve Delegue(s) - Delegate(s)

М. Н. Tandar Delegue(s)- Delegate(s) Charge d'affaires a.i., Mission permanente, Geneve М. G. Bendo Premier Secretaire, Mission permanente, Geneve

AFRIQUE DU SUD - SOUTH AFRICA Mme М. Gega Deuxieme Secretaire, Mission permanente, Geneve Chef de delegation - Chief delegate

Dr М. Tshabalala-Msimang ALGERIE - ALGERIA Minister of Health

Delegue(s) - Delegate(s) Chef de delegation - Chief delegate

Мг G.S. Nene М. А. Benyounes Ambassador, Permanent Representative, Geneva Ministre de la Sante et de la Population

Dr А. Ntsaluba Delegue(s)- Delegate(s) Director-General, Department of Health М. M.-S. Dembri Ambassadeur, Representant permanent, Geneve Suppleant(s) - Alternate(s)

Мг R.V. МаЬоре Dr D. Laraba Chief Director, National Health Systems, Department of Health Charge des Relations internationales, Ministere de la Sante et de la Population

Dr Н. Zokufa Chief Director, Pharmaceutical Services, Department of Health Suppleant(s) - Alternate(s)

Dr А. Ка га Mostepha Dr R. Matji lnspecteur general, Ministere de la Sante et de la Population Director, CommunicaЫe Diseases, Department of Health Professeur J.-P. Grangaud Conseiller(s) - Adviser(s) Directeur de la Prevention, Ministere de la Sante et de la Population

Mrs С. Makwakwa Director, lnternational Health Liaison, Department of Health Dr А. Guennar Directeur, Services de Sante, Ministere de la Sante et de la Population Ms М.А. Jacobs Child Health Specialist, Red Cross Hospital, Саре Town Dr К. Krim Chargee d'Etudes et de Syntheses, Ministere de la Sante et de la Ms В. Qwabe First Secretary, Permanent Mission, Geneva Population

Dr D.K. Johns Mlle F.-Z. Cha"ieb Chargee d'Etudes et de Synthese, Ministere de la Sante et de la Counsellor, Permanent Mission, Geneva Population ASЗNR page 152

Professeur R. Denine Mr К. Botzet Directeur de la Pharmacie et du Medicament, Ministere de la Sante Counsellor, Permanent Mission, Geneva et de la Population Mrs М. Niemeyer М. R. Morsly Attache (Politic Affairs), Permanent Mission, Geneva Directeur general, Laboratoire pharmaceutique algerien Mr Behles Mlle В. Kasbadji Personal Secretary to the Minister of Health Directeur general, lnstitut medical algerien Mrs Mondorf М. F. Bachtarzi Deputy Head, Division IX А 4, Budgetary Matters of lnternational Directeur commercial, lnstitut medico-chirurgical and Supranational Organizations and the UN, Federal Ministry of Finance М. N.-E. Benfreha Conseiller, Mission permanente, Geneve Mr R. Gilch Permanent Mission, Geneva М. R. Benidir President, Holding Chimie Pharmacie Mrs К. Lodemann Permanent Mission, Geneva Dr А. Chakou Directeur, Centres de Recherche SAIDAL

М. Р. Raffy ANDORRE-ANDORRA President-Directeur general, lnstitut medical algerien Chef de delegation - Chief delegate Conseiller(s) - Adviser(s) Mrs R.M. Mandicб Alcobe М. У. Gougetin Director, Ministry of Health and Welfare Conseitler aupres du President-Directeur general de l'lnstitut medical algerien Delegue(s)- Delegate(s)

Mrs М. Coll Armangue Head, Department of lnformation and Studies ALLEMAGNE-GERMANY Chef de delegation - Chief delegate ANGOLA - ANGOLA Mrs А. Fischer Federal Minister of Health Chef de delegation- Chief delegate Delegue(s) - Delegate(s) Dr A.J. Hamukwaya Ministre de la Sante Dr М. Lewalter Ambassador, Permanent Representative, Geneva Delegue(s)- Delegate(s)

Mr Н. Voigtlander Mr J.F. Martins Ministerialdirigent, Federal Ministry of Health Ambassadeur, Representant permanent, Geneve

Suppleant(s) - Alternate(s) Dr A.R. Mateus Neto Directeur, Bureau des Relations internationales, Ministere de la Mr Н. Eberle Sante Deputy Permanent Representative, Geneva Suppleant(s) - Alternate(s) Mr М. Rothen Permanent Mission, Geneva Dr A.F.S. Fernandes Directeur national de la Sante

Mr М. Debrus Head, Division Z23, Multilateral Cooperation in the Field of Health, Dr Е. Pedro Gaspar Federal Ministry of Health Conseillere du Ministre de la Sante

Mrs Konig Mme S.S. Pegado da Silva Division UN Specialized Agencies, Federal Foreign Office Premier Secretaire, Mission permanente, Geneve

Dr С. Luetkens Mme F. Carvalho Head of Division, Hessian Ministry for Energy, Environment, Youth, Secretaire du Ministre de la Sante Family Affairs and Health

Dr Н. Lehmann Federal Centre for Health Education, Cologne

Dr R. Korte Head of Division, German Agency for Technical Cooperation (GTZ), Eschborn

Mr U. Kalbltzer Counsellor, Permanent Mission, Geneva A53NR page 153

ARABIE SAOUDITE - SAUDI ARABIA Sra. А. Bodegan de Debuchy Presidenta del Directorio de la Unidad de Coordinaci6n de Programas у Proyectos con Financiamento Exterior, Ministerio de Chef de delegation - Chief delegate Salud

Dr О .А. М. Shobokshi Minister of Health Sr. Р. Chelia Consejero, Misi6n Permanente, Ginebra Delegue(s) - Delegate(s) Sr. Е. Varela Dr R.M. Khalil Consejero, Misi6n Permanente, Ginebra

Dr М. Nasser AI-Hawasi Sra. М. Wilkinson Primer Secretario, Misi6n Permanente, Ginebra Suppleant(s) - Alternate(s) Dr. D. Capurro RoЬies Dr A.-R.M. Akeel Director, Superintendencia de Servicios de Salud, Ministerio de Salud Dr М. Н. AI-Jeffri Dr. О. Gonzalez Carrizo Dr I.M. AI-Showey'er Director de Coordinaci6n у Relaciones Sanitarias lnternacionales, Ministerio de Salud Mr Н.М. AI-Fakhri Sra. Р. Mancuello Мг А.О. AI-Khatabl Asesora del Secretario de Politicas у Regulaci6n Sanitaria, Ministerio de Salud Мг M.S. AI-Hussein Sra. С. Guevara Мг N.H. Kotb Diputada Nacional, Presidenta de la Comisi6n de Salud de la HonoraЬie Camara de Diputados de la Naci6n Мг М. AI-Suraihi First Secretary, Permanent Mission, Geneva Sra. М.Т. Colombo Diputada Nacional, HonoraЬie Camara de Diputados de la Naci6n

Sra. В. Espinola ARGENTINE - ARGENTINA Diputada Nacional, HonoraЬie Camara de Diputados de la Naci6n

Chef de delegation - Chief delegate Dr. А. Pascielli

Dr. Н. Lombardo Dr. R.D. Romano Ministro de Salud

Dr. Р. Momefio Delegue(s) - Delegate(s)

Sr. J.C. Sanchez Arnau Dr. Н.Е. Salum Embajador, Representante Permanente, Ginebra Senador Nacional, HonoraЬie Camara del Senado de la Naci6n

Sr. А. Valdovinos Dr. О. Vaquir Diputado Nacional, HonoraЬie Camara de Diputados de la Naci6n Senador, Presidente de la Comisi6n de Asistencia Social у Salud PuЬiica del Senado

Suppleant(s) - Alternate(s) ARMENIE - ARMENIA Dr. Н. Moguilevsky Secretario de Politicas у Regulaci6n Sanitaria, Ministerio de Salud Chef de delegation - Chief delegate

Dr. Е. Podesta Мг А. Mkrtchian Subsecretario de lnvestigaci6n у Tecnologia, Ministerio de Salud Minister of Health

Dr. G. Gaudio Chef adjoint de la delegation - Deputy chief Subsecretario de Planificaci6n, Control, Regulaci6n у delegate Fiscalizaci6n, Ministerio de Salud Mr К. Nazarian Dr. N. Perez Balifio Permanent Representative, Geneva Subsecretario de Atenci6n Primaria de la Salud, Ministerio de Salud Delegue(s)- Delegate(s)

Ms А. Gevorgian Sra. N. Nascimbene de Dumont Third Secretary, Permanent Mission, Geneva Ministro, Misi6n Permanente, Ginebra

Dr. R. Cano Presidente del Directorio de la Superintendencia de Servicios de Salud, Ministerio de Salud A53NR page 154

AUSTRALIE - AUSTRALIA Мг U. Fгапk Secгetary, Регmапепt Missioп, Geпeva

Chef de delegation - Chief delegate Conseiller(s) - Adviser(s)

Pгofessoг R. Smallwood Dг Н. Hгabcik Chief Medical Officeг, Departmeпt of Health апd Aged Саге Head, Office of the Secгetary of State fог Health, Fedeгal Miпistry fог Social Secuгity апd Geпeгatioпs Delegue(s) - Delegate(s)

Dг F. Pietsch Ms М. Duпlop Assistaпt Secгetary, Populatioп Health Divisioп, Departmeпt of Adviseг of the Secгetary of State fог Health, Fedeгal Miпistry fог Social Secuгity апd Geпeгatioпs Health апd Aged Саге

Ms J. Веппеtt Assistaпt Secгetary AZERBAIDJAN - AZERBAIJAN Suppleant(s) - Alternate(s) Chef de delegation - Chief delegate Мг В. Eckhaгdt Diгectoг, lпteгпatioпal Oгgaпisatioпs Sectioп, Departmeпt of Мг А. lпsaпov Health апd Aged Саге Miпisteг of Health

Conseiller(s) - Adviser(s) Delegue(s)- Delegate(s)

Мг Е. Vап Dег Wal Мг 1. Vahabzada Fiгst Secгetary, Регmапепt Missioп, Geпeva Ambassadoг, Регmапепt Repгeseпtative, Geпeva

Мг К. Kutch М г А. Uпmyashkiп Couпselloг, Регmапепt Missioп, Geпeva Sепiог specialist fог Foгeigп Affaiгs, Miпistry of Health Suppleant(s) - Alternate(s) AUTRICHE - AUSTRIA Мг 1. Asadov Thiгd Secгetary, Регmапепt Missioп, Geпeva Chef de delegation - Chief delegate Pгofessoг R. Waпeck BAHAMAS-BAHAMAS Secгetary of State fог Health, Fedeгal Miпistry fог Social Secuгity апd Geпeгatioпs (Chef de delegatioп du 15 au 16 mai) Chef de delegation - Chief delegate (Chief delegate fгom 15 to 16 Мау) Dг R. Kпowles Chef adjoint de la delegation- Deputy chief Miпisteг of Health delegate Delegue(s) - Delegate(s) Dг G. Liebeswaг Dг М. Dahi-Regis Diгectoг-Geпeгal, PuЫic Health, Fedeгal Miпistry fог Social Chief Medical Officeг, Miпistry of Health Secuгity апd Geпeгatioпs (Chef de delegatioп le 17 mai) Dг В. Сагеу (Chief delegate оп 17 Мау) Diгectoг, PuЫic Health, Miпistry of Health Delegue(s) - Delegate(s)

Dг Н. Kгeid Ambassadoг, Регmапепt Repгeseпtative, Geпeva BAHREIN - BAHRAIN

Suppleant(s) - Alternate(s) Chef de delegation - Chief delegate

Dг V. Gгegoгich-Schega Dг F.R. AI-Mousawi Head, lпteгпatioпal Health Relatioпs, Departmeпt of PuЫic Health, Miпisteг of Health Fedeгal Miпistry fог Social Secuгity апd Geпeгatioпs (Chef de delegatioп du 18 au 19 mai) Delegue(s)- Delegate(s) (Chief delegate fгom 18 to 19 Мау) Мг А. AI-Haddad Dг S. WеiпЬегgег Ambassadoг, Регmапепt Repгeseпtative, Geпeva Deputy Head, lпteгпatioпal Health Relatioпs, Departmeпt of PuЫic Health, Fedeгal Miпistry fог Social Secuгity апd Geпeгatioпs Мг I.E. Akbaгi (Chef de delegatioп le 20 mai) Chief, lпteгпatioпal Relatioпs, Miпistry of Health (Chief delegate оп 20 Мау) Suppleant(s)- Alternate(s) Ms Е. Stгohmayeг Dг М. AI-Jalahma lпteгпatioпal Health Relatioпs, Departmeпt of PuЫic Health, Family Physiciaп апd Medical Tutoг Fedeгal Miпistry fог Social Secuгity апd Geпeгatioпs

Мг R.A. Dhaif Dг Н.-0. Rеппаu Diгectoг, Office of the Miпisteг of Health Miпistry of Foгeigп Affaiгs ASЗNR page 155

BANGLADESH-BANGLADESH Suppleant(s) - Alternate(s) М. Е. Yushkevich Chef de delegation - Chief delegate Conseiller, Mission permanente, Geneve

Мг F.K. Selim Minister of Health BELGIQUE - BELGIUM Delegue(s) - Delegate(s)

Dr I.A. Chowdhury Chef de delegation - Chief delegate Ambassador, Permanent Representative, Geneva Mme М. Aelvoet Ministre de la Protection de la Consommation, de la Sante Professor S.M. Ali puЬiique et de I'Environnement Director, Nationallnstitute of Ophthalmology Chef adjoint de la delegation - Deputy chief Suppleant(s) - Alternate(s) delegate Professor А. В. М. Ahsan Ulah Director-General, Health Services М. J.-M. Noirfalisse Ambassadeur, Representant permanent, Geneve Conseiller(s) - Adviser(s) Delegue(s)- Delegate(s) Ms 1. Jahan Counsellor, Permanent Mission, Geneva Mme Risopoulos Directrice d'Administration, Direction de I'Administration sociale et Sante, Commission communautaire fraщ:aise Мг Md. Shahidul Haque Counsellor, Permanent Mission, Geneva Suppleant(s)- Alternate(s)

Mr Md. Sufiur Rahman М. R. Snacken Counsellor, Permanent Mission, Geneva Conseiller, Cablnet du Ministre de la Protection de la Consommation, de la Sante puЬiique et de I'Environnement

М. G. Thiers BARBADE-BARBADOS Directeur, lnstitut scientifique de la Sante puЬiique Louis Pasteur

Chef de delegation - Chief delegate М. М. Vinck AttacM, Mission permanente, Geneve Мг Р.С. Goddard Minister of Health М. J. Laruelle Charge du Bureau des Organismes specialises pour la Delegue(s) - Delegate(s) Cooperation indirecte multilaterale, Direction generale de la

Мг N. Edwards Cooperation internationale (DGCI) Permanent Secretary, Ministry of Health М. J. Dams Representant du Ministere de la Communaute flamande, Adjoint Dr В. Miller Chief Medical Officer, Ministry of Health au Directeur de I'Administration des Soins de Sante

Suppleant(s) - Alternate(s) М. А. Berwaerts Directeur general, Ministere federal des Affaires sociales, de la Ms S. Rudder Sante puЬiique et de I'Environnement, Service des Relations Charge d'affaires, Permanent Mission, Geneva internationales

Ms N. Clarke Mme Р. Megal Counsellor, Permanent Mission, Geneva Conseiller adjoint, Ministere federal des Affaires sociales, de la Sante puЬiique et de I'Environnement, Service des Relations internationales

BELARUS - BELARUS М. С. Bourgoignie Delegue, Communaute fran~~aise Wallonie-Bruxelles, Geneve Chef de delegation - Chief delegate Mme L. Crapanzano м. 1. Zelenkevich Representante, Direction generale de la Sante de la Communaute Ministre de la Sante franc;:aise

Delegue(s) - Delegate(s) М. Р. Delcarte Conseiller Chef de Service, Commission communautaire franc;:aise М. S. Mikhnevich Representant permanent adjoint, Geneve М. Т. Lahaye Conseiller adjoint, Commission communautaire franc;:aise М. Е. Glazkov Directeur, Departement des Relations exterieures, Ministere de la Sante Mme С. Prins Verspoorten Secretaire, Cablnet du Ministre de I'Aide sociale, Commission communautaire commune A53NR page 156

Conseiller(s) - Adviser(s) BHOUTAN- BHUTAN Pгofesseuг F. Ваго Diгecteuг, lnstitut Sainte-Camille, Univeгsite catholique, Louvain Chef de delegation - Chief delegate

Mme L. Meulenbeгgs Мг L.S. Ngedup Expert, Centгe inteг-univeгsitaiгe роuг les facteuгs psychosociaux Ministeг fог Health and Education et Ьiologiques Delegue(s)- Delegate(s) Pгofesseuг R. Lagasse Мг D.B. Kesang Pгesident, Ecole de Sante puЬiique, Univeгsite libгe, Bгuxelles Ambassadoг, Peгmanent Repгesentative, Geneva

DгV. Tellieг Dг G. Tsheгing Service de Sante puЬiique et d'Epidemiologie,Univeгsite de LiE~ge Joint Diгectoг, Health Саге Division

Mme Anderson-Fгaseг Suppleant(s) - Alternate(s) Service de Sante puЬiique et d'Epidemiologie, Univeгsite de Ш~gе Dг R. Chophel DгThilly Joint Diгectoг, Health Саге Division Ecole de Sante puЬiique, Univeгsite libгe, Bгuxelles Ms Р. Choden М. Salomonson Second Secгetary, Peгmanent Mission, Geneva Collaboгateuг scientifique (ULA) Мг U. Tshewang Second Secгetary, Peгmanent Mission, Geneva

BELIZE - BELIZE Мг S. Tobgay Thiгd Secгetary, Peгmanent Mission, Geneva Chef de delegation - Chief delegate

Мг J.A. Соуе Ministeг of Health and the PuЬiic Service BOLIVIE - BOLIVIA

Delegue(s) - Delegate(s) Chef de delegation - Chief delegate

Dг Е. Vanzie Dг. G. Cuentas Yanez Diгectoг, Health Services, Ministry of Health Ministгo de Salud у Pгevisi6n Social

М. N.A. D'Angieгi Delegue(s) - Delegate(s) Ambassadoг, Peгmanent Mission, Geneva Dг. F. Antezana АnагfЬаг Suppleant(s) - Alternate(s) Asesoг del Despacho de Salud

Мг Н. Andeгson Chief Executive Officeг, Ministry of Health BOSNIE-HERZEGOVINE - BOSNIA AND Мгs A.Hunt HERZEGOVINA Fiгst Secгetary, Peгmanent Mission, Geneva Chef de de/egation- Chief delegate

BENIN - BENIN Pгofessoг В. Ljublc Delegue(s)- Delegate(s) Chef de delegation - Chief delegate МгТ. Dutina Mme М. d'Aimeida Massougbodji Ministгe de la Sante puЬiique Dг F. Gavгankapetanovic

Delegue(s) - Delegate(s) Suppleant(s) - Alternate(s) М. Р. Dossou-Togbe Dг Z. Pavic Secгetaiгe geneгal, Ministeгe de la Sante puЬiique Miss S. Avdic М. J.Z. Amegnigan Diгecteuг, Pгotection sanitaiгe, Ministeгe de la Sante puЬiique

Suppleant(s) - Alternate(s) BOTSWANA-BOTSWANA

М. 1. Abdoulaye Diгecteuг national des Pharmacies et Laboгatoiгes Chef de delegation - Chief delegate

Мгs J.J. Phumaphi Ministeг of HP.alth A53NR page 157

Delegue(s) - Delegate(s) Mr F. Costi Santarosa Second Secretary, Permanent Mission, Geneva Mr М. Chakalisa Permanent Secretary, Ministry of Health Ms Р. Santa Maria Press Attache, Ministry of Health Dr Р. Mazonde Director, Health Services Mr А. РеПа Ghisleni Third Secretary, Permanent Mission, Geneva Suppleant(s) - Alternate(s)

DrT. Moeti PuЫic Health Specialist BRUNEI DARUSSALAM - BRUNEI Mrs D. Mooka DARUSSALAM Deputy Principal, lnstitute of Health Science Chef de delegation - Chief delegate Ms F. Molefe Second Secretary, Botswana High Commission, London Mr Pehin Abdul Aziz Umar Acting Minister of Health (Chef de delegation du 15 au 16 mai) (Chief delegate from 15 to 16 Мау) BRESIL - BRAZIL Chef adjoint de la delegation - Deputy chief Chef de delegation - Chief delegate delegate

Dr J. Serra Mr P.H.S. Pengiran Haji Yusof Minister of Health Ambassador, Permanent Representative, Geneva (Chef adjoint de la delegation du 15 au 16 mai) Chef adjoint de la delegation - Deputy chief (Deputy chief delegate from 15 to 16 Мау) delegate Delegue(s)- Delegate(s) Mr А. Bahadian Ambassador, Deputy Permanent Representative, Geneva Dr Hajah lntan Haji Salleh Acting Director-General, Health Services, Ministry of Health Delegue(s) - Delegate(s) (Chef de delegation du 17 au 20 mai) (Chief delegate from 17 to 20 Мау) Professor J. Yunes PuЫic Health Faculty, University of Sao Paulo Suppleant(s) - Alternate(s)

Suppleant(s) - Alternate(s) Mr Н. Muhammad S. Haji Mohiddin Director, Administration and Finance, Ministry of Health Mr А. de Aguiar Patriota Minister Counsellor, Permanent Mission, Geneva Mr P.S. Pengiran Haji Md Salleh Administrative Officer Special Grade, Ministry of Health Mr J. Barbosa da Silva Jr Director, National Center of Epidemiology, Ministry of Health Mr Abu Sufian Haji Ali First Secretary, Permanent Mission, Geneva Mr R. Oliva Director, National Agency of Sanitary Vigilance, Ministry of Health Mr М. Zamree Junaidi Acting Special Duties Officer, Ministry of Health Mrs V.L. Costa е Silva National Coordinator of ТоЬассо Prevention and Cancer Vigilance, Mr Abdul Karim Haji Safar National Cancer lnstitute, Ministry of Health Third Secretary, Permanent Mission, Geneva

Mr F.S. Duque Estrada Meyer Counsellor, Permanent Mission, Geneva BULGARIE - BULGARIA Mrs D. Costa Coitinho Coordinator, Feeding and Nutrition, Health Policy Secretariat, Chef de delegation - Chief delegate Ministry of Health Dr S. Katsarov Mr P.R. Teixeira Deputy Minister of Health National Coordinator, STD/AIDS Programme, Health Policy Secretariat, Ministry of Health Chef adjoint de la delegation - Deputy chief delegate Mr А. Ruffino Netto Coordinator, Sanitary Pneumology, Health Policy Secretariat, Mr Р. Draganov Ministry of Health Ambassador, Permanent Representative, Geneva

Mr J.M. Nogueira Viana Delegue(s) - Delegate(s) First Secretary, Head of the lnternational Affairs Department, Dr S. Koulaksazov Ministry of Health Director, lntemational Cooperation and European lntegration, Ministry of Health Mr J.A. Zepeda Bermudez Researcher, Biological Sciences Department, National School of PuЫic Health, Oswaldo Cruz Foundation, Ministry of Health A53NR page 158

Suppleant(s) - Alternate(s) Suppleant(s) - Alternate(s)

Mr D. Satcheva Dr С. Bomba-Nkolo Chief of the Cablnet of the Minister of Health Chef de la Division de Cooperation, Ministere de la Sante puЫique

Ms В. Djoneva Dr В. Kollo Attache, Legal adviser, Permanent Mission, Geneva Directeur, Sante communautaire, Ministere de la Sante puЫique

М. R. Owona-Etende BURIONAFASO-BURIONAFASO Premier Secretaire, Mission permanente, Geneve

Chef de delegation - Chief delegate CANADA-CANADA М. A.L. Tou Ministre de la Sante Chef de delegation - Chief delegate

Delegue(s) - Delegate(s) Mr У. Charbonneau Parliamentary Secretary to Minister Rock, Liberal Party, Member of Dr В. М. Somble House of Commons Conseiller technique du Ministre de la Sante Delegue(s)- Delegate(s) Dr G. Conombo Sibdou Directeur regional de la Sante, Tenkodogo Mrs M.S. Jean Special Adviser to the Minister of Foreign Affairs оп Health, Brussels

BURUNDI - BURUNDI Dr Е. Aiston Director-General, lnternational Affairs Directorate, Policy and Chef de delegation - Chief delegate Consultation Branch, Health Canada Dr S. Ntahobari Suppleant(s) - Alternate(s) Ministre de la Sante puЫique Ms М. Gervais-Vidricaire Delegue(s) - Delegate(s) Minister and Deputy Permanent Representative, Permanent Mission, Geneva Dr L. Mboneko lnspecteur general de la Sante puЫique Dr J. Lariviere Senior Medical Adviser, lnternational Affairs Directorate, Policy and Dr J. Rirangira Consultation Branch, Health Canada Directeur general de la Sante puЫique Ms J. Perlin Counsellor, Permanent Mission, Geneva

CAMBODGE - CAMBODIA Mr А. Tellier First Secretary, Permanent Mission, Geneva Chef de delegation - Chief delegate Conseiller(s) - Adviser(s) Mr Hong Sun Huot Senior Minister and Minister of Health Мг G. White Associate Deputy Minister, Ministry of Health, Province of Delegue(s) - Delegate(s) Newfoundland

Dr Mean Chhi Vun М. R. Masse Deputy Director-General of Health Associate Deputy Minister for PuЫic Health, Department of Health and Social Services, Province of Quebec Dr Ног Bun Leng Deputy Director, National Center for HIV/AIDS, Dermatology and МгУ. Bergevin STD Senior Health Specialist, Canadian lnternational Development Agency

Mrs М. O'Shea CAMEROUN-CAMEROON United Nations and Commonwealth Division, Department of Foreign Affairs and lnternational Trade Chef de delegation - Chief delegate Ms А. Peart М. L. Esso UN Budgetary and Administrative lssues, Department of Foreign Ministre de la Sante puЫique Affairs and lnternational Trade Delegue(s) - Delegate(s) Мг В. Mills Reform Party, Member of House of Commons М. F.-X. Ngoubeyou Ambassadeur, Representant permanent, Geneve Mr R. Menard Member of Parliament Dr У. Boubakari lnspecteur general, Ministere de la Sante puЫique MrW. Tholl Executive Director, Heart and Stroke Foundation of Canada A53NR page 159

Mr J. Dosseter Dr Li Jiahu Senior Policy Adviser, Minister's Office, Health Canada Director-General, Guizhou Provincial Health Department

Dr Liu Keling Deputy Director-General, Department of Primary Health Саге and CAP-VERT - САРЕ VERDE Matemal and Child Health, Ministry of Health

Chef de delegation - Chief delegate М г Xu Nanshan Director, Division of lnternational Organizations, Department of М. J.B. Ferreira Medina External Finance, Ministry of Finance Ministre de la Sante Dr Ren Minghui Delegue(s) - Delegate(s) Secretary, Department of General Administration, Ministry of Health

М. 1. de Sousa Carvalho Dr Qi Qingdong Conseiller adjoint du Ministre de la Sante Deputy Director, Division of Multilateral Relations, Department of lnternational Cooperation, Ministry of Health М. А.Р. Alves Lopes Charge d'affaires, Mission permanente, Geneve Mr Hou Zhenyi Suppleant(s) - Alternate(s) Counsellor, Permanent Mission, Geneva

М. J.M. Medina Ms Zhang Xinmin Ministere de la Sante First Secretary, Department of Hong Kong, Масао and Taiwan Affairs, Ministry of Foreign Affairs

Мг Yang Xiaokun CHILI - CHILE Third Secretary, Department of lnternational Organizations and Conferences, Ministry of Foreign Affairs Chef de delegation - Chief delegate Conseiller(s) - Adviser(s) Dra. М. Bc:chelet Ministra de Salud Dr Li Ailan Program Officer, Department of lnternational Cooperation, Ministry Delegue(s) - Delegate(s) of Health

Sr. Р. Оуагсе Мг Qiu Yuangao Ministro Consejero, Misi6n Permanente, Ginebra Assistant Consultant, Department of lnternational Cooperation, Ministry of Health Ora. R. Child Presidenta, Corporaci6n Nacional del Sida Ms Bizhen Liang First Secretary, Permanent Mission, Geneva Suppleant(s)- Alternate(s) Professor Lu Rushan Dr. С. Montoya Presidente, Sociedad Chilena de Salud PuЫica

Sr. F. Ernst CHYPRE-CYPRUS Primer Secretario, Misi6n Permanente, Ginebra Chef de delegation - Chief delegate

М г F. Sawides CHINE - CHINA Minister of Health

Chef de delegation - Chief delegate Delegue(s)- Delegate(s)

Dr Zhang Wekang Mr А. Patzinakos Minister of Health Permanent Secretary, Ministry of Health

Delegue(s) - Delegate(s) Мг Р. Eftychiou Ambassador, Permanent Representative, Geneva Mr Qiao Zonghuai Ambassador, Permanent Representative, Geneva Suppleant(s) - Alternate(s)

Mr Liu Peilong Mrs С. Komodiki Director-General, Department of lnternational Cooperation, Ministry Chief Health Officer, Ministry of Health of Health Мг Р. Kestoras Suppleant(s) - Alternate(s) Deputy Permanent Representative, Geneva

DrM. Chan Conseiller(s) - Adviser(s) Director, Department of Health, Hong Kong Special Administrative Region Mr А. Vasiliou President, Pancyprian Medical Association DrWang Zhao Director-General, Department of Disease Control, Ministry of Health Mrs А. Tapakoudi President, Cyprus Nurses Association A53NR page 160

Delegue(s)- Delegate(s) COLOMBIE - COLOMBIA Sra. N. Rufz de Angulo Embajadora, Representante Permanente, Ginebra Chef de delegation - Chief delegate Sr. С. Guillermet Dr. М.А. Bustamante Garcfa Consejo, Misiбn Permanente, Ginebra Viceministro de Salud Suppleant(s) - Alternate(s) Delegue(s)- Delegate(s) Sr. Е. Penrod Dr. С. Reyes Rodriguez Ministro Consejero Embajador, Representante Permanente, Ginebra Sr. S. Corella Dra. F.E. Benavides Cotes Ministro Consejero Ministra Consejera, Misiбn Permanente, Ginebra Srta. С. Angulo Suppleant(s) - Alternate(s)

Dra. М. Gбmez Ferreira Jefe, Oficina de Cooperaciбn lnternacional, Ministerio de Salud СОТЕ D'IVOIRE -СОТЕ D'IVOIRE

Conseiller(s) - Adviser(s) Chef de delegation - Chief delegate Dra. М. Е. Posada-Corrales Professeur М. Bamba Segunda Secretaria, Misiбn Permanente, Ginebra Ministre de la Sante et de la Protection sociale

Dra. М.Е. Posada Chef adjoint de la delegation - Deputy chief Segunda Secretaria, Misiбn Permanente, Ginebra delegate

М. С. Beke Dassys CONGO-CONGO Ambassadeur, Representant permanent, Geneve Delegue(s) - Delegate(s) Chef de delegation - Chief delegate Professeur J.A. Diarra-Nama М. L.-A. Opimbat Directeur. lnstitut national de Sante puЬiique Ministre de la Sante, de la Solidarite et de I'Action Humanitaire Suppleant(s)- Alternate(s) Delegue(s) - Delegate(s) Dr К. Coulibaly Kounandi М. D. Bodzongo Directeur, Medecine du Travail Directeur general de la Sante М. J.К. Weya М. R.J. Menga Premier Conseiller, Mission permanente, Geneve Ambassadeur, Representant permanent, Geneve М. К. Kramo Suppleant(s) - Alternate(s) Charge d'Etudes, CaЫnet du Ministre

Dr А. Endzanza Conseiller sanitaire, Ministere de la Sante CROATIE- CROATIA М. Н. Kengouya Conseiller administratif et juridique, Ministere de la Sante Chef de delegation- Chief delegate

М. J. Biabaroh-lboro Professor А. Stavljenic Rukavina Ministre conseiller, Mission permanente, Geneve Minister of Health Mme D. Elenga Chef adjoint de la delegation - Deputy chief Assistante du Ministre de la Sante delegate

М. N. Damba Dr R. Ostojic Attache au CaЫnet du Ministre Deputy Minister of Health Delegue(s)- Delegate(s) COSTA RICA- COSTA RICA Professor Z. Reiner

Chef de delegation - Chief delegate Suppleant(s) - Alternate(s) Mrs S. Cek Dr. R. Pardo Evans Ambassador, Permanent Representative, Geneva Ministro de Salud PuЫica

Мг с. Grbesa Third Secretary, Permanent Mission, Geneva ASЗNR page 161 CUBA-CUBA Conseiller(s) - Adviser(s) Mr M.F. Pedersen Chef de delegation - Chief delegate Personal Secretary to the Minister, Ministry of Health

Dr. С. Dotres Martinez Ministro de Salud PuЫica DJIBOUTI - DJIBOUTI Chef adjoint de la delegation - Deputy chief delegate Chef de delegation - Chief delegate

Dr. С. Amat Fores М. M.D. Farah Embajador, Representante Permanente, Ginebra Ministre de la Sante

Delegue(s) - Delegate(s) Delegue(s)- Delegate(s)

Sr. Е. Comendeiro Hernandez Dr D.D. Aden Director de Relaciones lnternacionales, Ministerio de Salud PuЫica Chef du Service Hygieme et Epidemiologie Suppleant(s)- Alternate(s) Profesor С. Ordoiiez Carceller DOMINIQUE - DOMINICA Director, Policlinico Docente "Piaza de la Revoluci6n"

Dr. А. Gonzalez Fernandez Chef de delegation- Chief delegate Jefe, Departamento de Organismos lnternacionales, Ministerio de Dr J. Toussaint Salud PuЫica Minister of Health and Social Security

Sra. А. Rodriguez Camejo Segunda Secretaria, Misi6n Permanente, Ginebra EGYPTE - EGYPT Sr. А. Castillo Santana Tercer Secretario, Misi6n Permanente, Ginebra Chef de delegation - Chief delegate

Professor 1. Sallam DANEMARK-DENMARK Minister of Health and Population Delegue(s)- Delegate(s) Chef de delegation - Chief delegate DrW. Anwar Mrs S. Mikkelsen Director, Technical Support Office, Ministry of Health and Minister of Health Population

Delegue(s) - Delegate(s) Dr М. EI-Shafei Director, Central Department for Family Planning and Population, Mr 1. Valsborg Ministry of Health and Population Permanent Secretary, Ministry of Health Suppleant(s)- Alternate(s) Dr Е. Krag Chief Medical Officer, National Board of Health Dr Е. Mansour Director, Central Department for Basic Health Саге, Ministry of Suppleant(s) - Alternate(s) Health and Population

Mr H.R. lversen Dr 1. Salama Ambassador, Permanent Representative, Geneva Counsellor, Permanent Mission, Geneva

Mr М. Jorgensen Mrs Н. Sidhom Head of Division, Ministry of Health First Secretary, Permanent Mission, Geneva

Mrs U. Lehmann Nielsen Minister Counsellor, Permanent Mission, Geneva ELSALVADOR-ELSALVADOR Mrs L. Garval Head of Section, Ministry of Foreign Affairs Chef de delegation - Chief delegate

Mr S. Thomsen Sr. V.M. Lagos Pizzati Head of Section, Ministry of Health Embajador, Representante Permanente, Ginebra

Ms Е. Vinding Delegue(s)- Delegate(s) Deputy Director-General, National Board of Health Sr. М. Castro Grande Ministro Consejero, Misi6n Permanente, Ginebra Ms М. Kristensen Senior Adviser, National Board of Health A53NR page 162

EMIRATS ARABES UNIS- UNITED ARAB Delegue(s)- Delegate(s) EMIRATES Sr. D.J.-M. Martin Moreno Director, Escuela Nacional de Sanidad, Ministerio de Sanidad у Chef de delegation - Chief delegate Consumo

Mr Н .А. AI-Midfaa Sr. D.P.A. Garcia Gonzalez Minister of Health Subdirector General de Relaciones lnternacionales, Ministerio de Sanidad у Consumo Delegue(s) - Delegate(s) Suppleant(s) - Alternate(s) Dr F. Al Qassimi Assistant Under-Secretary Sr. D.J.L. Consarnau Guardiola Consejero, Misi6n Permanente, Ginebra Dr М. Fikri Assistant Under-Secretary, Preventive Medicine, Ministry of Health Dra. С. Perez Gutierrez Jefe de Area de Organismos lnternacionales Tecnicos, Ministerio Suppleant(s) - Alternate(s) de Asuntos Exteriores

Mr N.K. AI-Bodour Dra. 1. de la Mata Barranco Director, Minister's Office, Director of lnternational Relations Vocal Asesora de la Subsecretaria, Ministerio de Sanidad у Department, Ministry of Health Consumo

Dr Z. Khazal Dr. D.A. Rodriguez Expert, Preventive Medicine, Ministry of Health Jefe de Servicio de Direcci6n General de Farmacia у Productos Sanitarios, Ministerio de Sanidad у Consumo Mr А. Al Hamood Head, Foreign Affairs Section, Ministry of Health Dra. М. L. Garcia Tuii6n Jefe de Servicio de Subdirecci6n General de Relaciones lnternationales, Ministerio de Sanidad у Consumo

EQUATEUR-ECUADOR Dra. 1. Saiz Martinez-Acitores Jefe de Secci6n de la Direcci6n General de Salud PuЫica, Chef de delegation - Chief delegate Ministerio de Sanidad у Consumo

Dr. В. Garcia Mata Subsecretario General de Salud ESTONIE - ESTONIA Chef adjoint de la delegation - Deputy chief delegate Chef de delegation - Chief delegate

Dr. L. Gallegos Chiriboga Mr Н. Danilov Embajador, Representante Permanente, Ginebra Secretary General, Ministry of Social Affairs

Delegue(s) - Delegate(s) Delegue(s)- Delegate(s)

Dr. J.C. Castrill6n Ms К. Saluvere Segundo Secretario, Misi6n Permanente, Ginebra Adviser, Ministry of Social Affairs Suppleant(s) - Alternate(s) Dr. N.E. Jurado Balladares ETATS-UNIS D'AMERIQUE- UNITED STATES Profesor universitario у asesor internacional en gerontologia OFAMERICA

Chef de delegation - Chief delegate ERYТHREE - ERITREA Dr D. Shalala Chef de delegation - Chief delegate Secretary of Health and Human Services

Dr Mismay G. Hiwet Chef adjoint de la delegation - Deputy chief delegate

Dr D. Satcher ESPAGNE - SPAIN Assistant Secretary of Health and Surgeon General, Office of PuЫic Health and Science, Department of Health and Human Chef de delegation - Chief delegate Services

Sr. D.R. Perez-Hernandez у Torra Delegue(s)- Delegate(s) Embajador, Representante Permanente, Ginebra Mr G.E. Moose Ambassador, Permanent Representative, Geneva A53NR page 163

Suppleant(s) - Alternate(s) Ms С. Sim Acting Counsellor for Political and Specialized Agencies Affairs, Ms А. Blackwood Permanent Mission, Geneva Director, Health Programmes, Bureau of lnternational Organization Affairs, Department of State Ms M.L. Valdez Associate Director, Multilateral Affairs, Office of lnternational and Dr J.l. Boufford Refugee Health, Department of Health and Human Services Special Adviser to the Secretary, Department of Health and Human Services Dr К. Wachsmuth Oeputy Administrator, Office of PuЬiic Health and Science, Mr J.D. Long Department of Agriculture Counsellor for Political and Specialized Agency Affairs, Permanent Mission, Geneva Dr М. Akhter Executive Director, American PuЬiic Health Association Dr Т. Novotny Deputy Assistant Secretary, lnternational and Refugee Health, Ms J. Dunlop Department of Health and Human Services Director, А Women's Lens оп Global lssues, Rockefeller Brothers Fund Mr М. Southwick Deputy Assistant Secretary for Global Affairs, Bureau of Dr S. Gleason lnternational Organization Affairs, Department of State Director, lowa Department of PuЬiic Health

DrJ. Henney Dr R. Smoak Commissioner, Food and Drug Administration, Department of Chair, Board of Trustees, American Medical Association Health and Human Services

Mr Е. Cummings Ms L. Vogel Counsellor for Legal Affairs, Permanent Mission, Geneva Health Attache, Permanent Mission, Geneva

Conseiller(s) - Adviser(s)

Dr S. Blount ETHIOPIE- ETHIOPIA Assistant Director, Global Affairs, Centers for Disease Control and Prevention, Department of Health and Human Services Chef de delegation - Chief delegate

Dr N. Chavez Dr G. Hablemariam Administrator, Substance Abuse and Mental Health Services Head, Planning and Programming Department, Ministry of Health Administration, Department of Health and Human Services Delegue(s)- Delegate(s)

Dr J. Chow DrG. Azene Senior Adviser for Global Health Policy, Office of the Under­ Health Economist, Ministry of Health Secretary for Global Affairs, Department of State MrsA. Amaha Mr Р. Ehmer Counsellor, Permanent Mission, Geneva Deputy Director, Office of Health and Nutrition, Agency for lnternational Development

Dr J. Eisenberg EX-REPUBLIQUE YOUGOSLAVE DE Director, Agency for Health Саге Research and Quality, Department of Health and Human Services MACEDOINE ТНЕ FORMER YUGOSLAV REPUBLIC OF Ms К. Johnson MACEDONIA First Secretary, Permanent Mission, Geneva

Dr J. Koplan Chef de delegation - Chief delegate Director, Centers for Disease Prevention and Control, Department Dr М. Nexhipi of Health and Human Services Deputy Minister of Health

Dr В. Malone Chef adjoint de la delegation - Deputy chief Deputy Assistant Secretary for Health, Department of Health and Human Services delegate

Dr К. Salvani Mr О. Nicholson Under-Secretary, Ministry of Health Commercial Attache, Office of the U.S. Trade Representative, Geneva Delegue(s)- Delegate(s)

Dr S. Nightingale Mrs В. Stefanovska-Sekovska Associate Commissioner for Health Affairs and Senior Health First Secretary, Permanent Mission, Geneva Advisor, Office of lnternational and Constituent Relations, Food and Drug Administration, Department of Health and Human Services

М. R.L. Prosen Program Analyst, United Nations System Administration, Bureau of lnternational Affairs, Department of State A53NR page 164

FEDERATION DE RUSSIE- RUSSIAN FINLANDE - FINLAND FEDERATION Chef de delegation - Chief delegate

Chef de delegation - Chief delegate Mr К. Leppo Director-General, Department Professor Y.L. Shevtchenko of Social and Health Services Ministry of Social Affairs and Health ' Minister of Health

Chef adjoint de la delegation - Deputy chief Chef adjoint de la delegation - Deputy chief delegate delegate

Mr V.S. Sidorov Мг Р. Huhtaniemi Ambassador, Permanent Representative, Geneva Ambassador, Permanent Representative, Geneva

Delegue(s) - Delegate(s) Delegue(s)- Delegate(s)

Dr N.N. Fetisov Mr J. Eskola Director, lnternational Relations Department, Ministry of Health Director-General, Department of Promotion and Prevention Ministry of Social Affairs and Health ' Suppleant(s) - Alternate(s) Suppleant(s) - Alternate(s) Professeur Y.F. lsakov Ms L. Ollila Vice-President, Russian Academy of Medical Sciences Неа? of Section, UN and Multilateral Cooperation, lnternational Affa1rs Unit, Ministry of Social Affairs and Health Мг R.A. Kolodkin Deputy Permanent Representative, Geneva · Mr R. Pomoell Ministerial Adviser, Department of Social and Health Services Dr S.M. Furgal Ministry of Social Affairs and Health ' Deputy Director, lnternational Relations Department, Ministry of Health Dr М. Saarinen Senior Medical Officer, Department of Promotion and Prevention Dr V.K. Riazantsev Ministry of Social Affairs and Health ' Chief, Division of lnternational Relations Department, Ministry of Health Ms Т. Mikkola Senior Advisor, lnternational Affairs Unit, Ministry of Social Affairs Mr О.А. Shamanov and Health A~i~g Head of Division, Department of lnternational Organizations, M1n1stry of Foreign Affairs MrT. Piha Counsellor, Permanent Mission, European Union, Brussels Мг R.J. Alyautdinov Counsellor, Permanent Mission, Geneva Ms Н. Rinkineva-Heikkila Counsellor, Permanent Mission, Geneva Mr P.G. Chernikov Counsellor, Permanent Mission, Geneva Ms L. Talonpoika First Secretary, Ministry of Foreign Affairs Dr A.V. Pavlov Counsellor, Permanent Mission, Geneva Ms к. Haikkio First Secretary, Ministry of Foreign Affairs Mr A.V. Kovalenko Second Secretary, Permanent Mission, Geneva Conseiller(s) - Adviser(s)

Dr R.V. Grishchenko Мг Р. Puska Attache, Permanent Mission, Geneva Research Professor, National PuЫic Health lnstitute

Ms L. Elovainio FIDJI- FIJI Secretary-General, Finnish Cancer Society

Chef de delegation - Chief delegate FRANCE-FRANCE Dr 1. Cokanasiga Minister of Health Chef de delegation - Chief delegate

Delegue(s) - Delegate(s) Mme D. Gillot Secretaire d'Etat а la Sante et aux Handicapes Mr L. Rokovada Permanent Secretary for Health Chef adjoint de la delegation - Deputy chief Dr L. Waqatakirewa delegate Acting Director, Primary and Preventive Health Services Professeur L. Abenhaim Directeur general de la Sante, Ministere de I'Emploi et de la Solidarite ASЗNR page 165

Delegue(s) - Delegate(s) Suppleant(s) - Alternate(s)

М. Р. Petit Professeur Р.А. Komblla-Koumba Ambassadeur, Representant permanent, Geneve Directeur general de la Sante puЬiique

Suppleant(s) - Alternate(s) Mme М. Angone-Abena Conseiller, Mission permanente, Geneve М. F. Saint-Paul Representant permanent adjoint, Geneve М. Е.А. Lengota Attache de Cablnet, Ministere de la Sante puЫique et de la MmeA. Dux Population Chargee de Mission au Cablnet du Ministre delegue а la Cooperation et а la Francophonie

М. С. Chouaid GAMBIE- GAMBIA Conseiller technique, Cablnet du Secretaire d'Etat а la Sante et aux Handicapes Chef de delegation - Chief delegate

М. Р. Meunier М г А. Sallah Sous-Directeur des Affaires economiques, Ministere des Affaires Secretary, Department of State for Health and Social Welfare etrangeres Delegue(s) - Delegate(s) М. С. Causeret Conseiller diplomatique, MILDT Mrs S. Bojang Deputy Permanent Secretary, Department of State for Health and Mme М. Boccoz Social Welfare Conseiller, Mission permanente, Geneve Dr У. Kassama М. J.-C. Tallard-Fieury Director of Health Services, Department of State for Health and Conseiller des Affaires etrangeres, Sous-Direction des Affaires Social Welfare economiques, Ministere des Affaires etrangeres Suppleant(s) - Alternate(s) Dr М. Jeanfraщ:ois Mr 1. Njie Direction des Affaires europeennes et internationales, Ministere de Chief Nursing Officer, Department of State for Health and Social I'Emploi et de la Solidarite Welfare

Mme J. Harari Direction generale de la Sante, Ministere de I'Emploi et de la Solidarite GEORGIE - GEORGIA

М. Р. Maloukou Mission permanente, Geneve Chef de delegation - Chief delegate

Dr А. Jorbenadze Dr F. Varet Minister of Health and Social Affairs Chef, Division du Developpement sanitaire et social, Ministere des Affaires etrangeres Delegue(s) - Delegate(s)

Conseiller(s) - Adviser(s) Мг А. Kavadze Ambassador, Permanent Representative, Geneva М. Р. Chevit

Directeur, Ecole nationale de Sante puЫique, Rennes Dr А. Gamkrelidze First Deputy Minister of Health and Social Affairs М. М. Brodin President, Societe fraщ:aise de Sante puЫique Suppleant(s) - Alternate(s)

Mr Т. Bakradze Minister Plenipotentiary, Permanent Mission, Geneva GABON-GABON

Chef de delegation - Chief delegate GHANA-GHANA М. F. Boukoubl Ministre de la Sante puЫique et de la Population Chef de delegation - Chief delegate

Delegue(s) - Delegate(s) Professor К. Danso-Boafo Minister of Health Dr Epigat Apinda Conseiller special du President de la RepuЫique aupres du Chef adjoint de la delegation - Deputy chief Ministre de la Sante puЫique et de la Population delegate

MmeY. Bike Mr D. У. Adjei Ambassadeur, Representant permanent, Geneve Minister, Acting Permanent Representative, Geneva A53NR page 166

Delegue(s) - Delegate(s) GUINEE - GUINEA

Dr Е. N. Mensah Director-General, Health Services Chef de delegation - Chief delegate

Suppleant(s) - Alternate(s) Dr К. Drame Ministre de la Sante puЫique Dr А. lssaka-Tinorgah Acting Director of Medical Services, Ministry of Health Delegue(s)- Delegate(s)

Dr Р. Gbanace Мг К. Asante Minister Counsellor, Permanent Mission, Geneva Directeur, lnstitut de Sante puЫique

Dr A.S. Diakite Mrs А. Twum-Amoah First Secretary, Permanent Mission, Geneva Directeur national de la Pharmacie et des Laboratoires Suppleant(s) - Alternate(s) GRECE - GREECE М. S. Camara Charge d'affaires, Mission permanente, Geneve Chef de delegation - Chief delegate

Professeur С. Spyraki GUINEE-BISSAU - GUINEA-BISSAU Under-Secretary of State for Health and Welfare

Delegue(s) - Delegate(s) Chef de delegation - Chief delegate

Mr D. Karaitidis М. А. Bamba Ambassador, Permanent Representative, Geneva Ministre de la Sante

Mrs S. Kitsou Delegue(s)- Delegate(s) Director, lntemational Relations Division, Ministry of Health and М. А. Paulo Gomes Welfare Chef de Cablnet, Ministere de la Sante Suppleant(s) - Alternate(s) Mr А. Lanaras GUINEE EQUATORIALE- EQUATORIAL Expert in lnternational Law, lnternational Relations Division, Ministry of Health and Welfare GUINEA

Dr М. Violaki-Paraskeva Chef de delegation - Chief delegate Honorary Director-General, Ministry of Health and Welfare Sr. J.A. Bibang Nchuchuma Mrs Т. Stavrou Ministro de Sanidad у Bienestar Social PuЫic Health Division, Ministry of Health and Welfare Delegue(s)- Delegate(s) М г А. Ypsilantis Dr. S. Abla Nseng First Secretary, Permanent Mission, Geneva Director General de Salud PuЫica у Planificaci6n Mr V. Gounari Dra. С. Ondo Efua Third Secretary, Permanent Mission, Geneva Directora General de Farmacia у Medicina Tradicional

GUATEMALA-GUATEMALA HAITI - HAIТI Chef de delegation - Chief delegate Chef de delegation- Chief delegate Dr. М. Bolaiios Dr м. Amedee-Gedeon Ministro de Salud PuЫica у Asistencia Social Ministre de la Sante puЫique et de la Population Delegue(s) - Delegate(s) Delegue(s)- Delegate(s) Srta. S. Solis Castaiieda М. J.P. Antonio Ministro Consejero, Misi6n Permanente, Ginebra Ambassadeur, Representant permanent, Geneve Srta. S. Hochstetter Dr G. Jean-Pierre Segundo Secretario, Misi6n Permanente, Ginebra Chef de Cablnet du Ministre de la Sante puЫique et de la Population ASЗNR page 167

Suppleant(s)- Alternate(s) Conseiller(s) - Adviser(s)

Dr F.D. Lamothe Dr М. Groszmann Membre du Cablnet du Ministre de la Sante puЫique et de la Deputy Chief Medical Officer, State National Health and Medical Population Officer Service

Dr У. Biamby Jacques MrG. Szab6 Directeur, Unite de Communication et d'Education pour la Sante Counsellor, Permanent Mission, Geneva

Dr У. Lablssiere Dr А. Czimbalmos Directeur, Departement sanitaire du Sud-Est Desk Officer, Department of lnternational Cooperation and Coordination of European lntegration, Mme J. Deas Van Onacker Ministry of Health Coordonnatrice, IST/SIDA

М. F. Gaspard Conseiller, Mission permanente, Geneve ILES СООК - СООК ISLANDS

Dr J. Marhone Pierre Chef de delegation - Chief delegate ResponsaЫe de la Nutrition Mr N. George Deputy Prime Minister, Minister of Health Dr Е. Gedeon Delegue(s) - Delegate(s) Dr С. Lamothe MrV. Pare Under-Secretary to the Minister of Health HONDURAS-HONDURAS Dr Т. Tamarua Secretary, Ministry of Health Chef de delegation - Chief delegate

Dr. J.M. Matheu Viceministro de Politica Sectorial, Secretaria de Salud ILES SALOMON - SOLOMON ISLANDS Delegue(s) - Delegate(s) Chef de delegation - Chief delegate Sra. G. Bu Figueroa Consejero, Encargada de Negocios, a.i., Misi6n Permanente, Dr S.S. Aumanu Ginebra Minister of Health and Medical Services

Sra. F. Licona Azcona Delegue(s)- Delegate(s) Tercer Secretario, Misi6n Permanente, Ginebra Dr G. Maelefoasi Under-Secretary, Health Саге, Ministry of Health and Medical Suppleant(s) - Alternate(s) Services Sr. R. Najera

INDE -INDIA HONGRIE - HUNGARY Chef de delegation - Chief delegate

Chef de delegation - Chief delegate Mr N.T. Shanmugam Minister of State for Health and Family Welfare Dr А. G6gl Minister of Health Delegue(s)- Delegate(s) Chef adjoint de la delegation - Deputy chief Mr J.A. Chowdhary delegate Secretary (Health)

Мг F. Bosenbacher Ms S. Kunadi Charge d'affaires a.i., Permanent Mission, Geneva Ambassador, Permanent Representative, Geneva

Delegue(s) - Delegate(s) Suppleant(s) - Alternate(s)

Мг Z. Varga Dr S.P. Agarwal Deputy State Secretary, Ministry of Health Director-General of Health Services, Ministry of Health and Family Welfare Suppleant(s) - Alternate(s)

Mrs К. Novak Mr S. Sabharwal Head of Department, Ministry of Health Deputy Permanent Representative, Geneva

Ms К. Sujata Rao Joint Secretary, Ministry of Health and Family Welfare

MrK. Tuhin First Secretary, Permanent Mission, Geneva A53NR page 168

Мг А. Mishra Delegue(s)- Delegate(s) Personal Secretary to the Minister of Health and Family Welfare Dr А.А. Sayari Deputy Minister for Health Affairs, Ministry of Health and Medical Education INDONESIE - INDONESIA Suppleant(s) - Alternate(s)

Chef de delegation - Chief delegate Dr В. Sadrizadeh Adviser to the Minister, Ministry of Health and Medical Education Dr А. Sujudi Minister of Health Dr М. Safaie Farahani Director-General, Department for PuЫic Relations and lnternational Chef adjoint de la delegation - Deputy chief Affairs, Ministry of Health and Medical Education delegate Dr М. Т Cheraghchi Bashi Astaneh Dr N.H. Wirajuda Adviser to the Deputy Minister for Health Affairs, Ministry of Health Ambassador, Permanent Representative, Geneva and Medical Education Delegue(s) - Delegate(s) Mr N. Haj-Abedini Mr S. Sutoyo Head, Division of lnternational Organizations, Ministry of Health Deputy Permanent Representative, Geneva and Medical Education

Suppleant(s) - Alternate(s) Мг S.M. Hossien Mohammadi Expert, Department of lnternational Specialized Agencies, Ministry Dr D.S. Argadiredja of Foreign Affairs lnspectorate General, Department of Health · Mr M.R. Amirkhizi Professor А. Az.war Director-General, lnternational Economic and Specialized Affairs, Director-General of Community Health, Department of Health Ministry of Foreign Affairs

Dr S. Soeparan Conseiller(s) - Adviser(s) Head, Bureau of Planning, Department of Health Mr М. Baharvand

Ms М. Djamaludin Second Secretary, Permanent Mission, Geneva Secretary, Directorate General for Food and Drug Control, Department of Health Мг М. Babazadeh Expert, Ministry of Health and Medical Education

М г Sampurno Director-General, Food and Drug Control, Department of Health Conseiller(s)- Adviser(s) IRAQ -IRAQ Mrs L.H. Rustam Chef de delegation- Chief delegate Minister Counsellor, Permanent Mission, Geneva Dr М. AI-Douri Mr М.Р. Hendrasmoro Ambassadeur, Representant permanent, Geneve First Secretary, Permanent Mission, Geneva Delegue(s)- Delegate(s) Mrs А. Lantu-Luhulima Third Secretary, Permanent Mission, Geneva Dr А.А.А. Ghaleb Directeur, Division de la Sante internationale

Мг G. Pranoto Dr 0.1. Muslih Director, Р.Т. lndo Farma Medecin, Service des Affaires techniques, Ministere de la Sante

Suppleant(s) - Alternate(s)

IRAN (REPUBLIQUE ISLAMIQUE D') Dr D.N.N. Hermuz Bernouti IRAN (ISLAMIC REPUBLIC OF) Medecin gynecoloque, Hбpital Alwiya (Maternite), Bagdad, Ministere de la Sante Chef de delegation - Chief delegate Dr Н. М. Jaafar Dr М. Farhadi Ministere de la Sante Minister of Health and Medical Education Dr A.-J. Abdui-Aabass Chef adjoint de la delegation - Deputy chief Directeur, Section de la Planification, Ministere de la Sante delegate М. G.F. Askar М г А. Khorram Deuxieme Secretaire, Mission permanente, Geneve Ambassador, Permanent Representative, Geneva A53NR page 169

IRLANDE - IRELAND Suppleant(s) - Alternate(s) Мг S. Gudmundsson Chef de delegation - Chief delegate Diгectoг-Geneгal, PuЫic Health

Мг М. Martin Мг М. Halld6гsson Ministeг fог Health and Childгen Deputy Diгectoг-Geneгal, PuЫic Health

Chef adjoint de la delegation - Deputy chief Мг Н. 6iafsson delegate Deputy Peгmanent Repгesentative, Geneva

Ms А. Andeгson Мг 1. Einaгsson Ambassadoг, Peгmanent Repгesentative, Geneva Head of Department, Ministry of Health and Social Secuгity Delegue(s) - Delegate(s) Мг S. Magnusson Dг J. Kiely Head of Department, Ministry of Health and Social Secuгity Chief Medical Officeг, Department of Health and Childгen Ms R. Aгnlj6tsd6ttiг Suppleant(s) - Alternate(s) Head of Department, Ministry of Health and Social Secuгity

Dг Е. Connolly Deputy Chief Medical Officeг, Department of Health and Childгen ISRAEL - ISRAEL Мг J. Cгegan Department of Health and Childгen Chef de delegation - Chief delegate

Ms М. Aylwaгd Мг R.S. Benizгi Department of Health and Childгen Ministeг of Health

Miss S. O'Halloгan Delegue(s)- Delegate(s) Department of Health and Childгen Мг D. Peleg Ambassadoг, Peгmanent Repгesentative, Geneva Мг В. Bгogan Department of Health and Childгen Pгofessoг J. Shemeг Diгectoг-Geneгal, Ministry of Health МгВ. O'Shea Department of Health and Childгen Suppleant(s)- Alternate(s)

М г С. Mannion МгУ. Avidani Department of Health and Childгen Adviseг to the Ministeг, Ministry of Health

Мг G. O'Connell Dг А. Leventhal Department of Health and Childгen Head, PuЫic Health Services, Ministry of Health

Мг Е. Macaodha Dг У. Seveг Fiгst Secгetary, Peгmanent Mission, Geneva Head, Geneгal Medicine Division, Ministry of Health

Мг В. Aгdiff Pгofessoг В. Regeг Attache, Peгmanent Mission, Geneva Chief Scientist, Ministry of Health

МгУ. Amikam ISLANDE - ICELAND Deputy Diгectoг-Geneгal, lnfoгmation and lnteгnational Relations, Ministry of Health

Chef de delegation - Chief delegate МгУ. Malka Spokesman, Ministry of Health Мг D.A. Gunnaгsson Peгmanent Secгetary, Ministry of Health and Social Secuгity Мг J. Buchгis Chef adjoint de la delegation - Deputy chief Adviseг to the Ministeг, Ministry of Health

delegate Мг R. Кегеп Ministry of Health Мг В. J6nsson Ambassadoг, Peгmanent Repгesentative, Geneva Мг D. Goгen Delegue(s) - Delegate(s) Division of lnteгnational Oгganisations, Ministry of Foгeign Affaiгs

Ms R. Haгaldsd6ttiг МгН. Waxman Deputy Peгmanent Secгetary, Ministry of Health and Social Secuгity Fiгst Secгetary, Peгmanent Mission, Geneva A53NR page 170

Conseiller(s) - Adviser(s) JAMAHIRIYA ARABE LIBYENNE- LIBYAN Ms Т. Guluma ARAB JAMAHIRIYд Permanent Mission, Geneva Chef de delegation - Chief delegate Мг S. Shamir Attache, Permanent Mission Dr А. Rahil Counsellor (Health Affairs), Permanent Mission, Geneva

Delegue(s)- Delegate(s) IТALIE -ITALY Mrs N. AI-Hajjaji Chef de delegation - Chief delegate Charge d'Affaires, Permanent Mission, Geneva

М. А. Negrotto Camblaso Suppleant(s) - Alternate(s) Ambassadeur, Representant permanent, Geneve Dr I.A. Gebel Delegue(s) - Delegate(s) General Health Administration, General People's Committee for Health and Social Security М. G. Zotta Chef adjoint de Cablnet, Ministere de la Sante Dr М.А. Sammud General Health Administration, General People's Committee for М. V. Silano Health and Social Security Directeur general, Bureau des Rapports internationaux, Ministere de la Sante Мг S.M. Elhaj General People's Committee for Health and Social Security Suppleant(s) - Alternate(s) Мг M.J. Halloba Dr М. Di Gennaro General People's Committee for Foreign Liaisons and Secretaire generale, Conseil superieur de la Sante, Ministere de la lnternational Cooperation Sante Dr 1. Betelmal М. F. Oleari Assistant Director, Red Crescent Directeur general, Departement de la Prevention, Ministere de la Sante Мг R.A. Hassan General People's Committee for Health and Social Security М. С. Calvaruso Directeur general, Departement Etudes et Documentation, Ministere de la Sante JAMAIQUE - JAMAICA М. F. Cicogna Bureau des Rapports internationaux, Ministere de la Sante Chef de delegation - Chief delegate

М. S. Moriconi Мг J. Junor Bureau des Rapports internationaux, Ministere de la Sante Minister of Health

М. G. Majori Delegue(s)- Delegate(s) Directeur, Laboratoire de Parasitologie, lnstitut superieur de la Sante, Ministere de la Sante Мг R. Smith Ambassador, Permanent Representative, Geneva

М. Е. Missoni Expert, Departement de la Cooperation, Ministere des Affaires Dr J.P. Figueroa etrangeres Chief Medical Officer, Ministry of Health

М. Р. Procacci Suppleant(s) - Alternate(s) Expert, Departement de la Cooperation, Ministere des Affaires Dr Е. Lewis-Fuller etrangeres Director, lnternational Health, Ministry of Health Mme N. Quintavalle Mrs Т. Deer-Anderson Conseiller, Mission permanente, Geneve Chief Nursing Officer, Ministry of Health Mme M.G. Trozzi Dr В. Wint Mission permanente, Geneve Programme Manager, Health Sector Development, CARICOM Secretariat Mme L. Bronzini Mission permanente, Geneve Mrs С. Maryns Minister Counsellor, Permanent Mission, Geneva

Ms S. Betton First Secretary, Permanent Mission, Geneva ASЗNR page 171 JAPON-JAPAN Delegue(s)- Delegate(s) МгS. А. Madi Chef de dltll~gation - Chief delegate Ambassadoг, Peгmanent Repгesentative, Geneva

Мг К. Haгaguchi Dг A.-R. Shwaikini Ambassadoг, Peгmanent Repгesentative, Geneva Diгectoг-Geneгal of Health, Goveгnoгate of Aqaba

Delegue(s) - Delegate(s) Suppleant(s) - Alternate(s)

Мг S. Haketa Dг К. Abu-Rumman Vice-Ministeг fог Health and Welfaгe Head, Department of Pulmonary Diseases, Ministry of Health

Suppleant(s)- Alternate(s) Мг М. Qassem Head, lnternational Health Division, Ministry of Health Dг N. Sakai Counselloг fог Science and Technology, Ministeг's Secгetaгiat, Ministry of Health and Welfaгe МгN. Zidan Counselloг, Permanent Mission, Geneva

Мг F. lsobe Diгectoг, lnteгnational Affairs Division, Minister's Secгetaгiat, Мг К. Masгi Ministry of Health and Welfaгe Second Secгetary, Peгmanent Mission, Geneva

МгS. Sumi Counselloг, Permanent Mission, Geneva КAZAKHSTAN-КAZAKHSTAN

Мг М. Takezawa Counselloг, Permanent Mission, Geneva Chef de delegation- Chief delegate

Conseiller(s) - Adviser(s) Mrs М. Omaгova Chairpeгson, Agency оп PuЫic Health Саге МгТ. Uehaгa Fiгst Secгetary, Peгmanent Mission, Geneva Delegue(s) - Delegate(s)

Мг N. Danedov Dг N. Yoda Ambassadoг, Permanent Repгesentative, Geneva Deputy Diгectoг, lnternational Affaiгs Division, Minister's Secгetaгiat, Ministry of Health and Welfaгe Мг А. Zhumadilov Second Secгetary, Peгmanent Mission, Geneva Мг Т. Yamamoto Deputy Diгectoг, lnternational Affairs Division, Minister's Secгetariat, Ministry of Health and Welfaгe KENYA - KENYA Dг Е. Kashiwagi Deputy Diгectoг, Community Health, Health Pгomotion and Nutгition Division, Health Service Buгeau, Ministry of Health and Chef de delegation - Chief delegate Welfaгe Pгofessoг S. Ongeгi Ministeг of Health Мг А. Yokomaku Fiгst Secгetary, Peгmanent Mission, Geneva Chef adjoint de la delegation - Deputy chief

Мг К. Takebayashi delegate Deputy Diгectoг, Division of Long-Teгm Саге lnsuгance, Health and Pгofessoг J.S. Meme Welfaгe Buгeau fог the Elderly, Ministry of Health and Welfaгe Peгmanent Secгetary, Ministry of Health

Ms К. Kuгata Delegue(s) - Delegate(s) lnteгnational Affaiгs Division, Ministeг's Secгetaгiat, Ministry of Health and Welfaгe Dг К.А.А. Rana Ambassadoг, Peгmanent Repгesentative, Geneva Dг У. Takashima lnternational Affaiгs Division, Ministeг's Secгetaгiat, Ministry of Suppleant(s) - Alternate(s) Health and Welfaгe Dг Н. Waweгu Diгectoг, Kenyatta National Hospital, Naiгobl

JORDANIE - JORDAN МгW. Boit Diгectoг, Kenya Medical Tгaining College, Naiгobl Chef de delegation - Chief delegate Мгs G. Kandie Dг М. Taгawneh Chief, Nuгsing Office, Naiгobl Ministeг of Health Мг J.N. Busiega Fiгst Secгetary, Peгmanent Mission, Geneva A53NR page 172

KIRGHIZISTAN- КYRGYZSTAN Delegue(s)- Delegate(s) Dr М. Mosotho Chef de delegation - Chief delegate Principal Secretary for Health and Social Welfare

Professor Т.S. Mejmanaliev Mr V.R. Lechesa Minister of Health Ambassador, Permanent Mission, Geneva

Suppleant(s) - Alternate(s)

KIRIBATI- КIRIBATI Dr Т. Thabane

Chef de delegation - Chief delegate Mrs М. Thibeli

Mr В. Мооа Mrs М. Nkakala Minister of Health Chef adjoint de la delegation - Deputy chief delegate LETTONIE- LATVIA

Dr В. Tebau Chef de delegation - Chief delegate Director, Hospital Services, Ministry of Health Mr V. Jaksons Adviser to the Minister of Welfare

KOWEIT - KUWAIТ Delegue(s)- Delegate(s)

Chef de delegation- Chief delegate Mr R. Baumanis Ambassador, Permanent Representative, Geneva Dr М А. AI-Jarallah Minister of Health Mr М. Pavelsons Third Secretary, Permanent Mission, Geneva Delegue(s) - Delegate(s)

Mr D.A.R. Razzooqi Ambassador, Permanent Representative, Geneva LIBAN - LEBANON

Dr А. У. AI-Saif Assistant Under-Secretary for Community Health and Environment Chef de delegation - Chief delegate Dr К. Karam Suppleant(s) - Alternate(s) Ministre de la Sante

Dr У. А. AI-Nisf Delegue(s)- Delegate(s) Assistant Under-Secretary, Medical Suppor1ives Services DrW. Ammar Dr S.A. AI-Atteeqi Directeur general, Ministere de la Sante Director, AI-Sabah Health Region Dr М. Alameddine Dr D.F. Aburamia Directeur, Programme de la Banque mondiale Director, AI-Jahra Hospital Suppleant(s) - Alternate(s) Dr А.А. Ramadhan Assistant Director, Technical Affairs lbn Sina Hospital Mlle R. Hanna Layoune Economiste MrW.Y. AI-Wuqayyan Director, Cablnet of the Minister LIBERIA- LIBERIA Mr S.A. AI-Mutairi Deputy Director, Hospital of Natural Medicine Chef de delegation - Chief delegate Mr А.Н.Н.Н. AI-Jassam Dr Р. S. Coleman Third Secretary, Permanent Mission, Geneva Minister of Health and Social Welfare

Delegue(s)- Delegate(s)

LESOTHO - LESOTHO Dr N.S. Bar1ee Chief Medical Officer, Ministry of Health and Social Welfare Chef de delegation - Chief delegate Mr H.D. Williamson МrТ. Mabote Ambassador, Permanent Mission, Geneva Minister of Health and Social welfare A53NR page 173

Suppleant(s) - Alternate(s) Suppleant(s) - Alternate(s)

Ms V. Sawyer Dr S.H. Andrianarisoa County Health Officer, Maryland County Chef de Service des Laboratoires et de la Transfusion sanguine

Мг Е. Clarke Mme У. Pasea Conseiller, Mission permanente, Geneve

М. А. Koraiche LIТUANIE- LITHUANIA Secretaire, Mission permanente, Geneve

Chef de delegation - Chief delegate

Мг R. Alekna MALAISIE- MALAYSIA Minister of Health Chef de delegation - Chief delegate Chef adjoint de la delegation - Deputy chief delegate Mr Chua Jui Meng Minister of Health Professor V. Grabauskas Rector, Kaunas University of Medicine Chef adjoint de la delegation - Deputy chief delegate Delegue(s) - Delegate(s) Dr Mohamad Taha Arif Мг А. Gailiunas Deputy Director-General of Health First Secretary, Permanent Mission, Geneva Delegue(s)- Delegate(s) Suppleant(s) - Alternate(s) Dr lsmail Merican М г А. Navikas Deputy Director-General of Health, Research and Technical Charge d'affaires, a.i., Permanent Mission, Geneva Support

Suppleant(s) - Alternate(s)

LUXEMBOURG-LUXEMBOURG Мг Hamidon Ali Ambassador, Permanent Representative, Geneva Chef de delegation - Chief delegate Dr Т ее Ah Sian Dr D. Hansen-Koenig Deputy Director of Disease Control (Vector), Ministry of Health Directeur de la Sante, Ministere de la Sante Mr Hasnudin Hamzah Chef adjoint de la delegation - Deputy chief Deputy Permanent Representative, Geneva delegate Miss Тап Lee Cheng Mme А. Schleder-Leuck Private Secretary to the Minister of Health Conseiller de Direction, Ministere de la Sante

Мг Raja Nushirwan Zainal Abldin Delegue(s) - Delegate(s) Second Secretary, Permanent Mission, Geneva Mme М. Pranchere-Tomassini Ambassadeur, Representant permanent, Geneve Suppleant(s) - Alternate(s) MALAWI - MALAWI Mme J. Schiertz Chef de delegation - Chief delegate Attache, Mission permanente, Geneve Mr Р. Bwanali Deputy Minister of Health and Population

MADAGASCAR-MADAGASCAR Chef adjoint de la delegation - Deputy chief delegate Chef de delegation - Chief delegate Dr W.O.O. Sangala Professeur Н. Ratsimbazafimahefa Secretary for Health and Population Ministre de la Sante Delegue(s)- Delegate(s) Delegue(s) - Delegate(s) Mrs L.D. Ng'oma М. М. Zafera Controller, Nursing Services Ambassadeur, Representant permanent, Geneve

Dr J. Rasamizanaka Directeur interregional du Developpement sanitaire de Fianarantsoa A53NR page 174

MALDIVES - MALDIVES MAROC-MOROCCO

Chef de delegation - Chief delegate Chef de delegation- Chief delegate

Mr А. Abdullah М. M.N. Benjelloun-Touimi Minister of Health Ambassadeur, Representant permanent, Geneve

Chef adjoint de la delegation - Deputy chief Delegue(s)- Delegate(s) delegate Dr F. Hamadi DrA. Waheed Secretaire general, Ministere de la Sante Director-General of Health Services Professeur M.D. Archane Delegue(s) - Delegate(s) President, Conseil national de I'Ordre des Medecins

Mr А. Salih Suppleant(s) - Alternate(s) Deputy Director, Ministry of Health М. М. Laaziri Directeur de la Planification et des Ressources financieres, Ministere de la Sante MALI-MALI Dr J. Mahjour Chef de delegation - Chief delegate Directeur de I'Epidemiologie et de la Lutte contre les Maladies, Ministere de la Sante Mme F. Traore Nafo Ministre de la Sante М. М. ВеnаЫа Chef, Division de la Cooperation, Ministere de la Sante Delegue(s) - Delegate(s) М. А. Allouch Dr М. Drave Premier Secretaire, Mission permanente, Geneve Conseiller technique

Dr S. Samake Directeur national de la Sante puЫique MAURICE- MAURITIUS

Chef de delegation - Chief delegate

MALTE- MALTA Mr N. Deerpalsingh Minister of Health and Quality of Life Chef de delegation - Chief delegate Chef adjoint de la delegation - Deputy chief Dr L. Deguara delegate Minister of Health Mr K.R. Mudhoo Chef adjoint de la delegation - Deputy chief Permanent Secretary, Ministry of Health and Quality of Life delegate Delegue(s)- Delegate(s) Mr М. Bartolo Ambassador, Permanent Representative, Geneva Mr D. Baichoo Ambassador, Permanent Representative, Geneva Delegue(s) - Delegate(s) Suppleant(s) - Alternate(s) Dr R. Busuttil Director-General, Ministry of Health Mrs U. Dwarka-Canabady Minister Counsellor, Permanent Representative, Geneva Suppleant(s) - Alternate(s) MrR. Sawmy Dr А. Amato-Gauci Second Secretary, Permanent Mission, Geneva PuЫic Health Consultant, Ministry of Health

Mr А. Koodoruth Mr Р.С. Agius Second Secretary, Permanent Mission, Geneva Counsellor, Permanent Mission, Geneva

Mr Н. К. Bhunjoo Ms А. Mifsud Attache, Permanent Mission, Geneva First Secretary, Permanent Mission, Geneva

Mr S. GamЬin Private Secretary to the Minister of Health MAURITANIE- MAURIТANIA

Chef de delegation - Chief delegate

Mme D. В~ Ministre de la Sante et des Affaires sociales A53NR page 175

Delegue(s) - Delegate(s) MICRONESIE (ETATS FEDERES DE) Dr М. О. Menou MICRONESIA (FEDERATED STATES OF) Directeur de la Protection sanitaire, Ministere de la Sante et des Affaires sociales Chef de delegation- Chief delegate

М. А.О.М. Lehblb Dr J.B. Benjamin Directeur de la Planification, de la Cooperation et des Statistiques, Assistant Secretary for Health, Education and Social Affairs Ministere de la Sante et des Affaires sociales

Suppleant(s) - Alternate(s) MONACO - MONACO М. M.S.O.M. Lemine Ambassadeur, Representant permanent, Geneve Chef de delegation- Chief delegate М. 1.0. Капе Dr А. Negre Premier Conseiller, Mission permanente, Geneve Direction de I'Action sanitaire et sociale

MEXIQUE - MEXICO MONGOLIE - MONGOLIA

Chef de delegation - Chief delegate Chef de delegation- Chief delegate

Sr. J. А. Gonzalez Fernandez Dr S. Sonin Secretario de Salud Minister of Health and Social Welfare

Delegue(s) - Delegate(s) Chef adjoint de la delegation - Deputy chief Dr. R. Tapia Conyer delegate Subsecretario de Prevenci6n у Control de Enfermedades, Secretaria de Salud Mr D. Boldbaatar Charge d'affaires, a.i., Permanent Representative, Geneva Dr. J. Sepulveda Amor Director General, lnstituto de Salud PuЫica Delegue(s)- Delegate(s) Mrs D. Saintuya Suppleant(s)- Alternate(s) Officer, Ministry of Health яnd Social Welfare Dr. G. Sober6n Acevedo Presidente Ejecutivo, Fundaci6n Mexicana para la Salud Suppleant(s) - Alternate(s)

Mr В.-0. Erdenebulgan Sr. М. Melgar Adalid Third Secretary, Permanent Mission, Geneva Oficial Mayor, Secretaria de Salud

Sr. R. Martinez Aguilar Embajador, Asesor de la Subsecretaria para Naciones Unidas, MOZAMBIQUE - MOZAMBIQUE Africa у Medio Oriente, Secretaria de Relaciones Exteriores Chef de delegation - Chief delegate Sr. А. Hernandez Basave Encargado de Negocios, Misi6n Permanente, Ginebra Dr F. Ferreira Songane Minister of Health Sr. R. Martinez Asesor del С. Secretario, Secretaria de Salud Delegue(s)- Delegate(s)

Sr. Е. Jaramillo Navarrete Dr A.L.J. Manguele Director General, Asuntos lnternacionales, Secretaria de Salud National Director of Health

Sr. G. Ortiz Dr J.F.M. Tomo Director General, lnstituto de Salud del Estado de Mexico Deputy Director of Planning and Cooperation

Sra. L. Sosa Marquez Segundo Secretario, Misi6n Permanente, Ginebra MYANMAR- MYANMAR

Sra. М. Lozano Subdirectora de Asuntos Multilaterales, Secretaria de Salud Chef de delegation- Chief delegate Mr Ket Sein Minister of Health

Chef adjoint de la delegation - Deputy chief delegate

Mr Муа Than Ambassador, Permanent Representative, Geneva A53NR page 176

Delegue(s) - Delegate(s) NAURU-NAURU Mr Phone Myiint Ambassador, Embassy of the Union of Myanmar, Rome Chef de delegation - Chief delegate Suppleant(s) - Alternate(s) Mr V. Clodumar Permanent Representative to the United Nations, New York Dr Kyaw Myint Director-General, Department of Medical Sciences

Dr Kyi Soe NEPAL-NEPAL Director-General, Department of Health Planning Chef de delegation - Chief delegate Mr Tin Maung Ауе Deputy Permanent Representative, Geneva Dr R.B. Yadav Minister of Health Dr У е Myint Director (Disease Control), Department of Health Delegue(s)- Delegate(s) Dr S.R. Simkhada Dr Ohn Kyaw Ambassador, Permanent Representative, Geneva Chief, lnternational Health Division, Ministry of Health Dr S. Koirala Mr Мое Kyaw Aung Vice-Chancellor, В.Р. Koirala lnstitute of Health Sciences, Dharan First Secretary, Permanent Mission, Geneva Suppleant(s) - Alternate(s) Ms Ei Ei Tin Second Secretary, Permanent Mission, Geneva Dr B.D. Chataut Director-General, Department of Health Services, Ministry of Health MrYe Htut Second Secretary, Permanent Mission, Geneva DrC. Amatya Director, Planning Division, Ministry of Health Mr Denzil Abel Deputy Permanent Representative, Geneva Mr N.B. Shrestha Minister Counsellor, Permanent Mission, Geneva MrTun Ohn Counsellor, Permanent Mission, Geneva Mr P.R. Bhattarai Attache, Permanent Mission, Geneva Mr Kyaw Swe Tint First Secretary, Permanent Mission, Geneva NICARAGUA - NICARAGUA

NAMIBIE - NAMIBIA Chef de delegation- Chief delegate Chef de delegation - Chief delegate Sra. М. МсСоу Sanchez Ministra de Salud Dr Libertine Amathila Minister of Health and Social Services Delegue(s)- Delegate(s)

Delegue(s)- Delegate(s) Dr. М. Lopez Baldizon Secretario General, Ministerio de Salud Dr К. Shangula Permanent Secretary, Ministry of Health and Social Services Sr. М. Diaz Davila Embajador, Representante Permanente, Ginebra Dr N. Shivute Under-Secretary, Ministry of Health and Social Services Suppleant(s) - Alternate(s)

Suppleant(s)- Alternate(s) Srta. С. Sanchez Reyes Ministra Consejero, Misiбn Permanente, Ginebra Ms М. Nghatanga Director, Ministry of Health and Social Services

Dr N. Forster NIGER - NIGER Deputy Director, Ministry of Health and Social Services Chef de delegation - Chief delegate Ms К. Swartz Ministry of Health and Social Services М. А. Adamou Ministre de la Sante puЬiique Delegue(s)- Delegate(s)

DrG. Magagi Directeur dэ la Protection sanitaire et des EtaЬiissements de Soins

Dr М. Rosalie Directrice de la Sante de la Reproduction A53NR page 177

NIOUE- NIUE NIGERIA - NIGERIA Chef de delegation - Chief delegate

Chef de delegation - Chief delegate Мг R.M. Rex Minister of Health О г Т. Menakaya Minister of Health Delegue(s)- Delegate(s)

Delegue(s)- Delegate(s) Or Н. Paka Oirector of Health Mr S.A. Suleman Permanent Secretary

Mr P.l. Ayewoh NORVEGE - NORWAY Ambassador, Permanent Representative, Geneva

Suppleant(s) - Alternate(s) Chef de delegation - Chief delegate

MrT. Топпе Мг С.А. Osah Minister Minister of Health (Chef de delegation du 15 au 16 mai) (Chief delegate from 15 to 16 Мау) Ог S. Sani Oirector, Hospital Services Oepartment Chef adjoint de la delegation - Deputy chief Or S. Sule delegate Oirector, PR & S Ms Н.С. Sundrehagen Oirector-General, Ministry of Health and Social Affairs Or А. Nasidi (Chef de delegation du 17 au 20 mai) Oirector, Special Projects (Chief delegate from 17 to 20 Мау)

Or Е.А. АЬеЬе Delegue(s) - Delegate(s) Oirector, РНС & ОС Mr В. Skogmo Professor 1. Akinsete Ambassador, Permanent Representative, Geneva Chaiгman, NAC оп HIV/AIDS Suppleant(s) - Alternate(s) Ог М.Е. Anibuaze Or Р. Ogar Oeputy Oirector, РНС & ОС Oirector-General, Norwegian Board of Health

Or М. Lecky Or L. Urdal Oirector, Norwegian Council ofTobacco and Health Mrs С. Bob-Osamor Special Assistant to the Minister of Health Or О .Т. Christiansen Counsellor, Permanent Mission, Geneva Ог 0.0. Sofola Assistant Oirector, Tuberculosis and Leprosy Ms A.-S. Trosdahl Oraug Oeputy Oirector-General, Ministry of Health and Social Affairs Or А.О.О. Akinsete Assistant Oirector, NoncommunicaЬie Oiseases and ТоЬассо Or Т. Hetland Senior Adviser, Ministry of Health and Social Affairs О г А. Awosika Or G. Larsen М г А. Nzeribe Assistant Oirector, Section of PuЬiic Health, Norwegian Board of Senator Health

Мг О. Saror Or Р. Wium Senator Senior Adviser, Norwegian Board of Health

Мг М. Yellowe Ms С. Halsaa Senator Executive Officer, Ministry of Foreign Affairs

Ms С. Garuba Conseiller(s) - Adviser(s)

М г S.U. Aliyu Or Е. Vandvik County Medical Officer MrS.M. Raji Ms 1. Feet Or С. Osuala Oirector, Norwegian Nurses' Association

Or А. Awosike

Мг А. Hassan Minister Counsellor A53NR page 178

NOUVELLE-ZELANDE - NEW ZEALAND Delegue(s) - Delegate(s) Dr F. Omaswa Chef de delegation - Chief delegate Director-General, Health Service

Ms А. King Dr S.M. Zaramba Minister of Health Director, Health Service

Delegue(s) - Delegate(s) Suppleant(s) - Alternate(s)

Ms R. Earp Dr Р. Kadama Deputy Director-General, Maori Health, Ministry of Health Commissioner, Health Planning

Dr L.M. Lane Ms G. Kinimi Director of Public Health, Safety and Regulation Branch, Ministry of Commissioner, Nursing Health

Suppleant(s) - Alternate(s) OUZBEKISTAN- UZBEКISTAN Mr R. Farrell Ambassador, Permanent Representative, Geneva Chef de delegation - Chief delegate Ms D. Geels Professor F.G. Nazirov First Secretary (Politic Affairs), Permanent Mission, Geneva Minister of Health

Ms J. Macmillan Conseiller(s) - Adviser(s) First Secretary (Politic Affairs), Permanent Mission, Geneva Mr D.l. Makhmudova Mr R. Lind Director, Paediatric Research lnstitute, Ministry of Health

Conseiller(s) - Adviser(s) Mr А. Е. Sidikov Director, Coordination Department of VED, Ministry of Health Mr L. Falck Senior Adviser to the Minister of Health

PAКISTAN- PAКISTAN OMAN-OMAN Chef de delegation - Chief delegate

Chef de delegation - Chief delegate Mr А.М. Kasi Minister of Health Dr А.М. Moosa Minister of Health Chef adjoint de la delegation - Deputy chief Delegue(s) - Delegate(s) delegate

Mrs М.О.А. Aideed Ms S.S. Ali Ambassador, Permanent Representative, Geneva Provincial Minister of Health

Dr A.J.M. Sulaiman Delegue(s)- Delegate(s) Director-General of Health Affairs, Ministry of Health Мг М. Akram Ambassador, Permanent Representative, Geneva Suppleant(s) - Alternate(s) Suppleant(s) - Alternate(s) Dr J. А. Jawad Director, Disease Control Department, Ministry of Foreign Affairs Mr А. Ahmad Director-General of Health, Ministry of Health Mrs F.A. AI-Ghazali Health Attache, London Ms Т. Janjua Counsellor, Permanent Mission, Geneva Mr А. AI-Baloushi First Secretary, Permanent Mission, Geneva Ms M.Z. Baloch Third Secretary, Permanent Mission, Geneva Mr 1. AI-Khanjary First Secretary, Permanent Mission, Geneva Mr F.l. Kahn Third Secretary, Permanent Mission, Geneva

OUGANDA-UGANDA Мг S. Ahmad MrM.W. Khan Chef de delegation - Chief delegate

Mr С. Кiyonga Minister of Health A53NR page 179

PALAOS - PALAU Suppleant(s) - Alternate(s) Sr. R. Ramбn Recalde Chef de delegation - Chief delegate Consejero, Misiбn Permanente, Ginebra

Dr С.Т.О. Otto Sr. R. Ugarriza Director, Bureau of PuЫic Health Primer Secretario, Misiбn Permanente, Ginebra

Chef adjoint de la delegation - Deputy chief Sra. L. Casati delegate Primera Secretaria, Misiбn Permanente, Ginebra Ms J. Polloi Sra. С. Orue Guillen Chief, Division of Human Resources, Ministry of Health Tercera Secretaria, Misiбn Permanente, Ginebra

PANAMA-PANAMA PAYS-BAS - NETHERLANDS

Chef de delegation - Chief delegate Chef de delegation - Chief delegate Dr. J.M. Teran Sittбn Dr Е. Borst-Eilers Ministro de Salud Minister of Health, Welfare and Sports

Delegue(s) - Delegate(s) Delegue(s) - Delegate(s) Sr. А. Beliz Mr H.J. Heinemann Embajador, Representante Permanente, Ginebra Ambassador, Permanent Representative, Geneva

Dr. Е. Morales Mr G.M. van Etten Director General, Salud PuЫica Head, lnternational Affairs, Ministry of Health, Welfare and Sport

Suppleant(s)- Alternate(s) Suppleant(s) - Alternate(s) Sra. С. Guerrero Mr B.C.A.F. van der Heijden Subdirectora Nacional de Asuntos lnternacionales Deputy Permanent Representative, Geneva

Srta. А. Arosemena Mr A.A.W. Kalis Representante Permanente Alterno, Ginebra Director, Department of PuЫic Health, Ministry of Health, Welfare and Sports

PAPOUASIE-NOUVELLE-GUINEE - PAPUA Ms М.А.С.М. Middelhoff Senior Adviser, lnternational Affairs, Ministry of Health, Welfare NEWGUINEA and Sports

Chef de delegation - Chief delegate Mr J. Waslander First Secretary, Permanent Mission, Geneva Mr L. Mond Minister of Health Ms H.M.L. Koppers . Policy Officer, United Nations Department, Ministry of Fore1gn Chef adjoint de la delegation - Deputy chief Affairs delegate Ms М. Wijnroks Dr Р. Temu Health дdviser, Directorate of Social and lnstitutional Development, Secretary, Department of Health Ministry of Foreign Affairs

Conseiller(s) - Adviser(s) Mr H.R.V. Lancee

Mr Р. Kerenge Spokesman of the Minister of Health, Welfare and Sports, Provincial Health Adviser, Simbu Province lnformation and Communications Department

PARAGUAY-PARAGUAY PEROU- PERU

Chef de delegation - Chief delegate Chef de delegation - Chief delegate

Dr. М. А. Chiola Sr. J. Voto-Bernales Ministro de Salud PuЫica у Bienestar Social Embajador, Representante Permanente, Ginebra Delegue(s) - Delegate(s) Delegue(s)- Delegate(s)

Sr. L.M. Ramirez Boettner Sr. М. Rodriguez Cuadros Embajador, Representante Permanente, Ginebra Representante Permanente Alterno, Ginebra

Dr. R. Esperanza Dullak Pefia Sr. L.E. Chavez Basagoitia Director General de Planificaciбn у Evaluaciбn, Ministerio de Salud Consejero, Mision Permanente, Ginebra PuЫica у Bienestar Social A53NR page 180

Suppleant(s) - Alternate(s) Delegue(s)- Delegate(s)

Sr. L.E. Guillen М. J. М. Boquinhas Primer Secretario, Misiбn Permanente, Ginebra Secretaire d'Etat а la Sante

М. А. de Mendonva е Moura Ambassadeur, Representant permanent, Geneve PHILIPPINES - PHILIPPINES Suppleant(s) - Alternate(s) Chef de delegation - Chief delegate Professeur J.L. Castanheira Dr М. М. Galon Directeur general de la Sante Under-Secretary of Health for Standards and Regulation, Department of Health Professeur М. Falcao Directeur, lnstitut pour la Sante Chef adjoint de la delegation - Deputy chief delegate Professeur М. Andrade President, INFARMED Mr D.Y. Lepatan Charge d'affaires a.i., Permanent Mission, Geneva Conseiller(s) - Adviser(s)

Delegue(s)- Delegate(s) Mme Т. Xardone Chef de Cablnet, Ministere de la Sante Ms R.S. Paulino Director, Foreign Assistance Coordination, Department of Health М. J. Nabais Chef de Cablnet, Secretariat d'Etat а la Sante Conseiller(s) - Adviser(s) Mme R. Veiga da Cunha Ms М. Е. Callangan-Rueca Presidente, Groupe de Travail pour la Sante Second Secretary, Permanent Mission, Geneva Mme L. Branquinho Conseiller, Cablnet du Ministre de la Sante POLOGNE-POLAND М. Р. Barcia Conseiller, Mission permanente, Geneve Chef de delegation - Chief delegate Mlle D. Pinto Dr А. Rys Vice-Minister of Health Mission permanente, Geneve

Chef adjoint de la delegation - Deputy chief М. J.C. Machado delegate Mission permanente, Geneve

Mr К. Jakubowski Ambassador, Permanent Representative, Geneva QATAR- QATAR Delegue(s) - Delegate(s) Chef de delegation - Chief delegate Mrs В. Bitner Director, Department of European lntegration and Foreign Mr НАН. AI-Bin Ali Cooperation, Ministry of Health Minister of PuЫic Health Suppleant(s) - Alternate(s) Delegue(s)- Delegate(s)

Dr А. Pajak Mr F.A. AI-Thani lnstitute of Social Health, Jagiellonian University Ambassador, Permanent Representative, Geneva

Dr J.A. Piatkiewicz Dr К. AI-Jaber Director, Scientific Centre of Railway Medicine Assistant Under-Secretary for Technical Affairs

Mr К. Rozek Suppleant(s) - Alternate(s) Counsellor, Permanent Mission, Geneva Mr Н.М. AI-Hatmi Director, Office of the Minister of PuЫic Health

PORTUGAL-PORTUGAL Mr А.Н.А. AI-Abdalla Head of PuЫic and lnternational Relations Chef de delegation - Chief delegate

Mme М. Arcanjo Ministre de la Sante ASЗNR page 181

REPUBLIQUE ARABE SYRIENNE - SYRIAN Mrs У.-К. Lim lnternational Cooperation Division, Ministry of Health and Welfare ARAB REPUBLIC Mr K.-S. Lee Chef de delegation - Chief delegate Secretary to the Minister of Health and Welfare

Dr M.l. Al Chatti Minister of Health REPUBLIQUE DEMOCRATIQUE DU CONGO Delegue(s)- Delegate(s) DEMOCRATIC REPUBLIC OF ТНЕ CONGO Dr Т. Al Sheikh Deputy Health Minister Chef de delegation - Chief delegate

Dr Н. Al Haj Hussein Dr С. Miaka Mia Bilenge Director of lnternational Health Affairs Secretaire general а la Sante Delegue(s)- Delegate(s)

REPUBLIQUE CENTRAFRICAINE - CENTRAL Professeur М. М. Mampunza Directeur de Cablnet adjoint, Ministere de la Sante AFRICAN REPUBLIC Suppleant(s) - Alternate(s) Chef de delegation - Chief delegate М. М. Mutomb М. R. Lakoe Second Conseiller, Mission permanente, Geneve Ministre de la Sante et de la Population Delegue(s) - Delegate(s) REPUBLIQUE DEMOCRATIQUE POPULAIRE Dr N. Dimanche-Gilbert LAO Directeur gemeral de la Sante LAO PEOPLE'S DEMOCRATIC REPUBLIC М. А. Satoulou-Maleyo Charge de Mission aux Questions economiques et financieres Chef de delegation - Chief delegate

Dr Р. Dalaloy Ministre de la Sante puЫiq:Je REPUBLIQUE DE COREE - REPUBLIC OF KOREA Delegue(s)- Delegate(s) Dr N. Boutta Chef de delegation - Chief delegate Chef adjoint du Cablnet, Ministere de la Sante puЫique

Dr Н.-8. Cha Minister of Health and Welfare REPUBLIQUE DE MOLDOVA- REPUBLIC OF Chef adjoint de la delegation - Deputy chief MOLDOVA delegate

Mr M.-S. Chang Chef de delegation- Chief delegate Ambassador, Permanent Representative, Geneva Dr V. Parasca Delegue(s)- Delegate(s) Minister of Health

Mr D.-K. Oh Delegue(s) - Delegate(s) Director-General, Health Promotion Bureau, Ministry of Health and Welfare Mr V. Volovei Deputy Minister of Health Suppleant(s) - Alternate(s) Mr А. Cheptine Мг C.-J. Moon Ambassador, Permanent Representative, Geneva Counsellor, Permanent Mission, Geneva Suppleant(s) - Alternate(s) Mr С.-Н. Park Director, lnternational Cooperation Division, Ministry of Health and MrA. Calmac Welfare Deputy Permanent Representative, Geneva

Мг К.-1. Hu Ms L. Negru First Secretary, Permanent Mission, Geneva Second Secretary, Permanent Mission, Geneva

МгС. Lee Assistant Director, Human Rights and Social Affairs Division, Ministry of Foreign Affairs and Trade

Mr W.-K. Moon Assistant Director, lnternational Cooperation Division, Ministry of Health and Welfare A53NR page 182

REPUBLIQUE DOMINICAINE - DOMINICAN Delegue(s)- Delegate(s) REPUBLIC MrM. Somol Ambassador, Permanent Representative, Geneva Chef de delegation - Chief delegate Mrs J. Silhanova Dr. J.O. Ceballos Director, Department of lnternational Relations, Ministry of Health Secretario, Estado de Salud у Asistencia Social (Chef de delegation du 17 au 20 mai) Suppleant(s)- Alternate(s) (Chief delegate from 17 to 20 Мау) Professor F. Kolbel Chef adjoint de la delegation - Deputy chief Head, Clinic of lnternal Medicine of the Second Faculty of Medicine, Motol Faculty Hospital delegate Dr. S. Sarita Valdez Mr 1. Pinter Subsecretario, Estado de Salud у Asistencia Social Counsellor, Permanent Mission, Geneva

Delegue(s) - Delegate(s) Mrs М. Suranova United Nations Department, Ministry of Foreign Affairs Sr. F.A. Cuello Camilo Embajador, Representante Permanente, Ginebra (Chef de delegation du 15 au 16 mai) (Chief delegate from 15 to 16 Мау) REPUBLIQUE-UNIE DE TANZANIE UNIТED REPUBLIC OF TANZANIA Suppleant(s) - Alternate(s)

Dra. М. Bello de Kemper Chef de delegation- Chief delegate Consejera, Misi6n Permanente, Ginebra Dr A.D. Chiduo Minister of Health

REPUBLIQUE POPULAIRE DEMOCRATIQUE Chef adjoint de la delegation - Deputy chief DE COREE delegate

DEMOCRATIC PEOPLE'S REPUBLIC OF Dr А. М. Shein KOREA Deputy Minister of Health, Zanzibar Delegue(s) - Delegate(s) Chef de delegation - Chief delegate Dr U.M. Kisumku Mr Ri Chol Deputy Permanent Secretary, Ministry of Health, Zanzibar Ambassador, Permanent Representative, Geneva Suppleant(s) - Alternate(s) Delegue(s) - Delegate(s) MrA. Mchumo Mr Hong Song О Ambassador, Permanent Representative, Geneva Expert, lnternational Organizations Department, Ministry of Foreign Affairs Dr G.L. Upunda Chief Medical Officer, Ministry of Health DrKim Won Но Section Chief, Health Administration Research lnstitute Dr А.А. Mzige Director, Preventive Services, Ministry of Health Suppleant(s) - Alternate(s)

MrSo Chol Ms J. Safe First Secretary, Permanent Mission, Geneva Chief Nursing Officer, Ministry of Health

Mr Jang Chun Sik Mrs I.F. Kasyanju Counsellor, Permanent Mission, Geneva Counsellor, Permanent Mission, Geneva

Mr Ri Gwang 11 Second Secretary, Permanent Mission, Geneva ROUMANIE - ROMANIA

Mrs Han Не Ran Attache, Permanent Mission, Geneva Chef de delegation - Chief delegate Mr G.M. Hajdu Deputy Prime Minister, Minister of Health REPUBLIQUE TCHEQUE - CZECH REPUBLIC Chef adjoint de la delegation - Deputy chief Chef de delegation - Chief delegate delegate Mr 1. Maxim Professor В. Fiser Minister of Health Ambassador, Permanent Representative, Geneva A53NR page 183

Delegue(s) - Delegate(s) RWANDA - RWANDA

Dr М. Рора Director-General, General Department of PuЫic Health, Ministry of Chef de delegation - Chief delegate Health Dr Е. Rwabuhihi Suppleant(s) - Alternate(s) Ministre de la Sante Mrs L. Popescu Delegue(s)- Delegate(s) Director, Department of lnternational Relations, Ministry of Health Dr С. Е. Rwagaconde

Mrs С. Heredea Counsellor, Department of lnternational Relations, Ministry of Dr 1. Ntaganira Health Suppleant(s) - Alternate(s) Mrs А. Dumitrescu Dr С. Rugondihene lnstitute for PuЫic Health

Mr А. Pacuretu Third Secretary, Permanent Mission, Geneva SAINT-КITTS-ET-NEVIS- SAINT KIТTS AND NEVIS Мг Т. Negru Director-General, General Directorate for State Budget Chef de delegation - Chief delegate

Мг К. Elliott ROYAUME-UNI DE GRANDE-BRETAGNE ЕТ Health Services Administrator D'IRLANDE DU NORD UNIТED КINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND SAINT-MARIN- SAN MARINO

Chef de delegation - Chief delegate Chef de delegation - Chief delegate М. R. Morri Dr G. Stuart Ministre de la Sante et de la Securite sociale Parliamentary Under-Secretary of State for Health

Delegue(s) - Delegate(s) Delegue(s)- Delegate(s) Mme F. Bigi Professor L. Donaldson Ministre plenipotentiaire, Mission permanente, Geneve Mr S. Fuller Mme Н. Zeiler-Werbrouck Suppleant(s) - Alternate(s) Conseiller, Mission permanente, Geneve

Dr Р. Troop Suppleant(s) - Alternate(s) Mme G. Bertozzi Ms S. Mullally Coordonnateur du Departement de la Sante et de la Securite sociale DrW. Thorne

М. О. Rossi М г Т. Кingham Directeur general, lnstitut pour la Securite sociale

Mr G. Warrington М. S. Naccarato Medecin-Chef, Service de Neuropsychiatrie, lnstitut pour la Conseiller(s) - Adviser(s) Securite sociale

Мг J. Orr М. F. Righi Ministere de la Sante et de la Securite sociale Мг N. Boyd

М. Е. Gasperoni Professor А. Maslin Mission permanente, Geneve

Мг D. Walton

М г J. Bradley SAINT -VINCENT -ЕТ -GRENADINES SAINT VINCENT AND ТНЕ GRENADINES Мг L. Levy

Miss S. Cotton Chef de delegation - Chief delegate Ms N. Dablnovic Dr J. Metters Honorary Consul, Geneva A53NR page 184

SAMOA - SAMOA SEYCHELLES-SEYCHELLES

Chef de delegation - Chief delegate Chef de delegation - Chief delegate

Mr М. Telefoni Retzlaff Mr J. Dugasse Minister of Health Minister of Health

Chef adjoint de la delegation - Deputy chief Delegue(s)- Delegate(s) delegate Mrs М.-А. Houareau

Dr Е. Enosa Principal Secretary, Ministry of Health Director-General of Health, Health Department Dr С .. Shamlaye Delegue(s) - Delegate(s) Special Adviser, Ministry of Health

Dr S. Ainuu Director of Clinical Health Services, Health Department SIERRA LEONE - SIERRA LEONE Suppleant(s) - Alternate(s)

Mrs S. Papalii Chef de delegation - Chief delegate Nurse Manager, Health Department Mr Е. Е. Luy Consul, Consular General of the RepuЫic of Sierra Leone for Switzerland, Geneva SAO TOME-ET-PRINCIPE- SAO ТОМЕ AND PRINCIPE SINGAPOUR - SINGAPORE Chef de delegation - Chief delegate Chef de delegation - Chief delegate Dr A.Soares Marques de Lima Ministre de la Sante DrТ. Yoong Director, National Health Education Department, Ministry of Health Delegue(s) - Delegate(s) Delegue(s)- Delegate(s) Dr С. Augusto da Cruz Directrice, Centre hospitalier de Sao Tome Dr А. Wansaicheong Deputy Director, Health Service Department, Ministry of Health Ms Р. Aguiar Vila Nova Miss Puay lng Chua Assistant Director, Finance Policy and Planning, Ministry of Health SENEGAL-SENEGAL Suppleant(s) - Alternate(s)

Mr Chak Mun See Chef de delegation - Chief delegate Ambassador, Permanent Representative, Geneva

М. А. Fall Ministre de la Sante Ms М. Liang Deputy Permanent Representative, Geneva Delegue(s)- Delegate(s) Мг Нее Kyet Ann Mme А. С. Diallo First Secretaгy, Permanent Mission, Geneva Ambassadeur, Representant permanent, Geneve Ms Yen Cheng Ong М. 1. Ndiaye Second Secretary, Permanent Mission, Geneva Ministre conseiller, Mission permanente, Geneve М г V. Ramakrishnan Suppleant(s)- Alternate(s) Second Secretary, Permanent Mission, Geneva

Dr М. Niang Directeur de la Sante SLOVAQUIE- SLOVAКIA Dr С. Fall Conseiller technique, Cablnet du Ministre de la Sante Chef de delegation - Chief delegate

М. А. Basse М г т. Sagat Premier Secretaire, Mission permanente, Geneve Minister of Health

Professeur С. Faty Ndiaye Chef adjoint de la delegation - Deputy chief Chef, Division de la Sante Bucco-dentaire, Ministere de la Sante delegate

Professeur 1. Lб Mr к. Petocz Directeur de la Pharmacie et du Medicament Ambassador, Permanent Representative, Geneva A53NR page 185

Delegue(s) - Delegate(s) SRI LANКA - SRI LANКA Mr 1. Rovny Chief Hygienist, Ministry of Health Chef de delegation - Chief delegate

Suppleant(s) - Alternate(s) Мг N.S. de Silva Minister of Health and lndigenous Medicine Ms М. Kollarova Ministry of Health Delegue(s)- Delegate(s)

Ms J. Bartosiewiczova Mr H.M.G.S. Palihakkara Ministry of Foreign Affairs Ambassador, Permanent Representative, Geneva

Ms z. Cervena Dr Y.D.N. Jayathilaka Ministry of Health Secretary, Medical Services, Ministry of Health and lndigenous Medicine Mr F. Rosocha Second Secretary, Permanent Mission, Geneva Suppleant(s) - Alternate(s)

М г S.S. Ganegama Arachchi First Secretary, Permanent Mission, Geneva SLOVENIE - SLOVENIA Мг A.S.U. Mendis Second Secretary, Permanent Mission, Geneva Chef de delegation - Chief delegate

Dr D.P. Kosmac State Secretary, Ministry of Health SUEDE - SWEDEN Delegue(s) - Delegate(s) Chef de delegation- Chief delegate Мг G. Zore Ambassad\.Jr, Permanent Representative, Geneva Mr L. Engqvist Minister of Health

Мг F. Miksa Deputy Permanent Representative, Geneva Chef adjoint de la delegation - Deputy chief delegate Suppleant(s)- Alternate(s) Mrs К. Wigzell Dr V.K. Petric Director-General, National Board of Health and Welfare Counsellor to the Minister of Health Delegue(s)- Delegate(s)

Ms А.-С. Filipsson SOUDAN-SUDAN Deputy Director, Ministry of Health and Social Affairs Suppleant(s) - Alternate(s) Chef de delegation - Chief delegate Mr J. Molander Мг А.Е.М. lbrahim Ambassador, Permanent Representative, Geneva Federal Minister of Health

М г Т. Zetterberg Delegue(s)- Delegate(s) Counsellor, Ministry of Foreign Affairs Dr I.M. lbrahim Ambassador, Permanent Representative, Geneva Мг N. Kebbon First Secretary, Permanent Mission, Geneva Dr B.l. Mokhtar Under-Secretary, Federal Ministry of Federal Dr В. Carlsson Senior Research Officer, Swedish lnternational Development Suppleant(s) - Alternate(s) Authority

Dr Z.A. Zeidan Dr В. LindЫom Director-General, lnternational Health, Federal Ministry of Health Head of Department, National Board of Health and Welfare

Mr О.М. Ahmed Ms В. Schmidt Deputy Permanent Representative, Geneva Administrative Director, National Board of Health and Welfare

Мг А. Noureldeen Professor Е. Nordenfelt Second Secretary, Permanent Mission, Geneva Director-General, Swedish lnstitute for lnfectious Disease Control

Mr В. Pettersson Senior Adviser for Health Promotion, Nationallnstitute of PuЫic Health A53NR page 186

Conseiller(s) - Adviser(s) Mme В. Schulte Division Produits Ьiologiques, Office federal de la Sante puЫique, DrA. Molin Departement federal de l'lnterieur Senior Programme Officer, Swedish lnternational Development Authority М. Р. Jeanrenaud Service financier IV, Departement federal des Finances Dr А. Milton Secretary-General, Swedish Medical Association М. М. Schlagenhof Ressort Mesures поn tarifaires, Departement federal de I'Economie Ms Е. Fernvall President, Association of Health Professionals

Ms Н. Linden SURINAME - SURINAME Permanent Mission, Geneva Chef de delegation - Chief delegate

Mrs R.M. Codfried-Kranenburg SUISSE - SWITZERLAND Permanent Secretary, Ministry of Health

Chef de delegation - Chief delegate Delegue(s)- Delegate(s)

Mme R. Dreifuss Mrs F.C.F. Amanh Conseillere federale, Chef du Departement federal de l'lnterieur Policy Advisor, Ministry of Health

Chef adjoint de la delegation - Deputy chief delegate SWAZILAND - SWAZILAND Professeur Т. Zeltner Secretaire d'Etat, Directeur de I'Office federal de la Sante puЫique, Chef de delegation - Chief delegate Departement federal de l'lnterieur Dr Р.К. Dlamini Delegue(s) - Delegate(s) Minister of Health and Social Welfare М. С. Faessler Delegue(s)- Delegate(s) Ambassadeur, Representant permanent adjoint, Geneve Dr J. Kunene Suppleant(s) - Alternate(s) Deputy Director of Health Services

Mme М. Berger Mrs N.Т. Shongwe Adjointe scientifique, Mission permanente, Geneve; Section Chief Nursing Officer affaires multilaterales, Direction du Developpement et de la Cooperation, Departement federal des Affaires etrangeres Suppleant(s) - Alternate(s)

М. R. DOrler Mrs Т. Siblya Chef, Affaires internationales, Office federal de la Sante puЫique, Chief Pharmatist Departement federal de l'lnterieur Mrs Р. Кisanga М. F. Gruber Coordinator, lnternational ВаЬу Feeding Action Network (IBFAN) Conseiller, Mission permanente, Geneve

М. J. Burri Section ONU/01, Direction politique, Departement federal des TADJIКISTAN- TAJIKISTAN Affaires etrangeres Chef de delegation - Chief delegate М. М.Т. Schick Ressouces humaines, Direction du Developpement et de la М г А. Latipov Cooperation, Departement federal des Affaires etrangeres Deputy Minister of Health

Mme D. Sordat Affaires internationales, Office federal de la Sante puЫique, Departement federal de l'lnterieur TCHAD-CHAD

Mme А. Scherrer-Baumann Chef de delegation - Chief delegate Conseillere d'Etat, Chef de la Direction de la Sante du Canton d'Appenzeii-Rhodes exterieures М. D.L. Damaye Mir1istre de la Sante puЫique

М. D. Kraus Affaires internationales, lnstitut federal de la Propriete Delegue(s)- Delegate(s) intellectuelle, Departement federal de Justice et Police Dr М. Е. Mbaiong Directeur general adjoint, Ministere de la Sante puЫique Mme J. Jenny Section ONU/01, Direction politique, Departement federal des Dr G.M. Ndeikoundam Affaires etrangeres Chef de la Division des Maladies transmissiЫes, Ministere de la Sante puЫique A53NR page 187

Suppleant(s) - Alternate(s) Dr Pensri RaЬieb President, Nurses Association of Thailand Dr K.R. Grace Medecin Chef, Maternite, Hбpital general de N'Djamena, Ministere Мг Sek Wannamethee de la Sante puЫique First Secretary, Permanent Mission, Geneva

Mr Somsak Wattanasri THAILANDE - THAILAND Acting Director, lnternational Health Division, Ministry of PuЫic Health

Chef de delegation - Chief delegate Dr Viroj Tangcharoensathien Mr Korn Dabbaransi Senior Policy and Plan Analyst, Health Systems Research of PuЫic Health Deputy Prime Minister and Minister of Health lnstitute, Ministry

Chef adjoint de la delegation - Deputy chief Mrs Nantika Sungoonshorn Chief, lnternational Cooperation Section, lnternational Health delegate Division, Ministry of PuЫic Health

М г Virasakdi Futrakul Ambassador, Permanent Representative, Geneva Dr Chatree Charoensiri Medical Officer, Nan Hospital, Ministry of PuЫic Health Delegue(s) - Delegate(s) Dr Wanchai Sattayawuthipong Dr Sucharit Sriprapandh Medical Officer, Nong Khai Provincial Health Office, Ministry of Permanent Secretary, Ministry of Health PuЫic Health

Suppleant(s) - Alternate(s) Dr Patcharawan Srisilapanan Associate Professor, Department of Community Dentistry, Faculty Mrs Asha Dvitiyananda of Dentistry, Chiang Mai University Deputy Permanent Representative, Geneva Mrs Suchada Sakornsatian Dr Wannarat Channukul Director, Psychiatric Service Development Division, Mental Health Adviser to the Minister of PuЫic Health Development Bureau, Department of Mental Health, Ministry of PuЫic Health Мг Chatchaval Chatsuthichai Adviser to the Minister of PuЫic Health Ms С. Kanchanachitra Assistant Professor, lnstit~.:te for Population and Social Research, Sr. Supachai Kunaratanapruk Mahidol University Deputy Permanent Secretary, Ministry of Health Dr Siriwan Pitayarangsarit Professor Pakdee Pothisiri Dentist, Health Systems Research lnstitute, Ministry of PuЫic Director-General, Department of Medical Sciences, Ministry of Health PuЫic Health Mrs Sirinad Tiantong Dr Somsong Rugpoa Foreign Relations Officer, lnternational Health Division, Ministry of Director-General, Department of CommunicaЫe Diseases Control, PuЫic Health Ministry of PuЫic Health

Dr Mongkol Na Songkhla Director-General, Department of Medical Services, Ministry of TOGO-TOGO Health

Professor Natth Bhamarapravati Chef de delegation - Chief delegate Professor of Pathology, Center for Vaccine Development, Mahidol Professeur К. С. Agba University Ministre de la Sante Dr Hatai Chitanondh Delegue(s)- Delegate(s) President, Thailand Health Promotion lnstitute Dr В. Essosolem Dr Supat Vanichakarn Directeur general de la Sante Secretary-General, The Kidney Foundation of Thailand

Dr Suwit Wibulpolprasert Senior Consultant, PuЫic Health, Ministry of PuЫic Health TONGA-TONGA

Dr Kanchana Kanchanasinith Chef de delegation - Chief delegate Deputy Director-General, Department of Medical Sciences, Ministry of PuЫic Health Dr L. Malolo Director of Health Dr Supachai Rerks-Ngarm Senior Medical Officer, Department of CommunicaЫe Disease Delegue(s)- Delegate(s) Control, Ministry of PuЫic Health Mr D.B. Bourret Honorary Consul, Zurich Dr Tassana Boontong Acting President, Thai Nursing Council A53NR page 188

TRINIТE-ET-TOBAGO- TRINIDAD AND Suppleant(s) - Alternate(s) TOBAGO Dг S. Aycan . Geneгal Diгectoг, Pгimary Health Саге, Ministгy of Health Chef de delegation- Chief delegate Pгofessoг О. Canbolat Dг Н. Rafeeq Deputy Diгectoг-Geneгal of the Medicine and Phaгmacy, Ministry of Ministeг of Health Health

Delegue(s)- Delegate(s) DгV. Ulusoy Geneгal Diгectoг, Tгeatment Services, Ministry of Health Dг L. Chinnia Acting Medical Officeг of Health, Ministry of Health Dг О. Afsaг Deputy Geneгal Diгectoг, Tгeatment Services, Ministry of Health Miss L. Boodhoo Chaгge d'affaiгes a.i., Peгmanent Mission, Geneva Мг Е. lscan Deputy Peгmanent Repгesentative, Geneva

TUNISIE - TUNISIA Мг U. Aytac Deputy Geneгal Diгectoг, Mateгnal and Child Саге and Family Planning, Ministry of Health Chef de delegation - Chief delegate Ms А Siniгlioglu Mme N. Escheikh Counselloг fог Economic Affaiгs, Peгmanent Mission, Geneva Secгetaiгe d'Etat aupгes du Ministгe de la Sante puЫique

Delegue(s) - Delegate(s) Мг В. Metin Head, Department of Exteгnal Relations, Ministry of Health М. Н. Ben Salem Ambassadeuг, Repгesentant peгmanent, Geneve Мг К. Ozden Deputy Head, Department of Exteгnal Relations, Ministry of Health Dг Н. Abdessalem Diгecteuг geneгal, Unite de la Coopeгation technique, Ministeгe de Ms Z. Coban la Sante puЫique Adviseг, Ministry of Health

Suppleant(s) - Alternate(s) Pгofessoг А Akin Department of PuЫic Health, Hacettepe Univeгsity Dг М. Sidhom Diгecteuг des Soins de Sante de Base, Ministeгe de la Sante Мг Z. Gazioglu puЫique Counselloг, Peгmanent Mission, Geneva

М. G. Jomaa Мг S. Kulaksiz Conseilleг, Mission peгmanente, Geneve Chief of Cablnet, Ministry of Health

Ms А Soylu TURKMENISTAN- TURKMENISTAN Second Secгetary, Peгmanent Mission, Geneva

Мг L. Еlег Chef de delegation - Chief delegate Thiгd Secгetary, Peгmanent Mission, Geneva

Мг G. Beгdymuhammedov Мг М. Ak9abag Ministeг of Health and Medical lndustry Expert, Ministry of Health

Мг S. Cetik TURQUIE- TURKEY Expert, State Planning Oгganization

Chef de delegation - Chief delegate Мг Н. Yal9in Chief of Section, Geneгal Diгectoгate of Agгeements, Undeг­ Dг О. Duгmus Secгetaгiat fог Foгeign Тгаdе Ministeг of Health Мг М. Comert Chef adjoint de la delegation - Deputy chief Expert, Geneгal Diгectoгate of lmport, Undeг-Secгetaгiat fог delegate Foгeign Тгаdе

Dг Н. Tokщ:oglu Мг А Duгmus Undeг-Secгetary, Ministry of Health Ministry of Health

Delegue(s)- Delegate(s) Ms S. Akman Counselloг, Permanent Mission, Geneva Мг М. Sungaг Ambassadoг, Permanent Repгesentative, Geneva ASЗNR page 189

TUVALU - TUVALU Delegue(s)- Delegate(s) Mrs М. Abel Chef de delegation - Chief delegate Director of PuЫic Health, Ministry of Health

Мг L. Maatusi Assistant Secretary for Health, Women and Community Affairs VENEZUELA-VENEZUELA Delegue(s)- Delegate(s)

Dr Т. Pulusi Chef de delegation - Chief delegate Director of Health Dra. А.Е. Osorio Viceministra de Salud, Ministerio de Salud у Desarrollo Social Dr S. Homasi Chief PuЫic Health Delegue(s)- Delegate(s)

Sr. W. Corrales Leal Embajador, Representante Permanente, Ginebra UKRAINE - UKRAINE Sr. V. Rodriguez Cedeiio Chef de delegation - Chief delegate Representante Permanente Alterno, Ginebra

М г V. Moskalenko Suppleant(s) - Alternate(s) Minister of Health Dra. М. Urbaneja Delegue(s) - Delegate(s) Directora General, Oficina de Cooperaci6n Tecnica у Relaciones lnternacionales, Ministerio de Salud у Desarrollo Social Мг М. Maimeskoul Ambassador, Permanent Representative, Geneva Dr. W. Revello Director General de Salud PoЫacional, Ministerio de Salud у Mrs S. Homanovska Desarrollo Social Second Secretary, Permanent Mission, Geneva Sr. R. Salas Segundo Secretario, Misi6n Permanente, Ginebra URUGUAY-URUGUAY

Chef de delegation - Chief delegate VIET NAM- VIET NAM

Sr. Н. Fernandez Ameglio Ministro de Salud PuЫica Chef de delegation - Chief delegate Professor Pham Manh Hung Chef adjoint de la delegation - Deputy chief Permanent Vice-Minister of Health delegate Delegue(s)- Delegate(s) Sr. С. Perez del Castillo Embajador, Representante Permanente, Ginebra Mr Nguyen Qui Binh Ambassador, Permanent Representative, Geneva Delegue(s) - Delegate(s) Dr Trinh Bang Нор Dr. С. Sgarbl Director, Department of lnternational Cooperation, Ministry of Ministro Consejero, Misi6n Permanente, Ginebra Health

Suppleant(s)- Alternate(s) Suppleant(s) - Alternate(s) Dra. Р. Vivas Mrs Le Thi Thu На Consejero, Misi6n Permanente, Ginebra Deputy Director, Department of lnternational Cooperation, Ministry of Health

VANUATU- VANUATU Mrs Tram Cam Hung First Secretary, Permanent Mission, Geneva Chef de delegation - Chief delegate Мг S.K. Shem YEMEN-YEMEN Minister of Health

Chef adjoint de la delegation - Deputy chief Chef de delegation - Chief delegate delegate Dr А.А. Nasher Minister of Health Мг J. Shing First Political Adviser, Ministry of Health A53NR page 190

Delegue(s) - Delegate(s) Suppleant(s) - Alternate(s)

Dr M.S. AI-Attar Mr D. МаЬауа Ambassador, Permanent Representative, Geneva Director of Pharmacy Services

Dr A.U. AI-Salami Mrs Е. Mabuzane Secretary for Pharmaceutical Supply and Equipment, Ministry of EPI Manager Health Мг Т. Т. Chifamba Suppleant(s) - Alternate(s) Minister Counsellor, Permanent Mission, Geneva

Мг К.А. AI-Sakkaf Mr N. Kanyowa Adviser to the Minister Counsellor, Permanent Mission, Geneva

Mr N.N. Awad Mr F. Маопега Assistant Secretary Counsellor, Permanent Mission, Geneva

Mr N. AI-Muljim Director, Health Services

Mr A.J. AI-Mushiri Director, Technical Cooperation and lnternational Relations REPRESENTANTS D'UN MEMBRE Mr F. AloЬthani ASSOCIE First Secretary, Permanent Mission, Geneva

REPRESENTATIVES OF AN ZAMBIE - ZAMBIA ASSOCIATE MEMBER Chef de delegation - Chief delegate

Mr D. Mpamba Minister of Health PORTO RICO - PUERTO RICO Delegue(s) - Delegate(s)

Dr G. Silwamba Dr. R. Burgos Calderбn Director-General, Central Board of Health Coordinador de la Organizaciбn Panamericana de la Salud Departamento de Salud MrV. Musowe Director of Planning and Development, Ministry of Health

Suppleant(s) - Alternate(s)

Dr D. Kasungami District Director, District Health Management Board, Kafue OBSERVATEURS D'UN ЕТАТ NON

Ms 1.8. Fundafunda MEMBRE Charge d'affaires, Permanent Mission, Geneva

Мг Е. М. Katongo OBSERVERS FOR А NON-MEMBER First Secretary, Permanent Mission, Geneva STATE Ms А. Kazhingu Second Secretary, Permanent Mission, Geneva

Mr Е. Chisanga Second Secretary, Permanent Mission, Geneva SAINT -SIEGE - HOLУ SEE

Mgr J. Lozano Barragan ZIMBABWE - ZIMBABWE President du Conseil pontifical pour la Pastorale des Services de Sante Chef de delegation - Chief delegate Mgr G. Bertello Dr T.J. Stamps Nonce apostolique, Observateur permanent, Geneve Minister of Health and Child Welfare Mgr Е. Pelia Рагга Delegue(s)- Delegate(s) Conseiller, Mission permanente d'Observation, Geneve Mr B.G. Chidyausiku Mgr J.-M.M. Mpendawatu Ambassador, Permanent Representative, Geneva Expert Dr P.L.N. Sikosana Dr М. Ferrario Permanent Secretary, Ministry of Health and Child Welfare Expert A53NR page 191

Mlle А.-М. Colandrea Ms R. Ahluwalia Expert

Dr Р. Puddu Expert

Dr Е. Rocco OBSERVATEURS INVITES Expert CONFORMEMENT д LA RESOLUTION WHA27.37

OBSERVATEURS OBSERVERS INVITED IN ACCORDANCE WITH RESOLUTION OBSERVERS WHA27.37

ORDRE DE MAL ТЕ - ORDER OF MAL ТА PALESTINE - PALESTINE

М. Р.-У. Simonin Dr R. AI-Zaanoun Ambassadeur, Delegue permanent, Geneve Minister of Health

Mme М.-Т. Pictet-Aithann Dr 1. Tarawiyeh Ministre conseiller, Delegation, Geneve Director-General, Ministry of Health

Мг N. Ramlawi Ambassador, Permanent Observer, Geneva СОМIТЕ INTERNATIONAL DE LA CROIX­ ROUGE Dr N. Tobasi Director-General of the Prionaгy Health Саге in West Bank INTERNATIONAL СОММIТТЕЕ OF ТНЕ RED CROSS Mr R. Khouri Adviser to the Chairman of the Health Council for PuЫic Relations

Dr В. Eshaya-Chauvin М г Т. AI-Adjouri Chef, Division Sante et Secours

Mme А. Aerts-Novara ResponsaЫe Programme Sante, Division Sante et Secours

Mme С. Quan Attache, Division des Organisations internationales REPRESENTANTS DE L'ORGANISATION DES NATIONS UNIES ЕТ DES INSTITUTIONS FEDERATION INTERNATIONALE DES SOCIETES DE LA CROIX-ROUGE ЕТ DU APPARENTEES CROISSANT-ROUGE INTERNATIONAL FEDERATION OF RED REPRESENTATIVES OF ТНЕ CROSS AND RED CRESCENT SOCIETIES UNITED NATIONS AND RELATED Mr М. Schulz ORGANIZATIONS

М г Т. Svenning

Мг А. Bermejo

MrG. Gizaw

Dr В. Hersh

Mr Н. SandЬiadh

Mme М. Garcia

MrC. Lamb A53NR page 192

ORGANISATION DES NATIONS UNIES PROGRAMME ALIMENTAIRE MONDIAL UNITED NATIONS WORLDFOODPROGRAMME

Mr S. Khmelnitski М г W. Schleiffer External Relations and lnter-Agency Affairs Officer Director, WFP Liaison Office, Geneva

Mr J.-L. SiЫot Deputy Director, WFP Liaison Office, Geneva CONFERENCE DES NATIONS UNIES SUR LE COMMERCEETLEDEVELOPPEMENT Ms G. Atif UNITED NATIONS CONFERENCE ON TRADE Liaison Officer, WFP Liaison Office, Geneva AND DEVELOPMENT

OFFICE DE SECOURS ЕТ DE TRAVAUX DES Mr R. Uranga Senior, Economic Affairs Officer NATIONS UNIES POUR LES REFUGIES DE PALESTINE DANS LE PROCHE-ORIENT Mr D. Diaz UNITED NATIONS RELIEF AND WORKS Economic Affairs Officer AGENCY FOR PALESTINE REFUGEES IN ТНЕ NEAR EAST PROGRAMME DES NATIONS UNIES POUR LE DEVELOPPEMENT Dr F. Mousa Director of Health UNIТED NATIONS DEVELOPMENT PROGRAMME HAUT COMMISSARIAT DES NATIONS UNIES Ms Р. Andrea POUR LES REFUGIES Liaison Officer, UNDP, Geneva OFFICE OF ТНЕ UNITED NATIONS HIGH Mr Е. Bonev COMMISSIONER FOR REFUGEES Senior Advisor, UNDP European Office, Geneva

MrS. Male Chief, Health and Community Development Services, Division of PROGRAMME DES NATIONS UNIES POUR Operational Support L'ENVIRONNEMENT Mr Р. Couteau UNITED NATIONS ENVIRONMENT HIV/AIDS Focal Point, Health and Community Development PROGRAMME Services

Ms К. Burns MrJ.B. Willis Reproductive Health Officer, Health and Community Development Director, UNEP Chemicals Services

Mr S. Milad Ms У. Hasegawa Associate lnter-organisation Officer, Secretariat and lnter­ Ms А. Sunden Bylehn organisation service, Division of Communication and lnformation

FONDS DES NATIONS UNIES POUR LA ONUSIDA - UNAIDS POPULATION UNIТED NATIONS POPULATION FUND Dr Р. Piot Executive Director

Mr A.L. MacDonald Ms К. Cravero Director, UNFPA European Liaison Office, Geneva Ms J. Cleves Mr Е. Palstra Officer-in-Charge, UNFPA European Liaison Office, Geneva Dr А. М. Coii-Seck Dr D. Pierotti MrO. Elo Senior Adviser, UNFPA Emergency Relief Operations Ms F. McCaul Mr Н. Barzani Consultant, UNFPA European Liaison Office, Geneva Mr R. Chahii-Graf Mr S. Kolev Ms А. Winter

MrR.NoЫe A53NR page 193

Mr W. Sittitrai FONDS MONETAIRE INTERNATIONAL Mr S. Niyonzima INTERNATIONAL MONETARY FUND

Mr В. Makinwa Mr G.B. Taplin Special Representative, IMF Office, Geneva Ms G. Ernberg

Mr М. Grunitzky-Bekele ORGANISATION MONDIALE DE LA Mr J. Sherry PROPRIETE INTELLECTUELLE WORLD INTELLECTUAL PROPERTY ORGANIZATION

INSTITUTIONS SPECIALISEES Dr J.-P. Naim Head, Medical Unit

SPECIALIZED AGENCIES ORGANISATION DES NATIONS UNIES POUR LE DEVELOPPEMENT INDUSTRIEL UNITED NATIONS INDUSTRIAL DEVELOPMENT ORGANIZATION ORGANISATION INTERNATIONALE DU TRAVAIL Ms Е. Merz INTERNATIONAL LABOUR ORGANISATION Liaison Officer, UNIDO Liaison Office, Geneva

Mme G. Ullrich Departement des Activites sectorielles AGENCE INTERNATIONALE DE L'ENERGIE ATOMIQUE INTERNATIONAL ATOMIC ENERGY AGENCY ORGANISATION DES NATIONS UNIES POUR L'ALIMENTATION ЕТ L'AGRICULTURE Ms M.S. Opelz FOOD AND AGRICULTURE ORGANIZATION Head, IAEA Office, Geneva OF ТНЕ UNITED NATIONS Ms J. Knesl IAEA Office, Geneva Mr Т.N. Masuku Director, FAO Liaison Office with the United Nations, Geneva

Mr Р. Konandreas ORGANISATION MONDIALE DU COMMERCE Senior Liaison Officer, FAO Liaison Office with the United Nations, WORLD TRADE ORGANIZATION Geneva

Ms N. Brandstrup Mr Р.-Н. Ravier Liaison Officer, FAO Liaison Office with the United Nations, Geneva Deputy Director-General

М г А. Otten Director, lntellectual Property Division ORGANISATION DES NATIONS UNIES POUR L'EDUCATION, LA SCIENCE ЕТ LA CULTURE Mrs G. Stanton Senior Counsellor, Agriculture and Commodities Division UNIТED NATIONS EDUCATIONAL,

SCIENTIFIC AND CULTURAL ORGANIZATION Ms А. Carzaniga Economic Affairs Officer, Trade in Services Division

Mme А. Cassam Directeur, Bureau de Liaison de I'UNESCO, Geneve Mrs Thu-Lang Tran Wasescha Counsellor, lntellectual Property Division

Ms Doaa Abdel Motaal BANQUE MONDIALE - WORLD BANK Economic Affaiгs Officer, Trade and Environment Division

Мг С. Lovelace Мг М. Kennedy Director, Health, Nutrition and Population Legal Affairs Officer, lntellectual Property Division A53NR page 194 COMMISSION EUROPEENNE - EUROPEAN COMMJSSION REPRESENTANTS D'AUTRES ORGANISATIONS Мг R.E. Abbott INTERGOUVERNEMENTALES Ambassador, Permanent Delegation, Geneva MrW. Hunter Director, Directorate General Health and Consumer Protection, REPRESENTATIVES OF OTHER European Commission INTERGOVERNMENTAL Mr G. Gouvras Head, Directorate General Health and Consumer Protection, ORGANIZATIONS European Commission

Mr J. Ryan Deputy Head, Directorate General Health and Consumer Protection, European Commission LIGUE DES ETATS ARABES- LEAGUE OF Mrs М. Lauridsen ARAB STATES Directorate General Health and Consumer Protection, European Commission Mr M.D. Sweedan MrG. Thinus Secretaire general adjoint Directorate General Health and Consumer Protection, European Commission Mr M.S. Alfarargi Ambassadeur, Observateur permanent, Geneve Mrs N. Hvid Administrator, Directorate General Trade, European Commission Dr Н. Hamouda Directeur charge de la Sante et de I'Environnement М г С. Dufour Permanent Delegation, Geneva М. А. Ould Babaker Conseiller, Delegation permanente , Geneve Ms Т. Gisselbrecht Permanent Delegation, Geneva М. Salah Aeid Attache, Delegation permanente, Geneve Ms 1. Tasso Permanent Delegation, Geneva

ORGANISATION DE L'UNITE AFRICAINE ORGANIZATION OF AFRICAN UNIТY CONSEIL DES MINISTRES DE LA SANTE, CONSEIL DE COOPERATION DES ETATS М. М.Н. Doutoum ARABES DU GOLFE Ambassadeur, Addis-Abeba HEAL ТН MINISTERS' COUNCIL FOR GULF Dr V.E. Djomatchoua-Toko COOPERATION COUNCIL STATES Observateur permanent a.i., Geneve

Dr F.R. AI-Mousawi М. V. Wege Minister of Health, Bahrain Observateur permanent adjoint, Geneve

Мг R.I.N. Al Mosa М. 1.0. Mensa-Bonsu Ministre conseiller, Geneve Dr H.A.Gadallah

ORGANISATION INTERNATIONALE DE LA ORGANISATION DE LA CONFERENCE FRANCOPHONIE ISLAMIQUE ORGANISATION INTERNATIONALE DE LA ORGANIZATION OF ТНЕ ISLAMIC FRANCOPHONIE CONFERENCE

МгХ. Michel Mr А. Т. Hane Ambassador, Permanent Observer, Geneva

MrJ. Olia Deputy Permanent Observer, Geneva A53NR page 195

ORGANISATION INTERNATIONALE DE Alliance internationale des Femmes PROTECTION CIVILE lnternational Alliance of Women INTERNATIONAL CIVIL DEFENCE ORGANIZATION Ms G. Haupter

Mrs М. Pal Mr S. Zhaidi Secretary-General Ms J. Kehi-Lauff

Mr V. Kakusha Ms Е. Ворр Assistant to the Secretary-General

Ms Н. Sackstein

ORGANISATION INTERNATIONALE POUR LES MIGRATIONS Association du Commonwealth pour les INTERNATIONAL ORGANIZATION FOR Handicaps mentaux et les lncapacites liees MIGRATION au developpement Commonwealth Association for Mental Dr В. Gushulak Handicap and Developmental Disabllities Director, Migration Health Department

Mr Р. Schatzer Dr V.R. Pandurangi Director, External Relations Dr G. Supramaniam

Mr A.V. Pandurangi SECRETARIAT DU COMMONWEALTH COMMONWEALTH SECRETARIAT Association interamericaine de Genie Professor S. Matlin sanitaire et de I'Environnement

Dr Q. Q. Dlamini lnter-American Association of Sanitary and Environmental Engineering Dr S.V. Shongwe

Mr О. Sperandio Dr К. Т. Joiner

Dr В. Wint Association internationale de Conseil en Dr S. Prince Akpablo Allaitement Professor К. Stuart lnternational Lactation Consultant Association

Ms М. Lehmann-Buri

REPRESENTANTS DES Ms Е. Hormann ORGANISATIONS NON GOUVERNEMENTALES EN Association internationale de Logopedie et RELATIONS OFFICIELLES AVEC Phoniatrie L'OMS lnternational Association of Logopedics and Phoniatrics

REPRESENTATIVES OF Dr А. Muller NONGOVERNMENTAL ORGANIZATIONS IN OFFICIAL RELATIONS WITH WHO A53NR page 196

Association internationale de Lutte contre la Association internationale pour la Prevention М ucoviscidose et le Depistage du Cancer lnternational Cystic Fibrosis lnternational Society for Preventive Oncology (Mucoviscidosis) Association Dr Н. Е. Nieburgs Ms L. Heidet Dr L. Santi

Association internationale d'Epidemiologie Association internationale pour la Sante de la lnternational Epidemiological Association Mere et du Nouveau-Ne lnternational Association for Maternal and Dr R. Saracci Neonatal Health

Association internationale des Femmes Professor А. Сатрапа Medecins Mrs G.M. Santschi Medical Women's lnternational Association

Dr С. Bretscher-Dutoit Association italienne Amis de Raoul Follereau ltalian Association of Friends of Raoul Dr W. Diekhaus Follereau Dr J. Braak

Dr Е. Zecchini

Association internationale de Sociologie Dr S. Deepak lnternational Sociological Association Association medicale du Commonwealth Dr Е.В. Gallagher Commonwealth Medical Association

Association internationale des Techniciens Dr J. Havard de Laboratoire medical Ms М. Haslegrave lnternational Association of Medical Laboratory Technologists Association medicale mondiale Mrs М. HjalmarsdoШr World Medical Association

Dr А. Milton Association internationale d'Hygiime du Travail Dr О. Human lnternational Occupational Hygiene Professor J. Blahos Association Dr R. Smoak

Mrs В. Goelzer Mr R. Dennett

Ms С. Eychenne Association internationale d'lnformatique Ms S. Zaid medicale lnternational Medicallnformatics Association

Dr V. Griesser A53NR page 197

Associatioп moпdiale pour la Readaptatioп Coпfederatioп iпterпatioпale des Sages­ psychosociale Femmes World Associatioп for Psychosocial lпterпatioпal Coпfederatioп of Midwives Rehabllitatioп Ms R. Brauen Dr S. Flache Ms J. Bonnet

Mrs Р. ten Hoope-Bender Associatioп moпdiale veteriпaire World Veteriпary Associatioп Coпfederatioп moпdiale de Physiotherapie Dr W. Uebersax World Coпfederatioп for Physical Therapy

Ms S. Mercer Moore СМС - L'Actioп des Eglises pour la Saпte СМС - Churches' Actioп for Health Ms B.J. Myers

Dr Р. Nickson Coпseil de la Recherche еп Saпte pour le Dr М. Kurian Developpemeпt Couпcil оп Health Research for Developmeпt Mrs J. Matthey

Mrs J. Hume Dr L. Freij

Ms S. de Haan

College iпterпatioпal des Chirurgieпs Dr J. Kasonde lпterпatioпal College of Surgeoпs Dr М. Kerker

Professor Р.В. Hahnloser Dr У. Nuyens

Professor С. Suwanwela Comite iпter-africaiп sur les Pratiques traditioппelles ауапt effet sur la Saпte des Femmes et des Eпfaпts Coпseil de l'lпdustrie pour le Developpemeпt lпter-Africaп Committee оп Traditioпal lпdustry Couпcil for Developmeпt Practices affectiпg the Health of Womeп апd Childreп Dr D. Jonas

Dr S. Jongeneel Mrs В. Ras-Work

Mrs R. Bonner Coпseil des Orgaпisatioпs iпterпatioпales Mrs М. Greuter des Scieпces medicales Couпcil for lпterпatioпal Orgaпizatioпs of Mrs В. von der Weid Medical Scieпces

Comite iпterпatioпal catholique des Professor J.E. ldanpaan-Heikkila lпfirmieres et Assistaпtes medico-sociales Professor М. Abdussalam lпterпatioпal Catholic Committee of Nurses апd Medico-social Assistaпts Dr J. Gallagher

Mr S.S. Fluss Mrs J. Bartley Dr J.H. Bryant A53NR page 198

Coпseil iпterпatioпal des Femmes Coпsultatioп iпterпatioпale sur les Maladies lпterпatioпal Couпcil of Womeп urologiques lпterпatioпal Coпsultatioп оп Urological Mrs Р. Herzog Diseases

Professor S. Khoury Coпseil iпterпatioпal des lпfirmieres lпterпatioпal Couпcil of Nurses Federatioп deпtaire iпterпatioпale Dr J.A. Oulton FDI World Deпtal Federatioп

DrM. Kingma Dr J. Monnot

Dr Т. Ghebrehiwet

Miss F .А. Affara Federatioп iпterпatioпale de Chimie clinique Mrs L. Carrier-Walker et de Medeciпe de Laboratoire lпterпatioпal Federatioп of Cliпical Chemistry Mrs М. Bertholet Pradervand апd Laboratory Mediciпe

Ms С. Hyde-Pride DrA. Deom Ms А. Tsang

Mrs L. Arietti Federatioп iпterпatioпale de Cooperation des Mrs С. Bosson Ceпtres de Recherche sur les Systemes et Services de Saпte Mrs S. Rajakoski Federatioп for lпternatioпal Cooperatioп of Health Services апd Systems Research Conseil iпterпatioпal sur les ProЬiemes de Ceпters I'Aicoolisme et des Toxicomaпies Dr Bui Dang На Doan lпterпatioпal Couпcil оп Alcohol апd

Addictioпs Dr о. Levy

Dr J. Spieldenner Federatioп iпterпatioпale de Gyпecologie et Mr С. Pellet d'Obstetrique lпterпatioпal Federatioп of Gyпecology and Coпseil moпdial de la Saпte Obstetrics Global Health Couпcil Dr R. Kulier

Dr N. Daulaire

Мг J. Gloeb Federatioп iпterпatioпale de l'lndustrie du Medicameпt Dr А. RobЬins lпternatioпal Federatioп of Pharmaceutical Dr Н. McConnell Maпufacturers Associatioпs

Dr D.C. Johnson Dr Н. Е. Bale

Dr М. О. Gutekunst Мг J.-F. Gaulis

Dr О .А. Smith Dr О. Morin Carpentier

Dr Е. Noehrenberg

Mr А. Aumonier

Dr Р. Carlevaro

Ms L. Kroukamp ASЗNR page 199

Mr т. Bombelles Mr J. Veldhuyzen

Mr J.-J. Bertrand М г С. Schaars

Mr В. Lemoine Ms Е. Martino

Dr L. Teulieres Ms 1. Pedro

Mr С. Yoshida Ms S. Hogmark

Dr С. Fink-Anthe Mr Yi-Min Wang

Mrs F. Buhl Mr J. Schmidt

Ms S. Crowley Ms С. Buhmann

Professor R. Krebs

Mr S. Sargent Federation internationale des Associations du Dossier de Sante Mr Р. Hedger lnternational Federation of Health Records

Mrs H.J. Wong Organizations

Mr В. McDonough Ms V. Tichbourne

Ms А. Joannon

Mr М. Yazhari Federation internationale des Colleges de Chirurgie Mr М. Campolini lnternational Federation of Surgical Colleges

Federation internationale des Associations Professor S.W. Gunn d'Etudiants en Medecine Professor М. Masellis lnternational Federation of Medical Students Associations Federation internationale des lndustries des Mr М. Sundberg Aliments dietetiques lnternational Special Dietary Foods lndustries Mr R. Damgaard Nielsen

Ms S. de Ribeaupierre Dr А. Bronner

Ms О. Layton Mr М. de Skowronski

Mr N. Barengo М г А. Micardi

MrT. Monaco Mr S. Tasher

Mr 1. Barjaktarevic Ms J. Keith

Mr S. Sapkota Mr А. Raemaekers

Ms S. Koso Ms L. Pakalski

Mr F. Fuchs Mr N. Christiansen

Ms М. Ocampo Fontangordo Mr G. Fookes

Ms Z. Khatijah Khan Mr N. Siwabutr

Ms R. van Rooyen Ms М. Armada

Mr Т. Refaat Dr В. de Buzonniere

Ms Z. Moolani Dr D. Segal

Ms S. Zaid Mr К. de Jong

Ms J. Troon Mr А. Maier A53NR page 200

МгМ. Goto Federation internationale pour la Planification familiale Ms К. Bolognese lnternational Planned Parenthood Federation Ms Н. Mouchly Weiss Mrs 1. Brueggemann Мг А. Hill

Dr Р. Senanayake Мг D. Spiegel

Мг С. Ritchie Ms G. Coffy

М г V. Bordoni Federation mondiale de Chiropratique Ms А. Paonessa World Federation of Chiropractic Ms S. Jacobs Dr L. Sportelli Mr F. Albert Dr R. Baird Мг М. Warburg Dr С. Diem

Мг D. Chapman-Smith Federation internationale de Thalassemie Thalassaemia lnternational Federation Dr G. Auerbach

Dr S. Williams Мг С. Papageorgiou

Dr М. Allatar

Federation internationale pharmaceutique Dr R. Hoffman lnternational Pharmaceutical Federation Dr М. Brickman

Мг Р. Kielgast Federation mondiale des Anciens МгТ. Hoek Combattants Dr D. Steinbach World Veterans Federation

Professor Н. Junginger Мг С. Provoost Мг С. R. Hitchings

Professor L. Benet Federation mondiale des Associations de la

Professor С. Trinca Sante puЬiique World Federation of PuЬiic Health Professor S. Florence Associations Dr J. Gans Dr M.N. Akhter Professor К. Midha Ms М. Hilson Mrs J. Nicholson D.r С. Montoya Aguilar Мг J. Parrot Professor Niu Shiru Мг Н. Rice Мг Lu Rushan Мг М. Rouse Dr Wang Hexiang Professor Z. Vincze Mrs U. Bropkamp-Stone Mrs R. van Kesteren Professor J. von Troschke

Dr А. Leventhal

Dr S. Kitagawa

Dr Yong Wook Lee ASЗNR pagc 2vl

Ms S. Onceva Federation mondiale pour I'Enseignement de la Medecine Dr С. Korczak World Federation for Medical Education Dr N. Mahmud Кап

Mr Н. Karle Professor R. Beaglehole

Dr I.A. Demina Fondation Aga Khan - Aga Khan Foundatioh Мг G. Aston

Ms 1. de la Mata Mr J.B. Tomaro

Dr Т. Perneger German Pharma Health Fund e.V. Professor Т. Abelin German Pharma Health Fund e.V. Ms J. Safe

Dr С. Fink-Anthe Dr А. Кimambo

Dr G. Rayner lndustrie mondiale de I'Automedication Dr А. Jones responsaЫe Ms J. Gunby World Self-Medication lndustry

Dr Р. Orris Mr А. Uehara

Ms J. Foreit Dr J.A. Reinstein

Mr S. Young-Yoon Mr E.J. Gezzi

Ms S. Sapkota Ms J. Seifert

Dr J. Glasser Mr Н. Bolanos

Mr А. Pascielli Federation mondiale des Associations pour Mr У. Noro les Nations Unies World Federation of United Nations Mr D. Graham Associations

Ms L. Ciaffei lnternational Society of Doctors for the Environment Dr R. Masironi lnternational Society of Doctors for the

Мг Н. Регега Environment

Мг М. Weydert Dr G. Silberschmidt

Dr М. Violaki-Paraskeva Dr М. Fernex

Dr J.W. Steinbart Ligue internationale des Societes Federation mondiale pour la Sante mentale dermatologiques World Federation for Mental Health lnternational League of Dermatological Societies Dr S. Flache Professor J.-H. Saurat ASЗNR page 202

Ligue internationale La Leche Ms Е. 't Hoen La Leche League lnternational Or В. Pecoul

Ms G. Laviolle Мг J. Love

Мг S. Ochieng

Ligue mondiale contre I'Hypertension Ms О. Vicencio World Hypertension League Мг В. van der Heide

О г Т. Strasser Ms S. Bolton

Ms N. Cebotarenko Medicus Mundi lnternationalis (Organisation Ms С. Gavin internationale de Cooperation pour la Sante) Medicus Mundi lnternationalis (lnternational Mr Z. Chowdhury Organization for Cooperation in Health Care) Ms М. Shiva

Or М.А. Argal Mr М. Rowson

Or Е. Burnier Ms Е. Verheul

Or F. Ое Раере Ms А. Allain

Мг G. Eskens М г Amoussou Kouetete Ekoue

Ог N. Lorenz Or К. Coulibali

Ог В. Pastors Ms М. Epoulou

Professor Pawlowski Ms В. Fienieg

Мг Т. Puls Or S. Kanon

Or N. Rehlis Or Р. Lerma Bergua

Or S. Rypkema Ms N.J. Peck

Professor Н. Van Balen Ms Р. Rundall

Ог Е. Widmer Ms Е. Sterken

Mrs F. Wijckmans Ог F. Vallone

М г Т. Schwarz Or N. Vartapetova

Ms L. Hayes

Organisation internationale de Normalisation Ms L. Schlageter lnternational Organization for Standardization Ms Р. Zinkin

Мг T.J. Hancox Mr О. Вегтаn

Organisation internationale des Unions de Organisation pour la Prevention de la Cecite Consommateurs (Organisation Organisation pour la Prevention de la Cecite internationale des Consommateurs) lnternational Organization of Consumers Professeur Р. Queguiner Unions (Consumers lnternational) ASЗNR page 203

Save the Children Fund (Royaume-Uni) Union internationale contre le Cancer Save the Children Fund (UK) lnternational Union against Cancer

Ms Е. Cain Mrs N. Kaufman

Mrs J. Glanz

Societe internationale de Chimiotherapie Mrs J. Wilkinfield lnternational Society of Chemotherapy DгТ. Glynn

Professor J.-C. Pechere Ms 1. Mortara

Mr R. lsrael Societe internationale de Chirurgie Ms J. Foreit lnternational Society of Surgery

Professor S.W.A. Gunn Union internationale contre les lnfections transmises sexuellement lnternational Union against Sexually Societe medicale internationale de Paraplegie Transmitted lnfections lnternational Medical Society of Paraplegia

Dr G.M. Antal Professor А. Rossier

Union internationale de Pharmacologie Soroptimist lnternational - Soroptimist lnternational lnternational Union of Pharmacology

Professor F. Sjбqvist Ms I.S. Nordback

Union internationale pour la Conservation de The Network: Community Partnerships for Health through lnnovative Education, la Nature et de ses Ressources - L'Union Service, and Research mondiale pour la Nature The Network: Community Partnerships for lnternational Union of Conservation of Nature Health through lnnovative Education, and Natural Resources - The World Service, and Research Conservation Union

Mr С. Laufenberg Dr Р. Kekki

Union internationale contre la Tuberculose et Union interparlementaire - lnter­ les Maladies respiratoires Parliamentary Union lnternational Union against Tuberculosis and Lung Disease Mr А. В. Johnsson Mr S. Tchelnokov Dr J. Almendares

Мг О. Douglas Vision mondiale internationale Dr F. Sayek World Vision lnternational

Professor F. Wiebel Dr Е. Ram Mrs R. Bloem

Ms Е. Must Mr D. Werner Мг S. Moodliar Mr J. Kapito Ms М. Shiva Ms Р. Lynn MrM. Cisse М г G. Parajon Ms М. Ortiz

Ms К. Mulvey MrM.Ho A53NR page 204

REPRESENTANTS DU CONSEIL EXECUТIF

Professeur J.-F. Girard М. N.S. de Silva Dr A.J.M. Sulaiman Professeur Т. Zeltner

REPRESENTA ТIVES OF ТНЕ EXECUТIVE BOARD

Professor J.-F. Girard Mr N.S. de Silva Dr A.J.M. Sulaiman Professor Т. Zeltner A53NR page 205

INDEX OF NAMES

This index contains the names of speakers reported in the present volume.

INDEX DES NOMS DES ORATEURS

Cet index contient les noms des orateurs dont les interventions figurent dans le present volume.

ABDULLAH, А. (Maldives), 106 CASТILLO SANTANA, А. (Cuba), 137 AIТKEN, D.G. (Senior Policy Adviser/ СНА, Н.-В. (RepuЬlic ofKorea/RepuЬlique de Conseiller principal en politique), 133, Coree), 46 134 CНARВONNEAU, У. (Canada), 38 ALI, S.M. (Bangladesh), Chairman of СНАТАUТ, B.D. (Nepal/Nepal), 15 Committee A/President de la СНА ТТI, M.l. AL- (Syrian Arab RepuЬlic/ Commission А, 145 Republique arabe syrienne ), 62 AMATHILA, L. (NamiЬia/NamiЬie), СНUА Jui Meng (Malaysia/Мalaisie), 64 President ofthe Fifty-third World COLEMAN, P.S. (Li!:>eria/Liheria), 102 Health AssemЬiy/ COMENDEIRO HERNANDEZ, Е. (Cuba), 68 President de la Cinquante-Troisieme CUENTAS YANEZ, G. (Bolivia/Вolivie), 91 AssemЬlee mondiale de la Sante, 10, 148 ARCANJO, М. (Portugal), 29 DAMAYE, D.L. (ChadПchad), 104 AUMANU, S.S. (Solomon Islands/Iles DANSO-BOAFO, К. (Ghana), 143 Salomon), 14, 98 DE SILVA, N.S. (Sri Lanka), 58 DEGUARA, L. (Malta/Мalte ), 72 DIRECTOR-GENERAL/DIRECTEUR BACHELET, М. (Chile/Chili), 50 GENERAL, 20, 147 ВАМВА, А. (Guinea-Bissau/Guinee-Bissau), DLAMINI, Р.К. (Swaziland), 12, 35 115 DOURI, М. AL- (Iraq), 83 BENIZRI, R.S. (lsraelllsraёl), 58 DRAME, К. (Guinea/Guinee), 15 BENJELLOUN-TOUIMI, M.N. (Morocco/ DURМUS, О. (TurkeyПurquie), 59 Maroc), 117 BENYOUNES, А. (AlgerialAlgerie ), 78 BERМEJO, А. (Intemational Federation ofRed ENGQVIST, L. (Sweden/Suede), 52 Cross and Red Crescent Societies/ ЕSСНЕIКН, F. (Tunisia/Тunisie ), 82 Federation intemationale des Societes de la Croix-Rouge et du Croissant-Rouge), 113 FARНADI, М. (Islamic RepuЬlic oflranl BLACKWOOD, А. (United States of Republique islamique d'Iran), 116 America!Etats-Unis d 'Amerique), 13 8 FERNANDEZ AMEGLIO, М. (Uruguay), 63 A53NR page 206

FIKRI, М. (United Arab Emirates Health МсСОУ SANCHEZ, М. (Nicaragua), Foundation Prize/Prix de la Fondation Vice-Chairman of Committee А/ des Emirats arabes unis pour la Sante), Vice-President de la Commission А, 89 126 MENGA, R.J. (Congo), 132, 133, 134 FISER, В. (Czech RepuЬlic/Republique MORRI, R. (San Marino/Saint-Marin), 74 tcheque ), 61 MOUSAWI, F.R. AL- (Bahrain/Вahrein), 26 FOEGE, W. (Senior Adviser/Conseiller principal, Bill and Melinda Gates Foundation), 41 NAZIROV, F.G. (Uzbekistan/Ouzhekistan), Vice-President of the Fifty-third World Health AssemЬlyNice­ GARCIA МАТА, В. (Ecuador/Equateur), 88 President de la Cinquante-Troisieme GODDARD, Р.С. (Barbados/Вarbade), 85 AssemЬlee mondiale de la Sante, 95 GONZALEZ-FERNANDEZ, J.A. (Mexico/ NGEDUP, L. (Bhutan/Вhoutan), 66 Mexique), 27

OLIVEROS, S. (Family Planning Association, НABTEMARIAM, G. (Ethiopia/Ethiopie), 109 V enezuela (PLAF АМ), Sasakawa Health НАКЕТА, S. (Japan/Japon),.31 Prize/Association de Planification HORN, У. (Sasakawa Health Prize/Prix familiale, Venezuela (PLAF АМ), Prix Sasakawa pour la Sante), 123 Sasakawa pour la Sante), 125 OMAROVА, М. (Kazakhstan), 92 ONGERI, S. (Kenya), 99 IВRAHIM, I.M. (Sudan!Soudan), 108 OSORIO, А.Е. (Venezuela), 107 OVADJE, 0.0. (Sasakawa Health Prize/Prix Sasakawa pour la Sante), 124 КАRАМ, К. (Lebanon/Liban), Chairman of Committee B/President de la Commission В, 146 PEHIN ABDUL AZIZ UMAR (Brunei КASI, А.М. (Pakistan), 76, 77, 80 Darussalam/Вrunei Darussalam), 51 КATSAROV, S. (Bulgaria/Вulgarie), 114 PELEG, D. (Israel/Israёl), 141 КЕТ SEIN (Myanmar), 71 PONMEK DALALOY (Lao People's КЕТ SEIN (United Arab Emirates Health Democratic Republic/RepuЬlique Foundation Prize/Prix de la Fondation democratique populaire lao ), 80 des Emirats arabes unis pour la Sante), 129 KIIKUNI, К. (Nippon Foundation), 121 RI CHOL (Democratic People's Republic of KING, А. (New Zealand/Nouvelle-Zelande), 32 Korea/Republique populaire KIYONGA, С. (Uganda/Ouganda), 111 democratique de Coree ), 100 KORN DABBARANSI (Thailand/Thallande ), RICUPERO, R. (Secretary-General, UNCTAD, 55 Representative ofthe Secretary-General ofthe United Nations/Secretaire general, CNUCED, Representant du Secretaire LAKOE, R. (Central African RepuЬlic/ general de l'Organisation des Nations Republique centrafricaine), 11 О Unies), 3 LJUBIC, В. (Bosnia and Herzegovina!Вosnie­ RYS, А. (Poland/Pologne), 105 Herzegovine), 93 LOMBARDO, Н. (Argentina/Argentine ), 56 LOZANO BARRAGAN, J. (Holy See/ SALLAM, 1. (Egypt/Egypte ), 54 Saint-Siege), 112 SAVVIDES, F. (Cyprus/Chypre), 67 SEGOND, G.-0. (Representative ofthe Conseil d'Etat ofthe Republic and Canton of MARQUES DE LIMA, A.S. (Sao Tome and Geneva/Representant du Conseil d'Etat Principe/Sao Tome-et-Principe), 101 de la Republique et Canton de Geneve ), 2 A53NR page 207

SELIM, F.K. (Bangladesh), 73 TARAWNEH, М. (Jшdan/Jordanie), 70 SERRA, J. (Brazil/Вresil), 65 TELEFONI RETZLAFF, М. (Samoa), SНALALA, D. (United States of America/ Vice-President ofthe Fifty-second Etats-Unis d' Amerique), 33 World Health AssemЬly/ SНANMUGAM, N.T. (India/lnde), Vice-President de la Cinquante­ Vice-President ofthe Fifty-third Deuxieme AssemЬiee mondiale de la World Health AssemЬly/ Sante, 1, 5 Vice-President de la Cinquante­ TERAN SIТTON, J.M. (Panama), 86 Troisieme AssemЬlee mondiale de la TOPPING, T.S.R. (Legal Counsel/Conseiller Sante, 77 juridique), 133, 135, 137, 138 SНEVTCНENKO, Y.L. (Russian Federation/ TRAORE NAFO, F. (Mali), 94 Federation de Russie), 47 SOEDOKO, R. (United Arab Emirates Health Foundation Prize/Prix de la Fondation VIVAS, Р. (Uruguay), 136, 138 des Emirats arabes unis pour la Sante), VOTO-BERNALES, J. (Peru/Perou), 84 128 STAMPS, T.J. (Zimbabwe), 15 STAVLJENIC-RUКA VINA, А. (Croatia/ WANCНAI SATTAУ А WUTНIPONG Croatie ), 53 (Thailand/Thai1ande), 134, 136, 137 STUART, G. (United Kingdom ofGreat Britain and Northern Ireland/Royaume-Uni de Grande-Bretagne et d'Irlande du Nord), YADAV, R.B. (Nepal/Nepal), 69 34 SUJUDI, А. (lndonesia/lndonesie), 60 SULAIMAN, A.J.M. (Oman, Chairman ofthe ZAANOUN, R. AL- (Palestine), 91 Executive Board/President du Conseil ZELENКEVICH, 1. (Belarus/Вelarus ), 97 executif), 18 ZНANG Wenkang (China/Chine), 13,48

A53NR page 209

INDEX OF COUNTRIES AND ORGANIZATIONS

This index lists the countries, organizations and bodies represented Ьу the speakers whose names appear in the index on the preceding pages.

ALGERIA, 78 F AMILУ PLANNING ASSOCIATION, ARGENTINA, 56 VENEZUELA, 125

BAHRAIN, 26 GНANA, 143 BANGLADESH, 73, 145 GUINEA, 15 BARВADOS, 85 GUINEA-BISSAU, 115 BELARUS, 97 GULF COOPERAТION COUNCIL, 26 BНUTAN, 66 BOLIVIA, 91 BOSNIA AND HERZEGOVINA, 93 HOLУ SEE, 112 BRAZIL, 65 BRUNEI DARUSSALAM, 51 BULGARIA, 114 INDIA, 77 INDONESIA, 60 INSТITUTE OF NURSING, МУ ANMAR, 129 CANADA,38 INTERNA ТIONAL FEDERAТION OF RED CARICOM, 85 CROSS AND RED CRESCENT CENTRAL AMERICAN STATES AND SOCIEТIES, 113 DOMINICAN REPUBLIC, 87 IRAN (ISLAMIC REPUBLIC OF), 116 CENTRAL AFRICAN REPUBLIC, 11 О IRAQ, 83 СНАD, 104 ISRAEL, 58, 141 CHILE, 50 CHINA, 13, 48 CONGO, 132, 133, 134 JAPAN, 31 CONSEIL D'ETAT OF ТНЕ REPUBLIC AND JORDAN, 70 CANTON OF GENEV А, 2 CROAТIA, 53 CUBA, 68, 137 КAZAKHSTAN, 92 CYPRUS, 67 KENYA,99 CZECH REPUBLIC, 61

LAO PEOPLE'S DEMOCRAТIC REPUBLIC, DEMOCRAТIС PEOPLE'S REPUBLIC OF 80 KOREA, 100 LEBANON, 146 LIВERIA, 102

ECUADOR, 88 EGYPT, 54 MALA YSIA, 64 ETHIOPIA, 109 MALDIVES, 106 EUROPEAN UNION, 29 MALI, 94 A53NR page 210

МАLТА, 72 SOUTНERN AFRICAN DEVELOPMENT MEXICO, 27 COMMUNIТY, 36 MOROCCO, 117 SRI LANКA, 58 MYANMAR, 71 SUDAN, 108 SWAZILAND, 12, 35 SWEDEN, 52 NAMIВIA, 10, 148 SYRIAN ARAB REPUBLIC, 62 NEPAL, 15,69 NEW ZEALAND, 32 NICARAGUA, 89 TНAILAND, 55, 134, 136, 137 NIPPON FOUNDAТION, 121 TUNISIA, 82 ТURКЕУ,59

ОМАN, 18 UGANDA, 111 UNIТED ARAB EMIRATES HEALTH PAКISTAN, 76, 77, 80 FOUNDAТION, 126 PALESTINE, 91 UNIТED KINGDOM OF GREAT BRITAIN PANAMA, 86 AND NORTHERN IRELAND, 34 PERU, 84 UNIТED NAТIONS, 3 POLAND, 105 UNIТED STATES OF AMERICA, 33, PORТUGAL, 29 138 URUGUAУ, 63, 136, 138 UZBEKISTAN, 95 REPUBLIC OF KOREA, 46 RUSSIAN FEDERAТION, 47 VENEZUELA, 107

SAMOA, 1, 5 SAN МARINO, 74 WEST AFRICAN НЕАLТН COMMUNIТY, SAO ТОМЕ AND PRINCIPE, 101 102 SМALL ISLAND STATES OF ТНЕ WESTERN Р ACIFIC, 98 SOLOMON ISLANDS, 14, 98 ZIMBABWE, 15 A53NR page 211

INDEX DES PAYS ЕТ ORGANISATIONS

Cet index contient les noms des pays, organisations et organismes divers representes par les orateurs dont les noms figurent dans l' index precedent.

ALGERIE, 78 FEDERAТION DE RUSSIE, 47 ARGENTINE, 56 FEDERAТION INTERNA ТIONALE DES ASSOCIA ТION DE PLANIFICA ТION SOCIETES DE LA CROIX-ROlJGE FAMILIALE (VENEZUELA), 125 ЕТ DU CROISSANT-ROUGE, 113 FONDA ТION DES EMIRA TS ARABES UNIS POUR LA SANTE, 126 BAHREIN,26 BANGLADESH, 73, 145 BARВADE, 85 GНANA, 143 BELARUS, 97 GUINEE, 15 BHOUTAN,66 GUINEE-ВISSAU, 115 BOLIVIE, 91 BOSNIE-НERZEGOVINE, 93 BRESIL, 65 ILES SALOMON, 14,98 BRUNEI DARUSSALAM, 51 INDE, 77 BULGARIE, 114 INDONESIE, 60 INSТIТUT DE SOINS INFIRМIERS (МУ ANMAR), 129 CANADA,38 IRAN (REPUBLIQUE ISLAMIQUE D'), 116 CARICOM, 85 IRAQ, 83 CHILI, 50 ISRAEL, 58, 141 CHINE, 13, 48 СНУРRЕ, 67 COMMUNAUTE DE DEVELOPPEMENT JAPON, 31 DE L' AFRIQUE AUSTRALE, 36 JORDANIE, 70 COMMUNAUTE OUEST AFRICAINE POUR LA SANTE, 102 CONGO, 132, 133, 134 КАZАКНSТАN, 92 CONSEIL DE COOPERA ТION DES ETATS КЕNУА,99 DUGOLFE,26 CONSEIL D'ETAT DE LA REPUBLIQUE ЕТ CANTON DE GENEVE, 2 LIВAN, 146 CROAТIE, 53 LIВERIA, 102 CUBA, 68, 13 7

MALAISIE, 64 EGYPTE, 54 MALDIVES, 106 EQUATEUR, 88 MALI, 94 ЕТА TS D' AMERIQUE CENTRALE ЕТ MALTE, 72 REPUBLIQUE DOMINICAINE, 87 MAROC, 117 ETATS-UNIS D'AMERIQUE, 33, 138 MEXIQUE,27 ETHIOPIE, 109 МYANMAR, 71 A53NR page 212

NAMIВIE, 10, 148 REPUBLIQUE POPULAIRE NEPAL, 15,69 DEMOCRAТIQUE DE COREE, 100 NICARAGUA, 89 REPUBLIQUE TCHEQUE, 61 NIPPON FOUNDAТION, 121 ROYAUME-UNI DE GRANDE-BRETAGNE NOUVELLE-ZELANDE, 32 ЕТ D'IRLANDE DU NORD, 34

SAINT-MARIN, 74 OMAN, 18 SAINT-SIEGE, 112 ORGANISAТION DES NAТIONS UNIES, 3 SAMOA, 1, 5 OUGANDA, 111 SAO TOME-ET-PRINCIPE, 101 OUZBEKISTAN, 95 SOUDAN, 108 SRI LANKA, 58 SUEDE, 52 PAKISTAN, 76, 77, 80 SWAZILAND, 12,35 PALESTINE, 91 PANAMA, 86 ТСНАD, 104 PEROU, 84 TНAILANDE, 55, 134, 136, 137 PEТITS ETATS INSULAIRES DU ТUNISIE, 82 PACIFIQUE OCCIDENTAL, 98 ТURQUIE, 59 POLOGNE, 105 PORТUGAL, 29 UNION EUROPEENNE, 29 URUGUAУ, 63, 136, 138 REPUBLIQUE ARABE SYRIENNE, 62 REPUBLIQUE CENTRAFRICAINE, 11 О VENEZUELA, 107 REPUBLIQUE DE COREE, 46 REPUBLIQUE DEMOCRAТIQUE POPULAIRE LAO, 80 ZIMBABWE, 15