WORLD HEALTH ORGANIZATION
ORGANISATION MONDIALE DE LA SANT~
REGIONAL OFFICE FOR
THE WESTERN PACIFIC
BUREAU REGIONAL DU PACIFIQUE OCCIDENTAL
REGIONAL COMMITI'EE Nineteenth Session Manila 1-8 October 1968
WPR!RC19/7 12 August 1968 ORIGINAL: ENGLISH
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Provisional agenda item 15 IDNG-TERM PLANNING AND EVAWATION
1.
The Ad Ho£ COIIIIl1ttee of Experts established to examine the finances Of particular interest
of the United Nations and the Specialized Agencies in its report to the General Assembly made numerous recommendations. in this connexion are Recommendation 29 which calls for an integrated system of long-tem planning, of progranrne formulation and of budget preparation; Recommendation 30, which proposes that the organizations and Recommendation 31, asking for the development should take steps to improve and strengthen the evaluation process wherever possible; 2. of common evaluation methods and standards for the organizations. Annex 11 of WHO Official Records 165 summarizes the position of WHO concerning the 52 individual recommendations of the Ad Hoc Conmittee. Section H on "Programme Planning and Evaluation" of the Appendix to Annex 11 (WHO Off. Rec. 165, pp 64-66) deals specifically with progra.tlllle planning and evaluation (see Annex 1).
3.
In advocating the introduction of an integrated system of long-tem
planning of programme formulation and of budget preparation, the Ad Hoc Committee has also recommended that each organization should develop its own processes and staff capability in order to define what it hopes to accomplish wi thin def1n1 te points of time. In thus defining specific
objectives, the priority needs of Member States would be taken into / account as •••
WPR,IRCl9/7 page 2 account as would the overall capabllity of the Organization, and the probable financial costs. with related costs. 4. At the Twenty-first World Health Assembly resolutions were passed concerning the implementation of the recommendations in the Second Report of the Ad Hoc CollJll1ttee of Experts. Simultaneously, alternative courses of action for accomplishing the defined objectives would be formulated together
5.
Your attention is drawn in particular to resolutions WHA2l.32 and \~ch
WHA2l.49 luation.
deal with the implementation of Recommendations 29 and
30 of the Committee of Experts and concern long-tem planning and eva('lhese resolutions are reproduced, for ready reference, in Annex 2 of this docUlllent).
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6.
'lhese resolutions of the World Health Assembly concerning long-
tem planning and eValuation are part of a current trend manifest in many circles of the United Nations system which involves WHO in several ways. WHO has its own General Programme of Work for a Specific Period wng-range plans of a similar nature are now required by covering an average of five years, the current one, the fourth, extending to 1971. a variety of United Nations bodies and WHO must assist in the elaboration of the health sector of a World Plan of Action for Development being worked out by the United Nations Adv1so~
Committee on the ,.
Application of Science and Technology to Development (UN-ACSAT) as well as of the United Nations Plan for the Second Development Decade. Furthermore, a trend for Regional Economic Commissions to formulate long-tem plans for their respective regions has similar implications for WHO.
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7.
'lhese developments clearly create a need to further strengthen and Hitherto the General
extend the planning projections of the Organization.
Programme of Work for a Specific Period has been a somewhat centrifugal process in the. sense that the general programme has been formulated by the Executive :SOard, approved by the World Health by the Regional Committees to regional needS. Asse~bly
and adapted
'lhe situation is now
ripe for reversing the flow of action in the next exercise so that the /programme for •••
WPR/RC19/7 page 3 programme for 1972-76 would then be elaborated in the first instance at at the country level on the basis of consultations between WHO and individual government authorities. Regional offices could then build up, on These regional the basis of these consultations about national plans, needs and intentions, aggregated regional plans to be forwarded to Headquarters. projections \-lould then constitute the basis of and be har1lJonized into a global programme which, in the form appro'led by the World Health Assembly, would constitute the Qeneral Programme of Work for ~~e Organization to cover the period 1972-76 •
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8.
A general programme built up in this way would provide the best
basis for meeting the needs of UN-ACSAT's World Plan, the United Nations Second Development Decade Plan and any regional plans set up by Regional Economic Commissions. It would also provide an opportunity for Member States to ascertain their needs and thereby ensure that the technical co-operation of WHO be focused on priorities.
9.
Resolution WHA21.49 recommends that "Regional Committees give
particular attention at their 1968 session to long-term health planning and the formulation and evaluation of health programmes and to the possibilities of co-operation on a regional and inter-regional basis in the development of health plans!!. 10.
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Headquarters is studying the question of developing long-term Clearly the basis of any
financial indicators of future programmes.
such indicators must be established first in terms of programme goals and targets and the requirements necessary for their achievement. 11.
Headquarters is collaborating with regional offices in the study Operations are already under way for effecting at national and
of ways and means for further improving and strengthening the evaluation process. regional level a more systematic anticipatory pre-operational project assessment and evaluation of projects as well as impact analysis of work accomplished. Headquarters is undertaking an analytic review of programmes in search of the lessons of experience to be kept in mind in future programme development and action. 12. The Regional Committee may wish to consider the principles set /forth in •••
WPR/RC19/1 page 4 forth in Section H of the Appendix of Annex 11 of Official Records 165 and to express the consensus of its views on the planning and evaluation
aspects of the WHO programmes.
This will guide the Director-General who,
in reporting to the forty-third session of the Executive Board, is to pay special attention to the opinions of Member States and Regional Committees. 13. With regard to long-range planning, it is not necessary at this It is proposed that past experience guide Accordingly, the four General Programmes of Work stage to go into details. future developments.
for a Specific Period, the plan for health by the World Health Assembly for the Development Decade of the sixties and the WHO proposals for the World Plan of Action of the Advisory Comm1 ttee on Science and Technology of the United Nations suggest that Member States might wish to categorize their plans, needs and possible health targets along lines similar to the following: National Health Plans: (a) determination of priorities on the basiS of
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pre-operational surveys and expressed in terms of: Network of basic health services The extension of basic health services to achieve coverage of a targeted area; (b) Public health priority programme Reduction of priority communicable diseases Reduction of infant mortality Improvement of nutritional status Extension of sanitary services Other programmes (considered to be national priorities); (c) Education and training of staff Professional technical and auxiliary staff for the field of the various health professions. 14. Such categorization will enable WHO, in drawing up'its long-term programme of work, to concentrate more effectively on the needs of Member States.
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WPR/RC19/7 page
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ANNEX 1
EXECUTIVE BOARD, FORTY-FIRST SESSION, PART 1
H. PROGMMME PLANNING AND EVAWATION
LONG-TERM PLANNING
Recommendation 29
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WCa) Early steps should be taken to develop and adopt an integrated system of lon:;-term planning. of programme formulation and of budget preparation; Web) To this end, each organization should develop an effective long-term plan in keepin[l with the broad goals included in its charter or statute. The process would involve making these broad goals more speclfic by formulating the priority objectives to be accomplished by the organization \1ithin the planning period. Specific courses of action for accomplishing the agreed objectives and goals would be contained in the organization's proposed plan; ·Cc) Throughout the planning process choices should be made among competing demands. This entails establishing further priorities by the organization as well as givin;; consideration to alternative ways of accomplishing its specific objectives: Wed) Each organization should develop its o\~n processes and staff capability to carry out the following: (i) Define clearly its specific objectives - i.e •• ,.,hat it hopes to accomplish \lIthin definite points of time - by taking into account the priority needs of Member States, the overall capability of the organization, and the probable financial costs to Member States;
(ii) Formulate, following consultations with other interested organizations, major alternatives, \lIth related costs, which would express in specific terrns how to accomplish the previously defined objectives; analyse these alternatives (with related costs); and include in the plan those which would be likely to achieve the best results in terms of cost-effectiveness: (iii) Provide leeway for possible adjustments to chansing circumstances and for the inclusion of further activities which might respond to the special and often
changinG needs ofthe developing countries: (iv) Present the proposed plan to its governing body for consideration and commeltt on the content of the plan, the priorities, and the general magnitude and timephasing of expenditures; (v) Prepare an integrated document (containinG all programmes financed from both budsetary and extra-budgetary funds) for the selected time period, which would be based on the agreed plan, whieh, in addition to containin;; the long-terra a:;ency plan, would include the proposed programme and budget for the next budget period, having taken into consideration prospective resources. This
wPR/RC19/7 Annex 1 page
6 programme would be detailed and provide information on specific activities while the plan would concentrate on major activities and would be drawn up so as to provide the necessary degree of flexibility. The document would sho\'1 the estimated total cost time -phased ovcr the expected duration of the plan. The appropriate bodies of the organization would review and comment on this document, and approve \'1ith \'1hatever changes they considered necessary that part which corresponded to the next budget period. In preparing subsequent programme and budget documents, the heretofore agreed plan might be revised in the light of changcd circumstances, and an additional t\'1o-year tentative plan formulated to complete the suggested sixyear time period. An essential aspect is tile continuous process of revie\'1 and updating. The introduction of new elements into the plan would depend in part on the' progress achieved in tlie preceding period;
aCe} Each organization shOuld synchronize its planning and its budget cycle with those of other organizations in so far as they have the same budget periods; -(t) Each organization should incorporate in the process discussed above the experience and knowledge gained through systematic evaluation of its activities.· (para. 73)
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Position WHO has developed and operates through an integrated system of long-term planning and pro1. gramme formulation, through the inter-relationship of its general programmes of work for specific periods. its annual programmes and budgets, and its plans of operation for individual technical assistance projects, 2. The Executive Board, in accordance \'1ith Article 28(g) of the Constitution, periodically submits to the World Bealth Assembly, for consideration and approval, a general programme of work for a specific period. Because of the varying health situations throughout the \'1orld, such general programmes are more an expression of principles and objectives than detailed plans. Even so, they are invaluable indicators of the aggregated wishes of Member States to deal with the most urgent, the most important. and the most amenable of health problems in the light of modern scientific advanccs and the surveyed priority health needs of countries. 3. More than 110"11£ tlw =U:l1 budgc;t is devoted to direct assistance to governments, at their request. Therefore, long-term planning. programme formulation and budget preparation of this part of the programme depends to a large extent on the existence of long-term national health plans. 4. The epidemiological services collecting health data from all over the \'1orld establish the bases of policy formulation at the international level. At the national level pro;:rammes are developed in terms of country health priorities determined on the basis of surveys. The ;:;oals of general programmes are thus set with a view to bringing about an improvement in the world health situation while, at the national level, assisted programmes seek the raising of the health status of the communities involved. 5. A constant monitoring of the national health situation of Member States enables the planning process to concentrate effectively on the priorities as established by governments with or \'1ithout the technical assistance of the Organization. SpecifiC courses of action are then determined along these lines. The assistance requested by Member States is related in this way to the total of the health situation involved. To this end. the Organization has been stimulating Member States to undertake,
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WPR/RC19/7 Annex 1 page
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whenever possible. national health plans so as to ensure a greater degree of integration of the assisrance given and at the same time enable development of health services to proceed in an orderly fashlonand to benefit from the co-ordination of all external assistance which then becomes pos.~;.ble. 6. The general programmes give the Organization guidance as to what should be the major content of, and the priorities it should establish and the objectives it should pursue in, its annual programmes, which are then revie,~ed by the World Health Assembly, which approves the time-phasing and the expenditures involved. 7. Each project in the technical assistance part of the annual programmes is covered by a plan of operation negotiated with the government involved. These documents provide detailed information on the specific objectives sought, on the courses of action to be taken, on what is to be the wherewithal of the project, as well as on the commitments of both parties. Plans of operation are then, in each case, further strengthened and adjusted in the light of the initial pre-operative analysis of the base-line situation by the staff assigned to help requesting countries. This base-line situation is usually studied systematically in terms of its specific characteristics. its public health features and its public administration context. as well as in terms of the social and economic factors involved. In function of this base-line analysis the chronological evolution of the project is determined as well as the targets it should seek. 8. This intesrated system for the development of WHO's programme of assistance given to Member States is thus a triple one and consists of (1) the implementation of a general programme of work set by the governing bodies of the Organization for a specific period of time; (2) the investigation of needs as a basis for setting priority objectives. undertaken jOintly with governments; and (3) the development of plans of operation followed by systematic analysis of the base-line situation in the case of individual projects. This coherent operational sysrem lends itself to the systematic evaluation of such assistance. 9. One essential feature of the intimate relationship that exists in WHO between programme planning and prosramme evaluation is that. as described. planning paves the way Cor eventual evaluation of action taken and this in turn is made to feed back the experience acquired for the reformulation of policies and plans and to determine the areas of research and investigation required. 10, Another essential feature is the intimate pa11:nership that the system makes possible between the Organization and Member States, in th.Jl: the Oirectors-GunL:rru and Ministers of Health requesring aid will then themselves review in regional committees the plans made by the Organization for meeting such requests, and also participate in the analysis leading to the approval of the programme and budget at the World Health Assembly.
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11. A third essential feature of the relationship betl'leen planning and evaluation is that there is a continuous flo,~ of information on the health needs of Member States sent by them to the Organization in compliance with a provision of the Constitution so that in its turn the Organization can determine, through biostatistical analysis. global priorities and develop programmes in that light, Furthermore , a global system of world -wide panels of expects in each health field guides the development of programmes through technical recommendations contained in the repotts of expert committees convened from such panels, 12, To summarize. programme formulation in WHO is made up of a triad. namely (1) the programme directives received from the governing bodies; (2) the technical recommendations made by expects convened for the purpose; and (3) and the needs reported to the Organization by Member States, The execution of programmes so formulated generates in its turn a stream of field repotts on a quarterly
WPR/RC19/7 Annex 1 page 8 and annual basis. This feed-back of experience helps the Organization in two ways. First, it makes possible programme audits in that the implementation can be matched against the formulation of a given programme. Secondly, the reporting system helps guide the reformulation of policies and pla.'1S as necessary in each case.
13. Inaeasinglythe World Health Organization is endeavouring to decentralize evaluation of assistance to countries to the national level with the object of helping governments themselves to evaluate those national programmes for which they receive iDtemational assistance. 14. In the case of smallpox eradication and malaria eradication the objective is a predetermined one and does not vaty with the varying local cltcumstances. For this reason it is possible to have long-term plans which guide the development of the programme for periods extending over several years. The smallpox eradication programme presented by the Director-General to the Nineteenth World Health Assembll covered the period 1967-1976. 15. In point of fact, for most programmes of the OrgaDization the lack of long-term plans is more apparent than real. To begin with, all programmes of assistanr.e to countries are projected on to the sta81= of development of such countries and especially to the stage of development of their health services and adapted accordingly. In a minority, such development is available in concrete form as a national health plan. For the majority, however, the OrgaDization uses the information that Member countries supply, in compliance with their constitutional obligations, about their health situation and the state of development of their health services. Thus, individual projects, ,.,hile appearing to be planned in isolation, are in reality component parts of a long-term total plan which gives them context and paves the way towards their eventual integration within it. 16. As reported to the Twentieth World Health Assembly, 2 the Director-General is studying the possibilities for further improvement and refinement of the planning process, including the introduction of some broad long-term financial indicators of future programmes. He will report to the forty-third session of the Board on the subject.
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EVALUATION
Recommendation 30 "(a) The orgaDizations should take steps to improve and strengthen the evaluation process wherever possible; "(b) The organizations should utilize the information resUlting from internal reviews of their operations, as well as the views of Member States in which these operations are conducted, to a greater extent in programme formulation and execution, thus making results of their revie,.,s an important element ohhe system of long-term planning, programme formulation, and budget preparation ,.,.hieb the Committee has recommended: "(c) The organizations should be required to provide governing bodies (including executive committees or councils), as a part of timely progress reports, with evaluation data on continuing
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1 2
Off. Rec. WId HIth Org., 151, Annex 15. Off.
Rec. ''lId HIth Org., 160, Annex 8.
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WPR/RC19/7 Annex 1 page 9/10 projects or programmes ar intervals of no more than twelve months. as well as reports on evaluation of projects or programmes when completed.· (para. 79) PosJ.!ion
Evaluation. which is an integral part of WHO practice. has recently been further strengthened through the development of a programme information retrieval system for feed-back purposes. The implementation of programmes is compared with the main elements that have gone into their formulation so as to ascertain to what extent the execution of the activities of the Organization reflects the views and needs of Member States and confirms the technical recommendations received from expert committees. In addition. the Organization has systemarically been collecting standards, criteria and techniques for application in analysis and evaluation which take place through retrospective reviews of the major programmes of the Organization. The formulation of programmes is guided by these evaluation activities. which are continuous processes involving all levels of the Organization's structure, and \~hich are reported to the governing bodies of WHO. Each Annual Report of the Director-General includes an evaluation of projects completed during the year reported. As reported to the Twentieth World Health Assembly. recomulendation 30 of the Ad Hoc Committee on completed projects is already in operation in WHO. The Orsanization prepares quarterly progress reports ,~hich include assessment of projects under way. In selected programme reviews at the regional level these assessments are included for consideration by the regional committees. It is for the Executive Board to decide whether this procedure is sufficient or ,~hethet it needs supplementing by having the informarion also reviewed during its deliberations. Recommendation 31 "(d) The Economic and Social Council and the Administrative Committee on Co-ordinarion should encourage to the fullest extent the development of common evaluation methods and standards for the organizations; -(e) The Economic and Social Council should continue its systematic evaluation of the impact, both overall and specific. of the programmes of the organizations in the cCOODmic and social field in meeting the needs of Member States and, if necessary. strengthen arrangements for co-ordinating evaluaion •• (para. 79) Position The recommendations are directed primarily to the Economic and Social Council. However. it will be noted that WHO co-operates very closely with the Inter-Agency Group on Evaluation. It shares the wish to develop common evaluation methods and standards. to the extent that it is meaningful and practicable. For the most part evaluation procedures must be determined by and adapted to the nature of the operations. which vary \~ith each specialized agency, as must therefore the scope set for the evaluation studies to be undertaken by each of them. Evaluation in WHO is specifically adapted to the requirements of the medical and health work undertaken by the Organization. The aim is a technical appraisal of programmes in the light of technical directives they receive and the health needs of Member States. In addition, the impact of the assistance given to projects of Member States is systematically assessed in specific public health and socio-economic terms.
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WPR/RC19/7 page 11
RESOLUTION OF THE VJORLD HEAL'IH ASSEMBLY
'NENTY-FIRST \<lORLD HEALTH ASSEl'.f8LY
WHA21.32 22 f.1a.y 1968
CO-ORDINATION \f.rTH THE UNITED NATIONS, THE SPECIALIZED AGENCIES AND THE INTERNATIONAL Aror.rrC ENERGY AGENCY: AIMrNIS'ffiATIVE, BUDGETARY AND FINANCIAL r-1ATTERS
The Twenty-first vlorld Health Assembly, Having revievTed the Director-General's report l concerning the implementation of the recommendations in the second report of the Ad Hoc Committee of Experts to Examine the Finances of the United Nations and the Specialized Agencies; Bearing in mind al~o resolutions EB37.R43,2 WHA19.30,3 EB39.R42,3 V1HA20.223 and EB4l.R40;lJ. NOTES ~lith satisfaction that in his report to the Executive Board5 the Director-General states that he plans to submit to the Board at its forty-third session a report on "possibilities for further improvement and refinement of the planning process, including the introduction of some broad long-term financial indicators of future programmes"; 1.
2. WELCOMES also the action taken thus far by the Director-General concerning the development of additional procedures for programme evaluation;
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REQ.UESTS •••
IDocument A21/AFL/7. 2Handbook of Resolutions and Decisions, 9th ed., p. 411. 3Handbook of Resolutions and Decisions, 9th ed., p. 412. 40ff• Rec. WId Hlth Org., 165, p. 20. 5 0rr • Rec. ,.ad Hlth Org., 165, Annex 11.
WPR/RC19/7 page
Annex 2 12
3.
REQUES~ the Director-General to present to the forty-third session of the Executive Board for its consideration proposals for further improving and strengthening the evaluation process; and
4. REQUES~ the Director-General to report to the ~lenty-second World Health Assembly on further progress in the implementation of the recommendations in the second report of the Ad Hoc Committee, including the recommendation concerning reporting on budget perfonnance.
Sixteenth plenary meeting, 22 May 1968 A2l/VR/16
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WPR/RC19!7 Annex 2
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RE8OLUl'ION OF THE WORLD HEALTH ASSEMBLY
TWENTY-FIRST WORLD HEALTH ASSEMBLY
WHA21.49 24 May 1968
CO-oRDINATION WITH THE UNITED NATIONS, THE SP~IALIZED AGENCIES AND THE INl'ERNATIONAL ATOMIC ENERGY AGENCY ON PROORAMME MATTERS (LONG-TERM PLANNING)
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The Twenty-first World Health Assembly, Having adopted resolutions WHA21.32 and WHA2l.33; Having considered the report of the Director-General and resolution E84l.R40 of the Executive Board on the progress on implementation of the recommendations in the second report of the Ad Hoc Committee of Experts to Examine the Finances of the United Nations and the Specialized Agencier on the implementation of recommendation 29 concerning long-term planning; Awaiting with interest the report on measures taken further to improve and refine the planning processes of the World Health Organization which the Director-General will make to the Board at its forty-third session; Noting with appreciation the assistance given by WHO to the development of national health plans in the context of economic and social development;
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Recalling the broad directives in the Fourth General Programme of Work adopted by the Eighteenth ~orld Health Assembly guiding the work of the Organization through 1971; Believing that sound national health plans provide an important baSis to the development of WHO programmes at the regional and global levels to support the efforts made by Member States in the field of health; Appreciating the action taken by the Member States of the Regional Committee for Europe with a view to evaluating the activities of the World Health Organization in the European Region as well as to drawing up longterm plans in the different fields of health work; /Considering 1
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Off Rec. Wld HUh Orgo, 165. Annex 11. pP. 64-65.
2Resolution WHA18.}}.
WPR/RC19/7 Annex 2 page 14 Considering that the long-term plans of the regional offices should increasingly reflect the national plans of the Member states, and of their present and long-term needs in the field of health, 1. NOTES the fact that the Regional Committee for Europe has decided to continue to examine long-term planning in new fields of health activity of general interest to Member states; 2. RECOMMENDS that regional committees give particular attention, at their 1968 session, to long-term health planning and the formulation and evaluation of health programmes and to the possibilities of co-operation on a regional and inter-regional basis in the development of such plans;
3. INVITES the Member states to co-operate, within the framework of the regional committees. with a view to further extending the long-term planning of the programmes of the Organization on the basis of their national health plans and their present and long-term requirements in the field of health; and 4. RECOMMENDS that this question to the special attention to by the Member states the Director-General in presenting his report on forty-third session of the Executive Board. pay the recommendations made and the opinions expressed and the regional committees.
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Eighteenth plenary meeting, 24 May 1968 A2l/VR/18
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