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Executive Board 104th session, Geneva, 26 May 1999: resolutions and decisions, summary records

December 31, 1999 World Health Organization

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EB 104/1999/REC/1

WORLD HEALTH ORGANIZATION

EXECUTIVE BOARD 104th SESSION GENEVA, 26 MAY 1999

RESOLUTION AND DECISIONS

SUMMARY RECORDS

GENEVA 1999

EB 104/1999/REC/1

WORLD HEALTH ORGANIZATION

EXECUTIVE BOARD 104th SESSION GENEVA, 26 MAY 1999

RESOLUTION AND DECISIONS

SUMMARY RECORDS

GENEVA 1999

ABBREVIATIONS Abbreviations used in WHO documentation include the following: ACC ACHR ASEAN CIOMS - Administrative Committee on Coordination - Advisory Committee on Health Research - Association of South-East Asian Nations - Council for International Organizations of Medical Sciences - Economic Commission for Africa - Economic Commission for Europe - Economic Commission for Latin America and the Caribbean - Economic and Social Commission for Asia and the Pacific - Economic and Social Commission for Western Asia - Food and Agriculture Organization of the United Nations - International Atomic Energy Agency - International Agency for Research on Cancer - International Civil Aviation Organization - International Fund for Agricultural Development - International Labour Organization (Office) - International Maritime Organization - International Telecommunication Union OAU OECD PAHO

UN AIDS UNCTADUNDCP UNDP UNEP

ECA ECE ECLAC ESCAP

UNESCO -

ESCWA FAO

UNFPA UNHCR

IAEA IARC ICAO IFAD ILO IMO ITU

UNICEF UN IDO

UNRWA -

US AID WFP WIPO WMO WTO

Organization of African Unity Organisation for Economic Co-operation and Development Pan American Health Organization United Nations Joint Programme on HIV/AIDS United Nations Conference on Trade and Development United Nations International Drug Control Programme United Nations Development Programme United Nations Environment Programme United Nations Educational, Scientific and Cultural Organization United Nations Population Fund Office of the United Nations High Commissioner for Refugees United Nations Children's Fund United Nations Industrial Development Organization United Nations Relief and Works Agency for Palestine Refugees in the Near East United States Agency for International Development World Food Programme World Intellectual Property Organization World Meteorological Organization World Trade Organization

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

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PREFACE

The 104th session ofthe Executive Board was held at WHO headquarters, Geneva, on 26 May 1999. The Fifty-second World Health Assembly had elected 10 Member States to be entitled to designate persons to serve on the Executive Board 1 in place of those whose term of office had expired, giving the following new composition of the Board:

Designating country

Unexpired term ofomce2 2 years 3 years 1 year 1 year 2 years 2 years 3 years 2 years 2 years 3 years 3 years 1 year 3 years 1 year 2 years 1 year 3 years

Designating country

Unexpired term ofomce2 . . . . . . . . . . . . . . . 3 years 2 years 3 years 1 year 1 year 1 year 1 year 2 years 2 years 1 year 3 years 2 years 2 years 3 years 2 years

Bangladesh .............. . Belgium ................ . Burundi ................ . Canada ................. . Cape Verde ............. . Central African Republic ... . Chad ................... . Chile ................... . China .................. . Comoros ................ . Congo .................. . Cook Islands ............ . Cote d'Ivoire ............ . Cyprus ................. . France .................. . Germany ................ . Guatemala .............. .

India ................... Lao People's Democratic Republic .............. Lebanon ................ Netherlands ............. Norway ................. Oman .................. Peru ................... Qatar ................... Russian Federation ........ Sri Lanka ............... Switzerland ............. Trinidad and Tobago ...... United States of America ... Vanuatu ................ Yemen .................

Details regarding members designated by the above Member States will be found in the list of members and other participants.

By decision WHA52(11 ). The retiring members were those designated by Angola, Benin, Botswana, Burkina Faso, Honduras, Indonesia, Japan, Poland, United Arab Emirates, and United Kingdom of Great Britain and Northern Ireland. 2

At the time of the closure of the Fifty-second World Health Assembly. - Ill -

CONTENTS

Page Preface Agenda List of documents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii

vii ix

PART I RESOLUTION AND DECISIONS Resolution EB104.Rl Amendments to the Financial Regulations and Rules .................. .

Decisions EB104(1) Membership of the Programme Development Committee of the Executive Board ............................................... . Membership of the Administration, Budget and Finance Committee of the Executive Board .......................................... . Membership of the Audit Committee of the Executive Board ............ . Membership of the Executive Board's Standing Committee on Nongovernmental Organizations .................................. . Membership of the WHO/UNICEFIUNFPA Coordinating Committee on Health .................................................... . Membership of the Leon Bernard Foundation Committee ............... . Membership of the Jacques Parisot Foundation Committee .............. . Membership ofthe Ihsan Dogramaci Family Health Foundation Committee .................................................... . Membership of the Sasakawa Health Prize Selection Panel .............. .

EB104(2)

4 5

EB104(3) EB104(4)

EB104(5)

EB104(6) EB104(7) EB104(8)

5 6

EB104(9)

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Page EB104(10) Membership of the United Arab Emirates Health Foundation Committee 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

EB104(11)

Appointment of representatives of the Executive Board at the Fifty-third World Health Assembly 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

7 7

EB104(12) EB104(13) EB104(14)

Administration and award of foundation prizes and fellowships

Date, place and duration ofthe 105th session ofthe Executive Board Date and place of the Fifty-third World Health Assembly 0 0 0 0 0 0 0 0 0

7 7

PARTII SUMMARY RECORDS List of members and other participants Committees and working groups Summary records: First meeting Second meeting 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

11 21

•

23 36

INDEX Index to resolution and decisions

-VI-

AGENDA 1

I. 2. 3. 4.

Opening of the session and adoption of the agenda Election of Chairman, Vice-Chairmen and Rapporteurs Outcome of the Fifty-second World Health Assembly Technical and health matters • Research strategy and mechanisms for cooperation

5. 6.

Extrabudgetary resources: policy framework Staff development and support • Renewal process update • Statement by the representative ofthe WHO staff associations on matters concerning personnel policy and conditions of service • [deleted]

Management and financial matters • Amendments to Rules of Procedure of Executive Board on election of Chairman • Amendments to the Financial Regulations and Rules • Membership of committees and representatives of the Executive Board • Administration and award of foundation prizes and fellowships • Executive Board: future sessions • Fifty-third World Health Assembly

Matters for information • Report on meetings of expert committees and study groups

Closure of the session

Supplementary agenda item: UNAIDS Operating Reserve Fund

Adopted by the Board at its first meeting.

- vii-

LIST OF DOCUMENTS

EB104/1 Rev.l EB 104/2 EB 104/3 EB 104/4 EB 104/5 EB 104/6 EB I 04/7 and Add.l EB 104/8 EB I 04/9 EB104/IO EB 104/II EB I 04/I2

Agenda 1 Research strategy and mechanisms for cooperation Extrabudgetary resources: policy framework Staff development and support: renewal process update Amendments to Rules of Procedure of Executive Board on election of Chairman Amendments to the Financial Regulations and Rules Membership of committees and representatives of the Executive Board Administration and award of foundation prizes and fellowships Executive Board: future sessions Fifty-third World Health Assembly Report on meetings of expert committees and study groups UN AIDS Operating Reserve Fund

Information document

EBI04/INF.DOC./I

Statement by the representative of the WHO staff associations on matters concerning personnel policy and conditions of service

See page vii. -IX-

PART I RESOLUTION AND DECISIONS

RESOLUTION

EB104.Rl

Amendments to the Financial Regulations and Rules

The Executive Board, Having considered the report on amendments to the Financial Regulations and Rules, 1 CONFIRMS, in accordance with Financial Regulation 16.1, the amendments to the Financial Rules appended as an Annex with effect from 26 May 1999 concerning the mandate of the Office of Internal Audit and Oversight.

ANNEX Amendments to the Financial Rules

117.2

The Office oflnternal Audit and Oversight (IAO) is responsible for internal audit, inspection, monitoring and evaluation of the adequacy and effectiveness of the Organization's system of internal control, financial management and use of assets as well as investigation of misconduct and other irregular activities. All systems, processes, operations, functions and activities within the Organization are subject to IAO's review, evaluation and oversight. The Director-General shall appoint a technically qualified head ofiAO after consultation with the Executive Board. The Director-General shall likewise consult the Executive Board before any termination of the incumbent of that office. IAO shall function in accordance with the following provisions: (a) (b) The head ofiAO shall report directly to the Director-General; IAO shall have full, free and prompt access to all records, property, personnel, operations and functions within the Organization which, in IAO's opinion, are relevant to the subject matter under review; IAO shall be available to receive directly from individual staff members complaints or information concerning the possible existence of fraud, waste, abuse of authority or other irregular activities. Confidentiality shall be respected at all times, and no reprisals shall be taken against staff members providing such information unless this was wilfully provided with the knowledge that it was false or with intent to misinform;

11 7.3

117.4

(c)

Document EB I 04/6.

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EXECUTIVE BOARD, 104th SESSION

(d)

IAO shall report the results of its work and make recommendations for action to the Regional Director, Executive Director, Director or other responsible manager, with a copy to the Director-General and the External Auditor. At the request of the head ofiAO, any such report shall be submitted to the Executive Board, together with the Director-General's comments thereon; IAO shall submit a summary report annually to the Director-General with a copy to the External Auditor on IAO's activities, including the orientation and scope of such activities, as well as the implementation status of recommendations. This report shall be submitted to the Health Assembly together with comments deemed necessary.

(e)

117.5

The Director-General shall ensure that all IAO recommendations are responded to and implemented as appropriate. (Second meeting, 26 May 1999)

DECISIONS

EB104(1)

Membership of the Programme Development Committee of the Executive Board

The Executive Board appointed Dr M.E. Mbaiong (Chad), Dr J. Jimenez de la Jara (Chile), Mr Y.N. Chaturvedi (India), Dr Ponmek Dalaloy (Lao People's Democratic Republic), Or A. Meloni (Peru), Vice-Chairman ofthe Board, member ex officio, and Dr K.A. Al-Jaber (Qatar) as members of its Programme Development Committee, established under resolution EB93.R13, for a maximum period of two years, in addition to Dr G.M. van Etten (Netherlands), already a member of the Committee. It was understood that if any member of the Committee was unable to attend, his or her successor or the alternate member of the Board designated by the Government concerned, in accordance with Rule 2 of the Rules of Procedure, would participate in the work of the Committee. (Second meeting, 26 May 1999)

EB104(2)

Membership of the Administration, Budget and Finance Committee of the Executive Board

The Executive Board appointed Dr M. Toyb (Comoros), Mr H. VoigtHinder (Germany), ViceChairman of the Board, member ex officio, and Professor T. Zeltner (Switzerland) as members of its Administration, Budget and Finance Committee, established under resolution EB93.Rl3, for a maximum period of two years, in addition to Professor S.M. Ali (Bangladesh), Mr Liu Peilong (China), Mr C. Solomis (Cyprus) and Or J.I. Boufford (United States of America), already members of the Committee. It was understood that if any member of the Committee was unable to attend, his or her successor or the alternate member of the Board designated by the Government concerned, in accordance with Rule 2 ofthe Rules ofProcedure, would participate in the work of the Committee. (Second meeting, 26 May 1999)

RESOLUTION AND DECISIONS

EB104(3)

Membership of the Audit Committee of the Executive Board

The Executive Board appointed Mr P.H. Kengouya (Congo) (alternate to Dr D. Bodzongo), Mr V.A. Vislykh (Russian Federation) (alternate to Professor V.I. Starodubov) and Dr J.I. Boufford (United States of America) as members of its Audit Committee. The Board authorized the Chairman to appoint members to the Committee from among the members or alternates of the Board designated by China, Sri Lanka and Yemen, on the basis of curricula vitae to be submitted. (Second meeting, 26 May 1999)

EB104(4)

Membership of the Executive Nongovernmental Organizations

Board's

Standing

Committee

The Executive Board appointed Professor S.M. Ali (Bangladesh) and Professor J.-L. Mamdaba (Central African Republic) as members of its Standing Committee on Nongovernmental Organizations for the duration of their term of office on the Executive Board, in addition to Dr J. Jimenez de la Jara (Chile), Mr C. Solomis (Cyprus) and Dr G.M. van Etten (Netherlands), already members of the Committee. It was understood that if any member ofthe Committee was unable to attend, his or her successor or the alternate member of the Board designated by the Government concerned, in accordance with Rule 2 of the Rules of Procedure, would participate in the work of the Committee. (Second meeting, 26 May 1999)

EB104(5)

Membership of the WHO/UNICEF/UNFPA Coordinating Committee on Health

The Executive Board appointed Mr M. Colla (Belgium), Professor M. Kakou Guikahue (Cote d'Ivoire) and Dr K. Karam (Lebanon) as members ofthe WHO/UNICEF/UNFPA Coordinating Committee on Health for the duration of their term of office on the Executive Board, in addition to Dr T. Faireka (Cook Islands), Dr A. Meloni (Peru) and Mr N.S. de Silva (Sri Lanka), already members of the Committee. It was understood that if any member appointed by the Board was unable to attend, his or her successor or the alternate member of the Board designated by the Government concerned, in accordance with Rule 2 of the Rules ofProcedure, would participate in the work of the Committee. (Second meeting, 26 May 1999)

EB104(6)

Membership of the Leon Bernard Foundation Committee

The Executive Board, in accordance with the Statutes ofthe Leon Bernard Foundation, appointed Professor J.-F. Girard (France) as a member of the Leon Bernard Foundation Committee for the duration ofhis term of office on the Executive Board, in addition to the Chairman and Vice-Chairmen ofthe Board and the Chairman of the Expert Committee on Malaria, members ex officio. It was understood that if Professor Girard was unable to attend, his successor or the alternate member of the Board designated by the Government concerned, in accordance with Rule 2 of the Rules of Procedure, would participate in the work of the Committee. (Second meeting, 26 May 1999)

EXECUTIVE BOARD, 104th SESSION

EB104(7)

Membership of the Jacques Parisot Foundation Committee

The Executive Board, in accordance with the Implementing Regulations of the Jacques Parisot Foundation, appointed Dr K.A. Al-Jaber (Qatar) as a member of the Jacques Parisot Foundation Committee for the duration of his term of office on the Executive Board, in· addition to the Chairman and ViceChairmen ofthe Board, members ex officio. It was understood that ifDr Al-Jaber was unable to attend, his successor or the alternate member of the Board designated by the Government concerned, in accordance with Rule 2 of the Rules of Procedure, would participate in the work of the Committee. (Second meeting, 26 May 1999)

EB104(8)

Membership of the Ihsan Dogramaci Family Health Foundation Committee

The Executive Board, in accordance with the Statutes of the Ihsan Dogramaci Family Health Foundation, designated Mr N.S. de Silva (Sri Lanka), Vice-Chairman of the Board, as member ex officio of the Ihsan Dogramaci Family Health Foundation Committee, in addition to the Chairman of the Executive Board, representatives ofthe International Pediatric Association, the Turkish and International Children's Centre, Ankara, and the President of Bilkent University, Ankara, or his or her appointee, members ex officio. (Second meeting, 26 May 1999)

EB104(9)

Membership of the Sasakawa Health Prize Selection Panel

The Executive Board, in accordance with the Statutes of the Sasakawa Health Prize, appointed Mrs M. Abel (Vanuatu) as a member of the Sasakawa Health Prize Selection Panel, in addition to the Chairman of the Board and a representative of the founder, members ex officio. It was understood that if Mrs Abel was unable to attend, her successor or the alternate member of the Board designated by the Government concerned, in accordance with Rule 2 of the Rules of Procedure, would participate in the work ofthe Panel. (Second meeting, 26 May 1999)

EB104(10)

Membership of the United Arab Emirates Health Foundation Committee

The Executive Board, in accordance with the Statutes of the United Arab Emirates Health Foundation, appointed Dr K.A. Al-Jaber (Qatar) as a member of the United Arab Emirates Health Foundation Committee, in addition to the Chairman of the Board and a representative of the founder, members ex officio. It was understood that if Dr Al-Jaber was unable to attend, his successor or the alternate member of the Board designated by the Government concerned, in accordance with Rule 2 of the Rules of Procedure, would participate in the work of the Committee. (Second meeting, 26 May 1999)

RESOLUTION AND DECISIONS

EB104(11)

Appointment of representatives of the Executive Board at the Fifty-third World Health Assembly

The Executive Board, in accordance with paragraph 1 of resolution EB59.R7, appointed its Chairman, Or A.J.M. Sulaiman (Oman), ex officio, and Mr Liu Peilong (China), Professor J.-F. Girard (France) and Mr N.S. de Silva (Sri Lanka) to represent the Board at the Fifty-third World Health Assembly. (Second meeting, 26 May 1999)

EB104(12)

Administration and award of foundation prizes and fellowships

The Executive Board, having considered the report on administration and award of foundation prizes and fellowships, 1 decided to recommend to the respective committees that they should take such steps 'as are necessary to amend their regulations so as to replace the foundation committees by selection panels composed of up to three members2 and recommended that 13% for programme support costs should be assessed on the amount awarded by the Darling Foundation Prize, the Leon Bernard Foundation Prize, the Jacques Parisot Foundation Fellowship, the Ihsan Dogramaci Family Health Foundation and the Francesco Pocchiari Fellowship to help cover the cost of administering the prizes. (Second meeting, 26 May 1999)

EB104(13)

Date, place and duration of the 105th session ofthe Executive Board

The Executive Board decided that its 105th session should be convened on Monday, 24 January 2000, at WHO headquarters, Geneva, and should close no later than Saturday, 29 January 2000. (Second meeting, 26 May 1999)

EB104(14)

Date and place of the Fifty-third World Health Assembly

The Executive Board decided that the Fifty-third World Health Assembly should be held at the Palais des Nations, Geneva, opening on Monday, 15 May 2000. (Second meeting, 26 May 1999)

1 2

Document EB 104/8. See document EB 104/8, Annex.

PARTII SUMMARY RECORDS

LIST OF MEMBERS AND OTHER PARTICIPANTS

MEMBERS, ALTERNATES AND ADVISERS

OMAN Dr A. J. M. SULAIMAN, Director-General of Health Affairs, Ministry of Health, Muscat (Chairman)

BANGLADESH ProfessorS. M. ALl, Director, National Institute of Ophthalmology, Dhaka Alternate Dr K. RAHMAN, Counsellor, Permanent Mission, Geneva

BELGIUM M. M. COLLA, Ministre de la Sante publique et des Pensions, Bruxelles Alternates M. J.-M. NOIRF ALISSE, Ambassadeur, Representant permanent, Geneve Dr G. THIERS, Directeur, lnstitut scientifique de la Sante publique- Louis Pasteur, Bruxelles M. A. BERWAERTS, Conseiller general, Ministere des Affaires sociales, de la Sante publique et de l'Environnement, Service des Relations intemationales, Bruxelles M. M. VINCK, Premier Secretaire, Mission permanente, Geneve Advisers Mme C. HOEDEMAKERS, Chef de Cabinet adjoint du Ministre de la Sante publique et des Pensions, Bruxelles M. H. BECQUAERT, Conseiller au Cabinet du Ministre de la Sante publique et des Pensions, Bruxelles Mme P. MEGAL, Conseiller adjoint, Ministere des Affaires sociales, de la Sante publique et de l'Environnement, Service des Relations intemationales, Bruxelles M. G. RA YEE, Representant de I' Administration generate a la Cooperation au Developpement, Geneve M. C. BOURGOIGNIE, Delegue de la Communaute fran<yaise Wallonie-Bruxelles, Geneve

BURUNDI Dr J. M. KARIBURYO, Ministre de la Sante publique, Bujumbura Alternate Dr L. MBONEKO, Inspecteur general de la Sante publique, Ministere de la Sante publique, Bujumbura

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EXECUTIVE BOARD, 104th SESSION

CANADA Mrs M. JEAN, Special Adviser to the Minister of Foreign Affairs on Health, Brussels Alternates Or J. LARIVIERE, Senior Medical Adviser, International Affairs Directorate, Health Canada, Ottawa Ms J. PERLIN, Counsellor, Permanent Mission, Geneva Adviser Ms M. GERVAIS-VIDRICAIRE, Minister, Permanent Mission, Geneva

CAPEVERDE Or J. B. FERREIRA MEDINA, Ministre de la Sante et de la Promotion sociale, Praia

CENTRAL AFRICAN REPUBLIC Professeur J.-L. MAMDABA, Chef du Service de Chirurgie infantile, Bangui Alternate Dr G. NGAINDIRO, Inspecteur general des Services de Sante des Forces armees centrafricaines, Bangui

CHAD Or M. E. MBAIONG, Directeur general adjoint, Ministere de la Sante publique, N'Djamena Alternate Or N. M. DEIKOUNDAM, Chef de la Division des Maladies transmissibles, N'Djamena

CHILE Or J. JIMENEZ DE LA JARA, Profesor Auxiliar, Facultad de Medicina, Departamento de Salud Publica, Santiago Alternate Sr. P. SEGUEL, Coordinador de Asuntos Internationales, Oficina de Cooperaci6n y Asuntos Internationales, Santiago

CHINA Mr LIU Peilong, Director-General, Department of International Cooperation, Ministry of Health, Beijing Alternate Mr HOU Zhenyi, Counsellor, Permanent Mission, Geneva Advisers Ms LIU Guangyuan, Programme Officer, Division of Multilateral Relations, Ministry of Health, Beijing Or QI Qingdong, Deputy Director, Division of Multilateral Relations, Department of International Cooperation, Ministry of Health, Beijing

MEMBERS AND OTHER PARTICIPANTS

COMOROS Dr M. TOYB, Directeur general de la Sante, Moroni Alternate Dr A. OUMADI, Secretaire general de la Sante, Moroni

CONGO Dr D. BODZONGO, Directeur general de la Sante, Brazzaville Alternate M.P.H. KENGOUY A, Conseiller administratif etjuridique du Ministre de la Sante, de la Solidarite et de I' Action humanitaire, Brazzaville Adviser Dr A. ENZANZA, Conseiller du Ministre de la Sante, Brazzaville

COOK ISLANDS Mr T. FAIREKA, Minister ofHealth, Rarotonga

COTE D'IVOIRE Professeur M. KAKOU GUIKAHUE, Ministre de la Sante publique, Abidjan (Rapporteur) Alternates Professeur A. J. DIARRA, Directeur, Institut national de la Sante publique, Abidjan M. C. BOUAH-KAMON, Ambassadeur extraordinaire et plenipotentiaire, Representant permanent, Geneve M. J. K. WEYA, Conseiller, Mission permanente, Geneve Advisers Professeur K. AGOH, Conseiller technique charge des Questions juridiques au Cabinet du Ministre de la Sante publique, Abidjan M. H. KOUASSI, Premier conseiller, Mission permanente, Geneve Dr Z. BIAKA, Charge d'Etudes au Cabinet du Minstre de la Sante publique, Abidjan

CYPRUS Dr C. KOMODIKIS, Chief Medical Officer, Ministry of Health, Nicosia (alternate to Mr C. Solomis) Alternates Mr P. EFTYCHIOU, Ambassador, Permanent Representative, Geneva Mrs I. A TTESHLI, Director of Administration, Ministry of Health, Nicosia Mr P. KESTORAS, Deputy Permanent Representative, Geneva

FRANCE Professeur J.-F. GIRARD, Conseiller d'Etat, Paris Alternates Dr M. JEANFRAN<;OIS, Delegue pour Ies Affaires europeennes et internationales, Paris Mme M. BOCCOZ, Conseiller, Mission permanente, Geneve

EXECUTIVE BOARD, I 04th SESSION

GERMANY Mr H. VOIGTLANDER, Director, Directorate for European Union Affairs, International Cooperation in the Field of Health, Federal Ministry for Health, Bonn (Vice-Chairman) Alternates Mr W. LEWALTER, Ambassador, Permanent Representative, Geneva Mr H. EBERLE, Minister, Deputy Permanent Representative, Geneva Mr M. DEBRUS, Head of Division Z 23, Multilateral Cooperation in the Field of Health, Federal Ministry for Health, Bonn Mr U. KALBITZER, Counsellor, Permanent Mission, Geneva Ms E. ADERHOLD, First Secretary, Permanent Mission, Geneva Ms H. JIRARI, Third Secretary, Permanent Mission, Geneva Mr F. HOLZHEIMER, Division Z 23, Multilateral Cooperation in the Field of Health, Federal Ministry for Health, Bonn

GUATEMALA Dr C. ANDRADE LARA, Viceministro de Salud Publica y Asistencia Social, Guatemala Alternate Dr L. A. PADILLA MENENDEZ, Embajador, Representante Permanente, Ginebra Adviser Sra. S. SOLiS CASTANEDA, Ministro Consejero, Misi6n Permanente, Ginebra

INDIA Mr Y. N. CHATURVEDI, Secretary for Health and Family Welfare, Government oflndia, New Delhi Alternate Ms S. RAO, Joint Secretary, Ministry of Health and Family Welfare, New Delhi Adviser Mr R. SHAHARE, First Secretary, Permanent Mission, Geneva

LAO PEOPLE'S DEMOCRATIC REPUBLIC Dr Ponmek DALALOY, Ministre de la Sante publique, Vientiane

LEBANON Dr K. KARAM, Ministre de la Sante, Beyrouth

NETHERLANDS Dr G. M. VAN ETTEN, Head, International Affairs Division, Ministry of Health, Welfare and Sport, The Hague Alternates Ms M. A. C. M. MIDDELHOFF, Senior Adviser, International Affairs, Ministry of Health, Welfare and Sport, The Hague Mr J. WASLANDER, First Secretary, Permanent Mission, Geneva

MEMBERS AND OTHER PARTICIPANTS

Mr J. P. G. MOUT, Policy Officer, United Nations Department, Ministry of Foreign Affairs, The Hague

NORWAY Dr A. ALVIK, Director-General of Health, Norwegian Board of Health, Oslo Alternates Mr B. SKOGMO, Ambassador, Permanent Representative, Geneva Ms A.-S. TROSDAHL ORAUG, Assistant Director-General, Ministry of Health and Social Affairs, Oslo Dr T. HETLAND, Senior Adviser, Ministry of Health and Social Affairs, Oslo Dr A. B. KNAPSKOG, County Medical Officer, Skien Dr 0. T. CHRISTIANSEN, Counsellor, Permanent Mission, Geneva

PERU Dr A. MELONI, Director General, Oficina de Financiamiento, Inversiones y Cooperaci6n Externa, Ministerio de Salud, Lima (Vice-Chairman) Alternate Sr. G. GUILLEN-BEKER, Primer Secretario, Misi6n Permanente, Ginebra

QATAR Dr K. A. AL-JABER, Assistant Under-Secretary for Technical Affairs, Ministry of Public Health, Doha

RUSSIAN FEDERATION Dr N. N. FETISOV, Director, International Relations Department, Ministry of Health, Moscow (alternate to Professor V. I. Starodubov) Alternates Mr R. A. KOLODKIN, Deputy Permanent Representative, Geneva Mr V. A. VISLYKH, Deputy Director, Department oflnternational Organizations, Ministry of Foreign Affairs, Moscow Advisers Dr V. K. RIAZANTSEV, Chief Unit, International Relations Department, Ministry of Health, Moscow Dr A. V. PAVLOV, Counsellor, Permanent Mission, Geneva Mr A. V. KOVALENKO, Second Secretary, Pennanent Mission, Geneva Dr R. V. GRISHCHENKO, Attache, Permanent Mission, Geneva

SRI LANKA Mr N. S. DE SILV A, Minister of Health and Indigenous Medicine, Suwasiripaya, Colombo (Vice-Chairman) Alternates Mr H. S. PALIHAKKARA, Ambassador, Permanent Representative, Geneva

EXECUTIVE BOARD, I 04th SESSION

Or Y. D. N. JAYATHILAKA, Additional Secretary, Medical Services, Ministry of Health and Indigenous Medicine, Colombo Or V. JEGANATHAN, Director-General of Health Services, Colombo Advisers Mr S. S. GANEGAMA ARACHCHI, First Secretary, Permanent Mission, Geneva Mr A. S. U. MENDIS, Second Secretary, Permanent Mission, Geneva

SWITZERLAND Professeur T. ZELTNER, Directeur, Office federal de la Sante publique, Departement federal de l'Interieur, Berne Alternates Or S. ZOBRIST, Chef, Section des Affaires internationales, Office federal de la Sante publique, Departement federal de l'Interieur, Berne Or M. BERGER, Adjointe scientifique, Service des Ressources humaines, Direction du Developpement et de la Cooperation, Departement federal des Affaires etrangeres, Berne M. F. A. GRUBER, Conseiller, Mission permanente, Geneve

TRINIDAD AND TOBAGO Or R. PAUL, Manager, Health Policy and Planning, Ministry of Health, Port-of-Spain (alternate to Or H. Rafeeq) Alternates Ms D. JONES, Acting Permanent Secretary, Ministry of Health, Port-of-Spain Miss M.-A. RI CHARDS, Charge d'affaires a.i., Permanent Mission, Geneva

UNITED STATES OF AMERICA Or J. I. BOUFFORD, Special Adviser to the Assistant Secretary for Health/Surgeon General, Office of Public Health and Science, Department of Health and Human Services, Washington, D.C. Alternates Mr N. A. BOYER, Director for Health and Transportation Programs, Bureau of International Organization Affairs, Department of State, Washington, D.C. Or N. LURIE, Principal Deputy Assistant Secretary for Health, Office of Public Health and Science, Department of Health and Human Services, Washington, D.C. Mrs L. A. VOGEL, International Health Attache, Permanent Mission, Geneva Advisers Ms D. GIBB, Human Resources Coordinator, Office of Health and Nutrition, Bureau for Global Programs, Field Support and Research, United States Agency for International Development, Washington, D.C. Mrs K. E. JOHNSON, First Secretary, Permanent Mission, Geneva

VANUATU Mrs M. ABEL, Director of Public Health, Port Vila (Rapporteur)

MEMBERS AND OTHER PARTICIPANTS

YEMEN Dr A. 0. Al-SALLAMI, Under-Secretary for Pharmaceuticals, Ministry of Public Health, Sana'a Alternate Mr F. ALOBTHANI, First Secretary, Permanent Mission, Geneva

REPRESENTATIVES OF THE UNITED NATIONS AND RELATED ORGANIZATIONS

United Nations Mr T. RIEDY, Liaison Officer, United Nations Volunteers, Humanitarian Relief Unit and Liaison Office, Geneva

United Nations Population Fund Mr A. MACDONALD, Director, UNFPA European Liaison Office, Geneva Mr S. BA VELAAR, Senior External Relations Officer, UNFPA European Liaison Office, Geneva Miss N. CONFALONE, Junior Professional Officer, UNFPA European Liaison Office, Geneva

United Nations Children's Fund Mr J. J. DONOHUE, Regional Director, Central and Eastern Europe, Commonwealth of Independent States and the Baltics Regional Office, Geneva

UNAIDS United Nations Conference on Trade and Development Mr R. URANGA, United Nations Focal Point on Tobacco or Health Ms S. COW AL, Director, External Relations Dr A. M. COLL-SECK, Director, Department of Policy, Strategy and Research Mr B. FERY, Director, Programme Support Department Ms R. CHAHIL-GRAF, Manager, Governance and United Nations System, External Relations Dr E. NOEHRENBERG, External Relations Officer MrG. SHAW

United Nations Development Programme Mr E. BONEV, Senior Adviser, UNDP European Office, Geneva Ms S. PEDERSEN, Programme Officer, UNDP European Office, Geneva

SPECIALIZED AGENCIES

International Labour Organization Mme MIN-WHEE KANG, Bureau des Relations avec les Organisations internationales

Food and Agriculture Organization of the United Nations Mr T. N. MASUKU, Director, FAO Liaison Office, Geneva

EXECUTIVE BOARD, 104th SESSION

World Bank Mr 0. 0. ADEYI, Health Specialist, The World Bank Resident Mission, Budapest

International Atomic Energy Agency Ms M. S. OPELZ, Head, IAEA Office, Geneva Ms A. B. WEBSTER, IAEA Office, Geneva

REPRESENTATIVES OF OTHER INTERGOVERNMENTAL ORGANIZATIONS League of Arab States Dr 0. EL HAJJE, Delegation permanente, Geneve

European Commission Or A. BERLIN Mr M. HUBEL, Administrator, Directorate General for Employment and Social Affairs, European Commission, Brussels Mr C. DUFOUR, Permanent Delegation, Geneva

Organization of African Unity Mr A. BENSIB, Permanent Observer, Geneva Mr V. WEGE NZOMWITA, Deputy Permanent Observer, Geneva Mr I. 0. MENSA-BONSU, Minister Counsellor, Geneva

Organisation of the Islamic Conference Mr N. S. TARZI, Ambassador, Permanent Observer, Permanent Delegation, Geneva Mr J. OLIA, Deputy Permanent Observer, Permanent Delegation, Geneva

Commonwealth Secretariat Dr Q. Q. DLAMINI, Special Adviser, Head, Health Department

REPRESENTATIVES OF NONGOVERNMENTAL ORGANIZATIONS IN OFFICIAL RELATIONS WITH WHO

Council for International Organizations of Medical Sciences Dr Z. BANKOWSKI Professor M. ABDUSSALAM MrS. FLUSS Dr J. GALLAGHER

Inter-African Committee on Traditional Practices affecting the Health of Women and Children Mrs B. RAS-WORK Mrs R. BONNER

Council on Health Research for Development DrY. NUYENS Dr M. JEGATHESAN

Inter-Parliamentary Union Mr A. B. JOHNSSON Mr S. TCHELNOKOV

MEMBERS AND OTHER PARTICIPANTS

International Alliance of Women Ms G. HAUPTER MsM.PAL

International Pharmaceutical Federation Mr P. KIELGAST MrT. HOEK MrK. MOODY MrM.KOS

International Association for Maternal and Neonatal Health Mrs G. SANTSCHI Mr H. WAGENER

International Planned Parenthood Federation Mrs I. BRUEGGEMANN Dr P. SENANA Y AKE DrC.HUEZO

International College of Surgeons Professor P. HAHNLOSER

International Council of Nurses International Union against Cancer DrJ. A. OULTON Dr T. GHEBREHIWET MsM. FISHER Mr A. J. TURNBULL

International Council on Alcohol and Addictions DrS. FLACHE

Medical Women's International Association Dr C. BRETSCHER-DUTOIT DrD. WARD Dr W. DIEKHAUS

International Epidemiological Association Soroptimist International Dr R. SARACCI Professor R. BEAGLEHOLE Ms I. S. NORDBACK

International Federation of Gynecology and Obstetrics Dr S. NAZEER

World Association for Psychosocial Rehabilitation DrS. FLACHE

International Federation of Pharmaceutical Manufacturers Associations DrH. E. BALE Dr 0. MORIN CARPENTIER Mr J.-F. GAULIS Mr C. YOSHIDA

World Association of Girl Guides and Girl Scouts Mrs L. SCHURCH

World Federation for Medical Education DrH. KARLE

International Medical lnformatics Association DrY. GRIESSER

World Federation for Mental Health DrS. FLACHE

EXECUTIVE BOARD, 104th SESSION

World Federation of Occupational Therapists MsA. DIOAY

World Hypertension League Or T. STRASSER

World Federation of United Nations Associations Or R. MASIRONI Mrs L. CIAFFEI MrH. PERERA MrM.WEYOERT Or M. VIOLAKI PARASKEV A Or J. W. STEINBART

World Veterinary Association Or A. T. RANTSIOS

World Vision International OrE. RAM

COMMITTEES AND WORKING GROUPS 1

Programme Development Committee Dr M. E. Mbaiong (Chad), Dr J. Jimenez de la Jara (Chile), Mr Y. N. Chaturvedi (India), Dr Ponmek Dalaloy (Lao People's Democratic Republic), Dr G. M. van Etten (Netherlands), Dr A. Meloni (Peru, Vice-Chairman of the Board, member ex officio), Dr K. A. Al-Jaber (Qatar)

Administration, Budget and Finance Committee ProfessorS. M. Ali (Bangladesh), Mr Liu Peilong (China), Dr M. Toyb (Comoros), Mr C. Solomis (Cyprus), Mr H. Voigtliinder (Germany, Vice-Chairman ofthe Board, member ex officio), Professor T. Zeltner (Switzerland), Dr J. I. Boufford (United States of America) Meeting of 14 May 1998: Mr H. Voigtliinder (Chairman), Mr K. Rahman (alternate to ProfessorS. M. Ali), Dr A. Sanou Ira, Mr Liu Peilong, Ms A. Ashikali (alternate to Mr C. Solomis), Dr K. A. Al-Jaber, Mrs L. Vogel (alternate to Dr J. I. Boufford)

Audit Committee Mr P. H. Kengouya (Congo, alternate to Dr D. Bodzongo), Mr V. A. Vislykh (Russian Federation, alternate to Professor V. I. Starodubov), Dr J.l. Boufford (United States of America). The Chairman is authorized to appoint members from among the members or alternates of the Board designated by China, Sri Lanka and Yemen, on the basis of curricula vitae to be submitted.

Standing Committee on Nongovernmental Organizations ProfessorS. M. Ali (Bangladesh), Professor J.-L. Mamdaba (Central African Republic), Dr J. Jimenez de la Jara (Chile), Mr C. Solomis (Cyprus), Dr G. M. van Etten (Netherlands)

WHOIUNICEFIUNFPA Coordinating Committee on Health WHO members: Mr M. Colla (Belgium), Dr T. Faireka (Cook Islands), Professor M. Kakou Guikahue (Cote d'lvoire), Dr K. Karam (Lebanon), Dr A. Meloni (Peru), Mr N. S. de Silva (Sri Lanka)

Darling Foundation Committee Chairman of the WHO Expert Committee on Malaria and Chairman and Vice-Chairmen ofthe Board, members ex officio

1 Showing their current membership and listing the names of those who attended meetings held since the previous session of the Board.

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EXECUTIVE BOARD, I 04th SESSION

Leon Bernard Foundation Committee Professor J. F. Girard (France), together with the Chairman and Vice-Chairmen of the Board, members ex officio

Jacques Parisot Foundation Committee Dr K. A. Al-Jaber (Qatar), together with the Chairman and Vice-Chairmen of the Board, members ex officio

Ihsan Dogramaci Family Health Foundation Committee The Chairman of the Board and Mr N. S. de Silva (Sri Lanka), Vice-Chairman of the Board, members ex officio, a representative of the International Pediatric Association, a representative of the Turkish and International Children's Centre, Ankara, and the President ofBilkent University, Ankara, or his or her representative

10.

United Arab Emirates Health Foundation Committee Dr K. A. Al-Jaber (Qatar), the Chairman of the Board, member ex officio, and a representative designated by the founder

11.

Sasakawa Health Prize Selection Panel Mrs M. Abel (Vanuatu), the Chairman of the Board, member ex officio, and a representative designated by the founder

SUMMARY RECORDS

FIRST MEETING Wednesday, 26 May 1999, at 9:30 Chairman: Dr K. CALMAN (United Kingdom of Great Britain and Northern Ireland) later: Or A.J.M. SULAIMAN (Oman)

OPENING OF THE SESSION AND ADOPTION OF THE AGENDA: Provisional Agenda (Documents EB 104/1 and Add.1)

Item 1 of the

The CHAIRMAN declared the 104th session of the Executive Board open. He drew attention to a request by Dr van Etten (Netherlands) to add to the agenda an item on the operating reserve of UN AIDS (document EB 104/1 Add.1 ). The third sub-item of item 6, Amendments to the Staff Regulations and Rules (if any), should be deleted, since no such amendments had been proposed. Lastly, a request by the authorities of the host country, Switzerland, for a right of way across a portion of the land occupied by WHO headquarters could be considered as a sub-item of item 7 of the agenda, Management and financial matters. The agenda, as amended, was adopted. 1

ELECTION OF CHAIRMAN, VICE-CHAIRMEN AND RAPPORTEURS: Item 2 of the Agenda The CHAIRMAN invited nominations for the office of Chairman. Dr AL-JABER (Qatar) proposed Dr A.J.M. Sulaiman (Oman).

Dr JIMENEZ DE LA JARA (Chile), speaking on behalfofLatin American countries, proposed Dr A. Meloni (Peru). In response to a comment from Dr KARIBURYO (Burundi), Mr TOPPING (Legal Counsel) confirmed that the practice of rotating the chairmanship of the Board by regions, begun in 1990, was based on a gentlemen's agreement, rather than on any rule. According to that practice, it was the turn of the Eastern Mediterranean Region to provide a Chairman. Dr MELONI (Peru), while noting that there were no formal grounds for preventing a representative ofhis region from being elected Chairman of the Board, said that he would withdraw his candidacy in the interest of equity and efficiency, and seconded the nomination ofDr Sulaiman. He suggested, however,

See page vii.

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EXECUTIVE BOARD, 104th SESSION

that the traditional practice of rotation among the regions be regularized by an appropriate addition to the Board's Rules of Procedure. The CHAIRMAN thanked Dr Meloni for his magnanimity and consideration, and said that his suggestion would be taken into account under item 7 of the agenda, Management and financial matters.

Dr A.J.M. Sulaiman was elected Chairman. The DIRECTOR-GENERAL thanked Or Calman, the outgoing Chairman, for the force and spirit with which he had worked during the past year, an exceptionally important period of change of leadership and renewal. As a member of the Board before his election as Chairman, Dr Calman had been one of the driving forces for renewal and change, rallying support for changes which would benefit the Organization. She thanked him for his constructive work and praised the good-humoured and pleasant manner in which he had carried out his duties.

The Director-General presented Dr Calman with a gavel. Dr Sulaiman took the chair. The CHAIRMAN thanked the Board for the honour it had done him and his country by electing him to his post. He would bear his new responsibilities in the full conviction that members' experience of work in their countries would support him in that effort; without such support he would certainly be unable to carry out his duties. He wished the members every success during the coming year in the service of the health of all the peoples ofthe world with the new administration and leadership ofWHO. He invited nominations for the three offices of Vice-Chairmen. Mrs JEAN (Canada) proposed Dr A. Meloni (Peru). Professor ALl (Bangladesh) proposed Mr N.S. de Silva (Sri Lanka). Mr FETISOV (alternate to Professor Starodubov, Russian Federation) proposed Mr H. VoigtHinder (Germany). Dr ALVIK (Norway) seconded all three nominations.

Dr A. Meloni (Peru), Mr N.S. de Silva (Sri Lanka) and Mr H. VoigtHinder (Germany) were elected Vice-Chairmen. The CHAIRMAN noted that, under Rule 15 ofthe Rules ofProcedure, if the Chairman was unable to act between sessions, one of the Vice-Chairmen should act in his place, and that the order in which the Vice-Chairmen would be requested to serve should be determined by lot at the session at which the election had taken place. It was determined by lot that the Vice-Chairmen should serve in the following order:

Dr Meloni (Peru), Mr de Silva (Sri Lanka) and Mr Voigtlander (Germany). The CHAIRMAN invited nominations for the offices of English-speaking and French-speaking Rapporteurs. Mr FAIREKA (Cook Islands) proposed Mrs M. Abel (Vanuatu) as English-speaking Rapporteur.

SUMMARY RECORDS: FIRST MEETING

Or KARIBURYO (Burundi) proposed Professor M. Kakou Guikahue (Cote d'Ivoire) as Frenchspeaking Rapporteur. Mrs M. Abel (Vanuatu) and Professor M. Kakou Guikahue (Cote d'lvoire) were elected English-speaking and French-speaking Rapporteurs, respectively.

OUTCOME OF THE FIFTY-SECOND WORLD HEALTH ASSEMBLY: Item 3 of the Agenda

The CHAIRMAN reminded the Board that its representatives at the Fifty-second World Health Assembly had been Or Calman, Or Sanou Ira, Mr Liu Peilong and Or Al-Jaber. He invited Or Calman to deliver a report on their behalf. Or CALMAN (United Kingdom of Great Britain and Northern Ireland), representative of the Executive Board at the Fifty-second World Health Assembly, said that the Health Assembly had been marked by an important new initiative endorsed by the Board - the ministerial round tables on lessons learned in world health. Delegates had expressed enthusiasm for the innovation, and the Assembly had subsequently adopted a resolution to incorporate in the agenda for the next Health Assembly high-level discussions on subjects to be suggested to the Board by the Director-General. The principal focus of the Health Assembly's discussions had been the programme budget. Delegates had expressed strong approval for the restructuring of WHO, as reflected in the budget, particularly with respect to clarity of objectives, the alignment of regions with the new cluster structure at headquarters, the combination of regular budget and extrabudgetary funds to show a total resource base, and greater accountability. Delegates had also welcomed the unprecedented level of funding earmarked to support priority programmes in countries. Debate had centred on what Member States expected from WHO, and how WHO was best equipped to respond, and had confirmed the Organization's traditional strengths in setting international standards and leading the fight against such enduring problems as communicable diseases and malnutrition. There had also been calls for WHO support to deal with profoundly changing disease profiles, characterized by new epidemics and an upsurge in chronic diseases as lifestyles changed and populations aged throughout the world. After many hours of negotiation, and many statements to the effect that WHO deserved full financial support as it undertook welcome and rapid reform, an appropriation resolution had been drafted and adopted, by consensus, in the spirit of compromise. Although many delegates had referred to the universal climate of financial austerity and to economic crises in various parts of the world, no country wished to see the momentum of the reform slowed for lack of funds. Several had expressed confidence that continuing reform might lead to ways of streamlining operations further, attracting new financial partners, and thus maintaining vital WHO activities at least at their current level. On technical and health matters, the Assembly had considered nine items and seven resolutions. Among them had been the revised drug strategy, which had been the focus of vigorous debate for more than a year. The resolution proposed by the Board had been adopted by consensus in a spirit of compromise. Likewise, a resolution reaffirming the eventual destruction of the remaining smallpox virus stocks had been adopted by consensus, with amendments, after considerable work in a drafting group and subsequent debate. As on several other occasions, that process had illustrated the extent to which WHO's leadership as an objective guiding and coordinating authority was needed and appreciated. The Director-General's new Cabinet projects, Roll Back Malaria and the Tobacco Free Initiative, had provoked especially lively and enthusiastic debate. Many delegations had spoken in support of the malaria project, with some reminding the Organization of the need for an integrated approach to malaria control that relied on community participation. Others had noted that the WHO initiative had already given malaria a higher place on the political agenda, raised international awareness of the need for urgent concerted action, and engaged the interest of donors. The Roll Back Malaria resolution had been adopted by consensus. With

EXECUTIVE BOARD, I 04th SESSION

regard to the Tobacco Free Initiative, a number of speakers had expressed strong approval for the project and for the work on developing a WHO framework convention on tobacco control. Just as no country was safe in a world where diseases knew no boundaries, delegates had commented that no country could protect its people from the tobacco threat in a world where advertising messages could be beamed across borders by modem telecommunications. Once again, the debate had confirmed the interdependence of countries in health matters and the importance of WHO's global leadership. The resolution on a WHO framework convention on tobacco control - a significant step on the way to the first legally binding global convention in the Organization's history - had been adopted, as amended, by consensus. Progress in the global eradication of poliomyelitis, which was so close to its goal, had been debated by a large number of speakers, many of whom had pleaded for the political commitment and funding that would make it possible for the current century to present the next one with a world forever free of that crippling disease. Many had also noted how the success of the current campaign had strengthened all immunization efforts in countries and had provided vital lessons about ways of extending essential care to all children. The resolution on poliomyelitis had also been adopted, as amended, by consensus. A resolution on strengthening health systems in developing countries, which had been proposed by a large group of countries, had been adopted by consensus, and the resolution on the prevention and control of iodine deficiency disorders had also attracted broad support and had been adopted, as amended, by consensus. The Health Assembly had adopted a resolution on health conditions of, and assistance to, the Arab population in the occupied Arab Territories, including Palestine. Discussion on collaboration within the United Nations system and with other intergovernmental organizations had resulted in resolutions on the Agreement between the World Health Organization and the Universal Postal Union, active ageing, and support to the Central American countries affected by Hurricane Mitch, and a decision on WHO's participation in the United Nations Development Assistance Framework (UNDAF) exercise. The Health Assembly had reappointed South Africa as External Auditor of the accounts of WHO for the financial periods 2000-2001 and 2002-2003. A supplementary agenda item on the use of languages in WHO had been added to the agenda at the request of four Member States. Although after intense and lively debate, the resolution proposed on the use of official languages in the WHO Secretariat and in WHO publications had not been adopted, there had been consensus to include the item on the agenda of the I 05th session of the Executive Board with an accompanying overview of the needs and practices in the Organization, both at headquarters and in the regions. In conclusion, the Fifty-second World Health Assembly had succeeded in approving the programme budget and settling important technical, management and financial matters in the spirit of conciliation and consensus. Professor GIRARD (France) noting the decision by the Health Assembly to refer a draft resolution on international solidarity in AIDS control, proposed to it by some 15 delegations, to the Executive Board for more detailed review at its I 05th session in January 2000, said that action seemed wise since in view of the gravity of the AIDS epidemic, it was proper that WHO should be actively engaged in that area, as was UN AIDS and other bodies. Dr JIMENEZ DE LA JARA (Chile), commending The world health report 1999, said that one of WHO's main strengths was the quantity and quality of its published information. Adequate information on medicine and health was the source of all policy, and constituted an essential tool for countries in their efforts to understand the causes and consequences of disease. The report clearly demonstrated the way forward to a universal health policy for combating poverty by tackling health issues - an approach upheld by many studies. It also restored to WHO its leadership role as the body with the knowledge, information and know-how to devise effective disease control strategies that would make people's hopes for greater well-being a reality. The report made plain that it was not simply a question of"making a difference" for the sake of change, but of"making a difference" in the way health problems were tackled. It constituted a first sign that the Organization's new structure was working successfully, and demonstrated the importance to policy-making of the information group that had been

SUMMARY RECORDS: FIRST MEETING

set up. If future reports continued to focus as effectively on real world health problems, the impact could only increase, thereby enabling the Organization to assume the long-tem1 leadership role it merited. Professor ALl (Bangladesh) said that the round tables had proved highly productive and constituted a truly innovatory event in the history ofthe Health Assembly. However, in future the moderator's role could perhaps be scaled down to enable health ministers to play an even more effective part in the proceedings. The discussions on the budget had presented another opportunity for Member States to display a spirit of compromise and solidarity, particularly with regard to the adoption by consensus of the appropriation resolution. However, he recalled that the vast majority of delegations, commenting on general aspects ofthe budget programme presented by the Director-General, had appreciated the need for zero real growth. Despite that, negotiations had ultimately taken another tack, so that the views expressed in favour of the Director-General's proposal were reflected in the report on the Health Assembly. Noting that the financing of high priority programmes might have been severely curtailed had there been no casual income to support it and expressing concern that high levels of casual income might not be attainable in the future, he considered that Member States should reflect during the next biennium whether it might not be well to re-examine the issue of zero real growth. The CHAIRMAN, in the absence of further comments, said he took it that the Board wished to note the report of its representatives to the Fifty-second World Health Assembly. It was so agreed.

TECHNICAL AND HEALTH MATTERS: Item 4 ofthe Agenda

Research strategy and mechanisms for cooperation (Document EB 104/2) Dr FRENK (Executive Director), introducing the report, said that its purpose was to seek the Board's opinion with regard to a number of proposed changes resulting from a detailed discussion process. The principal contention was that research policies should play a leading role in the context of WHO reform. The Director-General had upheld that view on many occasions, and there was growing scientific evidence to show that knowledge had made a highly significant contribution to the improvements achieved in health in the twentieth century. Numerous examples to support the contention were to be found in The world health report 1999. In line with the importance the Director-General attached to the creation of a knowledge-based organization, a thorough review of its research mechanisms had been carried out. At its 103rd session, the Board had requested specific examples of subjects for review, resulting in recommendations that in turn had produced specific measures, an example being the recruitment of the Director of the Department of research policy and cooperation. To date, the review process had been confined to Geneva, although it was quite possible that similar exercises would be conducted in regional offices in future, a process that would also include detailed analysis of the Organization's arrangements for international cooperation in health research at the global level. The first part of the consultation process had seen the appointment of an internal working group at headquarters that included representatives from all parts of the Organization. The working group had produced a document that put forward a number of options for the Organization. That document was then discussed by a board made up of 13 distinguished external advisers drawn from the world scientific community on the basis of geographical representation. At a meeting in March 1999, they had been joined by representatives from four regional offices. The external board of advisers then submitted a document to the Cabinet, which had further expanded on those ideas to produce the report currently before the Board.

EXECUTIVE BOARD, 104th SESSION

With regard to the scope of the exercise, it was acknowledged that WHO played a highly strategic but limited role as regards direct production of state-of-the-art knowledge, and a broad definition of research was therefore adopted which also covered the explanation of knowledge, its validation, and its transfer in the form of policy and practice. The discussions on recommendations had focused on five main areas, namely research promotion and programme reviews, expert advisory panels and committees, WHO collaborating centres dealing with research, ACHR, and the Department of research policy and cooperation. With regard to research promotion and programme reviews, both the internal and external groups, and subsequently, the Cabinet, had endorsed the notion that all WHO technical programmes should undergo technical review. The Organization's limited experience of such reviews had been very successful, and it had therefore been decided to recommend their increased use. Another recommendation had been that all proposals for research to be carried out or supported by WHO should be subjected to peer review. That would also apply to ethical policy issues. In the case of expert advisory panels and expert committees, although the various working groups had recognized the strategic value to WHO ofhaving access to the world's leading experts on health, they were also of the opinion that the current process was somewhat lengthy and slow. As a result, too many programmes were bypassing the internal mechanisms. A strong consensus had emerged in favour of streamlining the existing system of expert committees. The resulting recommendation proposed that WHO should no longer maintain expert advisory panels, and should proceed with expert committees through direct and flexible selection of members. The proposed changes in expert committees and suppression of the expert advisory panels would need to await consideration by the Executive Board at its I 05th session in January 2000, before being passed on for final decision to the Fifty-third World Health Assembly. With regard to WHO collaborating centres dealing with research, the overwhelming feeling had again been that the system needed to be streamlined, despite having proved its worth as a highly valuable link to worldwide expertise. The principles underlying the recommendation were transparency in the designation of WHO collaborating centres, the need for collaboration to be mutually beneficial, and ease of administration. A review of WHO collaborating centres concerned with areas other than research would be completed in July 1999, the intention being to produce specific recommendations. On the subject of ACHR, the external board of advisers had felt that the existing system should be streamlined. They had recommended that ACHR should be replaced by a much smaller strategic research council, which would act as a permanent advisory body to the Director-General and would have the power to establish ad hoc committees on specific research topics. After examination of the external group's proposals by the Cabinet and the Legal Counsel, it was decided to incorporate them into the existing mechanism so as to create a new-style ACHR along the lines originally envisaged in resolution WHA 12.1 7, adopted in 1959. The final part ofthe review process related to the establishment of a Department of research policy and cooperation. The review process had confirmed the need for such a body at headquarters, but one with a different profile and strategic orientation. The idea was that, instead of focusing its energies on administering the process of maintaining expert advisory panels and ACHR, the Department would concentrate on a substantive agenda relating to health research, including the articulation of a definite position with regard to the monitoring of resource flows, strengthening of the review process and, importantly, interaction with national governments in strengthening countries' research capacities. On completion ofthe main consultative process, a profile of the work to be undertaken by the Director of the department had been adopted. Dr VAN ETTEN (Netherlands) laid emphasis on the need to expand the knowledge base of the Organization- one of the global challenges for health identified by the Director-General. In general, he supported the recommendations contained in the report, particularly those relating to the external evaluation of programmes, the reform of expert advisory panels and expert committees, and the review of WHO collaborating centres. He was also in favour of the proposal to replace ACHR with a strategic research council. The only aspect that had not been covered in the report, despite its title, was the need for WHO to develop its own research strategy and policy, starting with the setting of a research agenda and relevant

SUMMARY RECORDS: FIRST MEETING

priorities. That might be a task for the Department of research policy and cooperation, with the proposed strategic research council being involved in an advisory capacity. Furthermore, it was essential that WHO research should not be confined to biomedical matters, but should also embrace public health issues, health economics and behavioural and social sciences. Or AL VIK (Norway) welcomed the very informative report, which provided a useful basis for discussion. Although it was too early to draw conclusions on the recommendations, she welcomed the emphasis laid on quality control, greater use of external evaluations and reviews, and a more strategic and dynamic approach to collaborative partnerships. One positive aspect of the report was its focus on capacitybuilding and research relating to ill-health in poor countries. She looked forward to WHO stepping up its efforts in more horizontal research, including health systems, health sector development and gender issues. She endorsed the four areas of research outlined in paragraph 5 ofthe report and the concept of respecting the standards and role of science enshrined in paragraph 6. WHO collaborating centres were indeed a valuable resource for research; however, she was somewhat concerned about the selection criteria and transparency of the relevant national authorities. There was clearly a need for more collaborating centres in developing countries. She looked forward to the results of the broader review on the subject to be published in July 1999, which would no doubt shed some light on those issues. One topic that had not been mentioned in the report but was currently under discussion in the Organization was that of guidelines and WHO's authority in the area of research. She would welcome more information on the subject once it became available. She endorsed the proposal for the establishment of a strategic research council reporting to the Director-General to replace ACHR, but pointed to the need for a flexible system of participation so as to ensure the availability of the necessary expertise, as and when appropriate. Mr CHATURVEDI (India) welcomed the effort to strengthen WHO arrangements for research. He supported many ofthe ideas put forward in the report, including that of peer review of research proposals (which would bring WHO research into line with globally accepted research methods), and the greater emphasis on quality assurance of research proposals and outcomes as well as on ethical issues. He also endorsed the proposal for the periodic review of WHO collaborating centres - it was only logical that their status should depend on their performance and research results. Likewise he was in favour of establishing a competitive process for defining research projects, in keeping with worldwide research trends over the past two decades. The only proposal about which he had serious misgivings was the winding up of ACHR; the rationale for it in the report was far from convincing. He failed to understand how a meeting with so few participants, organized on a two-yearly basis, could be so difficult to manage and hold up the progress of research. Although he would not object to the idea of a smaller group of highly qualified researchers, it was essential for the Director-General to be advised by a committee comprising representatives from all the different regions, since their health concerns varied considerably. ACHR should continue its work, not . in place of, but along with, the proposed new strategic research council so as to avoid a situation in which, albeit unintentionally, greater attention was paid to the concerns of some regions rather than others. Mr VOIGTLANDER (Germany) said the time had come to address the issue of an appropriate research strategy for the Organization, now that a new Director-General had taken office, a new structure was in place and new priorities had been established. The Executive Board had begun to look into the matter two years previously and a comprehensive report containing rather elaborate proposals had been prepared by ACHR. He welcomed the idea of transforming ACHR into a smaller strategic research council; however, since considerable time, resources and effort had been invested in ACHR, the results of its work should be used, where possible, as a basis for the new body's discussions. In conclusion, he reiterated the necessity of devising a research strategy for the Organization; notwithstanding the valuable research being undertaken in many areas of WHO, it was essential to base policy orientation on scientific evidence for each particular programme within a strategic framework.

EXECUTIVE BOARD, 104th SESSION

Dr AL-JABER (Qatar) said that he generally favoured change, in line with WHO's current process of reform under the leadership of the new Director-General. He therefore supported the idea of closing down collaborating centres whose activities were no longer linked to WHO and disbanding committees that did not operate effectively. However, he had some queries regarding the proposed strategic research council. Why should it have 10 members rather than any other number? What criteria would be used for selecting candidates? Who would set priorities for their work and evaluate the results? He hoped that the scope of the new body would not be confined to medical matters, but would lay greater emphasis on health issues. He questioned the appropriateness of holding meetings every two years, fearing some difficulty in ensuring proper follow-up and evaluation. Mr FETISOV (alternate to Professor Starodubov, Russian Federation) welcomed the comprehensive and timely report on the very important issue of coordinating scientific research and improving arrangements for cooperation between headquarters, the regions and Member States. He endorsed the recommendations on research promotion and programme reviews aimed at enhancing WHO's role in research by strengthening scientific potential in clusters and encouraging research in the regions and Member States. However, the intent of the recommendations on expert advisory panels and expert committees was not entirely clear, so he looked forward to their further consideration at the Executive Board's next session. The WHO collaborating centres represented an enormous scientific reserve which the Organization should put to better use. In Russia, the Ministry of Health and the Academy of Medical Sciences had recently carried out a study into the effectiveness and relevance of such research centres. A meeting between the heads of those centres and WHO was scheduled for the end of the year to discuss such matters. He welcomed the establishment of a strategic research council which should give fresh impetus to WHO's scientific research. The report did not put forward any particularly weighty arguments for disbanding ACHR; furthermore, he regretted that despite its many years of activity and outstanding membership, no mention was made in the report of its significant contribution to the Organization, which under the circumstances would have seemed appropriate. He was greatly impressed by the list of very specific and difficult tasks set for the Department of research policy and cooperation, the Director and staff of which he wished every success in their work. Dr BOUFFORD (United States of America) said that the report was of critical importance, proposing a clear action plan to ensure that WHO's activities were firmly based on evidence as well as practice. In particular she appreciated the emphasis laid in the report on the transformation of knowledge into best practice. She also welcomed the process leading up to the formulation of the recommendations, namely the appointment of an internal working group and an external board of advisers, as well as the establishment of a focal point - the Department of research policy and cooperation - to coordinate efforts in WHO and the external research community. She endorsed proposals for a new approach to the work currently being done by ACHR. The functions of the proposed strategic research council were clearly outlined in the report and she looked forward to further recommendations relating to its composition, stressing the importance of equitable geographical distribution. She hoped that the selection procedures for the new body would ensure transparency and scope for a good mix of experts. One aspect which could have been highlighted better in the report was WHO's role in the active development of research capability in developing countries. Perhaps the review of WHO collaborating centres would afford an opportunity for developing partnerships between centres collaborating on research and on programme activities, and for joint North-South projects on priority programmes. Another possible function of the Organization was in identifYing high-priority areas of research, such as filling in gaps ofknowledge where little research had been carried out (risk behaviour and health services research), and encouraging more research into areas where there was a high global disease burden (mental health and substance abuse).

SUMMARY RECORDS: FIRST MEETING

Mrs JEAN (Canada) said that the excellent report in many respects reflected recent debate in Canada in connection with the restructuring of national research institutes and the establishment of new research programmes based on a broader definition of research which should not be limited to biomedical matters. WHO should take advantage of its image and reputation as the global technical authority in international health to ensure the wide dissemination of new health knowledge in the form of standards, guidelines and recommendations. Moreover, WHO could convene meetings to forge worldwide consensus and to resolve controversies on issues that often halted the progress of health development. She recognized that the time had come to discontinue formal panels of experts and use more flexible selection procedures for expert committees. She endorsed the proposal relating to ACHR. No mention had been made ofthe gender dimension of research in the report; she hoped that WHO would address the issue in its research policy. Mr LIU Peilong (China) was in full agreement with the recommendation of the external board of advisers for a periodic external review of WHO's technical programmes and for peer review of research proposals. The policy document of the new Regional Director for the Western Pacific had also emphasized the value of using external advisers, very much in line with the principles set forth in the Director-General's report. However, WHO should not only enhance its own external review and peer review mechanisms but, through its Department of policy research and cooperation, work with Member States, especially the developing countries, to enhance their research capability, and provide guidance on the ethical aspects of designing scientific research. The Chinese Government was reforming the country's scientific research mechanisms and required support and guidance, for example in formulating policies on medical ethics in line with international standards, especially in research and population genetics. Observing that many developing countries were facing the same problems, he endorsed Dr Boufford's call for enhanced collaboration with developing countries and looked forward to receiving support from WHO. The composition ofthe expert advisory panels and the expert committees should be discussed as two separate issues. He supported the expert advisory panels as a way of obtaining the world's best expertise through various channels. The expert committees should not necessarily be drawn from expert advisory panels. Though the expert advisory panels had problems, he cautioned against disbanding them without further study. The advisory panels and expert committees provided WHO with technical guidance and support, both spontaneously and upon request. They constituted an important and necessary reservoir of expertise for the Organization. Problematic aspects, such as the gender balance, could be resolved. He endorsed the recommendations of the external board of advisers on the WHO collaborating centres. There should be a reciprocal relationship between WHO and its collaborating centres. WHO should provide more opportunities for the development of the centres and help them to serve the Organization and the Member States better. WHO should also make full use of modem technology in establishing a network of its collaborating centres world wide, for instance centres operating in the same field could hold regular meetings for an exchange of views. China held a meeting of WHO collaborating centres every two years. He hoped that the report on the current review to be issued in July 1999 would help in improving the management of the collaborating centres and promoting their role. Professor GIRARD (France) said that the subject under discussion was second only to the budget in importance despite the fact that WHO did not itself engage in research. The relationship between research institutions and health policy institutions had always been a difficult one. However, two questions needed to be considered in advance of the issues raised in the report, namely WHO's mission and its strategy. It was an obvious but frequently overlooked fact that funding and power went hand in hand, so that power often lay not with health policy institutions but with autonomous research programmes and institutions the direction of whose work often went unscrutinized. Similarly, WHO had no financial power with which to change the course ofhealth policy; WHO's power lay in the moral sphere, which, combined with its global authority and legitimacy, enabled it to influence political choices. As to strategy, it was important to bear in mind that WHO's influence extended beyond the Organization itself, to countries and governments. For example, many countries might benefit from knowing that WHO attached as much importance to research into the behavioural sciences as to biomedical

EXECUTIVE BOARD, I 04th SESSION

research, which was currently in the forefront of attention. On ethical policy, WHO had missed the boat in the past. Ethics were not a matter for health experts alone, but for the public and society at large. It was puzzling that WHO had not stood alongside UNESCO and other institutions in that debate. Clearly, there was ground to be made up. Turning to the report itself he supported more flexible policies in relation to expert committees, as well as measures to ensure transparency. It was essential to separate expertise from decision-making. Even in health affairs, the decisions should not be taken by experts but at the political level by the Executive Board or the Director-General. He agreed with previous speakers that WHO collaborating centres should respond to the concerns of the developing countries. Efforts should be made to resolve the problems. Networks should be set up of centres working in the same field, one benefit of which would be to support emerging centres in the developing countries. With regard to ACHR, he questioned the wisdom of asking a single body, not subject to oversight, to give guidance on direction, recruitment and resource allocation. Professor ALl (Bangladesh), commending the report, said that the subject under discussion was probably even more important than the budget. WHO collaborating centres in Bangladesh needed money if they were to reach international standards. Greater investment was therefore needed in expanding knowledge-based partnerships with WHO. That, for him, was the key question. He agreed with previous speakers that an advisory committee representing all the regions would be beneficial for the Organization in assessing regional research needs. Limited resources made it very difficult to translate good policy into reality. Mr COLLA (Belgium), echoing the remarks of Professor Girard, said he saw two possible roles for WHO in the field of research. Although he was not against WHO undertaking research in well-targeted fields, he did not generally see WHO as a research institute, a function better performed by universities and other institutions. WHO's role consisted, rather, in asking the right questions, encouraging institutions to identify gaps in knowledge and subsequently - WHO was after all a political institution - in drawing conclusions and elaborating guidelines on the basis of scientific evidence and data. Of course there was a need for coordination, for example with the European Commission and the European Science Foundation in the field of the impact of environment on health. It was important therefore to be clear about the precise and limited role ofWHO in the field of research. Expressing his support for an external review group, he emphasized the importance of including experts on social affairs, ethics and public health in its composition. Paragraph 12 of the report gave the impression that the ethical guidance provided by WHO would be limited to issues arising within the Organization. Yet ethical problems were real, fundamental and universal. Research was required to avoid misunderstandings and non-truths, and to enable conclusions to be drawn. WHO was uniquely well placed to provide guidelines for all its Member States, for example on the difficult but unavoidable issues raised by biogenetics. Turning to the WHO collaborating centres, he was convinced of the need for a new philosophy. The matter would best be discussed after presentation of the report on the subject in July 1999. However, the Director-General would already be aware, following her visit to Brussels, that the WHO collaborating centres in Belgium had complained about insufficient feed-back from WHO and too little communication among centres working in the same fields worldwide. Dr MELON! (Peru) agreed with previous speakers that any analysis of WHO's research strategy and mechanisms must be based on the Organization's role in contributing to countries and peoples achieving the highest possible levels of health. Research was so important, as many speakers had pointed out, because of the huge amount of funds it absorbed and the increasingly rapid advances in knowledge and technological development. The differences between the countries that produced knowledge and those that used knowledge were also increasing. WHO's place was to be in the forefront, not so much for the production of new knowledge as in evaluating it, interpreting it and placing it within the reach of all. Obviously a return was expected from the huge investment in research. So it was important that the

SUMMARY RECORDS: FIRST MEETING

Organization should inspire confidence as the highest body and moral authority providing advice and guidance to countries. And since credibility and independence were two vital elements in creating confidence, independent external review, in addition to internal review, was very important. But it had to be possible to evaluate programmes according to criteria established ex ante, not ex post, and that was an essential part of programming and resource allocation. One point should be made clear. WHO consisted of its Member States, not just the Secretariat. Evaluation of the process and strategies had to be aligned with the Organization's goal, which was not an end in itself within the Secretariat but a mission on behalf of countries. He trusted that WHO intended to promote research, and not only within the Secretariat as implied in paragraph 21. The proposals made in the report went beyond a strategy, amounting to a design for the internal restructuring of the Organization to achieve more flexible mechanisms, which he supported. Nevertheless, strategy, together with technical cooperation and the Organization's mission, should be considered in greater depth and with reference to the aim of producing new knowledge and using that knowledge in the formulation of health policy, some of the core objectives of the Organization. Professor ZELTNER (Switzerland), endorsing much of what had been said by Professor Girard, drew attention to three areas relevant to WHO's role in research, and the role of research in public health, that had received only passing reference in the report. The first was validation of knowledge. The research and knowledge explosion had made it very difficult to decide what was really important for public health; countries should be able to turn to WHO for relevant assessment and advice. Secondly, WHO had a key role to play in promoting the capacity to respond to new health hazards, such as bovine spongiform encephalopathy, either by seeking out the expertise able to resolve them or providing answers itself. Because they were new, such emerging problems did not always fall within the ambit of a given cluster or existing programme. Thirdly, WHO, as Dr Boufford had pointed out, could support capacity-building for research, and not only for developing countries. It was well known that health professionals who were involved in research programmes were better prepared and thus performed better than those who were not. WHO should identity areas in which it considered that research could significantly improve the performance of health systems. Dr Ponmek DALALOY (Lao People's Democratic Republic) said that the ministerial round tables had clearly shown that the determination of priorities was a complex process which was both a science and an art. It was a science in that it had to respect certain principles such as maintaining harmony with the progress made in science and technology, conforming to the realities, conditions and possibilities of each country and region, and particularly maintaining a harmony with guidelines established by WHO. Determining priorities was also an art because it depended on political, social and climatic circumstances and on the will of peoples and communities. Research and development was all the more important when countries were poor and developing; they had greater needs but extremely limited means. Research problems were innumerable, and there were no miracle solutions. There was no substitute for research, which was the best guarantee of success and the essential component in the determination of priorities and the allocation of funds. His own country was poor and developing, and greatly appreciated the usefulness of and need for research. The programme for considering internal mechanisms to support research and development should be continued because it was the best investment that could be made. The internal working group and the external board of advisers were to be congratulated on the recommendations they had made. He agreed with previous speakers on the need to support research centres in developing countries. WHO's role was certainly linked to fields of research, but there were many ofthem and he shared the view expressed by Professor Zeltner that the Organization's role should be in the public health aspects of research and development. Or KARAM (Lebanon) said he hoped that WHO's policy on research strategy would become a strategy for implementation as well. The importance of a strategy on health research could not be overstressed. There was a strong need for external scientific advice and periodic scientific review. The

EXECUTIVE BOARD, 104th SESSION

expert committees were important, and should be freed from formal constraints in order to keep them in step with science and development. It was also important that research should be properly integrated within communities so that afterwards the research centres would be self-sustaining. Lastly, research should not be alien to the communities in which it was conducted; it should enjoy regional and central recognition and cooperation. A council on health research and development which operated centrally was thus very important. Or ANDRADE LARA (Guatemala), welcoming the report, said he agreed with the points previous speakers had made regarding its paragraph 21. As for the promotion of research within the Organization in country offices, regions and headquarters, the principal effort should be focused on subregional offices because although there were global and generic subjects of research applicable to all countries, there were also subjects specific to individual countries and regions. Secondly, although the strengthening of WHO's internal scientific capacity was certainly necessary, the scientific capacities of countries and subregions also had to be strengthened so that they could advance in parallel with the growth of health systems. Or KARIBURYO (Burundi) said that the importance of research was unquestioned since it was essential to coordinate disease control in order to avoid errors. WHO's credibility depended on it. All the regions possessed potential and expertise based on data gathered in the field regarding diseases specific to them, and WHO had to turn it to good account. In the case of malaria control for example, there were few research units in most developing countries. WHO could make the most of their knowledge by helping to establish proper units. Often they did not have the financial and human resources needed to produce useful work of real quality. The Executive Board should reflect more deeply on the establishment of such units, particularly for malaria control, in the regions most affected. Or JIMENEZ DE LA JARA (Chile), referring to paragraph 7 regarding capacity-building for health research, gave the example of the work over the past 20 years of the International Clinical Epidemiology Network (INCLEN), which had resulted in the establishment of more than 60 clinical epidemiology centres throughout the world, mainly in the developing countries. Local capacity had been developed for investigating local problems and producing health policies for individual regions. It had enabled responses to be made to emerging and endemic diseases. Efforts should be made to seek the resources needed to promote research capacity, since that would enable countries to establish their own policy priorities. Or BERLIN (European Commission), speaking at the invitation of the CHAIRMAN, said that the Fifth Framework Programme of the European Community for Research, Technological Development and Demonstration Activities (1998-200 1) contained an important health component with increased funding; spending of some three billion Euros was envisaged over the next five years. The Programme was open for funding to institutions of the European Union and for broad cooperation, and in very specific instances also funding to the countries associated with the European Union, the international organizations and other countries with which the European Union had research agreements. The Programme recognized the importance of including social and economic aspects in health research; at the insistence of the European Parliament, ageing, including its social aspects, had been included as a key area for research. Ethical aspects were also taken into account by the Ethics Advisory Committee of the European Commission. The European Commission was ready to continue discussions on cooperation with WHO in the area of research needs and requirements. The Executive Board might wish to consider how the Commission could provide adequate input into the work of a strategic research council or ACHR. Or FRENK (Executive Director), replying to what had been a very stimulating debate, said there was clearly a need for a research strategy which included priority-setting and reflection on the role of WHO in international cooperation for research. Reflection should continue, but the evidence pointed to research as a major motor for health improvement. WHO's financial resources were very small by comparison with the annual amount spent on health research world wide, but it was the Organization's moral authority and its strategic and global view of health research that had to be mobilized, as well as its consensus-building

SUMMARY RECORDS: FIRST MEETING

capacity to ensure better use of funds, especially by reorienting them towards meeting the needs of the poorest countries. The intent had been to adopt a broad definition of research which was not confined to the generation of new knowledge but covered its translation into policy, practice and guidelines. The intent of the review had been to look into the operational mechanisms WHO currently had at its disposal, rather than to engage in a wider reflection on its research role or to deal with broader questions of priority setting. The review had dealt with ways in which WHO could make better use of the instruments it already had at its disposal, especially at headquarters. One of the conclusions had been to reorient the Department of research policy and cooperation so that it could tackle those questions effectively. There was certainly a need to build on the previous work of ACHR, and especially on the research policy document it recently released, which contained interesting suggestions on networking that were being incorporated in the review of WHO collaborating centres and other forms of WHO cooperation. There was also a definite need to incorporate gender considerations and to deal with ethical issues more in depth: WHO was strengthening its in-house capacity to deal with ethical matters. ACHR had been a fundamental instrument, and the purpose of the recommendations had not been to do away with it but to see how it could be better used and adapted to new requirements. The document under review had presented the proposal of the external board of advisers that ACHR should be replaced by a strategic research council, but the Cabinet had requested further analysis, and it was considered that most of the recommendations could be accommodated within the current definition and mandate of ACHR, with some adaptation to meet current requirements. An important qualification was that ACHR globally had to be balanced in terms of gender, regions, and disciplines. He noted that there were also regional advisory committees for health research, which provided an opportunity for a more focused approach to health problems. Responding to Professor Girard on ACHR's revitalized advisory function, he clarified that it had not been intended to include nontechnical matters in its mandate; it would cover only the scientific foundations for the technical programmes. There had been general support for the review of WHO collaborating centres, and he echoed the need for a networking approach and for focus on supporting research capacity-building and research management capabilities in countries. It was hoped that by rearranging the department so that it was no longer managing the process ofthe expert advisory panels and expert committees, a much better response could be provided to country needs. Dr ALLEYNE (Regional Director for the Americas) said he hoped that the Board would agree that the programme areas already accepted as priorities would be the focus of WHO's efforts in research, and that the Board would not wish to see a divorce between the thematic and research aspects of the Organization's work. He hoped that the Board recognized that the Organization would engage in technical cooperation in research in the thematic areas identified in the programme and budget. Secondly, the problem with ACHR was not in the Committee per se but in the quality of the advice asked of it and the extent of the response to that advice; the issue was the quality of the advice sought of a committee and the use made of it. He wished to reassure the Board that there was no intrinsic conflict or incompatibility between having an ACHR and having expert committees in specific areas. The CHAIRMAN said he took it that the Board wished to note the report on the understanding that further consideration would be given to the issues raised. It was so agreed.

The meeting rose at 13:00.

SECOND MEETING Wednesday, 26 May 1999, at 14:30 Chairman: Dr A.J.M. SULAIMAN (Oman)

EXTRABUDGETARY RESOURCES: POLICY FRAMEWORK: Item 5 of the Agenda (Document EB104/3)

Dr BROUN (Resource mobilization), introducing the report (document EB104/3), said it contained in its Annex the policy document requested by the Board in decision EB 102(2). The draft strategy outlined dealt with mobilization of the resources formerly termed "extrabudgetary" but for which a new appellation would need to be found since such resources would in future form part of a single budget for the Organization. The strategy would be reviewed in the light of the Board's comments on the present occasion and resubmitted to the Board at its 105th session and subsequently to the Fifty-third World Health Assembly. The basic objectives ofthe strategy were to increase levels of investment in health globally, to ensure that such investment would be used to the best effect, and to secure the resources required by WHO for its own work. With respect to the last objective, a number of key strategic elements were identified. The first was the streamlining of resource mobilization into the biennial regular budget cycle so as to incorporate all resources available to the Organization within a single budget. The second was the creation of a new system for management of voluntary contributions to ensure that funds were channelled to four levels (thematic projects, cross-cluster projects, clusters and regional offices, and departments and country offices) with a minimum of earmarking. Other key elements would be the encouragement of long-term pledges, the convening of meetings with interested parties, the rationalization of bilateral meetings with donors, the streamlining of reporting mechanisms and proposal frameworks, the achievement of a unified strategy through consolidated work plans, the improvement of transparency and communication throughout the Organization, and the compilation of a database with government donor profiles. Work on the last three points was already under way. Professor ALl (Bangladesh), welcoming the report, said that an effective and objective policy framework for extrabudgetary resources was essential for achieving the Director-General's goal of one WHO with a single budget. With regard to meetings of interested parties, a practice that had already proved very useful and productive, it was vital to increase the participation of recipient developing countries. It might also be useful for the reports of such meetings to be brought to the attention of the Board and the Health Assembly. The "open house" option appeared promising, but he wondered whether simultaneous scheduling with the Health Assembly, with its crowded timetable, would be feasible. Referring to the Appendix setting out a two-year cycle of resource management, he asked whether, in the review process scheduled for March/April 2000, the regions would be restricted to reviewing existing programmes or whether they would have the opportunity to set regional priorities. Furthermore, would the review process scheduled for June 2000 involve the Organization as a whole, including the regional offices? In the new streamlining of resource mobilization it was important to ensure that small programmes existing at country and regional levels did not lose out. Dr BOUFFORD (United States of America) welcomed the policy framework, commenting that it was the successful culmination of a process initiated by the Board some two years earlier. The goal of that

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SUMMARY RECORDS: SECOND MEETING

process had been to achieve· an integrated use of WHO's funds from both regular budget and extrabudgetary sources for the priorities identified by the Director-General and approved by the governing bodies. However, although the proposed policy paper outlined an effective approach for fund-raising it failed to address the role of the Board and Health Assembly in priority-setting for extrabugetary resources in the review cycle set out in the Appendix. In addition, although it was appreciated that donors had specific interests, it was important to ensure that WHO priorities were not undermined by peripheral concerns by making those priorities plain to the donor community. On the operational level, it was important that bilateral donor meetings and briefings should continue to be held in addition to the meetings of interested parties. She welcomed the different models proposed for the latter, but stressed that sufficient notice should be given of their dates and agendas, and appropriate documentation provided in advance. It might also prove necessary to establish a specific mechanism for ensuring that senior staffboth at headquarters and in the regions were aware of needs in areas other than those under their own responsibility, so that they might be able to identify opportunities for other parts of the Organization. Similarly, a specific process should be implemented for approving the timing of contacts and the individual to be entrusted with fund-raising responsibilities for any cluster or programme. Furthermore, as Professor Ali had pointed out, it was important to ensure that programmes having difficulty attracting donor support should also be given the opportunity to make their case. Mr VOIGTLANDER (Germany) said that a high degree of coordination would be needed to achieve resource mobilization based, as the draft policy stated, on the concept of one single and coherent WHO under the guidance of its governing bodies. However, the current system could hardly be said to be coordinated at all, with Member States receiving competing requests tor funding from a plethora of sources at various levels within WHO, some of them in total disregard of the priorities set by the Organization. The Board had repeatedly drawn attention to the difficulties of channelling extrabudgetary resources. He therefore welcomed the Director-General's call for one WHO, one budget. It was, however, disturbing that a major part (52%) of that budget was not, strictly speaking, under the control of the governing bodies. Any move to redress that situation would be of benefit to the entire Organization. The current situation amounted to a race for resources, the winners not necessarily being the most deserving projects from the standpoint of WHO priorities. Germany had, for its part, established an annual cooperation project with WHO which reflected joint priorities and excluded the possibility of additional demands being made later in the year, thereby providing each party with security for long-term planning. Regarding the meetings of interested parties, he asked whether their purpose was to provide countries with technical briefings on specific programmes or to attract additional resources to a given programme. What system was envisaged for reporting back to the Director-General and to the Board? He noted that the two-year cycle for extrabudgetary resources envisaged in the draft policy might not suit those countries which had annual budgets. Or AL VICK (Norway), welcoming the draft policy, endorsed the need for closer coordination of extrabudgetary and regular budget sources of funds and their incorporation into a single budget process in order to allocate resources in a more strategic and democratic manner, particularly in view ofthe increasing proportion of WHO funds coming from voluntary sources. Introduction of an integrated budget would, however, make it necessary to have a united and transparent decision-making process and a comprehensive approach to the monitoring and evaluation of all programmes, regardless of source of funds. A clearer definition both of the role of the meetings of interested parties and of the division of responsibilities with the governing bodies would be appreciated. Furthermore, it would need to be made clear to donors that any targeting of funds in line with donor policies, agendas or preferences would have to take place within the framework of the priorities set by a single and coherent WHO under the guidance of its governing bodies. Professor ZEL1NER (Switzerland), expressing support for the draft strategy, said that it responded well to countries' requirements. Significantly, however, the strength of the Organization did not rest solely in its financial resources. Equally important were the moral integrity of its management, and its ability to

EXECUTIVE BOARD, 104th SESSION

influence the policies both of Member States and of other agencies. Given the difficulty in achieving any increase in the level of the regular budget, the additional funding the Organization needed for its work could only come from increased extrabudgetary resources. He shared Mr Voigtliinder's concern over the difficult position of donor countries, continually besieged with new requests for funding. The proposed strategy had the merit of making it easier to respect WHO priorities. However, a degree of competition between programmes for additional funding was actually beneficial in stimulating fund-raising at all levels and from a wide variety of sources; an overly rigid and centralized mechanism could cause the Organization to lose out on additional funds it might otherwise be able to procure. Dr VAN ETTEN (Netherlands) expressed approval for the draft policy framework while suggesting a number of areas meriting further improvement. The authority, legal status and terms of reference of the meetings of interested parties needed to be clarified, including their mechanisms for reporting to the Director-General and governing bodies and their relationship to bilateral donor meetings. Recipient countries needed to be stimulated to provide more input to meetings of interested parties. The manner in which voluntary contributions were spent should be transparent, which called for a single format for financial and narrative reporting that included a policy outlook for the two years ahead and the results of internal evaluations. There should be consistency in the way policy objectives financed by voluntary contributions were included in the consolidated budget. Efforts, involving both donor and recipient countries, would need to be made to achieve greater predictability of financial support in the long term and greater insight into donor earmarking practices. Opportunities to broaden the base of voluntary contributions and further the involvement of donors should be actively pursued, and means sought to overcome the high drop-out rate among private sector donors. Of the various models proposed for the meetings of interested parties, he much preferred the current procedure and would not welcome the "open house" format given the lack of time available for such work at Health Assemblies. The establishment of a database with government donor profiles would be welcome, provided it was made accessible to a wider public. The Netherlands had already begun preparations for the pledge of voluntary funds it would make for the coming biennium. Mr CHATURVEDI (India) said that the lack of growth in the regular budget made the contribution provided by extrabudgetary funds increasingly important. He therefore strongly supported the effort to provide a mechanism to get the best out of such resources and ensure transparency in the way they were used. As previous speakers had pointed out, a more detailed description of the system proposed would make it of even greater use to donors and recipient countries alike. He noted that the amount of extrabudgetary funds available to the South-East Asia Region in the 2000-2001 budget appeared to be about a quarter of that for the current biennium. In view of the large population and heavy disease burden of the Region, he was anxious that the shortfall should be addressed, and asked whether it was owing to some defect in the criteria for the draft strategy or to a lack of effort in the Region. Dr BODZONGO (Congo) applauded the document's focus on the importance of proper accountability of the use made of extrabudgetary funds and the need to maintain a relationship of trust with donors. Meetings of interested parties, by bringing donors and recipients together, would play an important part in ensuring that the Organization's goals were met. He suggested amending paragraph 11(4) to indicate a stronger role for regional offices in the allocation of voluntary funds to departments/programmes and country offices, which would reflect a true decentralization of the Organization. Although decentralization did not exclude control, full empowerment of the regional offices as to allocation of resources would expedite the Organization's work by reducing bureaucracy and facilitating the liberation of funds. Mr LIU Peilong (China), welcoming the report, endorsed the strategic approach set out in the draft policy annexed to it. He applauded the proposed move to a consolidated budget incorporating both regular

SUMMARY RECORDS: SECOND MEETING

budget and extrabudgetary funds, proposals to increase the predictability of extrabudgetary resources and achieve a minimum level of earmarking, establishment of a streamlined biennial cycle for extrabudgetary resources related to the regular budget cycle, a comprehensive advocacy and promotion package for donors, and consultation with donors on the implementation of a unified reporting system. However, with a view to encouraging long-term pledges in line with WHO's requirements, donors should be given a clear picture of the planned allocation of resources and of the relationship between the two sources of budget funds. Furthermore, with regard to resource allocation to clusters and regional offices, for which Cabinet approval was proposed, he suggested that Regional Directors should also be involved in resource allocation to the regions. Mrs JEAN (Canada) said that a number of WHO special programmes and some cosponsored programmes depended almost entirely on extrabudgetary contributions, and most other programmes would suffer considerably if extrabudgetary funding were withdrawn. There had been fears that an excessive reliance on extrabudgetaty funds might distract WHO from its agreed priorities, but she felt that the first report of the Oslo Group had dispatched that concern. She therefore welcomed the comprehensive strategy described in the draft policy, which aimed to mobilize, coordinate and manage extrabudgetaty resources with due consideration for regional issues and smooth management of the cosponsored programmes. It would enable extrabudgetaty contributions to be used more effectively and more resources to be raised for WHO programmes and for other activities in developing countries which reflected WHO's collective priorities. However, it was important to emphasize that extrabudgetary resources did not replace the obligation on Member States to pay their assessed contributions to the Organization in full and on time. The strategy discussed the importance of encouraging donors to make long-term pledges and pay their contributions promptly. However, WHO needed to give more thought to the conditions governing donors' support for health programmes and to consider how investment in health could be made more attractive. International development was a very competitive field and in all sectors needs were much greater than available resources. The reform of the extrabudgetaty fund-raising process would require close consultation with all interested parties; changes should not be introduced until their merits had been properly assessed. She asked the Director-General to submit a report to the Board in two or three years' time giving a full assessment of the implementation of the policy. Or MELONI (Peru) said that the proposed resource mobilization strategy was a good one. The crucial section was that outlining the strategic approach, although he could not see the link between the statement that resource mobilization needed to be based on the concept of one single and coherent WHO and the importance given to linking resource mobilization to the time-line process of the regular budget. He was not at all sure that the problem was one of timing: it was surely more that donors and WHO did not necessarily share the same priorities. But of course, the matter could be tackled in a manner which fitted in with the budget cycle, principally by adjusting the timing of the negotiations, as recognized in paragraph 5 of the draft strategy. For the sake of clarity, the draft strategy should state explicitly that references to the budget cycle or other time issues referred basically to the time to be chosen for negotiations on common objectives and lines of action. As the text currently stood, it implied that adjusting the timing of fund-raising activities would solve the whole problem, which he did not believe was the case. The real difficulty was to achieve consistency between the objectives and interests of donors and those of WHO. After all, countries and organizations which contributed additional funds were part of the Organization, to some extent. Turning to paragraph 9 of the draft strategy, he asked for further information about the assertions that the management of resources should be more transparent and professional follow-up should be implemented, especially with private sector donors, to counteract the unduly high drop-out rate. He had thought that donors preferred to give extrabudgetary resources precisely because they were used in a more transparent manner and with better follow-up than regular budget resources.

EXECUTIVE BOARD, 104th SESSION

Paragraph 11 of the draft strategy implied that the Organization received resources from donors and was free to assign them as it wished; indeed it described four levels within the Organization at which those resources might be disbursed. That was certainly a possible option but, according to paragraph 5, the policies, agendas and preferences of donors would also need to be taken into account. So there was a discrepancy between the two paragraphs that needed to be clarified. Paragraph 11 also referred to the allocation of funds to departments, programmes and country offices on the basis of work plans approved by Executive Directors and Regional Directors. However, in his opinion, funds could not be allocated at that level without consultation with governments, particularly ministries of health. Surely, the work plan must be approved first by the country concerned, then by the WHO Executive Director and the Regional Director. The strategy said a good deal about mobilization of resources, but he could not see many references to the use of those resources afterwards. It was essential that regions and countries should be given more power to use resources as they saw fit, in other words the use of resources should be decentralized. He had been very surprised to hear, according to information which was, admittedly, more than a year old, that in the African Region, for example, the Regional Office was not empowered to assign resources: resources were allocated by headquarters. Dr TOYB (Comoros), speaking on the subject of resource utilization, said that the resources mobilized for countries and programmes should be managed at regional level. It was notoriously difficult for countries to gain access to resources managed by headquarters, because of the long and complex procedures involved. He suggested that paragraph 11(3) should be amended to indicate that funds would be allocated to clusters and regional offices on the basis of the budget document and work plans first approved by Executive Directors and the Cabinet. Likewise, in paragraph 11(4) resources should be allocated to departments, programmes and country offices on the basis of work plans approved by the Regional Directors only, not by the Executive Directors as well. Dr THIERS (alternate to Mr Colla, Belgium) said that greater predictability of extrabudgetary resources was essential for good planning. He agreed with the statement to that effect in paragraph 13 of the draft strategy, although the budget and legislation system of his own country, for example, did not in theory allow it to make any financial pledges extending beyond the annual budget cycle. Nevertheless, Belgium did consider it feasible to enter into a medium-term commitment for collaboration with WHO, which would benefit both WHO and the government department responsible for international cooperation in health matters. Belgium considered the meetings of interested parties very important. They provided answers to a great many questions, and helped donors to report back to their taxpayers that public funds were being used wisely. Recipient countries should participate in all meetings, with due observance of the principle of equitable geographical distribution, in order to forge a real and permanent partnership with donor countries. Belgium supported the proposal to introduce a unified system for reporting on the use of extrabudgetary resources, as described in paragraph 18 of the draft strategy. The Belgian government department responsible for international cooperation already held annual consultations with WHO, ofthe type described in paragraph 17 of the draft strategy. In February 1999, for the first time, the Belgian delegation had included all WHO's Belgian partners. It was a useful way of increasing coordination between various donors within a single country. Lastly, he welcomed the idea of a database giving details of all donors. Dr KARAM (Lebanon), commending the comprehensive draft policy before the Board, said it was clear that WHO had a need for extrabudgetary funds in order to pursue its health goals. Since continuity of funding was important, he welcomed the emphasis in the draft strategy on the need for transparency and good communication with donors of extrabudgetary funds at all levels of WHO. It was essential to offer donors well planned projects in areas of interest to them.

SUMMARY RECORDS: SECOND MEETING

It was also important to inform donors of the way in which their funds had been spent, by means of a reporting mechanism such as that described in the draft strategy, thorough follow-up and demonstration of the results of the project concerned, in order to maintain donor commitment at a high level.

Dr MBAIONG (Chad) praised the high quality of the draft policy. Many previous speakers had stressed the importance of transparency in resource allocation. He felt that the best way to achieve transparency was to allocate extrabudgetary resources on the basis of work plans drawn up by Executive Directors and Regional Directors, who were the most familiar with country programmes. He therefore agreed with the proposals ofDr Bodzongo and Dr Toyb to redraft subparagraphs 11(3) and 11(4) ofthe draft strategy. The meetings of interested parties should bring together not only donors, but also recipient countries, so that they could highlight their particular needs. Professor GIRARD (France) felt obliged to point out a certain degree of hypocrisy in the current debate. The proposed programme budget submitted to the Health Assembly the week before had been a zero real growth budget, and the budget eventually adopted had been increased only by US$ 15 million, taken from casual income. Yet, today, Board members were welcoming the growth in extrabudgetary contributions. It was important to remember the risks inherent in an imbalance between regular budget funds and extrabudgetary resources, namely the danger of fragmentation of contributions and the accompanying difficulty of exercising political control over those contributions. World spending on health was increasing, but fewer funds were being allocated to WHO, which was a cause of real concern. Mr FAIREKA (Cook Islands) welcomed the resource mobilization strategy. Like others, however, he felt that subparagraphs 11(3) and 11(4) should be amended along the lines suggested by previous speakers. Dr Ponmek DALALOY (Lao People's Democratic Republic) said that there seemed to be a general desire to make WHO into a single entity, whereas in fact it consisted of six regions and almost 200 countries. On the one hand, the Organization wanted to keep control over all its resources in order to stay on the path it had set for itself but, on the other, it needed more funds. Those two aims might seem contradictory, but they could be reconciled. Control could be exercised by determining priorities and drawing up plans; the need to obtain more financing could be met by granting more flexibility in resource mobilization and, consequently, in the use of the resources, while adhering to the priorities and plans of the Organization. More work needed to be done on procedures and on the division of labour between the various levels of WHO ifthe mobilization of extrabudgetary resources were not to suffer. He was sure that some middle way could be found between the two extremes of mobilization and use of resources without any priorities whatsoever and an over-rigid centralist style of management which would restrict dynamism and initiative. Dr AL-JABER (Qatar) said that the main problem, in his opinion, was lack of coordination with the regional offices. Voluntary contributions should remain within the regions and the regions should be free to allocate them as they saw fit. Decentralization should be the aim. Dr BROUN (Resource mobilization), responding to the points raised by Board members, said that the debate had been a very useful one. He agreed with the remarks which Professor Girard had made: he only wished WHO could spend all its time mobilizing resources for world health instead of merely trying to finance its budget, but one had to be realistic. With regard to concerns about the biennial procedure of resource mobilization, which was an essential planning tool for WHO, he assured the Board that the fiscal procedures of each country would be respected. WHO was trying to establish an overall framework for cooperation with a number of countries, in order to arrive at a planning system which fitted in with the WHO budget cycle, while respecting those countries' own systems. It was essential to ensure that funds were not mobilized or used

EXECUTIVE BOARD, 104th SESSION

without priorities or plans, as Dr Ponmek Dalaloy had said. The required predictability could only be achieved by thorough planning. The issue of ensuring that funds went to WHO priorities had come up several times. The work of the Oslo Group and of the ad hoc working group established by the Executive Board had shown that no real problem had yet arisen, since most additional resources were used on WHO priority activities in any event. However, there might be cause for concern in the future as dependence on additional resources grew; for that reason, efforts were already being made to reduce earmarking to a minimum and ensure the management of funds within approved work programmes corresponding to WHO priorities. Donors would be encouraged to refrain from giving detailed instructions for their use so that the Executive Directors and Regional Directors could use those funds for WHO priority activities. Paragraph 11 of the proposed strategy had given rise to a number of problems, and it would clearly be necessary to rewrite that paragraph before the strategy was resubmitted to the Board at its next session. The paragraph was largely concerned with the restructuring of the Voluntary Fund for Health Promotion, as recommended by the Health Assembly. It was hoped to revise the entire system of reporting to donors on the basis of the new structure, which should make the allocation and use of funds much more transparent. The issue of competition for extrabudgetary funds had also been raised. WHO was certainly competing with other worthy causes on the international assistance "market", and if that made the Organization try harder, it was no bad thing. There was no question of centralizing resource mobilization completely: no monolithic framework was in view. Instead, the aim was to achieve a planning system acceptable to all concerned and a uniform system of work plans for all WHO programmes. Resource mobilization would be carried out on a decentralized basis, using that unified framework. Another important point concerned the issue of evaluation and follow-up. If WHO were to ask donors to refrain from earmarking the funds they gave, they would need evaluation tools which would show them how WHO was using their money. Work was in progress, and he hoped to present more information about the proposed internal and external evaluation framework at a later date. Some Board members had commented on the meetings of interested parties; he hoped that many would be able to attend those scheduled for June 1999. The Board's comments would be taken into account in preparing a revised draft policy for consideration by the Board at its 105th session.

STAFF DEVELOPMENT AND SUPPORT: Item 6 ofthe Agenda

Renewal process update (Document EB 104/4) Dr BOUFFORD (United States of America) said she would be glad if information could be made available to the Board at its 105th session on the issue of short-term contracts. As the Organization moved more towards extrabudgetary funding, it was understandable that long-term commitments to staff would become more problematic. She would also appreciate information on the impact of the reorganization on women employees at different levels of the Organization. Dr VAN ETTEN (Netherlands) said paragraph 11 of the report, which dealt with the meeting of WHO country representatives held in February, seemed unduly brief; he would be glad to have further details. Dr THIERS (alternate to Mr Colla, Belgium) congratulated the Director-General on the far-reaching and difficult reforms undertaken both at headquarters and in the regions. The process of change was certainly not yet complete. It should continue with maximum transparency and the full involvement of the staff concerned. He considered that his country's contribution to the Renewal Fund was both justified and

SUMMARY RECORDS: SECOND MEETING

necessary, and hoped that other countries would follow Belgium's example. information on how the monies raised had been used.

He would appreciate

Mrs JEAN (Canada), referring to paragraph 12 of the report, said she would like to know how the additional funds allocated to upgrading technical and managerial skills had been used, and also whether any positive results had been achieved by the new approach towards human resources management. In reducing the number of programmes from 50 to 35, had any technical activities been reduced or eliminated, and if so, which were they? Or JIMENEZ DE LA JARA (Chile) said that although it was somewhat too early to be able to assess the results ofthe reform process, he would like to ask the Director-General whether she had encountered any difficulties in making such swift and drastic changes in a fairly extensive bureaucratic structure. He would also like to know whether the new criteria for ensuring greater representativity in staff appointments had proved useful in practice. Had it been possible to reconcile criteria such as gender equity and regional equity with criteria such as levels of skills and efficiency? Mrs KERN (Executive Director), in response to Or Boufford, said the two important issues she had referred to would be the subject of a subsequent report. A more detailed report on the meeting of WHO country representatives was available and could be circulated if required. The meeting had discussed some fundamental issues, including what WHO's role in the countries could be, given the right resourcing, and the need for more communication between headquarters, regions and country otlices. It had emerged that only three WHO country offices were not linked with headquarters by the Internet: that mechanism would be used more freely for communications in the future. A wide range of administrative, efficiency and policy issues had been raised, including technology, financial management, accounting abilities, staff training, and staff appointments. The meeting had achieved a good balance in terms of gender, age and experience and had been considered a success by participants. The Director-General believed that staff development was an important issue and had committed substantial sums of money from the Renewal Fund for that purpose, only a small part of which had so far been used. Particular attention was now being paid to improving stafftraining and staff mobility. Regions and clusters were working together in the development effort, using part of the funds for team-building and part to create specific areas of expertise as needed. In response to Mrs Jean, she said there had been a realignment rather than a reduction in the technical units, with certain aspects being dropped and others strengthened. For instance, the drug management programme and the drug action programme had been amalgamated into one integrated unit. That had led to a better managerial and policy approach, as well as to a saving of US$ 1 miJiion. A close look was being taken at a variety of evaluation and monitoring systems which would measure how far the various units and clusters were complying with the rules of good business. In-depth reviews and evaluations had always been part of WHO's work in the past. In response to an earlier request by the Board, information on past reviews had been included in Annex 2 of document WHA52/INF.DOC./2 submitted to the Health Assembly. It was too early for any evaluation to be made of the period since the Director-General had taken office. The DIRECTOR-GENERAL, referring to the Renewal Fund, said that during the transition period, governments had been asked to contribute to a special fund, so that time would not be lost in setting in motion the process of change and renewal. Indeed, that process would have been very difficult to achieve without such a mechanism. Seventeen countries had pledged US$ 6.5 million of the US$ 10 million sought. So far, US$ 4 million had been received, and of that sum US$ 750 000 had been used to meet the costs ofthe first ever meeting of WHO Representatives, which had proved a most worthwhile exercise in that it had brought together people both from different regions and from different parts of the same region. The money thus spent had been a valuable investment in the "person factor". US$ 1 million had been invested in headquarters and regional office staff training, and US$ 800 000 in information technology. Other worthwhile initiatives had been the Partnership for Health Sector

EXECUTIVE BOARD, 104th SESSION

Development project, which introduced a new country focus, and the informal retreat held the previous autumn, which had increased the capacity of Board members to support each other in the renewal process. She thanked all those who had contributed to the Fund: without their help such positive developments would not have been possible. Statement by the representative of the WHO staff associations on matters concerning personnel policy and conditions of service (Document EB 104/INF .DOC./1) Mrs DWEGGAH (representative of the WHO staff associations) thanked the representative of Belgium for having drawn attention to the importance of staff participation in the renewal process. Highlighting the points raised in the document under review, she was glad to say that there was now increased communication between staff and the Administration: however, staffwere still not sufficiently involved at operational level. There was concern that the cluster system might lead to the creation of nine mini-WHO's under the umbrella of a single organization. Staff should be permitted to attend cluster meetings as observers, to ensure that there were no disparities in treatment of staff between the various clusters. She welcomed the new procedure whereby staff could participate in the process of selection of candidates, which was fairer to staff and candidates alike. Or Boufford had raised the important issue of short-term employment. Some staff had in fact been working on a temporary basis for as long as 14 years, and clearly could no longer be regarded as temporary. There was also concern at the lack of uniformity and consistency in the application of new policies throughout the Organization, and in particular as between headquarters and the regions. Such inconsistency ran counter to the fundamental concept of the new WHO, and created inequitable working conditions, thereby affecting morale and productivity. Staff representatives should be involved from the outset in task forces and working groups dealing with important issues such as relocation, security, and staff displacement. The disparity in employment security and other rights between locally recruited staff and those of internationally recruited staff should also be remedied. The problem of the lack of human resources skills on the part of some managers was a long-standing one. In particular, the problem of psychological harassment ofstaffhad existed for many years without ever being addressed, and she welcomed the fact that the new Administration had admitted its existence and was developing a policy to tackle it. Lastly, equity on the basis of geographical distribution was not reflected in the balance of staff at WHO, especially ofhigh-level staff, and that situation too needed to be remedied. The DIRECTOR-GENERAL said it had been a positive experience to work with the headquarters Staff Association, and to discuss in depth many important issues: such discussions were essential if WHO was to move ahead. The approach of the headquarters Staff Association had been open, constructive and frank. A continuous dialogue on how to change, improve and overcome weaknesses was vital if the Organization was to fulfil its mandate effectively. Professor GIRARD (France) said that a period of change in any institution was always a testing time, and it was bound to be difficult for staff to adapt to new circumstances. On behalf of the Board, he would like to express his gratitude to the staff for making possible the renewal and strengthening of the Organization, and the increase in its efficiency in the struggle to overcome the health problems of the world's peoples. Mrs KERN (Executive Director) added her thanks to the staff for their contribution during a difficult and challenging time. She was grateful for the positive relationship which existed between the administration and the staff associations. When recruiting, the Organization took into account three factors: excellence, gender and geographical balance. In order to achieve the latter, monthly monitoring was carried out, which had showed that currently there were 63 countries on the under-represented list, 50 of which had no nationals in the Organization. Everything possible was being done to remedy that situation: thus, promotions of

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persons from countries which were already well- or over-represented were considered carefully in case equally qualified candidates from other countries might be available. Dr AL-JABER (Qatar) said he was grateful to the Director-General for her efforts to achieve equitable allocation of posts. However, he would ask her to review the criteria governing geographical balance, particularly for senior posts. It was important that priority should not be given to one region at the expense of another. Dr JIMENEZ DE LA JARA (Chile) said that he had found the proposed structure of the Administration to be outstandingly politically correct and therefore difficult to accomplish in practice. Nevertheless, according to the representative ofthe staff associations, staffhad been in agreement with the process. The success was to the credit of both staff and senior management. Rapid or radical change could pose difficulties and he was reassured to see that the process had not been traumatic, although there had been and doubtless still would be some problems. Board members had experienced the management of change in ministries and large organizations and they understood the importance of the relationship between management and staff in that most difficult process. Dr RAHMAN (alternate to Dr Ali, Bangladesh) noted with approbation that the human element in the approach of both staff and management had been retained through the challenges posed by change. Leading into the twenty-first century, he hoped that all those involved in working hard for the Organization would remain human beings, with all their emotions and imperfections. The CHAIRMAN invited the Executive Board to note the statement by the staff representative. The Board took note of the statement of the representative of the WHO staff associations.

MANAGEMENT AND FINANCIAL MATTERS: Item 7 ofthe Agenda

Amendments to Rules of Procedure of Executive Board on election of Chairman (Document EB104/5) Mr TOPPING (Legal Counsel), introducing the report, explained that it had been suggested that the Chairman (and, by extension, the Vice-Chairmen) of the Executive Board should be elected at the end of the January session in order to give the persons chosen time to prepare before chairing their first Board session in May. On the basis of the precise wording of Article 27 of the Constitution, such a process would not be unconstitutional. However, as one-third of the membership of the Board was replaced each May, a January election would mean that one-third ofthe outgoing membership would be voting for a Chairman under whom they would not serve and, conversely, one-third of the incoming membership in May would find themselves presided over by a Chairman in whose election they had not participated. Furthermore, the one-third of the membership whose term ended in May and their subsequent replacements would be ineligible to stand for election. However, after consultation with the legal counsels in other organizations and bodies of the United Nations system, he had concluded that as long as the process was clear in the Rules of Procedure, the problem of disenfranchisement was not a bar to proceeding with that course of action. The Chairman could take office at the end of the January session, thus allowing the DirectorGeneral the opportunity to consult with him or her on the provisional agenda for the May session as set down in Rule 8 and Rule 10 of the Rules of Procedure. It was proposed that the procedure envisaged would also apply to the Vice-Chairmen. He drew the Board's attention to a proposal for amendment of Rule 12 ofthe Rules ofProcedure contained in paragraph 10 ofthe report.

EXECUTIVE BOARD, I 04th SESSION

Dr AL-JABER (Qatar) noted that the proposed new procedure was not in fact a practice in other United Nations organizations. He saw no reason to change the procedure at WHO as that might lead to amendment not only of the Rules of Procedure, but also of the Constitution. Or BOUFFORD (United States of America) explained that the proposed change had been prompted, in part, by the changing nature of the position of Chairman ofthe Board. In line with the new structure of the Organization, the role would become more active, with an office and support being set up. The new structure would allow for enhanced planning and communication. Furthermore, since officers of the Board were generally in their second or third year of tenure on the Board because familiarity with its work was required, the fact that the procedure might deny election to a new member would not therefore be an issue. The officers of the Board were involved in the improved functioning of the Organization and early election of a Chairman would allow greater involvement of the Board in the planning of the Assembly and ensuing session of the Board. The DIRECTOR-GENERAL said that the Legal Counsel had explained all the implications of the proposed change, which had been proposed in order to allow better preparation and participation on the part of the newly-elected Chairman and Vice-Chairmen. Past experience had indicated that the proposed change would be a useful one. Mr TOPPING (Legal Counsel) assured those present that the proposed change would not require an amendment to the Constitution. Dr FETISOV (alternate to Professor Starodubov, Russian Federation) said that the proposed amendment to Rule 12 might prove complicated. He advocated exploration of alternative methods of providing experience to an incoming Chairman. Even ifthe Chairman entered into the role in January, the position would not be formally recognized until the following May when one-third of the Board's membership was replaced. The process as described might be perceived as undemocratic, as one-third of the membership would not have a chance to participate in the election. It might be that the proposed new structure would endanger the good working relationship and spirit of cooperation that traditionally prevailed within the Board. He wondered whether it would not be simpler to hold an election for the Chairman at the end of the May session, with only those members who had been on the Board for at least one year having the right to vote. The Chairman would serve for one year and then revert to ordinary Board membership. All members would be entitled to vote for the remaining officers. The Chairman would still be involved in the preparation of the agenda for the following Health Assembly. An advantage would be that candidates would only be eligible for election to the Chair once during their term of service on the Board. Dr BODZONGO (Congo) said that he considered it wiser to elect the Chairman at the end ofthe Health Assembly when stock could be taken of the position of the Organization. The Chairman could then conduct affairs for one year before reporting to the next Assembly. If the new arrangement were to be put in hand, the Chairman would only have four months' experience before the Health Assembly. Furthermore, a complicated situation would arise whereby the periods of office of the incoming and outgoing Chairmen would overlap. He recommended that traditional practice should be adhered to, with the Chair rotating from region to region. Dr MELONI (Peru) suggested that discussion of the matter should be adjourned, and taken up by the Board at its next session. The proposed amendment dealt merely with the term and dates of office of the Chairman, but there were additional issues which had been raised by other speakers. One major requirement was to ensure a close relationship between the Board and the Assembly, in which the Chairman played a major part.

SUMMARY RECORDS: SECOND MEETING

Dr KARIBURYO (Burundi) recalled that the new measure had been proposed in an effort to improve the performance of the Board. He seconded the proposal to adjourn discussion of the matter until the following January by which time a report could have been prepared taking into account the points raised during the discussion. Dr RAHMAN (alternate to Dr Ali, Bangladesh) suggested that, before submission of a report to the next session of the Board, informal discussions should be held between those members having differing views, so that agreement could be reached. Dr ALVIK (Norway) agreed that an informal discussion on the topic and, more generally the functioning of the Executive Board, would be useful. Dr VAN ETTEN (Netherlands) said that, although he would have lent his support to the proposed amendment to Rule 12 as set out in the report, he could agree to postpone discussion ofthe matter until the next session of the Board. Professor KAKOU GUIKAHUE (Cote d'lvoire), Rapporteur, suggested that an informal group should be formed to study the matter and to report back to the next session of the Board. The CHAIRMAN undertook to consult with Board members and the Director-General and her staff before the matter was submitted to the Board again for consideration at its I 05th session. It was so decided.

Amendments to the Financial Regulations and Rules (Document EB I 04/6) Dr BOUFFORD (United States of America) said that creation of the post of internal auditor and the proposed incorporation of the mandate of the Office oflnternal Audit and Oversight (IAO) in the Financial Rules placed WHO at the forefront of the movement towards transparent decision-making in the United Nations system. With regard to the draft amendments to the Financial Rules contained in the Annex to the report, she suggested that to make the role of the internal auditor perfectly clear they should be further modified as follows: removal of the words "Chairperson and other officers of the" from the first sentence of paragraph 11 7.3 and the words "the officers of' from its last sentence; addition of the words "Confidentiality shall be respected at all times and" at the beginning of the second sentence of paragraph 117.4(c) and addition ofthe words "as well as the implementation status of recommendations" to the end ofthe first sentence in paragraph 117.4(e). Lastly, a new paragraph 117.5 would be added to read: "The Director-General shall ensure that all IAO recommendations are responded to and implemented as appropriate.", thus making explicit the Director-General's duty to respond to the recommendations of the internal auditor. Mr TOPPING (Legal Counsel) explained that the amendments to the Financial Rules were presented to the Board for confirmation, which was in conformity with the provisions of the Financial Regulations. Although the Board did not thus have the possibility of amending the text submitted by the DirectorGeneral, he was informed that the Director-General could accept the proposals submitted by Dr Boufford. Those proposed changes could therefore be considered as incorporated into the text submitted to the Board for confirmation. The CHAIRMAN said that in the absence of objections he took it that the Board agreed to confirm the modifications to the Rules submitted by the Director-General, incorporating the proposals of Dr Boufford.

EXECUTIVE BOARD, I 04th SESSION

It was so decided.

The CHAIRMAN drew the Board's attention to the draft resolution contained in paragraph 4 of the report. The resolution was adopted. Membership of committees and representatives of the Executive Board (Documents EB I 04/7 and Add. I) Programme Development Committee The CHAIRMAN reminded the Board that the Committee consisted of six Board members, one from each of the WHO regions, plus the Chairman or a Vice-Chairman of the Board. Decision. The Executive Board appointed Dr M.E. Mbaiong (Chad), Dr J. Jimenez de la Jara (Chile), Mr Y.N. Chaturvedi (India), Dr Ponmek Dalaloy (Lao People's Democratic Republic), Dr A. Meloni (Peru), Vice-Chairman of the Board, member ex officio, and Or K.A. Al-Jaber (Qatar) as members of its Programme Development Committee, established under resolution EB93.RI3, for a maximum period of two years, in addition to Dr G.M. van Etten (Netherlands), already a member of the Committee. It was understood that if any member ofthe Committee was unable to attend, his or her successor or the alternate member of the Board designated by the Government concerned, in accordance with Rule 2 ofthe Rules ofProcedure, would participate in the work of the Committee. Administration, Budget and Finance Committee The CHAIRMAN reminded the Board that the Committee consisted of six Board members, one from each of the WHO regions, plus the Chairman or a Vice-Chairman of the Board who should, wherever possible, have experience of administration and budgetary and financial matters. Decision: The Executive Board appointed Dr M. Toyb (Comoros), Mr H. VoigtUinder (Germany), Vice-Chairman of the Board, member ex officio, and Professor T. Zeltner (Switzerland) as members of its Administration, Budget and Finance Committee, established under resolution EB93.R I3, for a maximum period of two years, in addition to Professor S.M. Ali (Bangladesh), Mr Liu Peilong (China), Mr C. Solomis (Cyprus) and Dr J.l. Boufford (United States of America), already members of the Committee. It was understood that if any member of the Committee was unable to attend, his or her successor or the alternate member of the Board designated by the Government concerned, in accordance with Rule 2 ofthe Rules ofProcedure, would participate in the work of the Committee. Audit Committee The CHAIRMAN said that in accordance with resolution EBI03.R8 each candidature for the Committee should be supported by a standard curriculum vitae, highlighting the candidate's background in financial, audit and management matters. In a circular letter to all Regional Directors and to the 22 members of the Board known prior to the Fifty-second World Health Assembly, the Director-General had called for nominations and attached a standard curriculum vitae to be completed by those wishing to be considered. The name of one person from each region who would be willing to serve had been received, but not all the necessary curricula vitae. The candidates were Mr P.H. Kengouya (Congo) (alternate to Dr D. Bodzongo), Mr Liu Peilong (China), Mr V.A. Vislykh (Russian Federation) (alternate to Professor V.l. Starodubov), Mr N.S. de Silva (Sri Lanka), Dr J.I. Boufford (United States of America) and Dr A.O. AI-Sallami (Yemen). Without all the curricula vitae it was difficult to constitute the Committee. He proposed that he should review the curricula vitae on the Board's behalf and the Committee could then

SUMMARY RECORDS: SECOND MEETING

meet as soon as possible, at which time it could also elect its Chairman. The other option was to delay the nomination process until January 2000. Mr LIU Peilong (China) said that owing to the late arrival of the information his country had not yet nominated a candidate. He wondered whether the Rules of Procedure permitted a candidate to be nominated at a later stage. The CHAIRMAN, after consulting Mr AITKEN (Senior Policy Adviser), said that it was open to members and alternates to submit their curricula vitae. Mr FETISOV (alternate to Professor Starodubov, Russian Federation) said that the decision should not be deferred. The composition of the Committee was basically established and the Board would gladly trust the Chairman to decide on the remaining candidates. In view ofthe importance of the Committee for WHO, deferral till January 2000 would involve too long a delay. The CHAIRMAN took it that the three candidates whose curricula vitae had been received should be appointed and that the suitability of the others should be assessed as and when their curricula vitae were received. Decision: The Executive Board appointed Mr P.H. Kengouya (Congo) (alternate to Or D. Bodzongo), Mr V.A. Vislykh (Russian Federation) (alternate to Professor V.I. Starodubov) and Or J.I. Boufford (United States of America) as members of its Audit Committee. The Board authorized the Chairman to appoint members to the Committee from among the members or alternates of the Board designated by China, Sri Lanka and Yemen, on the basis of curricula vitae to be submitted. Standing Committee on Nongovernmental Organizations Decision: The Executive Board appointed Professor S.M. Ali (Bangladesh) and Professor J.-L. Mamdaba (Central African Republic) as members of the Standing Committee on Nongovernmental Organizations for the duration of their term of office on the Executive Board, in addition to Or J. Jimenez de la Jara (Chile), Mr C. Solomis (Cyprus) and Or G.M. van Etten (Netherlands), already members of the Committee. It was understood that if any member of the Committee was unable to attend, his or her successor or the alternate member of the Board designated by the Government concerned, in accordance with Rule 2 of the Rules of Procedure, would participate in the work of the Committee. WHOIUNICEFIUNFPA Coordinating Committee on Health Decision: The Executive Board appointed Mr M. Colla (Belgium), Professor M. Kakou Guikahue (Cote d'Ivoire) and Or K. Karam (Lebanon) as members of the WHO/UNICEFIUNFPA Coordinating Committee on Health for the duration of their term of office on the Executive Board, in addition to Dr T. Faireka (Cook Islands), Or A. Meloni (Peru) and Mr N.S. de Silva (Sri Lanka), already members of the Committee. It was understood that if any member appointed by the Board was unable to attend, his or her successor or the alternate member of the Board designated by the Government concerned, in accordance with Rule 2 of the Rules of Procedure; would participate in the work of the Committee. Leon Bemard Foundation Decision: The Executive Board, in accordance with the Statutes of the Leon Bernard Foundation, appointed Professor J.-F. Girard (France) as a member of the Leon Bernard Foundation Committee,

EXECUTIVE BOARD, 104th SESSION

in addition to the Chairman and Vice-Chairmen of the Board and the Chairman of the Expert Committee on Malaria, members ex officio. It was understood that if Professor Girard was unable to attend, his successor or the alternate member of the Board designated by the Government concerned, in accordance with Rule 2 ofthe Rules of Procedure, would participate in the work of the Committee. Jacques Parisot Foundation Decision: The Executive Board, in accordance with the Implementing Regulations of the Jacques Parisot Foundation, appointed Or K.A. Al-Jaber (Qatar) as a member of the Jacques Parisot Foundation Committee for the duration of his term of office on the Executive Board, in addition to the Chairman and Vice-Chairmen of the Board, members ex officio. It was understood that if Or Al-Jaber was unable to attend, his successor or the alternate member of the Board designated by the Government concerned, in accordance with Rule 2 of the Rules of Procedure, would participate in the work of the Committee. Ihsan Dogramaci Family Health Foundation Decision: The Executive Board, in accordance with the Statutes of the Ihsan Dogramaci Family Health Foundation, designated Mr N.S. de Silva (Sri Lanka), Vice-Chairman of the Board, as member ex officio of the Ihsan Dogramaci Family Health Foundation Committee, in addition to the Chairman of the Executive Board, representatives of the International Pediatric Association, the Turkish and International Children's Centre, Ankara, and the President ofBilkent University or his or her appointee, members ex officio. Sasakawa Health Prize Decision: The Executive Board, in accordance with the Statutes of the Sasakawa Health Prize, appointed Mrs M. Abel (Vanuatu) as a member of the Sasakawa Health Prize Selection Panel, in addition to the Chairman of the Board and a representative of the founder, members ex officio. It was understood that ifMrs Abel was unable to attend, her successor or the alternate member of the Board designated by the Government concerned, in accordance with Rule 2 of the Rules of Procedure, would participate in the work of the Panel. United Arab Emirates Health Foundation Decision: The Executive Board, in accordance with the Statutes of the United Arab Emirates Health Foundation, appointed Or K.A. Al-Jaber (Qatar) as a member of the United Arab Emirates Health Foundation Committee, in addition to the Chairman of the Board and a representative of the Foundation, members ex officio. It was understood that if Or Al-Jaber was unable to attend, his successor or the alternate member of the Board designated by the Government concerned, in accordance with Rule 2 of the Rules of Procedure, would participate in the work of the Committee. Representatives of the Executive Board at the Fifty-third World Health Assembly Decision: The Executive Board, in accordance with paragraph I of resolution EB59.R7, appointed its Chairman, Or A.J.M. Sulaiman (Oman), ex officio, and Mr Liu Peilong (China), Professor J.-F. Girard (France) and Mr N.S. de Silva (Sri Lanka) to represent the Board at the Fifty-third World Health Assembly.

SUMMARY RECORDS: SECOND MEETING

Administration and award of foundation prizes and fellowships (Document EB I 04/8) The CHAIRMAN drew the Board's attention to paragraph I 0 of the report, which set out action for the Board to consider. Dr JEANFRAN<;OIS (alternate to Professor Girard, France) requested clarification of the proposal to restrict the foundation committees to three members. According to her understanding, a proposal at the most recent meeting of the Leon Bernard Foundation to reduce the Committee to three members had been rejected, on the grounds that the savings involved would be slight, whereas the value of the prize was underpinned by its having to be scrutinized by six members rather than three. She wondered if the Foundation Committee had changed its view since then. Mr AITKEN (Senior Policy Adviser) said that the proposal before the Board was to ask the Foundation Committee to reconsider the matter at its next meeting in January 2000, in the light of the general proposal applying to all the foundations. Decision: The Executive Board, having considered the report on administration and award of foundation prizes and fellowships, 1 decided to recommend to the respective committees that they should take such steps as are necessary to amend their regulations so as to replace the foundation committees by selection panels composed of up to three members (as described in the Annex to the report); and recommended that 13% for programme support costs should be assessed on the amount awarded by the Darling Foundation Prize, the Leon Bernard Foundation Prize, the Jacques Parisot Foundation Fellowship, the Ihsan Dogramaci Family Health Foundation and the Francesco Pocchiari Fellowship to help cover the cost of administering the prizes. Executive Board: future sessions (Document EB 104/9) The CHAIRMAN announced that the retreat referred to in paragraph 3 of the document would be held from 20 to 22 October 1999. Decision: The Executive Board decided that its 105th session should be convened on Monday, 24 January 2000, at WHO headquarters, Geneva, and should close no later than Saturday, 29 January 2000. Fifty-third World Health Assembly (Document EB104/10) Dr MELON! (Peru) conveyed a request from the Government of Mexico that the Fifty-third World Health Assembly should be moved forward to 8 to 13 May 2000, as it was intending to hold a world health promotion conference at the time of the proposed date. The conference was an important one, and changing the dates of the Assembly to allow a sufficient interval between the two events would make it possible for senior ministers to attend both. Mrs JEAN (Canada) said that she understood that the dates of the conference in Mexico were 5 to 9 June. Mr DE SILV A (Sri Lanka) said that the Assembly should not be rescheduled; the Mexican Government had ample time to change its own arrangements. It was logical that the senior organization in a given field should take priority; it would set a poor precedent if the Health Assembly had to accommodate its sessions to a Member State.

Document EB 104/8.

EXECUTIVE BOARD, 104th SESSION

Decision: The Executive Board decided that the Fifty-third World Health Assembly should be held at the Palais des Nations, Geneva, opening on Monday, 15 May 2000, and should close no later than Saturday, 20 May 2000. Use of land Mrs KERN (Executive Director) said that the State of Geneva had given WHO the right to the use ofland on which the headquarters building was situated so long as WHO continued to be based in Geneva. The State of Geneva also owned two pieces of property behind WHO. The Swiss Government wished to construct urgently on one of those pieces of land a building housing about 50 people for the InterParliamentary Union, but it had been unable to obtain permission from the local municipal authorities to gain access to the land from behind. It was therefore requesting WHO for access via WHO premises. The Director-General had indicated to the Government that she wished to consult the Executive Board before giving a final response, since the Board had been closely involved in the initial negotiations about the building of WHO headquarters. Acceding to the Government's request would lead to inconvenience in the short and the long term with regard to traffic congestion and problems with security. Preliminary negotiations with the State of Geneva had been positive and the Director-General would wish to respond favourably; but she needed to be sure that WHO's present and future interests were protected. Traffic flow and security should be assured. She had indicated the preferred option, under which there would be a supplementary entry point into WHO premises, a supplementary exit point out of WHO premises, and the right to use the other piece of land for a building that it was hoped might be built for UNAIDS staff currently occupying cramped space in the WHO building. If the Board agreed, the Director-General would proceed accordingly and report back to the Board at its 105th session if she was unable to obtain adequate assurances from the State of Geneva. Or AL-JABER (Qatar) said that the Director-General was in full possession of the facts. The Board should authorize her to negotiate with the State of Geneva. The CHAIRMAN took it that the Board so authorized the Director-General. It was so decided.

MATTERS FOR INFORMATION: Item 8 ofthe Agenda

Report on meetings of expert committees and study groups (Document EB 104/11) The Executive Board considered and took note of the report1 on the meetings of the following expert committees and study groups: the WHO Expert Committee on Specifications for Pharmaceutical Preparations; 2 the Joint FAO/WHO Expert Committee on Food Additives (Evaluation of Certain Food Additives and Contaminants); 3 the WHO Expert Committee on the Use of Essential Drugs. 4

1 2 3 4

Document EB 104/11. WHO Technical Report Series, No. 885. WHO Technical Report Series, No. 884. WHO Technical Report Series, No. 882.

SUMMARY RECORDS: SECOND MEETING

UNAIDS OPERATING RESERVE FUND: Supplementary agenda item (Document EB104/12)

Dr VAN ETTEN (Netherlands) expressed concern at the high level of the UN AIDS Operating Reserve Fund, which amounted to US$ 33 million, as against a budget of US$ 60 million: probably the highest proportion of reserves against budget of any of the United Nations voluntary funds. It was difficult to explain from a political point ofview why UNAIDS needed extra money if its reserve was so large and he feared that the issue would become an impediment to attracting extrabudgetary funding. Although the issue had been discussed by the UNAIDS Programme Coordinating Board, there seemed very little flexibility on the part ofUNAIDS to solve the problem, because the level of the reserve was in part dictated by WHO financial rules, which applied to UN AIDS. A possible course of action had been to request the Director-General to amend the rules, but the complexity of the issues and possible conflicts with United Nations accounting standards had ruled that out. Some action would, however, have to be taken to reduce the reserve and also to explain its level. The matter would be discussed again at the next meeting of the Programme Coordinating Board, but he requested the Director-General to explore what could be done within the limits of the United Nations accounting standards and WHO's own financial practices, and to provide a more detailed explanation of the difference in the level of the Fund compared with other United Nations funds and programmes. Mrs KERN (Executive Director) said that the Director-General was more than willing to discuss the problem. She noted that the next meeting of the Programme Coordinating Board was to consider a proposal to reduce the reserve. One difficulty was that where WHO provided administrative services for UN AIDS it applied United Nations accounting standards, an essential feature of which was that staff salaries should be paid regularly and on time. The main issue was therefore how high the reserve should be for that purpose. Salaries were a predictable expense, but income was less predictable: pledges were made but payment was not always on time. Discussions on further reduction should be held and more efforts should be made to explain what was a complicated situation. The Board took note of the report and the situation relating to the UNAIDS Operating Reserve Fund.

CLOSURE OF THE SESSION: Item 9 of the Agenda After the customary exchange of courtesies, the CHAIRMAN declared the session closed.

The meeting rose at 19:00.

INDEX TO RESOLUTION AND DECISIONS

(Numerals bearing the symbol "EBJ04.R... "refer to resolutions; numerals alone in parentheses refer to decisions)

Page Administration, Budget and Finance Committee, membership (2) ... . Audit Committee, membership (3) .... . Leon Bemard Foundation Committee, membership ( 6) . . . . . . . . . . . . . .

Page

4 5

Dogramaci, Ihsan, Family Health Foundation Committee, membership (8) ............. .

Nongovemmental Organizations, Standing Committee on, membership (4) . .

6 Programme Development Committee of the Executive Board, membership ( 1) . . . . . . . . . . . . . . 4 5

Executive Board Administration, Budget and Finance Committee, membership (2) .. Audit Committee, membership (3) .. Date, place and duration of 105th session(l3) .............. . Programme Development Committee, membership (1) ........... . Standing Committee on Nongovernmental Organizations, membership (4) ........... .

Sasakawa Health Prize Selection Panel, membership (9) . . . . . . . . . . . . . .

7 4 UNICEF/UNFPA Coordinating Committee on Health, membership (5) . . . . . United Arab Emirates Health Foundation Committee, membership (1 0) . . .

Financial Regulations and Rules, amendments to (EB104.Rl) ..... Foundation prizes and fellowships, administration and award (12) ...

3 7

Jacques Parisot Foundation Committee, membership (7) ............. .

WHO/UNICEF/UNFPA Coordinating Committee on Health, membership (5) . . . . . . . . . . . . . . World Health Assembly, Fifty-third, appointment of representatives of the Executive Board (11) . . . . . . . Date and place (14) . . . . . . . . . . . . . .

7 7

-55-

Key facts

Organisation World Health Organization (WHO)

Document type Governing Bodies documents

Adoption date December 31, 1999

Source World Health Organization