(WPR/RC38/SR/7)
SUMMARY RECORD OF THE SEVENTH MEETING Red Cross National Training Centre, Beijing Friday, 11 September 1987 at 9 a.m. CHAIRMAN: Professor Chen Minzhang (China) CONTENTS
Consideration of draft resolutions 2. Programme budget for 1988-1989:
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174
Contingency plan . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . 174
3.
Consideration of draft resolutions (resumed) 3.1 3 •2
182
Regional priorities under the Eighth General Programme of Work •••••••••••••••••••••••••• 182 Acquired immunodeficiency syndrome (AIDS) • • • • • • • • • • 183
3.3 Special programme of research, development and research training in human reproduction: Membership of the policy and coordination advisory committee •• •• •••••••••••• 186 3·4 Development of health research
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186 188
J.5 Technology transfer
3.6 Resolutions of regional interest adopted by the Fortieth World Health Assembly •••••••••••••• 188 Drug supply management in the South Pacific
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189 190
4·
Management of WHO's resources
- 173 -
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1.
CONSIDERATION OF DRAFT RESOLUTIONS
The Chairman drew attention to seven draft resolutions that had been distributed. Dr WEINSTEIN (United States of America) proposed that consideration of the resolutions, which had been distributed only that morning, be deferred until after the morning coffee break so that participants would have more time to read them.
Dr CHRISTMAS (New Zealand) endorsed the proposal. It was so decided. 2. PROGRAMME BUDGET 1988-1989: Agenda (Document WPR/RC38/3) CONTINGENCY PLAN: Item 8 of the
The REGIONAL DIRECTOR observed that, as stated in document WPR/RC38/3, the Western Pacific Region had formulated a contingency plan for programme budget implementation reductions for 1988-1989 in the amount of US$4 370 000. The document gave the breakdown of those reductions by programme and organization level. One thing that was very clear was that the programme budget for 1988-1989 would not be implemented as originally approved. There were three possible scenarios which could materialize. The first possible scenario was that, if by the end of that year the major contributor had paid all or virtually all of its outstanding contributions for 1986-1987 and could give reasonable assurances that it would pay in full its assessed contributions for 1988-1989, there would be no need for the Director-General to impose contingent programme budget implementation reductions, as he had had to do for 1986-1987. However, in those circumstances the DirectorGeneral was committed to recommend to the Executive Board and the World Health Assembly in 1988 that the approved 1988-1989 global programme budget be officially reduced by US$25 million. Approval of such a recommendation by the Health Assembly would be in the form of an amendment to the Appropriation Resolution for 1988-1989. If that should occur, the approved total regional allocation for the Western Pacific Region would be reduced by US$2 185 000, from US$55 422 000 to US$53 237 000. The second possibility was that, if by the end of 1987 the financial cr~s~s was still plaguing the Organization to the same extent as at present, the Director-General would have no alternative but to carry out the contingent global programme budget implementation reductions in the amount of US$50 million as originally foreseen for 1988-1989. For the Western Pacific Region, the contingent programme budget implementation reduction was · US$4 370 000, and therefore the regional working allocations would be effectively reduced from US$55 422 000 to US$51 052 000. The third possibility was that, if by the end of 1987 the major contributor had paid a significant part, but by no means all, of its outstanding contributions for 1986 and 1987 and could give reasonable
SUMMARY RECORD OF THE SEVENTH MEETING
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assurances that it would pay ita assessed contributions for 19881989, thereby considerably alleviating but not ending the current financial crisis, the Director-General would most probably recommend to the Executive Board and the Health Assembly a reduction of US$25 million to the approved 1988-1989 global programme budget and, at the same time, maintain a contingent programme budget implementation reduction for 1988-1989 of US$25 million. The combined effect of those two measures would result in global programme budget implementation reductions to the approved programme budget for 1988-1989 of US$50 million, to be shared between the regions and Headquarters on a pro rata basis. For the Western Pacific Region, the approved regional allocation would be reduced b,y US$2 185 000, from US$55 422 000 to US$53 237 000. A further contingent programme budget reduction of up to US$2 185 000 would need to be provided for, pending a final decision b,y the DirectorGeneral. Consequently, b,y year's end, the 1988-1989 contingent programme budget implementation reductions might require a further review and prioritizing, according to which scenario eventually materialized. Dr TAPA (Tonga), noting the term "contingency" used in the Regional Director's report on the subject, asked whether there was a in programme budget difference between contingent reductions budget implementation and reductions in the actual programme approved by the Health Assembly. Dr DE SOUZA (Australia) supported the Regional Director's initiative in developing a contingency plan for 1988-1989. From statements made at the Health Assembly, it was clear that the outstanding assessed contributions might not be paid in full, so it was timely to try and quantify the financial and programme implications of the diminished resource base. He would, however, find it useful to have figures not only on the proposed reductions but also, for purposes of comparison, on the initial allocations, programme by programme. In addition, he would welcome an explanation of the reasons for the selectivity of the reductions, since the Regional Director was obviously not proposing a uniform reduction across the board. Perhaps a revised document could be provided. Mr SONG YUNFU (China), having read the document carefully, shared the concern over the adverse effects of the financial crisis, particularly on priority programmes. He was grateful for the remedial efforts made b,y the Director-General and the Regional Director but further action was necessary to urge the timely payment of assessed contributions. He appealed to those concerned to place the health-for-all goal above their national interests. At the same time, he hoped that the crisis would lead to streamlined administrative and resource management within WHO so as to optimize the use of the limited resources available for achieving health for all.
Ma OIZUMI (Japan) said that the subject of the financial crisis, much debated at the Health Assembly, was a painful one, yet information on WHO's financial situation was indispensable to her
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Government in planning its own budget for the coming fiscal years. According to the Regional Director's report, the Region would have to return part of its allocation to Headquarters. Could that cutback be offset by the devaluation of locally used currencies, e.g. the Philippine peso, against the United States dollar? If not, she was all the more in agreement with Australia that it was essential to know the criteria applied in making the various programme reductions. To take just one example, why was it that the health manpower programme seemed to have suffered the biggest cut?
Mr TAGUIWALO (Philippines) said that, while the contingency plan was necessary for reasons outside the control of WHO and individual Member States, it could be used as an opportunity to sharpen the Organization's thinking about priorities and the diverse impacts of its activities at different organizational levels and in various programme areas. Additional information as requested by the representative of Australia would thus be welcome, for it would help clarify the policy implications of the proposed reductions. For example, he wondered how the relative reductions had been decided as between country and intercountry programmes and, within countries, between the various programmes• His Government had appreciated being involved in decisions on programme reductions for the Philippines, and would welcome a similar participation when it came to the regional contingency plan as a whole. The REGIONAL DIRECTOR, replying to the requests for information on the criteria used in deciding on programme rednctions, said that, in practice, criteria based strictly on priority rankings were often inapplicable in the case of country programmes. For one thing, some priority programmes, no matter how well planned, would encounter implementation difficulties, which was a factor to consider. Systematically sparing priority programmes from reductions also ignored the fact that such programmes were the ones most able to attract extrabudgetary funding. Strict application of such criteria might also entail sacrificing programmes that appeared marginal but were essential for continuity, for example, the fellowship programme for small islands. If the number of fellows were to be cut below the m1n1mum needed, over the long term the country's health infrastructure would suffer. In contrast, intercountry programmes lent themselves far better to the application of straightforward criteria.
Mr UHDE (Director, Support Programme), replying to the representative of Tonga, said that contingency reductions in programme implementation were very different from reductions in the official programme budget, which required a World Health Assembly appropriation resolution and was final in the sense that it ruled out the use of funds that might later become available - an option that remained open with the contingency approach. A revised document would be issued with complementary information, as requested by the representative of Australia and others. The cutbacks had not been uniform: thirty-three programmes ranging from 1% to 27%) while had been reduced (the cuts thirteen had remained untouched.
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In answer to the representative of the Philippines, he said that the first task had been to divide the reductions as between regional and intercountry activities, on the one hand, and country activities, on the other. The criterion had been to reduce the former as much as possible so as to spare the latter. However, there were limits to how deeply the regional allocations could be reduced, given the standing costs of staff, Regional Office facilities, etc. Through reductions in planned meetings and duty travel, the regional and intercountry allocations had been reduced by US$1 324 700, leaving US$3 045 300 to be absorbed by the country programmes. The individual country allocations had been reduced on a pro rata basis, as had the Region's allocation, and each country in turn had set its own programme priorities in close collaboration with the WHO representative. The countries had then been faced with the same dilemma as had arisen at the regional level, and had similarly had to consider a variety of factors. Timing was one. If an activity was planned for implementation in late 1989, the tendency had been to sacrifice it temporarily in the hope that by then funds would have become available. Some activities had simply been postponed to 1990-1991. An effort had been made to spare ongoing activities, as it would not be cost-effective to cut them off and thereby lose momentum, which was tantamount to throwing away the prior investment. Although contingency planning was an unpleasant exercise, and the underlying financial crisis was not of WHO's making, he was confident that the Organization would continue to be a good partner to its Member States despite the unavoidable disruptions in some activities. He pointed out that, if implementation reductions were effectively carried out in 1988-1989, that would in turn affect the 1990-1991 programme budget, planning for which would be starting shortly. Dr CHRISTMAS (New Zealand) asked whether he was understanding that the preamble to the contingency plan that the Regional Director was informing the Regional rather than seeking its approval for the plan, which therefore be changed. right in indicated Committee could not
The REGIONAL DIRECTOR said that the total reductions had been fixed by the Director-General as a pro rata amount, but recently an amount had been added to offset losses in exchange against the United States dollar. The manner of distribution of the cuts between country and intercountry programmes and within categories or types of programme was a subject of continuous dialogue, and decisions were taken by the Regional Director- who was responsible - in consultation with Member States. The decision was relatively easy to reach; for example, when a post became vacant it could be "frozen", i.e. recruitment could be delayed. Reductions had already had to be implemented in 1986-1987, because of variations in the exchange rate for the Philippine peso, and it had been ensured that only intercountry programmes were affected. Then further reductions had been implemented because of nonpayment of assessed contributions, and they had also affected
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country programmes as a result of decisions taken in consultation with the authorities. It was not possible to reduce intercountry programmes beyond a point at which their provision for consultant services for countries or important meetings had to be suppressed. Representatives' suggestions for ways of implementing the reductions, including the possiblity of employing consultants instead of some permanent staff, were welcome. In further reply to the representative of New Zealand, he confirmed that the Regional Committee was asked to note the contingency plan, with the three possible scenarios to be applied from 1988. Dr DE SOUZA (Australia) said that he had understood that situation, but had requested further information in order to be able to judge the impact of the contingency plan on individual programmes. It could be useful if the additional document showed, besides a comparison of the situation before and after the contingency plan, the type of information given by the Director, Support Programme broad explanatory notes and examples rather than details of the criteria by which the decisions or reductions were reached.
Mr BOYER (United States of America), noting the Regional Director's reply to the representative of New Zealand, said that the Regional Committee had decided at its preceding session upon the regional component of the biennial programme budget and was now asked to consider the application of the contingency plan to the extent that it became necessary. It could be noted, and no vote was required; yet the purpose of its consideration was surely to give representatives the chance to express their agreement or disagreement. The main question was how it should be applied, and many suggestions had already been made: across-the-board pro rata reductions on all programmes; proportional reductions; the preservation of some important programmes at the expense of others; priority to programmes that were going well; suspending of programmes not yet started; or attention to the efficient use of resources, as had been mentioned in connection with the fellowship programme.
The Regional Committee was not yet in a position to make that kind of decision, and that was one reason why he favoured the continuation of the work of the competent Sub-Committee; there should be stronger involvement of Member States in the process of selection. Dr HAN (Director, Programme Management) replied to the representative of Tonga that the "programme budget implementation reduction" - in the terminology used by the Headquarters Secretariat - meant that the approved programme budget might have to be modified as it was being implemented if the current financial crisis prevailed. The proposed reductions would be made in the course of implementation only i f the plan had to be applied, not if unpaid contributions were forthcoming, for example.
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To the representative of Japan, he replied that the cuts in the 1986-1987 budget totalled some US$500 000 in accordance with calculations based on the rate of implementation of the programme That was budget for the Region at intercountry and country levels. much less than for other regions. To the representative of the Philippines, he replied that the criteria used for the contingency plan in its application to the programme budget for 1988-1989 depended, where possible, upon programme priorities, but in some cases it had been necessary to consider the priority to be accorded to certain components within a programme. The overall rate of reduction applied for countries was 10.5% of the country planning figure, and national authorities were asked to indicate which programme components could be reduced in order to meet the requirements of the contingency plan. Examples of components identified for possible reductions in intercountry and regional activities were: a small amount under the Regional Director's Development Programme; the intercountry health manpower development language and communication project (US$100 000); a freeze on certain long-term posts; certain research grants; some Regional Committee expenses; postponement or suppression of certain meetings; some local and common services costs. To the representative of Australia, he said that comparative tables showing the proposed reductions under the contingency plans as percentages of the original estimates in the programme budget for 1988-1989 would be prepared for submission to representatives after the session. To the representative of Japan, he further replied that the health manpower development share of the regional budget had originally been 19.55%; it was being reduced by 12.04%, totalling US$171 000 under regional and intercountry activities, of which US$100 000 was for the language and communication project to which he More than US$1 million had been cut by had already referred. countries according to their own criteria, applying, it was hoped, the general priorities. Further details would be provided on request. Mr UHDE (Director, Support Programme), replying further to the representative of Japan on the exchange rate losses, said that in the period 1986-1987 there had already been a loss of US$733 000 due to the fall in value of the Philippine peso from 16.00 pesos to 1 United States dollar to the current rate of 20.33 pesos to 1 United States dollar. In the experience of the Secretariat, changes in the exchange rate were accompanied by variations in costs in the affected currency, so that a simple mathematical calculation did not give a complete idea of the losses sustained by WHO. Those added expenses were not compensated.
Dr TAPA (Tonga) commended the preparation of the contingency plan. He said he wished to record his gratitude, as a representative of a Member State being assessed at the m~n~mum rate of 0.01%, to the major contributors who bore the brunt of the costs of cooperation
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with small island communities like his own. current financial difficulties would not last.
He hoped
that the
Mr TAGUIWALO (Philippines) expressed his concern that the three scenarios for the contingency reductions plan did not appear to take into account the possibility that, if only US$3 million instead of US$4 million had to be saved, it would be necessary to go through the same process in reverse. He suggested that the criteria for that exercise should be indicated in the ' document requested by the representative of Australia. He regarded the contingency plan as a good opportunity to consider priorities and economies similar to the challenge faced by his country in recent years.
The CHAIRMAN expressed his appreciation of those comments. Ms OIZUMI (Japan) noted that her country's delegation to the Fortieth World Health Assembly had supported the programme budget and contingency plan on the understanding that the Director-General would use US$24.1 million of casual income to help finance the budget and reduce assessments if the financial situation improved. Her delegation had never expected that there would be no improvement and that the full proposed US$50 million reduction would have to be implemented. She expressed her reservations as to that situation, hoping that WHO would collect all contributions and that the crisis would be resolved. Dr KHALID (Malaysia) shared the view of the representative of Australia on the need for further information to permit a comparison between the funds that had been requested initially and those that were likely to be available. Some reduction appeared to be unavoidable but he hoped that, if the situation improved, they might be less than foreseen. He agreed with the general criteria used in effecting the necessary reductions, as explained by the Regional Director and the Director, Support Programme, for example, and the need to meet commitments already undertaken. Activities that were planned for implementation later in the biennium could perhaps be reexamined. While it seemed easiest to apportion the reductions on a pro-rata basis, it should be borne in mind that a percentage reduction in what was already a small budget could have more drastic effects than the same percentage reduction of a large budget. Mr BOYER (United States of America) remarked that the key question affecting the choice of scenario was whether the financial situation was likely to improve by the end of the year. He informed the Committee that the United States of America would pay US$35 million of its 1986 assessment at the beginning of October 1987. Following the adoption of the resolution on budget reform by the Executive Board, the United States executive branch had requested the United States Congress to approve payment of the 1987 assessments in full. The final decision on the matter was not yet known. He hoped that it would be possible to return to full payment of assessed contributions in the near future and that, providing other Member States were also paying their contributions on time, the contingency plan would not be needed.
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181
Dr DE SOUZA (Australia) wished to know what the actual and potential shortfall in the contributions of the United States of America would be for 1986 and 1987.
Mr BOYER (United States of America) replied that, after the payment of US$35 million in October, the shortfall for 1986 would be US$17 million. If the United States Congress appropriated the same amount for 198? as for 1986, the shortfall over the biennium would be US$34 million. If, however, the United States Congress approved payment of assessed contributions for 198? in full, the deficit would be less. Dr CHRISTMAS (New Zealand) asked whether there had been any proposal to the Executive Board that the allocation of payments be reassessed.
Mr UHDE (Director, Support Programme) replied that he did know of any plan to change the rate of assessments.
not
Mr BOYER (United States of America) added that, while the United States Government had expressed the opinion that major donors to all agencies in the United Nations system should have a greater say in budgetary decisions, it had never suggested a change in assessment rates, and he was not aware of any such suggestion by others. Mr UHDE (Director, Support Programme), referring to the comments by the representatives of Malaysia and the Philippines on the possibility of smaller reductions than currently foreseen, stressed that there was no planned alternative to the three possible scenarios elaborated b,y the Regional Director. The payment of US$35 million b,y the United States of America in October might not be sufficient to be considered a substantial proportion of their assessed contribution, and it most likely would still be necessary to implement the contingency plan. The REGIONAL DIRECTOR thanked the representatives for their comments. He pointed out that the current contingency plan was in response to delayed payment of contributions. However, further difficulties might be caused by changes in the exchange rates between the United States dollar and the S iss franc, and the United States dollar and the Philippine peso. It was necessary also to look for other sources of funds to compensate for the likely deficit. As far as possible, extra donations and contributions from countries both within and outside the Region would be sought and used to minimize the adverse effects of the budget cuts. He expressed his gratitude to other international organizations, governments and nongovernmental organizations that had made contributions through WHO or direct to particular countries. In the absence of further comments, the CHAIRMAN invited the Rapporteurs to prepare an appropriate draft resolution. (For consideration of the draft resolution, see the ninth meeting, section
2.5.)
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3.
CONSIDERATION OF DRAFT RESOLUTIONS (resumed) The Committee considered the following draft resolutions:
3.1
Regional priorities under the Eighth General Programme (Document WPR/RC38/Conf. Paper No. 4 Rev.1) "The Regional Committee,
of Work
Having considered Part II of the report of the Sub-Committee on Programmes and Technical Cooperation on its work in relation to the regional contribution to the Eighth General Programme of Work covering the period 1990-1995; Taking into account the importance of the Regional Committee agreeing to programme priorities at both the country and the intercountry level; Considering the responsibility assigned committees b,y the Executive Board in resolution decisions on budgetary allocations;
to the regional EB79.R9 regarding
1. ASSIGNS to each programme under the Eighth General Programme of Work for the Western Pacific Region an order of priority as set out in Annex 1 of document WPR/RC38/6; 2. DECIDES that the Sub-Committee should continue to work in reviewing programme priorities, in order to assist the Regional Committee in 1988 in carrying out the responsibilities assigned to it by the Executive Board in resolution EB79.R9;
J. URGES Member States to use the assigned priorities formulating their programmes of cooperation with WHO;
when
4·
REQUESTS the Regional Director: (1) to take the programme priorities into consideration when implementing the Eighth General Programme of Work in the Western Pacific Region, due regard being given to the specific needs of individual countries; (2) to keep the programme priorities under review and to make proposals to the Regional Committee that will assist Member States in reaching conclusions on these priorities."
Dr KHALID (Malaysia) asked whether, in the second preambular paragraph, the reference to intercountry level was intended to include the regional level. Dr CATI (Kiribati), Rapporteur, replied that it was. Dr KHALID (Malaysia) suggested that the paragraph should include specific mention of the regional level. Dr WEINSTEIN (United States of America) expressed agreement with the representative of Malaysia.
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R~ORD
OF THE SEVENTH MEETING
183
Decision: The resolution, resolution WPR/RC38.R4). 3.2
as
amended,
was
adopted
(see
Acquired immunodeficiency syndrome (AIDS) (Document WPR/RC38/Conf. Paper No. 5) "The Regional Committee,
Having considered that part of the report of the Regional Director for the period July 1985 to June 1987 dealing with AIDS; Conscious of the report of Special Programme on AIDS; the Director-General on the WHO
Recalling resolutions WHA40.26 and WPR/RC36.R2; Seriously concerned that AIDS may become more prevalent Western Pacific Region; in the
Affirming that the spread of AIDS is a problem that knows no national or geographical boundaries and that each Member State should be concerned with protecting the health of the people of other Member States, as well as their own; Recognizing, especially in the present absence of' a cure, the critical importance of surveillance, reporting, information transfer and the education of' health professionals and the general public on the prevention of AIDS; Acknowledging the need for sufficient flexibility within regional programmes so that they are responsive to local conditions and needs consistent with the priorities and objectives of' the WHO global strategy; 1. NOTES that, at the WHO/Australian Interregional Ministerial Meeting on AIDS, held in Sydney from 21 to 24 July 1987, government representatives issued a statement which, inter alia, called on WHO to support and strengthen national programmes and to facilitate and coordinate bilateral, multilateral and international assistance for their implementation; 2. RESOLVES that a regional programme for the prevention and control of' AIDS should be developed urgently, in conformity with the global strategy, integrated with the activities of' the health system based on primary health care and with activities for the control of' other viral diseases prevalent in the Western Pacific Region;
3.
URGES Member States: (1) to give high priority to establishing or strengthening comprehensive long-term national policies and programmes on AIDS within the framework of the WHO global strategy, and integrated, where appropriate, with programmes concerned with the prevention and control of other viral diseases prevalent in the Region, providing for such measures as:
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(a) adequate screening intended for transfusion; (b)
of blood and
blood
products
strengthening of surveillance and reporting; of health education and counselling
(c) strengthening services; (d)
provision of information and advice to the community;
(2) to share openly with each other and with WHO all relevant and reliable information on AIDS, and to develop closer cooperation in areas of mutual concern;
4.
REQUESTS the Regional Director: (1) to cooperate with Member States in their efforts for prevention and control of HIV infection, with emphasis on: the
(a) the development of integrated national strategies and plans of action; (b) coordination of data collection and exchange;
(c) the further strengthening of laboratory diagnostic capability as an important part of surveillance; (d) the materials; further development of health education
(2) to promote the strengthening of training activities in laboratory diagnosis, health education and epidemiology; (3) to encourage and support research on the behavioural, epidemiological and clinical aspects of AIDS, and on simple, low-cost, sensitive and specific laboratory diagnostic methods;
(4) to take the necessary measures to expand the network of WHO collaborating centres for training and for the laboratory confirmation of HIV infection; (5) to provide all feasible support, subject to the availability of resources, in supplementing the contributions of Member States and other organizations to the prevention and control of AIDS; (6) to ensure that information on the policies and recommendations agreed to at meetings sponsored by WHO and other organizations is disseminated to Member States as soon as it becomes available; (7) to facilitate the periodic evaluation of programme for the prevention and control of AIDS; the regional
(8) to report annually to the Regional Committee in the form he considers most appropriate."
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Dr CHRISTMAS (New Zealand) expressed some doubts over operative paragraph 2, which inter alia resolved that the regional programme for AIDS control be integrated with activities for the control of other viral diseases prevalent in the Region. The sentence presumably was not intended to cover all viral diseases in the Region, and he suggested that the words "as appropriate" be added. Dr DE SOUZA (Australia) agreed Zealand. with the representative of New
Mr TAGUIWALO (Philippines) wished to amend operative paragraph 3(1) to refer to immediate, as well as long-term national policies and programmes. He also suggested that operative paragraph 4(1) should refer to all people who were HIV positive, and not just to AIDS patients. Finally, in operative paragraph 4(5), he wished to replace the words "subject to the availability of resources" by "subject to the reasonable allocation of resources" to ensure that AIDS control was undertaken in the context of other programmes in the Region.
· Dr MUGITANI (Japan) suggested that, in the absence of effective treatment, operative paragraph 4(3) should refer also to research on preventive aspects of AIDS.
Dr REILLY (Papua New Guinea) proposed that operative paragraph should be amended to ensure that the AIDS programme did not detract from other disease control programmes.
4(5)
Dr CHRISTMAS (New Zealand) suggested that that could be achieved simply by changing "all feasible support" to "appropriate support". Dr HAN (Director, Programme Management) , referring to the amendment to operative paragraph 4(5) proposed by the representative of the Philippines, pointed out that the word "availability" had been used because, under the global strategy, all resources were handled by the global programme at Headquarters. The resources in the Region were thus made available from global funds. The use of the word "allocation" might suggest that the funds were allocated by the Regional Director. That was only possible with regard to funds not specifically earmarked for AIDS control activities.
Mr TAGUIWALO (Philippines) said that, in view of the comments of the Director, Programme Management, he would withdraw his proposed amendment to operative paragraph 4(5). Dr SUNG WOO LEE (Republic of Korea), referring to the comment of the representative of the Philippines on operative paragraph 4(1), said he wished to hear the Secretariat's position in regard to the treatment of HIV positive cases. The REGIONAL DIRECTOR, said that HIV infection was intended to include all HIV positive people. However, if it was felt necessary, HIV carriers could be mentioned specifically.
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Dr MUGITANI (Japan) said that he would like to receive a copy of the draft resolution, containing all the proposed amendments, by Monday at the latest. Decision: The draft resolution, resolution WPR/RC38.R5). 3-3
as amended, was
adopted (see
Special Programme of Research, Development and Research Training in Human Reproduction: Membership of the Policy and Coordination Advisory Committee (Document WPR/RC38/Conf. Paper No. 6) Decision: The draft resolution was (see resolution WPR/RC38.R6). adopted without comments
3.4 Development of health research (Document WPR/RC38/Conf. Paper No. 7) "The Regional Committee, Having considered the report development of health research; of the Regional Director on the
Noting the efforts being made to develop adequate mechanisms at national level to ensure effective research coordination in order to relate research priorities to the solution of major health or healthrelated problems; Noting also the progress being made in the strengthening of national research capability, particularly in developing countries, through the organization of national training courses in research methodology and the award of training and research grants; 1. ENDORSES the recommendations of the Western Pacific Advisory Committee on Health Research at its eleventh session; 2. REQUESTS the Regional Director: (1) to implement the recommendations of Advisory Committee on Health Research; the Western Pacific
(2) to ensure that the subject of the research activities supported b,y WHO will not only strengthen national research capability but will produce results of relevance to more than one Member State; (3) to ensure that the best possible use is made of the results of research activities and that they are made available for the benefit of all other Member States." Dr KHALID (Malaysia) thought that in operative paragraph 2(2) the words "of relevance to more than one Member State" were too restrictive. Research might be relevant specifically to one country.
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187
Countries should not be inhibited from requesting WHO cooperation by the fact that other countries were not interested in the research proposed. Mr TAGUIWALO (Philippines) thought that, even at country level, priority should be given to research that was useful to more than one Member State.
Dr CHRISTMAS (New Zealand) felt that the difficulty might possibly be resolved by inserting the words "preferably but not exclusively" after the word "relevance" in line 3 of operative paragraph 2(2). Mr
TAGUIWALO (Philippines) endorsed that suggestion.
Dr KHALID (Malaysia) said that the Executive Board had emphasized the need for country-specific programmes. It would be difficult and time-consuming to ensure that research proposals for which WHO cooperation was to be requested were relevant to more than one country. Professor HOANG DINH CAU (Viet Nam) agreed with the reasoning of the representative of Malaysia. His reservations about the text might be removed by substituting for the word "will" in line 3 of operative paragraph 2.(2) the words "might possibly", thus making the paragraph less categorically restrictive. Dr TAPA (Tonga) suggested inserting the words "not only to one but" after the word "relevance" in the third line of the paragraph. DR CHRISTMAS (New Zealand) felt that the resolution should be returned to the Rapporteurs for revision in the light of the discussions.
Dr WEINSTEIN (United States of America) thought that they must first be clear as to what the consensus of the meeting was. Dr KHALID (Malaysia) felt that the phrase "of relevance to more than one Member State" in operative paragraph 2(2) went against the principle of country-specificity clearly enunciated by the Executive Board. There were problems requiring research at country level that were quite specific to a particular country. In pursuing such research the country concerned might call for cooperative support from WHO and the Regional Director might consider allocating funds. As the resolution stood at the moment, however, the country involved would first have to find out whether other countries were interested in the research proposal. It must be clearly recognized that there were country-specific problems that required country-specific research acti viti es for which WHO/Member State cooperation was necessary. If the revised resolution reflected that fact, he could accept it. Mr TAGUIWALO (Philippines) thought that there was a clear difference of principle involved. The representative of Malaysia apparently felt that no preference at all should be given to research
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activities of relevance to more than one Member State. Others, including himself, thought that, in view of the limited resources available and the need to distinguish between high-priority and lowpriority problems, preference should be given to research on problems of interest to more than one country but not necessarily exclusively to such research. Dr KHALID (Malaysia) said that he had never stated that no priorities should be set. The resolution as it stood meant that the Regional Director, to whom all requests for WHO/Member State cooperation must be addressed, would be forced to refuse such cooperation for research if it was of benefit to only one country. That was his objection to the present text. It was obvious that priority must be given to intercountry and regional programmes. Dr BIUMAIWAI (Fiji) suggested replacing the text after the word results 11 in line 3 of operative paragraph 2(2) by the words 11 that may be relevant to other Member States;" 11
The CHAIRMAN asked the Rapporteurs, together with the representatives of Malaysia and the Philippines, to draw up a revised draft resolution in the light of the Committee's comments. (For consideration of the revised draft resolution, see the ninth meeting, section 2.1). 3.5 Technology transfer (Document WPR/RC38/Conf. Paper No. 8) Decision: The draft resolution was adopted without comment (see resolution WPR/RCJ8.R7). J.6 Resolutions of regional interest adopted by the Fortieth Health Assembly (Document WPR/RC38/Conf. Paper No. 9) World
Dr WEINSTEIN (United States of America) thought that, since most of the Health Assembly resolutions mentioned referred to subjects that had been exclusively discussed on the two previous days, it would be preferable not to proceed with the resolution before them. Dr TAPA (Tonga) said that operative paragraph 2 of resolution WHA40.18 requested "the regional committees to initiate the establishment of regional research groups to undertake studies on the improvements in health conditions that result from adequate housing". He had proposed on the previous day that the matter be referred to the Western Pacific Advisory Committee on Health Research for detailed consideration and that the Advisory Committee should make its views known to the Regional Committee at a future session. The present resolution did not reflect that proposal at all. Dr CHRISTMAS (New Zealand) and America) concurred. Dr WEINSTEIN (United States of
The REGIONAL DIRECTOR said that they had the option of adding an operative paragraph to the present resolution reflecting what had just been said or of not proceeding with the resolution at all and embodying what the representative of Tonga had said in a decision of the Committee.
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Dr DE SOUZA (Australia) and Dr WEINSTEIN (United States of America) proposed that the views of the representative of Tonga should be recorded in the summary records of the Regional Committee and that they should not proceed with the resolution. Decision: 3.7 It was so agreed. the South Pacific (Document
Drug supply management in WPR/RC38/Conf. Paper No. 10) "The Regional Committee,
Having considered the report of the Regional Director on supply management in the South Pacific; Recalling resolution WPR/RC37.R3;
drug
Recognizing the importance of WHO's intercountry programme of cooperation in drug supply management as a catalyst in collaborative activities in the South Pacific; 1• ENDORSES the Director's report;
recommendations
contained
in
the
Regional
2.
URGES Member States of the South Pacific: (1) to implement the recommendations contained in the Regional Director's report; (2) to collaborate management; with other Member States in drug supply
3.
REQUESTS the Regional Director: (1) to continue to support Member States, through the intercountry programme in the South Pacific, in strengthening their programmes for drug procurement and supply management, quality assurance and information exchange; (2) to study further alternative financial arrangements that could be beneficial to South Pacific countries."
Dr DE SOUZA (Australia) suggested that the words "particularly in relation to drug quality assurance" be inserted at the end of operative paragraph 3(2). Dr HAN (Director, Programme Management) said that reference to quality assurance had been included in operative paragraph 3(1). Operative paragraph 3(2) called on the Regional Director to study the feasibility of bulk purchasing and establishing revolving funds for the use of countries of the South Pacific. Dr DE SOUZA (Australia) thought that particular concern had been expressed regarding drug quality assurance, and that that should be reflected in the reference in operative paragraph 3(1). In view of
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the Director, Programme Management's comments, he operative paragraph 3(2) might also be more specific.
suggested that
Dr TAPA (Tonga) considered that the amendment proposed by the representative of Australia was acceptable, in view of the high cost of drug quality assurance laboratories. Furthermore, he proposed that a further amendment be made - namely, the addition of the words "and to report to the Regional Commi.ttee". Dr REILLY (Papua New Guinea) agreed with the two previous speakers, but suggested that the word "particularly" in the amendment by the representative of Australia be replaced by proposed "including 11 • Dr DE SOUZA (Australia) had no objection to that modification. He said that he had not had in mind drug quality assurance laboratories, but rather the funds necessary for training in quality assurance so that the small countries acquired the necessary technology. Dr HAN (Director, Programme Management) proposed that a separate paragraph be added, concerning training and the quality assurance aspect. The CHAIRMAN suggested that the Rapporteurs be requested to prepare a revised text, including an additional paragraph and the amendment proposed by the representative of Tonga. (For consideration of the revised draft resolution, see the ninth meeting, section 2.2.) Decision: 4· It was so agreed. Item 9 of the Agenda (Documents
~~NAGEMENT OF WHO'S RESOURCES: WPR/RC38/4 and Add.1)
The REGIONAL DIRECTOR said that agenda item 9 related to an issue which had far-reaching implications for the management of the Organization's resources over the next decade and beyond. In the Region they had always endeavoured to ensure that resources were put to optimal use, taking into account the policies collectively agreed on by Member States as well as country-specific priorities and needs. He thought they had succeeded quite well in that respect. Apparently, however, there was some feeling at the global level that, collectively, the regional offices' performance in managing WHO's resources needed to be further looked into. With 70% of the resources allocated to regional and country activities, the regions and countries had therefore been the main targets for action. By resolution WHA40.15 the Health Assembly had requested the regional committees to consider those issues and options for action. Those attending the Fortieth World Health Assembly in May and the seventy-ninth session of the Executive Board would already be familiar with the issues raised by the Director-General in his Introduction to the 1988-1989 programme budget. To facilitate discussion at the regional committees, the Director-General had
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prepared document EB81/PC/WP/2, entitled "Management of WHO's resources". To make it easier to consider the contents of the document, Addendum 1 had been issued summarizing the main issues for discussion by the Committee. The first issue to consider was the WHO value system, policy and strategy. Did Member States in the Region consider that system, policy and strategy still valid? ae was quite sure they would all agree that it was still valid, in which case the Committee was requested to discuss improved and practical ways of carrying it out in the Region. If they felt there were obstacles hindering implementation, then he would welcome views on how those obstacles might be overcome. Next was the issue of how best to implement in the Region resolutions WHA33.17 on the study of WHO's structures in the light of its functions and WHAJ4.24 on the meaning of WHO's international health work through coordination and technical cooperation. The resolution on WHO's structures emphasized the individual responsibilities of Member States, their responsibilities in the regional committees and the Health Assembly, and the functions of the Executive Board and the Secretariat. The second resolution reiterated WHO's dual role of directing and coordinating international health work and of ensuring technical cooperation between WHO and its Member States. The third issue related to the monitoring and evaluation of the health-for-all strategies as part of the health managerial processes of countries and not as a separate WHO exercise. Experience in the Region showed that, while the initial reaction of Member States had been that health-for-all monitoring and evaluation was a WHO exercise, that attitude had significantly changed through the years, as evidenced by their response to the evaluation exercise conducted in 1985. The fourth issue concerned decentralized management. Regional committees were requested to re-examine the main features of the managerial arrangements in order to ensure effective decentralization to Member States of operational responsibility for technical cooperation activities. The fifth issue concerned the question whether the managerial arrangements previously agreed upon and the regional programme budget policy were being applied effectively in deciding on the use of WHO's resources in countries. In relation to that, specific issues concerning the allocation of resources to countries and the implementation of country programme budgets, including the provision of fellowships and supplies and equipment, might be discussed. In reviewing the subject, he reminded representatives that, when the draft regional programme budget policy had been considered by the Regional Committee in 1986, the need for flexibility in its application had been stressed. Regional committees were also urged to review WHO's action in individual Member States. Two suggestions had been made for carrying
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that out - first, through a review by the Regional Committee of the programme budget proposals of each Member State and, second, by institutionalizing regional audits in policy and programme terms. The Regional Committee would be aware that, even before the adoption of the Health Assembly resolution on WHO's structures, it had, through its Sub-Committee on Programmes and Technical Cooperation, been conducting such a review, although in a limited manner. The question therefore was, did they think the review mechanism was sufficient or did they need to expand it? Lastly, there was the question of whether WHO's structures were being properly used, and the capacity of staff at all levels to carry out the functions required of them. The views of the Regional Committee were invited as to whether it felt that WHO's structures were appropriately used in the Region, and whether it was able to provide technical cooperation efficiently and effectively through its staff, both at country and Regional Office levels. Comments on how they could be further improved would be useful. He believed that Member States in the Region had been doing quite well in managing WHO's resources, but if there were any further suggestions for improvements the Secretariat would be happy to learn of them so that it could provide better support to countries in their health development efforts. Mr TAGUIWALO (Philippines) said that his Government considered that WHO had managed its resources reasonably, professionally, and appropriately in pursuit of the collectively agreed goals. The Ph~lippines had long worked in close collaboration with WHO, and looked forward to continuing and strengthening that cooperation. Whatever comments he would make on each issue to be discussed would be secondary to that belief.
Dr CHRISTMAS (New Zealand) noted the particular importance of document EB81/PC/WP/2, and expressed doubt as to whether the Regional Committee would be able to do i t justice in the time available. Representatives would probably wish to hear the opinions of their colleagues and discuss the subject among themselves. Many of them He wondered had not had time to consider the document adequately. whether discussion on that important item might be continued at the Regional Committee's next session, or whether the subject might be considered by a sub-committee. Dr TOEOLESULUSU SIUEVA (Samoa) shared the concern expressed by the representative of New Zealand; he felt that more time was needed. He wondered whether individual countries might submit their views on the subject to the Regional Director. Alternatively, he would support the proposal for setting up a sub-committee. Mr BOYER (United States of America) understood that no specific conclusion or action was required of the Committee; the Regional Director was merely requested to report on the Committee's discussions to the eighty-first session of the Executive Board in January 1988. He considered document EB81/PC/WP/2 somewhat revolutionary. It was not at all usual for organizations of the
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United Nations system to produce for circulation to their member countries a paper that was so self-critical. It was also remarkable that the Programme Committee recommended in its report to the Executive Board that certain steps be taken to deal with some of the shortcomings. The Regional Committee should join in the Organization's efforts at improvement, and encourage the process. The REGIONAL DIRECTOR drew attention to resolution WHA40.15, in which the Fortieth World Health Assembly requested the regional committees to review the relevant documents and comments of the Health Assembly and to report on the outcome of their deliberations to the Board in January 1988. It would therefore not be feasible to refer the subject to a sub-committee. There was a possibility of deferring some other agenda items for discussion at a future session in order to allow the time necessary for consideration of this important subject. It was not necessary to reach any conclusions; a summary of the discussion would be sufficient. The subject was of particular importance in view of WHO's unique regional structure.
Mr TAGUIWALO (Philippines), supported by Dr NAKATANI (Japan) and Dr TAPA (Tonga) proposed that the Committee immediately commence discussion on the subject at its next meeting, it being understood that, if necessary, some other items of the agenda would be deferred until the Committee's following session. Decision: It was so agreed.
The meeting rose at 12.30 p.m.