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Fifty-second World Health Assembly, Geneva, 17-25 May 1999: verbatim records of plenary meetings and list of participants = Cinquante-deuxième Assemblée mondiale de la Santé, Genève, 17-25 mai 1999 : comptes rendus in extenso des séances plénières et liste des participants

December 31, 1999 World Health Organization

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WHA52/1999/REC/2

WORLD HEALTH ORGANIZATION

ORGANISATION MONDIAL£ DE LA SANTE

FIFTY-SECOND WORLD HEALTH ASSEMBLY GENEVA, 17-25 MAY 1999

VERBATIM RE CORDS OF PLENARY MEETINGS AND LIST OF PARTICIPANTS

CINQUANTE-DEUXIEME ASSEMBLEE MONDIALE " DELASANTE GENEVE, 17-25 MAl 1999

COMPTES RENDUS IN EXTENSO , ' DES SEANCES PLENIERES ET LIS TE DES PARTICIPANTS ;

GENEVA

GENEVE

2000

WHA52/1999/REC/2

WORLD HEAL TH ORGANIZATION ORGANISATION MONDIALE DE LA SANTÉ

FIFTY-SECOND WORLD HEALTH ASSEMBLY GENEVA, 17-25 MAY 1999

VERBATIM RECORDS OF PLENARY MEETINGS AND LIST OF PARTICIPANTS

' CINQUANTE-DEUXIEME ASSEMBLÉE MONDIALE DELA SANTÉ GENÈVE, 17-25 MAI 1999

COMPTES RENDUS IN EXTENSO DES SÉANCES PLÉNIÈRES ET LISTE DES PARTICIPANTS GENEVA GENÈVE

2000

PREFACE

The Fifty-second World Health Assembly was held at the Palais des Nations, Geneva, from 17 to 25 May 1999, in accordance with the decision of the Executive Board at its 102nd session. Its proceedings are published in three volumes, containing, in addition to other relevant material: Resolutions, decisions and annexes - document WHA52/1999/REC/1 Verbatim records of plenary meetings and list of participants - document WHA5211999/REC/2 Summary records of committees and ministerial round tables, reports of committees - document WHA52/1999/REC/3 For a list of abbreviations used in these volumes, the officers of the Health Assembly and membership of its committees, the agenda and the list of documents for the session, see preliminary pages of document WHA52/1999/REC/1. In these verbatim records, speeches delivered in Arabie, Chinese, English, French, Russian or Spanish are reproduced in the language used by the speaker; speeches delivered in other languages are given in the English or French interpretation. The texts include corrections received up to end July 1999, the eut-off date announced in the provisional version, and are thus regarded as final.

AVANT-PROPOS

La Cinquante-Deuxième Assemblée mondiale de la Santé s'est tenue au Palais des Nations à Genève du 17 au 25 mai 1999, conformément à la décision adoptée par le Conseil exécutif à sa cent deuxième session. Ses actes paraissent dans trois volumes contenant notamment : les résolutions et décisions et les annexes qui s'y rapportent - document WHA52/1999/REC/1, les comptes rendus in extenso des séances plénières et la liste des participants - document WHA52/1999/REC/2, les procès-verbaux des commtsstons et des tables rondes ministérielles et les rapports des commissions- document WHA52/1999/REC/3. On trouvera dans les pages préliminaires du document WHA52/1999/REC/1 une liste des abréviations employées dans la documentation de l'OMS, l'ordre du jour et la liste des documents de la session ainsi que la présidence et le secrétariat de l'Assemblée de la Santé et la composition de ses commissions. Les présents comptes rendus in extenso reproduisent dans la langue utilisée par l'orateur les discours prononcés en anglais, arabe, chinois, espagnol, français ou russe, et dans leur interprétation anglaise ou française les discours prononcés dans d'autres langues. Ces comptes rendus comprennent les rectifications reçues jusqu'à la fin juillet 1999, date limite annoncée dans leur version provisoire, et sont donc considérés comme finals.

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INTRODUCCION

La 52" Asamblea Mundial de la Salud se celebr6 en el Palais des Nations, Ginebra, del 17 al 25 de mayo de 1999, de acuerdo con la decisi6n adoptada por el Consejo Ejecutivo en su 102" reuni6n. Sus debates se publican en tres volumenes que contienen, entre otras cosas, el material siguiente: Resoluciones y decisiones, y anexos: documenta WHA52119991REC/1 Actas taquigrâficas de las sesiones plenarias y lista de participantes: documenta WHA52/l999/REC/2 Actas resumidas de las comisiones y de las mesas redondas ministeriales e informes de las comisiones: documenta WHA52/1999/REC/3. En las paginas preliminares del documenta WHA52/19991REC/1 figuran una lista de las siglas empleadas en estos volumenes, la composici6n de la Mesa de la Asamblea y de sus comisiones, el orden del dia, y la lista de documentas de la reuni6n. En las presentes actas taquigraficas los discursos pronunciados en arabe, chino, espafiol, francés, inglés o ruso se reproducen en el idioma utilizado por el orador. De los pronunciados en otros idiomas se reproduce la interpretaci6n al francés o al inglés. Las actas contienen las correcciones recibidas hasta el final de julio de 1999, fecha limite anunciada en la versi6n provisional, y por consiguiente se consideran definitivas.

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CONTENTS

Page Preface lll

VERBATIM RECORDS OF PLENARY MEETINGS First plenary meeting 1.

2. 3. 4. 5. 6.

Opening of the session .................................................... . Address by the Director-General of the United Nations Office at Geneva ............. . Address by the representative of the Conseil d'Etat of the Republic and Canton ofGeneva. Address by the President of the Fifty-first World Health Assembly .................. . Appointment of the Committee on Credentials .................................. . Election of the Committee on Nominations ..................................... .

2 3 5 6 6

Second plenary meeting 1.

First report of the Committee on Nominations ................................... . Second report of the Committee on Nominations ................................ .

8 9

Third plenary meeting l. 2. 3. Presidential address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Adoption of the agenda and allocation of items to the main committees . . . . . . . . . . . . . . . . Anno un cements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Il 13 18

Fourth plenary meeting 1. 2. 3. 4. A year of change: reports of the Executive Board on its 102nd and 103rd sessions . . . . . . . Looking ahead for WHO after a year of change: report of the Director-General (including The world health report 1999) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Health in development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Looking ahead for WHO after a year of change: report of the Director-General (including The world health report 1999) (resumed) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 23 28 33

Fifth plenary meeting First report of the Committee on Credentials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

Sixth plenary meeting Loo king ahead for WHO after a year of change: report of the Director-General (including The world health report 1999) (continued) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Page Seventh plenary meeting Looking ahead for WHO after a year of change: report of the Director-General (including The world hea/th report 1999) (continued) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Eighth plenary meeting Awards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Presentation ofthe Darling Foundation Prize . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Presentation ofthe Léon Bernard Foundation Prize . . . . . . . . . . . . . . . . . . . . . . . . . Presentation ofthe Jacques Parisot Foundation Medal . . . . . . . . . . . . . . . . . . . . . . . Presentation of the Ihsan Dogramaci Family Health Foundation Prize . . . . . . . . . . . Presentation of the Sasakawa Health Prize . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Presentation ofthe United Arab Emirates Health Foundation Prize . . . . . . . . . . . . . Francesco Pocchiari Fellowship . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ninth plenary meeting 1. 2. 3. 4. 5. 6. 7. 8. First report ofCommittee B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Second report of Committee B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . First report ofCommittee A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Third report of Committee B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Second report ofCommittee A............................................... Third report of Committee A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Executive Board: election [ofMembers entitled to designate a person to serve on] . . . . . . Reports ofthe ministerial round tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124 126 126 126 127 127 127 128 110 110 112 113 114 116 119 122

Tenth plenary meeting 1. 2. 3. 4. 5. 6. Second report of the Committee on Credentials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Fourth report ofCommittee B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Fourth report ofCommittee A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A year of change: reports of the Executive Board on its 102nd and 103rd sessions (continued) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Selection of the country in which the Fifty-third World Health Assembly will be held.... Announcement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134 134 134 135 135 135

Eleventh plenary meeting Closure of the session....................................................... 136

MEMBERSHIP OF THE HEALTH ASSEMBLY List of delegates and other participants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Representatives of the Executive Board . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 191

Indexes (Nam es ofspeakers; countries and organizations) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

193

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TABLE DES MATIERES

Pages

Avant-propos . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

111

COMPTES RENDUS IN EXTENSO DES SEANCES PLENIERES Première séance plénière

1. 2. 3.

4. 5. 6.

Ouverture de la session . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. Allocution du Directeur général de l'Office des Nations Unies à Genève ............. . Allocution du représentant du Conseil d'Etat de la République et Canton de Genève .... . Allocution du Président de la Cinquante et Unième Assemblée mondiale de la Santé .... . Constitution de la Commission de Vérification des Pouvoirs ....................... . Election de la Commission des Désignations

1 2

3 5 6 6

Deuxième séance plénière

1. 2.

Premier rapport de la Commission des Désignations ............................. . Deuxième rapport de la Commission des Désignations ........................... .

8 .9

Troisième séance plénière

1. 2. 3.

Discours du Président de 1'Assemblée ......................................... . Adoption de 1'ordre du jour et répartition des points entre les commissions principales .. . Communications .......................................................... .

13 18

Quatrième séance plénière

1. 2. 3. 4.

Une année de changement : rapports du Conseil exécutif sur ses cent deuxième et cent troisième sessions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . L'avenir de l'OMS après une année de changement: rapport du Directeur général (y compris le Rapport sur la santé dans le monde, 1999) ...................... . Santé et développement .................................................... . L'avenir de l'OMS après une année de changement: rapport du Directeur général (y compris le Rapport sur la santé dans le monde, 1999) (reprise) ............... .

20 23 28 33

Cinquième séance plénière

Premier rapport de la Commission de Vérification des Pouvoirs Sixième séance plénière

L'avenir de l'OMS après une année de changement: rapport du Directeur général (y compris le Rapport sur la santé dans le monde, 1999) (suite) . . . . . . . . . . . . . . . . . . -xi-

Pages Septième séance plénière

L'avenir de l'OMS après une année de changement: rapport du Directeur général (y compris le Rapport sur la santé dans le monde, 1999) (suite) . . . . . . . . . . . . . . . . . . Huitième séance plénière

Distinctions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Remise du Prix de la Fondation Darling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Remise du Prix de la Fondation Léon Bernard . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Remise de la médaille de la Fondation Jacques Parisot. . . . . . . . . . . . . . . . . . . . . . . . Remise du Prix de la Fondation Ihsan Dogramaci pour la Santé de la Famille . . . . . Remise du Prix Sasakawa pour la Santé . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Remise du Prix de la Fondation des Emirats arabes unis pour la Santé . . . . . . . . . . . Bourse Francesco Pocchiari . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Neuvième séance plénière

11 0 110 112 113 114 116

119 122

1. 2. 3.

4. 5. 6. 7. 8.

Premier rapport de la Commission B .......................................... . Deuxième rapport de la Commission B ........................................ . Premier rapport de la Commission A .......................................... . Troisième rapport de la Commission B ........................................ . Deuxième rapport de la Commission A ........................................ . Troisième rapport de la Commission A ........................................ . Election de Membres habilités à désigner un représentant au Conseil exécutif . . . . . . . . . . Rapports des tables rondes ministérielles ....................................... .

124126 126 126 127 127 127

128

Dixième séance plénière

1. 2.

3. 4. 5. 6.

Deuxième rapport de la Commission de Vérification des Pouvoirs ................... . Quatrième rapport de la Commission B ........................................ . Quatrième rapport de la Commission A ........................................ . Une année de changement : rapports du Conseil exécutif sur ses cent deuxième et cent . .' . (smte . ) .................................................. troiSieme sessiOns Choix du pays où se tiendra la Cinquante-Troisième Assemblée mondiale de la Santé ... . Communication ........................................................... .

134 134

134 135 135 135

Onzième séance plénière

Clôture de la session . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

136"

COMPOSITION DE L'ASSEMBLEE DE LA SANTE Liste des délégués et autres participants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Représentants du Conseil exécutif . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Index (noms des orateurs; pays et organisations) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 191

193

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A52/VR/1

page1

VERBATIM RECORDS OF PLENARY MEETINGS COMPTES RENDUS IN EXTENSO DES SEANCES PLENIERES

FIRST PLENARY MEETING Monday, 17 May 1999, at 10:00 President: Dr F.R. AL-MOUSA WI (Bahrain)

PREMIERE SEANCE PLENIERE Lundi 17 mai 1999, 10 heures Président: Dr F.R. AL-MOUSA WI (Bahreïn)

OPENING OF THE SESSION OUVERTURE DE LA SESSION

The PRESIDENT: The Assembly is called to order. Distinguished delegates, ladies and gentlemen, as President of the Fifty-first World Health Assembly, I have the honour to open the Fifty-second World Health Assembly. I now have pleasure in welcoming, on behalf of the Assembly and the World Health Organization our special guests: Mr Vladimir Petrovsky, Director-General of the United Nations Office at Geneva and representing the Secretary-General of the United Nations; Mr M. Ülkümen, Chief of Protocol, United Nations Office at Geneva; Mr Guy-Olivier Segond, Councillor of State, Department of Social Action and Health of the Republic and Canton ofGeneva, representing the Geneva State Council; Mr Jean Spielmann, President of the Parliament of the Republic and Canton of Geneva; Mr Walter Gyger, Ambassador, Permanent Representative of Switzerland to the International Organizations at Geneva and Permanent Observer to the United Nations; Professor Peter Suter, Dean of the Faculty of Medicine, University of Geneva; Mr Carlos Fortin, Assistant Secretary-General, United Nations Conference on Trade and Development; Mr Patrice Robineau, representing the United Nations Economie Commission for Europe; Dr Brian Gushulak, representing the Director-General, International Organization for Migration; Mr Cornelio Sommaruga, President, International Committee of the Red Cross; Mr George Weber, Secretary-General of the International Federation of Red Cross and Red Crescent Societies; the representatives of the United Nations specialized agencies; the representatives of the various United Nations bodies; and the delegates ofMember States. I also welcome the observers of non-Member States, the observers from the Order of Malta, the International Committee ofthe Red Cross, the International Federation of Red Cross and Red Crescent Societies, and from Palestine; and the representatives of intergovernmental and nongovernmental organizations in official relations with WHO. I also welcome the representatives of the Executive Board.

A52/VR/1

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ADDRESS BY THE DIRECTOR-GENERAL OF THE UNITED NATIONS OFFICE AT GENEVA ALLOCUTION DU DIRECTEUR GENERAL DE L'OFFICE DES NATIONS UNIES A GENEVE

The PRESIDENT: Mr Petrovsky, Director-General of the United Nations Office in Geneva and representing the Secretary-General of the United Nations, will now address the Assembly. Mr PETROVSKY (Director-General of the United Nations Office at Geneva): Mr President, Madam Director-General, Excellencies, ladies and gentlemen, 1 am really very pleased to have been given the opportunity to address this distinguished Assembly of the World Health Organization. 1 would like to convey to ali ofyou the good wishes ofthe Secretary-General ofthe United Nations, Mr Kofi Annan. 1 would like also to say a word of appreciation to Dr Gro Harlem Brundtland, whose leadership at WHO is contributing significantly to achieving the goals and objectives ofthe United Nations system as a whole. Y our Assembly is meeting at an important time - at the threshold of a new millennium when economie globalization and tremendous scientific and technological advancements are reshaping the world. Ifproperly utilized, these advancements can contribute a great deal to the realization of the goals and ideals of the people of the United Nations for the twenty-first century, namely peace, stability and well-being. The dramatic evolution oftechnology over the past 100 years has had a profoundly positive effect, in particular, on human health. Advances in our understanding of disease, hygiene and the secondary effects of our daily consumption of such things as food, cigarettes and alcohol have transformed our way ofthinking about our health. This knowledge has empowered people to improve their health dramatically and has deepened our comprehension of the source and impact of different elements in our daily environment. Nevertheless, a disturbing problem has emerged as a result of these improvements, namely the disparity in the quality ofhealth of the rich and poor. Unfortunately, the distribution of important medical information and the ability to shield oneself from the harmful effects of industrialization and population growth are unevenly broken down along economie !ines. The gap between the rich and poor communities ofthe world can first and foremost be seen in the quality of the health care available to each group. This disparity exists today on an unprecedented scale and is one of the major challenges facing bodies such as the W orid Health Organization. Health is the core priority of ali efforts in development and is a fundamental element of what we cali "human security". Nothing can be achieved at the micro or macro leve) in a community unless the individuals in that community fee! safe from such recurring threats as hunger, disease and repression, and are able to enjoy a wide range of choices and opportunities. In other words, a more people-centred vision in the approach of the international community to human security would be symbiotic with its development efforts and, together, would form a constructive mechanism for meeting the challenges of improving the quality of !ife of ali people, regardless of the ir economie status. As Dr Brundtland has said, "health is both a condition and an outcome of development". The pursuit of lasting improvements in health can bring about considerable social and economie gains. However, sustainable development cannot come about without the assurance of continuity in one's daily activities. As the old adage goes, "you are nothing without your health". Adequate health care is one of the most important elements in both sustainable development and human security. People must always be placed at the centre of development, as they are entitled to a healthy and productive !ife in harmony with the environment. ln order to achieve this we need a more holistic approach to development, one that responds more effectively to the material and spiritual needs of individuals, the ir families, and the communities in which they live. This will require an effective and equitable system of social security, ecological or environmental monitoring and, most of ali, a dedicated investment in human capital. The opportunity to improve the lives of humans ali over the world is the tremendous gift of medical advancement but is also a monumental undertaking. l completely agree with Dr Brundtland when she says, "with opportunity cornes responsibility". WHO understands very weil its role ofworking to improve the quality of life for ali. lt also recognizes that the ultimate responsibility for such efforts remains at the national govemment leve!. Govemments bear the primary responsibility for pro vi ding an adequate measure of health and educational services to the ir populations. Through such mechanisms as the WHO country offices, these govemments have at their disposai the best knowledge and expertise in the field. However, the govemments must take the initiative to address these issues in such a way as to maximize the health

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benefits that can be achieved with limited resources and guarantee the most equitable distribution ofthese benefits among various groups of society. WHO also understands that there is an important role for the international community to play in helping to improve the standards of health worldwide. The dissemination of information to ali co un tries and communities, the early warning of and response to serious epidemies, medical norm-setting, the provision of a forum for discussion and action on behalf of vulnerable or poorly represented groups, the funding of research and the targeting of programmes to benefit the poor are ali ways in which the international community can contribute to a global effort to improve health standards in ali countries. To this end, the United Nations Development Assistance Framework (UNDAF) was created as a mechanism to focus the efforts of a broad base of organizations active in the development field with a view to formulating strategie approaches to large-scale problems. Through the participation of WHO, UNDAF has deepened its commitment to the health aspects of many developmental initiatives. In reviewing and updating its mandate regarding humanitarian assistance and emergency relief, WHO is contributing to improving United Nations' efforts in this field. Today, WHO is committed to playing a greater role in response to serious humanitarian crises with large movements of population such as in Kosovo and in other parts of the Federal Republic ofYugoslavia, the former Yugoslav Republic of Macedonia, and Albania. In such difficult circumstances, health is the most vital issue to take into consideration, and WHO successfully tries to work as effectively as it can with donor governments, UNHCR and other United Nations agencies to protect and promote the health of displaced people. I strongly support the Director-General's determination to Jaunch the project on Partnerships for Health Sector Development. We know that a broad health agenda will require WHO to cooperate closely with its partners in ali fields relevant to the health sector. This agenda cannat function without strong links to national governments, the private sector and elements of civil society. The project is a means of strengthening the Organization's work in and with countries. It is a way of ensuring that ministries of health will be able to work with other parts oftheir governments and to regulate the private sector so asto provide quality health care for ali. I believe that the deliberations on health in the context ofhuman security and development that will take place during this Health Assembly will provide valuable input to next year's Millennium Assembly ofthe United Nations. As his contribution to this Assembly, the Secretary-General of the United Nations will prepare a report addressing the key challenges which the international community will face in the decade ahead, together with proposais for ways in which Member States can respond effectively to those challenges. In this context, the Millennium Assembly will become an essential mechanism for bringing together ali relevant actors to focus on issues of global importance, and to generate agreements and specifie commitments that provide a comprehensive framework for further mutually supportive international cooperation. The Millennium Assembly will help to ensure that the twenty-first century will be more peaceful than the last and that ali the people of the United Nations will be able to have a bright and healthy future for themselves and their families, regardless oftheir economie means. Let me conclude by wishing you ali once again much success in your work during this important Fifty-second World Health Assembly. I thank you for your attention. The PRESIDENT: Thank you, Mr Petrovsky. 3. ADDRESS BY THE REPRESENTATIVE OF THE CONSEIL D'ETAT OF THE REPUBLIC AND CANTON OF GENEVA ALLOCUTION DU REPRESENTANT DU CONSEIL D'ET AT DE LA REPUBLIQUE ET CANTON DE GENEVE

The PRESIDENT: 1 now give the floor to Mr Guy-Olivier Segond, Councillor of State, Department of Social Action and Health, ofthe Republic and Canton ofGeneva. M. SEGOND (représentant du Conseil d'Etat de la République et Canton de Genève): Monsieur le Président, Madame la Directrice générale, Mesdames et Messieurs les délégués, Excellences, Mesdames et Messieurs, à l'occasion de l'ouverture de la Cinquante-Deuxième Assemblée mondiale de la Santé, j'ai le plaisir de vous souhaiter, au nom des autorités fédérales, des autorités cantonales et des autorités communales, la bienvenue à Genève et en Suisse.

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En cinquante ans, depuis la fondation de l'OMS, le monde a bien changé politiquement, économiquement et socialement. Après l'effort de reconstruction qui a suivi la Seconde Guerre mondiale, après les luttes de libération nationale et après l'indépendance de nombreux nouveaux Etats, la rivalité Est-Ouest a été progressivement remplacée par la dynamique Nord-Sud. La globalisation de tous les problèmes a bouleversé le cours ordinaire des choses et, grâce au prodigieux développement des nouvelles technologies de la communication, le monde est devenu un. Chacun le sait et chacun Je voit, ces dernières années, de formidables forces de changement sont nées. Les attitudes politiques et culturelles à l'égard de l'Etat se sont profondément modifiées. D'importants problèmes démographiques et sociaux liés aux migrations, au vieillissement et à l'exclusion se sont développés et, partout dans Je monde, il y a des mouvements amples et puissants en faveur d'une réforme des systèmes de santé. L'OMS a pris sa part de ces grands changements mondiaux. Ainsi, la Conférence d' Alma-Ata en 1978 n'a pas seulement défini les objectifs de la santé pour tous en l'an 2000. Elle a aussi imposé le passage d'un système de santé centralisé privilégiant la pathologie urbaine à une pratique communautaire de soins de santé primaires. Grâce à l'amélioration de l'accès aux soins de santé primaires voulue par la Conférence d'Alma-A ta, les taux de mortalité infantile ont baissé dans la plupart des pays pendant que l'espérance de vie à la naissance augmentait régulièrement. Mais là aussi le temps a passé. De nombreux pays qui n'étaient pas en 1978 à Alma-Ata sont devenus des Etats. De nouvelles technologies et de nouveaux modes d'intervention ont vu le jour et une nouvelle génération de professionnels de la santé a pris la relève. Plusieurs facteurs déterminants de la santé, qu'ils soient environnementaux, sociaux, politiques, économiques, démographiques ou épidémiologiques, ont affecté le profil sanitaire des populations. Plusieurs problèmes de santé spécifiques vont croissant, tels que la résistance aux antimicrobiens, la mortalité liée au tabac et le VIHISIDA. Enfin, dans trop de pays encore, les inégalités concernant l'état de santé continuent de s'élargir en fonction du niveau de développement et des classes sociales. Comment cette situation s'explique-t-elle? Car après tout, au cours de ces cinquante dernières années, la médecine a davantage progressé qu'au cours des cinquante derniers siècles. Après des millénaires d'impuissance, la médecine nous a donné le pouvoir de triompher de nombreuses maladies fatales, telles que la tuberculose, la syphilis, la variole. Aujourd'hui, des: transplantations d'organes sont possibles et les lois qui président à la formation de la vie et à la définition de l'identité personnelle sont découvertes. Pourquoi donc la recherche, si active dans le domaine de la reproduction et de l'hérédité, n'arrive-t-elle pas à maîtriser les maladies ordinaires qui frappent la grande majorité de la population de la planète ? La réponse, Mesdames et Messieurs, est simple; vous la connaissez. Cinquante-six milliards de dollars sont consacrés chaque année à la recherche publique et privée en matière de santé. Mais moins de 10% de cette somme impressionnante sont consacrés aux problèmes de santé affectant 90% de la population mondiale. Pour aider à corriger ce déséquilibre, dont les coûts économiques et sociaux sont énormes, cent institutions, publiques et privées, ont constitué Je Forum mondial de la recherche en santé, dont le secrétariat est ici à l'OMS. Dans son premier rapport annuel, le Forum mondial analyse les causes de ce formidable déséquilibre et présente des plans d'action pour contribuer à le corriger. L'une des causes expliquant ce déséquilibre dans la recherche est la mauvaise information des décideurs et - La Palice l'aurait trouvé -,pour que les décideurs puissent prendre de meilleures décisions concernant l'attribution des fonds pour la recherche, ils ont besoin de meilleures informations. C'est l'une des tâches de l'OMS, qui doit rappeler aux chefs d'Etat, aux premiers ministres, aux ministres des finances qu'ils sont eux-mêmes des ministres de la santé. En investissant mieux dans la recherche en santé, on luttera mieux contre les problèmes de santé qui touchent 90% de la population de la planète. On obtiendra une amélioration de la qualité de la vie et on constatera un accroissement de la productivité, ce qui permettra de s'attaquer à l'une des causes fondamentales de la pauvreté. Je suis personnellement convaincu que, par un plaidoyer efficace à l'échelle mondiale, l'OMS, sous la ferme direction du Dr Gro Harlem Brundtland, atteindra au début du XXI• siècle l'objectif d'une meilleure santé pour tous entraînant un vrai changement de la qualité de la vie des habitants du monde entier. Je vous remercie. The PRESIDENT: Thank you, Mr Segond.

A52NR/1 pages

ADDRESS BY THE PRESIDENT OF THE FIFTY-FIRST WORLD HEALTH ASSEMBLY ALLOCUTION DU PRESIDENT DE LA CINQUANTE ET UNIEME ASSEMBLEE MONDIALE DE LA SANTE

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The PRESIDENT: Before proceeding we shaH have a brief pause to allow our distinguished guests to leave the hall, and on behalf of the Assembly, 1 thank them for having honoured us with their presence. 1 would ask ali delegates to kindly remain seated, as we shall soon resume our work.

APPOINTMENT OF THE COMMITTEE ON CREDENTIALS CONSTITUTION DE LA COMMISSION DE VERIFICATION DES POUVOIRS

The PRESIDENT: We shaH now proceed with the Appointment of the Committee on Credentials. The Assembly is required to appoint a Committee on Credentials in accordance with Rule 23 of the Rules of Procedure of the Assembly. In conformity with this Rule, 1 propose for your approval the following 12 Member States: Andorra, Angola, Colombia, Costa Rica, Cyprus, Guinea, Iceland, Maldives, Palau, Portugal, United Republic ofTanzania, United Arab Emirates. Are there any objections? If there are no objections, 1 declare the Committee on Credentials, as proposed by me, appointed by the Assembly. Subject to the decision of the General Committee, and in conformity with resolution WHA20.2, this Committee will hold its first meeting on Tuesday, 18 May at 14:30.

ELECTION OF THE COMMITTEE ON NOMINATIONS ELECTION DE LA COMMISSION DES DESIGNATIONS

The PRESIDENT: We shall now proceed with the Election ofthe Committee on Nominations. This item is govemed by Rule 24 ofthe Rules of Procedure of the Assembly. In accordance with this Rule, a list consisting of

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24 Member States and the President ex officia has been drawn up, which I shall submit to the Assembly for its consideration. May I explain that, in compiling this list, the following distribution by Region has been applied: Africa: six Members; Americas: five Members; South-East Asia: two Members; Europe: six Members; Eastern Mediterranean: three Members; Western Pacifie: three Members. 1 therefore propose to you the following Member States: Bangladesh, Botswana, Brazil, China, Dominica, Ecuador, Ethiopia, France, Greece, Honduras, Hungary, Islamic Republic of Iran, Liberia, Myanmar, Namibia, Nigeria, Paraguay, Poland, Qatar, Russian Federation, Rwanda, Solomon Islands, Tonga, United Kingdom of Great Britain and Northern lreland (ex officia: Bahrain). Are there any observations? In the absence of observations, 1 declare the Committee on Nominations elected. As you know, Rule 25 ofthe Rules of Procedure, which defines the mandate ofthe Committee on Nominations, also states that "the proposais of the Committee on Nominations shall be forthwith communicated to the Health Assembly". The Committee on Nominations will meet at Il :00 in Room VII. I repeat: members of the Committee on Nominations are invited to go to Room VII where the meeting will start punctually at Il :00. The next plenary meeting will be held at 12:00. The meeting is adjoumed.

The meeting rose at 10:50. La séance est levée à 10h50.

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SECOND PLENARY MEETING Monday, 17 May 1999, at 12:00 President: Dr F.R. AL-MOUSA WI (Bahrain) later: Mrs Maria de Belém ROSEIRA (Portugal)

DEUXIEME SEANCE PLENIERE Lundi 17 mai 1999, 12 heures Président: Dr F.R. AL-MOUSA WI (Bahreïn) puis: Mme Maria de Belém ROSEIRA (Portugal)

FIRST REPORT OF THE COMMITTEE ON NOMINATIONS 1 PREMIER RAPPORT DE LA COMMISSION DES DESIGNATIONS 1

The PRESIDENT: The Assembly is called to order. The first item on our agenda this afternoon is the consideration of the first report of the Committee on Nominations. This report is contained in document A52/28 which 1 will now read. The Committee on Nominations, consisting of delegates of the following Member States: Bangladesh, Botswana, Brazil, China, Dominica, Ecuador, Ethiopia, France, Greece, Honduras, Hungary, Iran (Islamic Republic of), Liberia, Myanmar, Namibia, Nigeria, Paraguay, Poland, Qatar, Russian Federation, Rwanda, Solomon Islands, Tonga, United Kingdom of Great Britain and Northern lreland, and Dr F .R. Al-Mousawi, Bahrain (ex officia) met on 17 May 1999. In accordance with Rule 25 ofthe Rules of Procedure ofthe Health Assembly and respecting the practice of regional rotation that the Assembly has followed for many years in this regard, the Committee decided to propose to the Assembly the nomination of Mrs Maria de Belém Roseira (Portugal) for the Office of President of the Fifty-second World Health Assembly. Are there any observations? Election of the President Election du Président de l'Assemblée

The PRESIDENT: In the absence of any observations, and as it appears that there are no other proposais, it will not be necessary to proceed to a vote since only one candidate has been put forward. In accordance with Rule 80 of the Rules of Procedure, J therefore suggest that the Assembly should approve the nomination submitted by the Committee and elect its President by acclamation. (Applause/Applaudissements)

1 1

See reports of committees in document WHA52/1999/REC/3. Voir les rapports des commissions dans le document WHA52/1999/REC/3.

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Mrs Maria de Belém Roseira is thereby elected President of the Fifty-second World Health Assembly and I invite her to take her seat on the rostrum.

Mrs Maria de Belém Roseira (Portugal) took the presidential chair. Mme Maria de Belém Roseira (Portugal) prend place au fauteuil présidentiel. The PRESIDENT: Y our Excellencies, Honourable Ministers, Ambassadors, delegates, Madam Director-General, I would like to thank this august Assembly for the trust in electing me as the President ofthe Fifty-second World Health Assembly. Taking this opportunity, I would like to express my appreciation to Dr AI-Mousawi, my predecessor for his contribution to the last Health Assembly. 1 shall deliver the customary address later today and we will now continue with our work.

SECOND REPORT OF THE COMMITTEE ON NOMINATIONS 1 DEUXIEME RAPPORT DE LA COMMISSION DES DESIGNATIONS 1

The PRESIDENT: 1 now invite the Assembly to consider the second report of the Committee on Nominations. This report is contained in document A52/29 which you have before you. 1 invite the Assembly to pronounce, in order, on the nominations proposed for its decision.

Election of the five Vice-Presidents Election des cinq vice-présidents de l'Assemblée The PRESIDENT: We shall begin with the election of the five Vice-Presidents of the Assembly. The following names have been proposed: Dr T.J. Stamps (Zimbabwe), Mr J. Junor (Jamaica), Dr E.F. Ehtuish (Libyan Arab Jamahiriya), Mr S.U. Yusuf(Bangladesh), Mr M. Telefoni Retzlaff(Samoa). Are there any comments? There being no comments, 1 propose that the Assembly declare the five Vice-Presidents elected by acclamation. (Applause/Applaudissements) 1 shall now determine by lot the order in which the Vice-Presidents shall be requested to serve should the President be unable to act in between sessions. The names of the five Vice-Presidents have been written on five separate sheets of paper which 1 am going to draw by lot. The Vice-Presidents will be requested to take the chair in the following order: Mr M. Telefoni Retzlaff(Samoa), Dr E.F. Ehtuish (Libyan Arab Jamahiriya), Dr T.J. Stamps (Zimbabwe), Mr S.U. Yusuf (Bangladesh), Mr J. Junor (Jamaica). I request the Vice-Presidents kindly to come to the rostrum and take their places there.

Election of the Chairmen of the main committees Election des présidents des commissions principales The PRESIDENT: We now come to the election of the Chairman of Committee A. Dr A.J. Sulaiman (Oman) is proposed. Are there any comments? There being no comments, 1 invite the Assembly to declare Dr Sulaiman elected Chairman of Committee A by acclamation. (Applause/Applaudissements) 1 1

See reports ofcommittees in document WHA52/1999/REC/3. Voir les rapports des commissions dans le document WHA52/1999/REC/3.

A52NR/2 pagE:l10

We have now to elect the Chainnan ofCommittee B. Dr R. Tapia (Mexico) is proposed. Are there any comments? There being no objections, I invite the Assembly to declare Dr Tapia elected Chairman of Committee B by acclamation. (Applause!Applaudissements)

Establishment of the General Committee Constitution du Bureau de l'Assemblée The PRESIDENT: We shall now proceed with the establishment of the General Committee. In accordance with Rule 31 ofthe Rules of Procedure, the Committee on Nominations has proposed the following 17 countries, the delegates of which, added to the officers just elected, would constitute the General Committee of the Assembly. These proposais provide for an equitable geographical distribution of the General Committee: Argentina, Benin, Burkina Faso, Cape Verde, China, Cuba, France, Israel, Japan, Kenya, Lebanon, Lithuania, Russian Federation, Sri Lanka, United Kingdom of Great Britain and Northem Ireland, United States of America, Zambia. Ifthere are no observations I shall declare these 17 countries elected. I see that there are none and therefore they are so elected. The members of the General Committee are the President and the Vice-Presidents of the Assembly, the Chainnen of the main Committees, and the delegates of the 17 countries you have just elected. Before adjouming this plenary meeting, I would like to remind you that the General Committee of the Assembly will meet at 13:00 in Room VII. Sandwiches will be served in the delegates' lounge next to Room VII for the participants at the General Committee when this meeting adjoums. Also at 13:00 there will be a technical briefing in room XIX on the Overview of legal and technical aspects of the framework convention for tobacco control. The next plenary meeting will be held this aftemoon at 14:30. The meeting is adjoumed.

The meeting rose at 12:25. La séance est levée à 12h25.

A521VR/3 page 11

THIRD PLENARY MEETING Monday, 17 May 1999, at 14:30 President: Mrs Maria de Belém ROSEIRA (Portugal)

TROISIEME SEANCE PLENIERE Lundi 17 mai 1999, 14h30 Président: Mme Maria de Belém ROSEIRA (Portugal)

PRESIDENTIAL ADDRESS DISCOURS DU PRESIDENT DE L'ASSEMBLEE

The PRESIDENT: Your excellencies, honourable ministers, ambassadors, distinguished delegates, Dr Brundtland, dear coileagues and friends. Ailow me to thank you for honouring the European Region, my own country Portugal and me personally by electing me as President of this Fifty-second World Health Assembly. 1 do appreciate your trust. We ali come to this Health Assembly each year to contribute to a better world. Our contribution is made through our work to improve health. 1 also know that we are committed to act in the interests of the whole world, even wh en this might sometimes be at the immediate ex pense of our own interests. 1 shail rely on ali of you to help us to reach the right conclusions, as in fact we usually do. Over the past few years, we, the Member States of WHO, took important initiatives to make our common health organization a better one. We shall be considering reports from the Executive Board on a year of change. The Director-General and her staff have responded effectively in reshaping the way WHO works. We shall be able to join the special briefing on change in WHO during Wednesday lunch time. It is now up to us once more to take the policies we hear about to each and every one of our communities. May 1 also refer to the W orld Health Declaration that we adopted last year. This was a wonderful expression of the spirit ofhealth for ail. 1 believe we have ail, during the past year, renewed our efforts to live up to the ethical concepts of equity, solidarity and social justice, and to the incorporation of a gender perspective into our national strategies. We are doing this by paying the greatest attention to those most in need, to those who are burdened by ill health, to those who are not receiving adequate health services, or are affected by poverty, and also by reducing social and economie inequities and addressing directly the basic determinants and prerequisites for health. 1 am pleased to tell you that the Regional Committee for Europe has taken last year's World Health Declaration very seriously. In September our 50 active Members States adopted Health 21 as the healthfor-ail policy framework for the WHO European Region- twenty-one targets for the twenty-first century. The World Health Declaration and our new health-for-all policy framework have given us a new opportunity for action. Health is the flesh and bones of human development. It is the precondition for a state ofweil-being. It is a prerequisite for the satisfaction of other needs. Health concems every individual. It is easily understood by everyone, in fact, health is everybody's business. It concems the private and public sectors, professionals, nongovemmental organizations, politicalleaders and other partners who must be railied around our common agenda. That is surely the democratie way. However, for this to become reality and not just wishful thinking, we must create clear mechanisms for ail these partners to come together at different levels of society. At national, regional and locallevels, we need more and better work across different social and economie sectors. We must remember the

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importance of our health professions, and involve them openly and consistently in shaping policies for professions as part of our health strategies. In cities and local communities we need to pull together city leadership, govemment and nongovemmental organizations and many others to create healthy city or healthy community movements. In schools, teachers, pupils and parents should form school health councils for action. At the work-site similar principles should apply. Ali these structures should use national health policies as their inspiration and guide for development. In this way synergy and cohesion can be created throughout society, relying on the participating and democratie partnerships. The key to achieving health for ali is leadership, if it is a leadership that recognizes the formidable potential ofhealth development, not just to improve people's health, but also to strengthen social cohesion and purpose. Only in this way can we create a truly healthy society. We need public health leaders who are willing to learn not only from a careful analysis of their own experience and that of other countries, but also by setting targets and systematically measuring progress towards them. In this way, we can reach out, inspire and release a tremendous human potential for creating movement for a healthy society, preconditioned for healthy people. W e are determined to continue to push ahead with the development that we started in this very hall 21 years ago, when we agreed that health development throughout the world should be inspired by a mutually agreed upon common policy framework. I believe health for all is a wonderful combination of today's realities and tomorrow's dreams. Today between us we have an unparalleled collective knowledge, tools, technologies and experience to promote health very effectively. Let us use them ali weil. May I also recall that last November we celebrated the twentieth anniversary of the Alma-Ata Declaration on primary health care. I am pleased to tell you that in the European Region we firmly be lieve that those basic aims, which were agreed 20 years ago, are still very appropriate for us and equally valid for the twenty-first century. We are working towards community-based health promotion and disease prevention, coming together with high quality primary and hospital care. Dr Gro Harlem Brundtland, let me salute you very wannly on behalf of ali of us here on the occasion of your first Health Assembly as WHO's Director-General. Let us now look at the work that has been taking place in WHO since you have been appointed. W e have been impressed by the energy with which you have approached the task of reforming our Organization. W e are loo king forward with great interest to listening to you tomorrow moming when you tell us again about your plans for the future. We weil remember your inauguration address to us last year. I would like to refer especially to your bold Roll Back Malaria and Tobacco Free Initiative projects and the wholehearted efforts that you have since directed towards these projects. And it is particularly important that you have taken on board the needs and ongoing initiatives of the WHO regions. I particularly refer to the expansion of the Roll Back Malaria project, and the inclusion of the malaria-infected countries of the European and other regions in the project. The discussion of the technical issues listed on our agenda in Committee A will provide us with upto-date information on WHO's coordinating role and allow us to report on developments in our own countries. The proposed programme budget for the next biennium presented to us in a new format seems to be much easier to understand. That is important for us. We are all very busy and often do not have too much time to work our way through columns of figures, cross-references and difficult formulations. I believe that we shall now be able to pick up the programme budget document and know just what WHO is doing. That will be helpful tous and helpful to WHO's Secretariat too. This I know has meant a lot of work by the Director-General and her staff for which I offer y ou our thanks. The Committee issues on management and financial matters are of course just as important. One of the most interesting and innovative changes for us this week is the way our Assembly programme is shaped. W e must thank y ou, Dr Brundtland, for this. W e look forward with excitement to the round-table discussions. They will allow us to exchange experiences and ideas and learn from each other. This, after ali, is one of the main reasons why we are here. We are privileged to join the first round tables at this Fifty-second World Health Assembly, the start of a new assembly tradition, I am sure. We are unfortunately still facing conflict and wars in many parts of the world. There are many areas in the world where people do not enjoy the most basic human rights of security, democracy and health. I know you alljoin me in a prayer for peace as we think of the unwanted and disabled people and refugees. We feel for the millions of children and other vulnerable groups such as sick persans and the aged. We fervently be lieve that the United Nations and its organizations and bodies must play very active roles in taking humanitarian assistance to the civilian populations, in dealing with the enormous problems of refugee groups, and ultimately in brokering peaceful solutions. It has been particularly rewarding to see the stronger role that WHO now plays in such crises, but I believe we have to be prepared for playing an even stronger role in such situations in the years to come. In those situations do people suffer more than when war erupts? WHO's scientific, coordinating and brokering rote is a key factor in bringing cohesion, synergy and purpose to such complex situations.

A52/VR/3 page 13

Lastly, may 1 assure you that the elected officers of the Health Assembly will try to guide the work of this Assembly impartially and effectively so that ali our discussions achieve a mutually satisfactory conclusion by the close of business next week. With your cooperation and the assistance of the DirectorGeneral and her staffl know we shall succeed. Thank you.

ADOPTION OF THE AGENDA AND ALLOCATION OF ITEMS TO THE MAIN COMMITTEES ADOPTION DE L'ORDRE DU JOUR ET REPARTITION DES POINTS ENTRE LES COMMISSIONS PRINCIPALES

The PRESIDENT: The first item to be considered this aftemoon is item 1.4, "Adoption of the agenda and allocation of items to the main committees", which was examined by the General Committee at its first meting earlier today. The General Committee examined the provisional agenda for the Fifty-second World Health Assembly (document A52/1) as prepared by the Executive Board and sent to ali Member States. The General Committee recommended the following changes to the provisional agenda: deletion of item 6, "Admission of new Members and Associate Members [if any]," sin ce no new applications have been received; and deletion of item 15, "Assessment of new Members and Associate Members [if any]". Does the Assembly agree with these recommendations? 1 see no objections. It is so decided. 1 wish to convey to the Assembly the Committee's proposais regarding agenda item 5, "Round tables: !essons leamed in world health" as a new initiative. This item has been included in response to Executive Board resolution EB 103.R19 in arder to enhance the involvement of ministers ofhealth in policy discussions. lt is proposed to have severa! round tables to discuss the following four issues: "Prioritysetting in the health sector: challenges to ministers", "Investment in hospitals: dilemmas faced by ministers", "Finding the money: dilemmas facing minsters" and "HIV/AIDS: strategies for sustaining an adequate response to the epidemie". However, in arder to agree on the agenda and so as to fit these round tables properly within the context of the rules goveming the functioning of the Health Assembly, the General Committee proposed that they should be considered as committees of the Assembly. This would mean that the Health Assembly would establish special committees for this purpose, which it is entitled to do under Rule 42 of the Rules of Procedure. The General Committee also agreed to recommend that the round tables should be dealt with in six committees which would subsequently report back to the Plenary. If the Plenary agrees with this recommendation, the committees dealing with these issues would not consider any proposais for draft resolutions, as the purpose of the discussions on the four topics in these committees was to permit ministers of health to report on national !essons with global potential and to enhance the involvement ofministers ofhealth in policy discussions. 1 repeat that reports of the discussions will be presented to Plenary at a later stage. With this clarification, and unless there are any comments on the general proposai to hold the round tables and that they should be committees of the Assembly, 1 propose that we proceed with our consideration of the agenda and come back to the details later. Does the Assembly agree to the recommendation of the General Committee to deal with item 5 in this way? 1 see no objection. It is so decided.

Inclusion of supplementary items on the provisional agenda Inscription de points supplémentaires à l'ordre du jour provisoire The General Committee also considered the addition oftwo supplementary agenda items, for which proposais had been received by the Director-General. The first proposai was to include a supplementary agenda item "lnviting the Republic of China (Taiwan) to participate in the World Health Assembly as an Observer". The Committee took the same position as the Assembly did last year when presented with the same proposai and recommended not to include this item on the agenda. Are there any comments? 1 cali on the delegate ofNicaragua.

A52NR/3 pag~ 14

La Sra. McCOY SÂNCHEZ (Nicaragua): Sefiora Presidenta, respecto al informe de la Mesa, larnentarnos profundarnente que la propuesta de incluir como punto suplementario del orden del dia el de invitar a la Republica de China (Taiwan) a participar en la Asarnblea Mundial de la Salud como observador, enviada a la Directora General de conformidad con el articulo 12 del Reglarnento Interior de la Asarnblea, no baya sido aceptada por la Mesa. Fundarnentarnos nuestra recomendaci6n en la necesidad de garantizar la salud para todos, ya que la salud no es un asunto politico y ningün pais deberia ser excluido, menos aun en estos tiempos en que la civilizaci6n esta llegando al principio del tercer milenio, cuando se presupone que nuestras naciones han alcanzado grandes conocimientos y madurez. Es una petici6n a la sensibilidad humana, ya que las enfermedades no tienen fronteras. Afrrmarnos el aporte que la Republica de China (Taiwan) ha brindado en aquellos paises en vias de desarrollo que han solicitado la cooperaci6n y el intercarnbio bilateral en el ârea de ayuda médica, humanitaria y en emergencia ante desastres naturales. Ante estos requerimientos, la Republica de China (Taiwan) se ha hecho presente de inmediato promoviendo los principios y el espiritu de nuestra Organizaci6n Mundial de la Salud. Queremos destacar, en particular, la ayuda humanitaria inmediata brindada por la hermana Republica de China (Taiwan) ante el desastre del huracan Mitch en Centroarnérica y la respuesta râpida y generosa ofrecida a la regi6n para apoyar sus esfuerzos de reconstrucci6n y transformaci6n. Este espiritu de apoyo humanitario intemacional se ha manifestado también en la colaboraci6n médica y financiera a la Ex Republica Yugoslava de Macedonia a fin de recibir refugiados procedentes de Kosovo. Asimismo, se ha expresado en donativos de fondos dirigidos a financiar prograrnas mundiales de salud, apoyando de esta manera estrategias impulsadas por esta magna Organizaci6n. Creemos que es bora de que los mas de 22 millones de personas que habitan la Republica de China (Taiwan) estén formalmente representadas, y de que ésta goce de los beneficios y del honor de ser miembro de la magna comunidad de las Naciones Unidas con la aspiraci6n de alcanzar un mejor nivel de salud para sus habitantes, cumpliendo de esa manera el mandato de la Declaraci6n de Alma-Ata de Salud para Todos en el Afio 2000. Rechazar los aportes de la Republica de China (Taiwan) a la salud mundial, y en particular a esta Organizaci6n, no contribuye al espiritu de esta Organizaci6n y afecta a las naciones mas pobres y vulnerables del mundo. Vemos en esta decisi6n de la Mesa una oportunidad perdida para que los paises desarrollados y en vias de desarrollo puedan beneficiarse de una relaci6n arnistosa y de cooperaci6n en materia sanitaria. Por otra parte, debe reconocerse la universalidad de los derechos humanos y queremos recalcar que la salud tiene que ser para todos los seres humanos de este globo terrestre. Estamos ingresando en el siglo XXI en esta fragil nave llarnada Tierra, en la cual surcarnos los espacios infinitos, lo cual nos debe hacer reflexionar en omitir limites. Lo que debe hacer la humanidad para alcanzar la prosperidad es la unidad de los seres humanos, sin distinci6n de raza, sexo, religi6n, opini6n politica; ése sera nuestro porvenir. Cada vez somos mas conscientes de los grandes retos que enfrentamos, los cuales s6lo podremos vencer conjuntamente. Con todo respeto, estimados delegados ante esta magna Asarnblea Mundial, lo que bernos expuesto en este contexto es para que el beneficio sea de todo el género humano, y queremos recordar el Preambulo de la Declaraci6n Universal de Derechos Humanos que reconoce la dignidad intrinseca y los derechos iguales e inalienables de todos los miembros de la farnilia humana; esperarnos que para la Asarnblea del milenio esto sea una realidad. Que Dios los bendiga y los ilumine. Muchas gracias. The PRESIDENT: 1 thank the delegate of Nicaragua, and 1 cali on the delegate of China. Professor WANG Longde (

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The PRESIDENT: 1 thank the delegate of China, and 1 cali on the delegate ofDominica. Mrs PAUL (Dominica): Let me take this opportunity to offer my sincerest congratulations to you on your election as President. The Commonwealth ofDominica supports the application ofthe Republic of China (Taiwan) for observer status of the Health Assembly. WHO establishes as its priority a global strategy on the principles of equity and health for ali. WHO is a benign organization working to eradicate and control disease and to improve the health of people around the world. The Director-General of WHO has proposed an aggressive programme to roll back malaria and to fight the impact oftobacco-smoking. WHO is also continuing its efforts to eradicate measles, poliomyelitis and combat HIV/AIDS. The Republic of China (Taiwan) has a population of22 million, which is larger than that ofthree-quarters of the Member States of WHO. It is of concern that the epidemiological profile of the Western Pacifie, and indeed the world as presented by WHO, does not take into account that of the Republic of China (Taiwan). This is a significant omission. Notwithstanding, Madam President, the Republic of China (Taiwan) has made considerable achievements in the health sector. lts infant and maternai mortality rates are comparable to those of developed countries. It has eradicated infectious diseases such as cholera, smallpox, plague and

A521VR/3 pagE: 16

poliomyelitis. It is the first country in the world to provide children with hepatitis B vaccine. Apart from the US$ 17 million presented by Rotary Clubs of the Republic of China (Taiwan) to support WHO's global poliomyelitis eradication programme, the Taiwanese Government and its Rotary Clubs have committed a further US$ 10 million through Rotary International in support of this vital programme. Given the serious challenges ofHIV/AIDS and other new, emerging and re-emerging diseases and in response to natural and man-made disasters, WHO should not deny itselfthe opportunity to access the significant resources both human and financial that the Republic of China (Taiwan) is prepared to contribute to world health. Indeed, diseases know no international boundaries. The efforts at rolling back malaria recognize that it spreads through migration. If we were to achieve success in ali other countries, and malaria continues to exist in Taiwan, we will not have achieved true success and malaria will indeed still be with us. I therefore regret that the General Committee failed to recommend the inclusion in the agenda of the supplementary item to consider the Republic of China (Taiwan) for observer status in the Health Assembly, and I would urge the Assembly to accept its inclusion. Thank you. The PRESIDENT: I thank the delegate of Dominica, and I cali on the delegate of Myanmar. Mr A YE (Myanmar): Madam President, I have requested the floor to respond to the proposai to invite Taiwan to participate in this Fifty-second session ofthe World Health Assembly as an observer. For those among us who have participated in the work of the Health Assembly during the past two years it may come as no surprise that this irrelevant and needless exercise is once again being deliberated at the current session of the Assembly. It is our eamest hope that this proposai will not be adopted and that it will be rejected just as it was in the years past. The proposai for observer status for Taiwan had been repeatedly rejected for a number of fundamental reasons that are ali crystal clear and accepted by us. The distinguished delegates gathered here will recall that United Nations General Assembly resolution 2758(XXVI) recognizes that the representatives ofthe People's Republic of China represent China and are the only lawful representatives to the United Nations. Furthermore, resolution WHA25 .1 pertaining to China's representation in the W orld Health Organization reiterates and acknow1edges this state of affairs. The reality is obvious. There exists only one China, and Taiwan is a part of the People's Republic of China. Thus it would naturally follow that any unnecessary and prolonged consideration of the proposai at this Assembly would be tantamount to gross interference in the internai affairs of a sovereign country. In this case, that country is the People's Republic of China, and delegates will surely concur that noninterference in the internai affairs of a sovereign State and a Member ofthe United Nations is a cardinal principle of the Charter of the United Nations. Indeed the proposai runs counter to the stipulations of the WHO Constitution itself, which we are ali gathered here today to collectively uphold. As such there exists no valid ground whatsoever for granting observer status to Taiwan. But, Madam President, let us for a briefmoment reflect in an objective manner on the health-related merits of the situation before us. Expressions to the effect that health is a basic right of ali and that diseases respect no national boundaries, have often been used in attempts to lend credence to the proposai in question. For their part, the health authorities of the People's Republic of China have never questioned the right of ali their compatriots to good health. On the contrary, as the delegate of the People's Republic of China has just clarified, the Chinese Government places great emphasis on good health care and proper medical facilities for their Taiwan compatriots. Furthermore, the delegate of the People's Republic of China in that earlier explanation outlined the various ways and means by which the inhabitants of Taiwan can enjoy the services and the benefits of the World Health Organization. Hence it is evident that satisfactory solutions to the matter must necessarily be arrived at by the Chinese people themselves, free from outside interference. We have no doubt that such endeavours will be successful and we take this occasion to wish them every success. Meanwhile, we on our part must demonstràte what is expected of us as called for in the Charter of the United Nations and the Constitution of the World Health Organization. The General Committee has already undertaken to review the proposai to place the Taiwan issue as a supplementary item on the agenda. The report of the General Committee on the matter and its recommendation is now before us. The delegation of the Union ofMyanmar is confident that this august Assembly will deem it appropriate to oppose the proposai to place the Taiwan issue on the agenda and at the same time to uphold the recommendation ofthe General Committee. We hereby add our own appeal to the distinguished delegates gathered here to do so.

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The PRESIDENT: Thank you. 1 see no further requests for the floor. May 1 therefore assume that the Assembly agrees with the General Committee not to include this supplementary agenda item? It was so decided. The second proposai was to include a supplementary agenda item on "The use of languages in WHO". The General Committee reached a consensus to recommend inclusion of this supplementary agenda item. May 1 therefore assume that the Assembly agrees to adopt the provisional agenda as amended with the addition of this supplementary agenda item. 1 see no objection, it is so decided. The agenda is adopted as amended. Document A52/1 Rev.l reflecting the changes will be distributed tomorrow moming.

Allocation of items to the main committees Répartition des points de l'ordre du jour entre les commissions principales The provisional agenda of the Assembly was prepared by the Executive Board in such a way asto indicate a proposed allocation of items to Committees A and B, on the basis of the terms of reference of the main committees. Since the Assembly has agreed to consider the supplementary agenda item on "The use of languages in WHO", does the Assembly agree that this item be discussed in Committee B as recommended by the General Committee? 1 see no objection. It is so decided. The General Committee has recommended that the items appearing on the agenda of the Plenary as amended, which have not yet been disposed of, should be dealt with in Plenary. With regard to item 5 of the provisional agenda "Round tables: tessons learned in world health", we have already agreed that these round tables will be considered as committees of the Health Assembly. The proposais considered within the Executive Board for the establishment and functioning ofthese round tables are quite innovative. The intention when establishing them was to provide a forum for health ministers ofMember States to discuss in an informai manner major issues of concem to the health community. It is hoped that these discussions will be lively, interesting to ali concemed, and that the discussions will evolve taking into account the exchange ofviews. In order to achieve these objectives, it is felt necessary to restrict participation in each round table to ensure that ali participants have the opportunity to take part actively in the debate. Consequently, and using the authority provided under Rule 85 of the Rules of Procedure for the Assembly to make special arrangements for the conduct of business of committees, the General Committee made the following proposais: On Tuesday aftemoon, there will be three round tables: two will discuss "Priority-setting in the health sector: challenges to ministers", and the third will discuss "lnvestment in hospitals: dilemmas facing ministers". On Wednesday moming, there will be another three round tables, two ofwhich will discuss "Finding the money: dilemmas facing ministers", and the other discussing "HIV/AIDS: strategies for sustaining an adequate response to the epidemie". Each of these round tables will be considered as a separate committee of Iimited membership. They will be limited in membership to those ministers of health or delegates at ministerial levet representing Member States at this Assembly who have registered for participation in one or more specifie round tables. The list of participants in each ofthe round tables is published in the Journal. As 1 have already said, only these participants will be considered as members of each of the round tables. Ali other delegations and representatives of associate Members and observers to the Health Assembly, including members of the delegation of the Minister ofHealth participating in the round table, may attend as observers. During the discussion, Argentina proposed that an observer should be able to participate in the discussion. However, it was explained that the legal status of observers, who normally only took the floor to make a statement at the end of an agenda item, was not consistent with the nature of the intended discussions which was to involve an active exchange ofviews between the participating ministers ofhealth. Therefore, this proposai was not supported. Consequently, only the participants - that is to say, the ministers ofhealth constituting the membership of each of the round tables- will be permitted to speak in order to ensure a full debate between ali ministers present. As the purpose of the round tables is to permit everyone to profit from an exchange ofviews between the participants, and not necessarily to an agreed position in ali cases, the round tables will not have a mandate to approve resolutions, but rather only to submit to the Plenary a summary of the discussions.

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Each of the round tables will be chaired by one of the Vice-Presidents of the Assembly, the first Vice-President having kindly agreed to chair two round tables. In order to promote a lively discussion on each of the subject matters being discussed, the Chairmen of each ofthe round tables will be assisted by a moderator provided by the Secretariat. The Chairmen of each of the round tables will submit to the Plenary an oral report summarizing the discussions between the participants. With regard to the items appearing under the two main committees in the provisional agenda, there has been sorne interest in considering the issue of casual income (under item 15), along with the budget. The Committee agreed to recommend to the Plenary moving consideration of this item from Committee B to Committee A, and taking it up under item 12, "Proposed programme budget for 2000-2001". It is understood that, later in the session, it may become necessary to transfer items from one committee to the other, depending on each main committee's workload. Does the Assembly agree with this proposai? I see no objection. It is so decided. A revision of document A52/1 will be distributed tomorrow.

ANNOUNCEMENTS COMMUNICATIONS

The PRESIDENT: I wish now to make an important announcement conceming the annual election ofMembers entitled to designate a person to serve on the Executive Board. Rule 101 ofthe Rules ofProcedure as amended by resolution WHA50.18 reads: At the commencement of each regular session of the Health Assembly the President shall request Members desirous of putting forward suggestions re garding the annual election of th ose Members to be entitled to designate a person to serve on the Board to place their suggestions before the General Committee. Such suggestions shall reach the Chainilan of the General Committee not later than twenty-four hours after the President has made the announcement in accordance with this Rule. I therefore invite delegates wishing to put forward suggestions conceming these elections to submit them to the Assistant to the Secretary of the Assembly not later than Tuesday aftemoon, 18 May, at 16:00, in order to enable the General Committee to meet to draw up its recommendations to the Assembly. When considering the tentative programme of work of the Assembly, the General Committee, realizing that the list of speakers for item 3, Looking ahead for WHO after a year of change, may not be completed by Wednesday, 19 May, recommended holding an additional plenary meeting. It would be held on Thursday, 20 May, at 9:00 simultaneously with Committee A; on adjoumment of the Plenary, Committee B would hold its second meeting. Is this agreeable to the Assembly? I see no objection. It is so decided. The programme of work for tomorrow, Tuesday, 18 May will be as follows: in the moming, the Plenary will deal with item 2, A year of change: reports of the Executive Board on its 102nd and 103rd sessions, item 3, Looking ahead for WHO after a year of change, Report of Dr Gro Harlem Brundtland, Director-General, and item 4, Health in development, presentation by Professor Amartya Sen, Master of Trinity Co liege, Cambridge, Nobel Laureate in Economies, followed by the review of The world health report 1999. In the aftemoon, at 14:30, the round tables will meet to deal with the topics "Priority-setting in the health sector: challenges to ministers" and "Investrnent in hospitals: dilemmas faced by ministers". The Committee on Credentials will hold its first meeting at 14:30. On Wednesday, 19 May, the Plenary will hold its fifth meeting at 9:00 to consider the report of the Committee on Credentials, after which the ministerial round tables will continue on the topics "Finding the money: dilemmas faced by ministers", and "HIV/AIDS: strategies for sustaining an adequate response to the epidemie". In the afternoon, the sixth Plenary meeting will continue its review of item 3 and simultaneously Committee A will meet. The General Committee will then hold its second meeting at 17:30. I would like to mention already at this stage that, at the request of a Member State, it is proposed to reschedule the discussion of item 17, Health conditions of, and assistance to the Arab population in the occupied Arab territories, including Palestine so that it is considered in Committee B on Thursday, 20 May, instead ofFriday, 21 May. Does the Assembly agree with this request? It is so decided. I would also like to remind the few delegates who have not yet submitted their formai credentials that they shou1d hand them over to the secretariat of the Credentials Committee in office A.671 of this building, before 12:00 tomorrow.

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The main committees will now meet to elect their officers. The next plenary will meet tomorrow at 9:00. The meeting is adjourned.

The meeting rose at 15:40. La séance est levée à 15h40.

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FOURTH PLENARY MEETING Tuesday, 18 May 1999, at 9:00 President: Mrs Maria de Belém ROSEIRA (Portugal)

QUATRIEME SEANCE PLENIERE Mardi 18 mai 1999, 9 heures Président: Mme Maria de Belém ROSEIRA (Portugal)

A YEAR OF CHANGE: REPORTS OF THE EXECUTIVE BOARD ON ITS 102ND AND 103RD SESSIONS UNE ANNEE DE CHANGEMENT: RAPPORTS DU CONSEIL EXECUTIF SUR SES CENT DEUXIEME ET CENT TROISIEME SESSIONS

The PRESIDENT: We shaH now pass on to item 2, A year of change: reports of the Executive Board on its 102nd and 103rd sessions. Before giving the floor to the representative of the Executive Board, 1 should like to explain briefly the rote of the Executive Board representatives at the Health Assembly and of the Board itself, in order to avoid any uncertainty on the part of sorne delegates on this matter. The Executive Board bas an important rote to play in the affairs of the Health Assembly. This is quite in keeping with WHO's Constitution, according to which the Board bas to give effect to the decisions and policies of the Health Assembly, to act as its executive organ, and to advise the Health Assembly on questions referred toit. The Board is also called upon to submit proposais on its own initiative. The Board, therefore, appoints four members to represent it at the Health Assembly. The rote ofthe Executive Board representatives is to convey to the Health Assembly, on behalf of the Board, the main issues raised and the flavour of the Board's discussions during its consideration of the items which need to be brought to the attention of the Health Assembly, and to exp lain the rationale and nature of any recommendations made by the Executive Board for the Assembly's consideration. During the debate in the Health Assembly on these items the Executive Board representatives are also expected to respond to any points raised whenever they feel that a clarification of the position taken by the Board is required. Statements by the Executive Board representatives, speaking as members of the Board appointed to present its views, are therefore to be distinguished from statements of delegates expressing the views of their governments. 1 now have pleasure in giving the floor to the representative of the Executive Board, Dr Calman, Chairman of the Board. Dr CALMAN (Chairman of the Executive Board): Madam President, Madam Director-General, your excellencies, distinguished delegates, 1 should first of ali congratulate you, Madam President, on your election, and on behalf of the Executive Board extend to you our full support, and wish you weil. It bas been a very great privilege to have been the Chair of the Board over a year of such change and excitement. It bas also been an honour to represent WHO at a number of events including a meeting ofthe European Parliament. WHO is a great organization whose expertise and influence are essential ifwe are to improve the health of the people ofthe world. A glanee at its Constitution makes it clear that this is our primary purpose, and 1 quote, "The objective ... shall be

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the attainment by ali peoples of the highest possible levels of health." Health, using the broad WHO definition, must also in elude quality of li fe and happiness. As I have suggested to the Secretary of State for Health in the United Kingdom, perhaps a better title for the Department of Health might be the Department ofHealth and Happiness, reflecting the importance 1 attach to well-being and a whole persan approach to health. We must not forget that this is our overall purpose, and to achieve this will require a great deal ofhard work, energy, commitment, initiative, good will, clear strategie aims and the collaboration of many partners. The th erne of this presentation of the work of the Executive Board is that there is an enarmous potential to improve health now, ifwe were to harness the knowledge, skills and expertise that we already have. I will develop this theme in a moment, but first a review of what has happened in a year of change. The full details are in the formai report 1 and at this stage I will highlight only sorne important developments. There was a change in the way in which Members are represented on the Board. In the past it was in a persona) capacity; now we represent our countries. The long-term significance of this remains to be seen. There was a change in the Director-General, from Dr Nakajima, to whom we gave our best wishes for his retirement, to Dr Gro Harlem Brundtland, whom we welcomed and to whom we pledged our support. There has also been a considerable change in the working methods of the Board. We have worked in smaller and more focused groups. A virtual working group was created to look at sorne constitutional issues. There have been shorter and, I hope, more effective contributions to the Board. We eut the January session by two-and-a-half days. There have been fewer resolutions to the Assembly this year, ali of them are on major issues. There was an important private session of the Board with Dr Brundtland to get to know each other and share our optimism for the future. A newsletter from the Chairman of the Board has been initiated to improve communication between members of the Board, and this has been weil received. An Executive Board retreat was held, and I will discuss this more fully in a moment. There have been very good working relationships with the Administration, Budget and Finance Committee and the Programme Development Committee. I would like to thank the Chairmen of these committees for their hard work and achievements. Ail in ali we have been busy in the process of change and improvement in the work of WHO. The Executive Board retreat in October at Leysin, Switzerland, was a first, and one which, I hope, will be repeated regularly. It was very useful and allowed a frank exchange ofviews between members, the Director-General and Executive Directors. We got to know each other better and in more informai surroundings. If there is to be another retreat I would hope that Regional Directors will be invited. It provided an excellent opportunity to consider the long-term vision of the Organization and for the Board members to feel part of the process. In the middle of the Retreat the group ascended the local mountain and walked back in unison. A symbolic vision of our work together. The work of the Executive Board itself was focused on the January meeting where we had an opportunity to take part in creating "one WHO". There was a very important discussion on vision and strategy, and sorne key decisions and resolutions were adopted. They included those on the eradication of poliomyelitis, the Roll Back Malaria project, a framework convention on tobacco control, the revised drug strategy, the role ofthe Executive Board, and reform of the Health Assembly- sorne ofwhich have been introduced at this Assembly. The Board also discussed health systems development, and the role of country offices. The employment and participation ofwomen in the work of WHO was discussed in depth. We agreed, following full discussion, that Articles 2 and 73 ofthe Constitution should remain unchanged. Sir George Alleyne and Dr Uton Muchtar Rafei were reappointed as Regional Directors and Dr Shigeru Omi was appointed as the new Regional Director for the Western Pacifie. We said thank you to Dr Han for ali his work over the years for WHO. The proposed programme budget for 2000-2001 was also debated in detail. Additional information was requested and this will be the subject of further discussion at this Assembly. Ail very important issues. I am most grateful to the members of the Board for their hard work and constructive thinking on these matters. I am particularly grateful to Professor Girard for his work on the revised drug strategy. Being the Chairman of the Executive Board, even for a single year, leads to a single conclusion. WHO is needed as never before to put forward the voice of health in the world as it works through its Member States with the many other partners involved. This also provides me with an opportunity to pay tribute, on behalf of the Executive Board to ali the staff of WHO, here in Geneva, in the regions, and in countries. They have great skills, expertise and courage to do the things they do in difficult conditions and with buge problems. Their commitment to WHO and to improving the health of the peoples of the world is both real and tangible. We thank you. You maintain the values of WHO, combining caring and

Document A52/2.

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compassion with being at the leading edge of innovation, research and education. The hard edge of the evidence base is brought together with the values of quality and a con cern for others. The world health report 1999 sets out both the past contributions of WHO and its future direction. The Declaration of Alma-Ata, health for ali, an effective primary care service, the eradication of smallpox, the great achievements of the Expanded Programme on Immunization represent sorne of the first category. The Roll Back Malaria project, the Tobacco Free Initiative, the eradication of poliomyelitis, and the improvements in the de li very of care represent the second. It is an exciting prospect. It emphasizes that local initiatives cao be made global as the tobacco initiatives in Europe have shown. Someone needs to take the lead and to show the way. WHO has that responsibility working with its Member countries. This leadership role is one of the most important of ali WHO' s functions. The report continues to emphasize the importance of partnerships, from the voluntary sector to govemment agencies to intergovemmental bodies, from universities to industry, from people to politicians. 1t is the people of the world who will change health, and it is our responsibility to be there to help them. The European Environment and Health Committee and the ministerial conference on environment and health to be held in London in June of this year show how successfully such programmes cao be developed if we ali work together in partnership. Let me now retum to one of my earlier comments, that of the potential for health. The key determinants of health are well known: poverty, unemployment, education, violence and other socioeconomic factors, ali of which contribute to inequity and inequality; the environment, and its sustainability; persona] factors such as Iifestyle, diet, tobacco, drugs and alcohol; genetic and biological factors; communicable disease; health services, and access to them, with particular concems here for the health ofwomen and children, mental health and the health ofthe elderly. The role ofprimary care is central to this. The refugee problems around the world show how relevant ali these factors are, and how acute they are. To help achieve our objectives we need competent practitioners with energy, curiosity and enthusiasm, motivated by compassion and concem. We need an educational process, which delivers this worldwide. These factors have been known for generations, yet still need action today. We already have the knowledge and thus the potential to deal with many, though not ali, ofthese issues. We will always need more information, more research. Y et with what we already know we could improve the health of the people of the world now. We need to act, we cannot wait. The potential cao be realized ifwe implement our bxisting knowledge of hygiene, nutrition, the environment and lifestyle issues, including tobacco smoking, and the eradication ofpoliomyelitis worldwide would be the outstanding example of this. We cao doit. We must doit. It has been a privilege and a pleasure to be part of WHO for almost 10 years. 1 have seen many changes and considerable improvements in health in many areas, though new problems in others. May 1 thank the members of the Executive Board and the Secretariat for their help and support, coupled with a special thanks to those members of the Board who are leaving. We wish the Organization, the DirectorGeneral and the Executive Board well. Before 1 close let me read to you two quotations which 1 hope summarize my comments on the potential for health. The first cornes from Robert Burns, Scotland's national poet. As it happens, the anniversary of his birth fell on the first day of the January Board session and 1 used this quotation theo. It symbolizes the idea towards which we should strive and cornes for a poem on poverty: "Then let us pray that come it may As come it will for a' that That sense and worth o'er a' the earth May ali agree with a' that For a' that and a' that It's coming yet for a' that That man to man the warld o'er Shall brithers be for a' that." This highlights the importance of common sense, of working together and of the brotherhood of man. The second quot&tion is from Martin Luther King, which 1 first heard from Sir George Alleyne in his acceptance speech as Rt:gional Director of the Americas, and shows how far we still have to go to get there: "Human progress is neither automatic, nor inevitable ... every step towards social justice requires sacrifice, suffering and struggle, and the passionate concems of dedicated individuals. This is no time for apathy or complacency. This is a time for vigorous and positive action." WHO is needed as never before and 1 know that WHO, as an organization, as Member States, and as individual staff members, will rise to the challenge as we rn ove into the new millennium.

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

LOOKING AHEAD FOR WHO AFTER A YEAR OF CHANGE: REPORT OF THE DIRECTOR-GENERAL (INCLUDING THE WORLD HEALTH REPORT 1999) L'A VENIR DE L'OMS APRES UNE ANNEE DE CHANGEMENT: RAPPORT DU DIRECTEUR GENERAL (Y COMPRIS LE RAPPORT SUR LA SANTE DANS LE MONDE, 1999)

The PRESIDENT: And now 1 give the floor to Dr Gro Harlem Brundtland, Director-General, so that she may present, under item 3 of the agenda, her report on the work of WHO, including a review of The world health report 1999. The DIRECTOR-GENERAL: Thank you Madam President. Let me first congratulate you upon your election as President of the Fifty-second World Health Assembly. We are pleased to have such an experienced minister to lead our work. I have, in fact, consulted the records of the Assembly, and find that you are the first woman President since 1981, so it is a double pleasure to see you in the Chair. (Applause/Applaudissements)

Let me wish ali the health leaders gathered here today a heart-felt welcome to the 1999 World Health Assembly. In the days to come many will be looking to Geneva. We will be setting the future direction for global health policy. That is our role. Our responsibility is to capture the aspirations of the millions of people on earth who wish for better health, for equal opportunities and the right to enjoy the benefits of development and progress. The health gains of the twentieth century count as one of the biggest social transformations of our times. Living conditions dramatically improved for the large majority ofhuman beings. But the century left a legacy. More than a billion fellow human beings have been left behind in the health revolution. We must bring the excluded billion on board. This can be done. The world has the knowledge and the means to address the unfinished health agenda of the twentieth century. We know what it will take and we can go a long way in the next decade. We have to do so while being ready to confront new challenges from re-emerging infections, an ageing world population and a dramatic increase in noncommunicable diseases. And - not to forget - to unveil and to address seriously the growing burden of mental illness. We have to address difficult questions: What will be the health consequences of climate change? Can the world manage to feed a growing population, meet its energy needs and secure clean water for all? How can we be sure that ethical norms will govem the scientific advances that offer hope, but also carry risks? How can we care for the growing migrant and displaced populations? And will humanity continue to experience conflict and violence -killing and mutilating people and hampering development in so many parts of the world? Look to the Balkans. ln just a few months more than a million people have been deprived oftheir identity, their homeland and their future security. The toll on human health will weigh for a long time throughout the entire region. WHO alongside the entire United Nations system will do what it canto assist people forced into tragic misery. Let us also remind ourselves that similar disasters have happened and are happening in other parts of the world- in areas where the television cameras do not tell the stories or spread the images. All people who suffer deserve our attention. This is a time for leadership. Humankind has never made progress by giving in to complexity. This is a time for cool heads and warm hearts. We can make a difference. My message is that with vision, realism and commitrnent the world could end the first decade of the twenty-first century with sorne notable accomplishments. It will take global leadership to set the process in motion and this Organization is ready to play its role. Times may be changing, and we will be on the side ofthe change process.

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WHO bas done this before. Health for ali unleashed a powerful movement. Inspiration and guidance from Alma-Ata in 1978, with its emphasis on the critical role of primary health care, contributed in no small measure to the health revolution and tangible health gains in the last two decades of the twentieth century. Looking ahead, WHO can doit again. The world is fast discovering how better health can drive development. We have long known that poverty is a fundamental cause ofill-health. Now we are learning a more powerfullesson - that health gains trigger economies to grow and poverty to be eut. Think about it: in poor countries, it would take very little to increase life expectancy by addressing the main killers of children and adolescents. A five-year difference in life expectancy may yield an extra annual growth of0.5% per year. It is a powerful boast to economie growth which will happen. Modest improvements in health can help children, women and men to better achieve their potential, unlocking value in every area of their lives. We are not aiming at modest gains. In East Asia life expectancy increased by over 18 years in the two decades that preceded the most dramatic economie take-off in history. Repeat these gains and we cou1d be 1aunching a new 1eap forward for human progress and development. This knowledge is made availab1e to us by people who have searched for a deeper understanding of deve1opment. One of them will address us later this morning. 1 wish to pay tribute to Professor Amartya Sen, Nobel Laureate in economies. Having placed poverty and development at the core of economie theory, linking the social and economie dimensions of human development, he has been instrumental in shaping international development thinking. He deserves our warm appreciation.

(Applause/Applaudissements) This year's World health report highlights four key challenges. First and foremost, there is a need to greatly reduce the burden of excess mortality and preventable disability suffered by the poor. The goal ofhalving the number of people living in absolute poverty by the year 2015 is attainable, but will require major shifts in the way govemments ali over the world use their resources. In several regions of the world we need more money for health. But, equally important, we should have more health for our money. It AlOS, tuberculosis, malaria and other childhood means giving renewed attention to diseases like HIV1 killers. It will mean investing more in women's health, reducing maternai mortality and improving maternai and childhood nutrition. It will mean revitalizing and extending the coverage of immunization programmes and ensuring access to cast-effective health technologies such as essential drugs. Second, there is the need to counter threats to health resulting from economie crises, from unhealthy environments and risky behaviour. In health the success stories often give rise to new challenges. Ifwe succeed in curbing poverty and giving populations a real chance to climb the development ladder, then new health threats will follow, from noncommunicable diseases, from the very fact that people live longer, from changing lifestyles, and from exposure to threats such as tobacco. So the message is: let us prepare wisely. Third, we need to develop more effective health systems. In many parts of the world, health systems are ill-equipped to cope with present demands, let alone those they will face in the future. Pressure for change provides an opportunity for reform. But reform requires a sense of direction. Better health for ail, securing equitable health services, must guide that change. Fourth, there is the need to invest in expanding the knowledge base that made the twentieth century revolution in health possible. A key message in The world health report is the critical role played by the generation and application ofknowledge. Knowledge about diseases and their control. Knowledge about the effectiveness of interventions and healthy behaviour. Knowledge made available through research through experiences - through leaming from successes and failures. Our search for knowledge -the research agenda - cannat be limited to diseases and risk factors or the right technical interventions. Many governments find it difficult to shift resources away from expensive curative services, which primarily serve their wealthier and more influential constituencies, to basic services that benefit the majority of the population. We must also better understand the impact and politics ofpriority-setting. This is one of the themes at the round tables for ministers this afternoon. Poor countries, and the poor in rich countries, are inadequately protected from financial exploitation or treatment of varying efficacy when they use the private sector. We need to know how the required regulatory mechanisms can be developed to protect the public without deterring innovation. On the other band, public service providers often fail to treat people with respect and dignity. We need tore-examine how to improve public sector performance - including giving people a real voice in holding service providers to account. In the global economy there are things that the market cannot huy. Theœ are critical tasks that will not be fulfilled unless someone does it on behalf of ali. WHO is a repository of public health knowledge for the whole world. Today 1 plead with you to safeguard this vital public good. There are functions that the economie actors cannat fulfil, such as setting global standards for blood safety; establishing and

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reporting objectively from a global surveillance system, which monitors new and emerging diseases; determining every year's influenza vaccine; providing unbiased figures on the global burden of disease; or maintaining updated international health regulations, a road map to a safe future for ali generations. WHO can provide the mirror in which Member States see a reflection oftheir own performance. If this performance is weak - particularly if the poor do not participate in health gains - we must be prepared to say so on the basis of sol id evidence from reliable health indicators. 1 am pleading the cause for global advocacy and normative functions - a weli-informed voice in a complex and changing world. Maintaining a solid and reliable global agency is a cost-effective investment that benefits everyone. This year your countries - ali our countries -will spend sorne US$ 2300 billion on health care. The knowledge generated and made available by WHO can positively influence how wisely this money- 10% of the world's GDPis spent. Y ou are the owners of the World Health Organization. Take good care ofit. When 1 was elected Director-General 1 pledged that WHO can and must change to become more effective, more accountable, and more receptive to a changing world. Today, looking back at months of intense work with my staff, 1 feel 1 can say that we are moving decisively in that direction. Let me highlight sorne of the main features. Priorities are coming back to the World Health Organization. World health is an immensely broad and complex area to cover. Even a global organization would lose its focus if it tried to do everything. The programme budget we propose to you is a first major step. We have sharpened our focus and shifted resources to priority areas. The budget for the next biennium represents a shift from the past, but it is only a beginning. The next programme budget will be prepared from scratch with a focus on how WHO as a who le - in countries, regions and headquarters - can make the most substantial impact - by our own activities and through those of our partners. At headquarters we have refocused our work around nine clusters, sending a very clear message of what business we are in. For the first time there is an empowered senior management team - 10 Executive Directors with real corporate responsibilities. Representing ali WHO regions, they make a truly global team. Last year 1 told you that the time has come to increase the number ofwomen in the World Health Organization. Women represent half of the world 's population, but carry much more than half of the world's health burden. How can we then accept massive under-representation ofwomen at WHO? The answer is simple: we will not accept it. Time has come for a change. We will do what we canto take the gender balance towards parity. It cannot be done ovemight, but we will work steadily to get there. Cabinet has set a target of 60% of new recruits being female. Of my Executive Directors, five are women and five are men. Last July, when 1 took over, only four out of more than 50 directors were women. We have taken advantage of a process of rotation and mobility to change that equation. Today, 10 out of 33 department directors are women. The ratio has gone from a few percent to close to 30%. We are on track. We are developing a gender policy in WHO. We need to evaluate how men and women are served by health systems. The aim is clear: they should benefit equaliy from the fruits ofhealth and development. Let me say from this rostrum: 1 pay tribute to WHO staff who have been through a profound process of change. With their technical skills and capabilities they constitute our ultimate resource. They deserve our appreciation. 1 am proud of my staff. (Applause!Applaudissements) In 10 months we have been through a major administrative overhaul. We have invested in priority areas by "sunsetting" other activities. This is not a one-time operation; it will continue. We have moved management support near to the managers. The management support units are an innovation in the United Nations system. The role of administration and management, remember, is truly to support, facilitate and back up ali our technical work. During these months we have worked closely with the Regional Directors seeking to assure consistency throughout WHO. We are one WHO, not seven: we are seeking more unity ofpurpose, and each regional office has undertaken studies of its own structure and direction better to pursue new priorities and strategie directions. The real untapped resources of this Organization, however, are not located in Geneva or in the regional offices. They are in countries. For the first time ever in the history of WHO we brought the WHO Representatives and Liaison Officers to Geneva for a week in February. During that week we started a process of change towards a more determined focus on how we can make a tangible difference in our work in and with countries. That is where people live. That is where they struggle to make ends meet, combat disease and strive for a healthy future. That is where our focus must always be. What lies ahead? Let me share with this Assembly how 1 see the next stage in the process of change of the World Health Organization. The real change, and the change that realiy matters, is where we must now focus our attention. 1 am talking about increasing our effectiveness as an organization, so that we can

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maximize the impact we have on people's health. The next stage will be pursued with determination. If the only change we make is to repack and dress up in new clothes, we will achieve little, and we will convince no one. Making a difference is our watchword. In everything we do we have to ask: how can we best - through our own efforts - and through th ose of others with whom we work - make the biggest impact and difference in people's health? For too long, our spending patterns have been driven too much by traditions and not enough by the real needs of a changing world. This is now changing. WHO is not itself a funding agency. WHO is first and foremost a technical agency devoted to the support of sustainable health systems, offering its advice strategically to support the real needs of countries. We have a clear mandate. But our role is also to be catalytic - to unleash the resources of national governments, development banks and bilateral partners. We hear the cali from Member States: they want to see one WHO, acting to maximize what its contribution can achieve. We will respond to that cali. But we also need to challenge the Member States. Ifwe are to be more strategie and continue to shift resources to priority areas - then we need your support for these changes at the regional committees.WHO's contribution to the national health budget should not be spread thinly across a large number of inputs and activities. To take just one example: in one country US$ 4.9 million from WHO's regular budget was allocated to cover the cost of 428 priority activities in 44 different national health programmes. That is not the best way to make a difference, and it should now be considered past history. WHO is the lead agency in health, one of severa) key players. I have called for a change in our working relationship with the other players, many ofwhich should be our natural partners. Since July we have pursued a po licy of reaching out to these partners, knowing that it is the combined impact of our efforts that will make a lasting difference. In doing so we preserve our public health values and our integrity. We have created and recreated partnerships- within the United Nations family, with the Bretton Woods institutions, with the private sector, with nongovernmental organizations, with research and with civil society. First of ali we work differently and more closely with the Member States. We have increased communications with governments through frequent interaction with the missions here in Geneva. We have developed more strategie methods ofwork in and with the Executive Board. Last year's retreat with the Board will be repeated this fall. Let me take this opportunity to thank the Chairman of the Board, Sir Kenneth Calman, for his support and creativity during this important year of change.

(Applause!Applaudissements) Most importantly, we wish to see a politically strong and vocal Health Assembly- and it is my hope that discussions and decisions during the coming days will send a clear health message to the world. Last week I met the Ieading providers of voluntary contributions to WHO and representatives of developing countries from the regions. Our objective was to start a discussion on how the major financial players in health can pull in the same direction - on how we can target our effort so that what we do really spurs development and benefits the poor. WHO will pursue this agenda and take the emerging consensus further towards concerted action. I am pleased with the way we have come closer to our fellow organizations and bodies ofthe United Nations system. UNICEF and WHO have strengthened collaboration for the home stretch of the poliomyelitis eradication campaign. I have met with Dr Nafis Sadik ofUNFPA and we have agreed to collaborate more closely in the areas of sexual and reproductive health, in particular at country level. I will meet again with Carol Bellamy of UNICEF to review how we can have more impact through joint activities related to child health and development, not )east in the area of immunization. I have enjoyed working closely with Peter Piot and UNAIDS, to take our joint efforts further. WHO bas chaired the Committee of Cosponsoring Organizations, and for the first time we have developed and set in motion an Organizationwide strategy within the context of a unified response from ali the UNAIDS cosponsors. And as we speak, WHO is working closely with UNHCR to address the public health challenge from the refugee crisis in the Balkans. During my visits to countries I have met representatives of the United Nations partners and 1 have seen what we can achieve when we work weil together at a country level. I support the Secretary-General's cali for closer interagency collaboration and from what I have seen and learned this year I believe the time bas come for WHO to make a significant move. We are ready to formalize and intensity our collaboration with our United Nations partners in countries, includingjoining them on common premises when that is appropriate and when it will add to our efficiency. I announce today that the World Health Organization is ready to join the United Nations Development Group. We have intensified our cooperation with the World Bank. We welcome ideas such as the comprehensive development framework that bas been proposed by its President, Jim Wolfensohn. This framework takes sector-wide thinking a stage further- making the links between the overall economy, the

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structure of government, and the many facets of human development much more explicit. We have engaged in a new dialogue with the International Monetary Fund, speaking out for the need to better protect health and social services in times of financial turmoil. We have taken new steps with the private sector. Over the past 10 months we have held a number of round tables with industry and with nongovernmental organizations, exploring how we can provide drugs and vaccines to the most vulnerable populations. Gradually we are getting closer to doing away with many ofthe old obstacles. We have conducted external and internai studies ofWHO's own research agenda to ensure that we can meet the needs of the next century. We are now better equipped to interact with the global research community and to pursue our own role in setting the public health agenda in research. We are also completing an evaluation of the way we work with WHO collaborating centres. There are severa} thousand of these centres, and they add a crucial dimension to our work. With this evaluation we will be able to deepen our cooperation and to take it further into new areas of work. Can we achieve this change in the way we work as an organization and the way we work with our partners? My answer is yes - and we have sorne very concrete examples of this already happening. Wh en 1 was elected 1 introduced two specifie projects: Roll Back Malaria and the Tobacco Free Initiative- one in the area of communicable diseases and the other in the area of noncommunicable diseases. In both cases WHO needed to respond with increased and focused action. Malaria is a killer. We need to confront it with both traditional and innovative means. Roll Back Malaria is drawing on existing initiatives, especially in Africa, and introduces new ways oftaking malaria control and prevention forward. At country level Roll Back Malaria is evolving into a social movement - integrating with the health sector, but also going beyond it to reach ali th ose vulnerable populations that a fragile health sector does not reach. Success will require commitment from governments in malaria-affected countries. It will require also new sources of funding. This Assembly is invited to adopt a resolution to endorse Roll Back Malaria. This new drive has the ambition to eut by half the number of deaths from malaria within a decade through better access of ali people in malaria-affected areas to a range of effective interventions. If we succeed - and we will - what we learn will reach beyond malaria. The ultimate ambition is to strengthen the health sector and build capacity in that system as weil as in people - in their communities and in the prime arena for health - the home and the family. This is a new way ofworking for WHO, for governments and for our other partners. As we proceed, what we leam will benefit our work in other areas, not least in our fight against HIV1 AlOS and tuberculosis. Tobacco is also a killer, and we must confront it. I repeat what 1 said from this rostrum last year. Tobacco should not be advertised, subsidized or glamorized. We need urgently to curb a growth rate that is about to turn tobacco use into the single foremost cause of death and instability - 10% of the global burden of disease - sorne 20 years from now. Sorne point to the threat that effective tobacco control would represent for tobacco growers. Let us remind ourselves. The issue here is human health. Succeeding in a lasting change will take years - enough time for other sectors to adapt. And do not let second agendas take the high ground. At this Assembly we present a World Bank study on the economies oftobacco. The truth is simple: tobacco is not only bad for health, it is also bad for the economy, and it is particularly bad for the developing world. The tobacco epidemie is about to hit the developing world, penetrating countries which at present have very weak means of defence. In 20 years it will add an extra 7 million premature deaths and yet another Joad to already overburdened health systems. We invite the Member States of WHO to initiate work on a framework convention for control - to take the first step in a process that the Health Assembly has called for before. The convention will offer important support to countries. But the treaty will only be effective if it works in conjunction with, and builds upon, sound domestic interventions. Last month 1 invited the International Conference ofDrug Regulatory Authorities to look into the way tobacco products are regulated. 1 was encouraged to note that their response was positive. It is an amazing fact. A product which kills every second of its consumers is not regulated. The fact is this: tobacco is the only product on the market which when used as intended leads to death. That we must change. Looking ahead we see that ali our knowledge is about the past, whereas ali our challenges lie in the future. Think for a moment ofthe researcher. She needs to build on evidence. But she also needs to take risks. She needs to go for her vision - to reach one step further than anyone has done before. In health we have seen it so many times. Decades ago, a poliomyelitis vaccine was just a dream. A debate was raging between those who fought for it, and those who wanted better iron lungs and rocking beds to help alleviate the suffering ofthe poliomyelitis victims. As we approach the historie event ofpoliomyelitis eradicationmade possible by the development of effective oral vaccines - we often forget how difficult the decision was to keep investing in a dream that no one could know would become a reality. Now we have new vaccines for pneumonia and new tools for attacking major killers of children. But when will we see the dream come true of getting them to those who have the need but Jack the means? That is a challenge as big as developing the vaccines themselves.

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Let us repeat a well-known fact: whereas 90% of the disease burden is in the developing countries, these countries only have access to 10% of the resources going to health. It cannot change ovemight, but AIDS pandemie. The pandemie of the twentieth century will succeed in it must change. Take the HIV1 entering the twenty-first century in full force. It has become the first cause of death in Africa, it is on the rise in Asia and in large parts of Europe. A historie human, social and economie setback is unfolding. We must not walk away. We need to confront the epidemie with renewed energy and commitment. As long as HIV/AIDS affects any community or any country, our world is in danger. In the new WHO we are not AIDS activities to a single department. It is the entire Organization, through its confining our HIV1 technical resources and skilled people, which is now being marshalled. We will actively play our role- also in taking forward the emerging partnership against the pandemie in Africa. Health is a fondamental human right. We need public voices- and you can count WHO as one- to speak out for ali those who are denied their human rights to health. Y ou can count on WHO to speak out for the most courageous of ali - the woman who gives birth. We need to renew our commitment to combat maternai mortality. No other indicator so starkly reflects the disparities between rich and poor, between the haves and the have nots, between the developed and developing worlds. Each death is a tragedy. The death of a young woman, who may have other children, is a multiple tragedy. These deaths are preventable with simple and cost-effective interventions. We can make pregnancy safer. A newbom healthy baby is hope, expectation and promise. Let us go to work. Together we can make a difference.

HEALTH IN DEVELOPMENT SANTE ET DEVELOPPEMENT

The PRESIDENT: Thank you, Dr Brundtland, for your eloquent words. We shall now proceed to item 4 of the agenda, Health in development. It is a great honour for me to welcome, on behalfofthis Assembly, Professor Amartya Sen, Master ofTrinity College, Cambridge, Nobel Laureate in Economies. Professor Sen has very kindly agreed, in spite of his very heavy schedule, to address this Assembly on "Health in development", and it is with pleasure that 1 give you the floor, Professor Sen. Professor SEN (Nobel Laureate in Economies): Madam President, Director-General, Chairman and members of the Executive Board, ladies and gentlemen, 1 feel very honoured - and of course delighted - to have the opportunity of giving this lecture at this extraordinarily important conference. 1 feel triply privileged, first because the occasion is so significant (the World Health Assembly is a gathering of people who can influence the health and longevity ofbillions ofpeople in the world), second because the agenda is so momentous (we have just heard the priorities that have been outlined by the Director-General for a year of change), and third because it is so wonderful to be here on the invitation of Dr Gro Harlem Brundtland for whom 1 have the greatest of admiration. My admiration is now even greater, after hearing her speech about the programmes in which WHO will play a leading role in the world. We are ali very dependent on the community of doctors and medical professionals across the globe. 1 have had my own encounters with them: at the age of 12 1 had malignant malaria; at the age of 18 1 had cancer. So ifl am alive today, it is to a great extent due to doctors on the one hand and the arrangements for medical delivery on the other hand. 1 therefore welcome the programme of preventive and curative medical action outlined by the Director-General. 1 have been asked to speak on the subject ofhealth in development. 1 must take on the questionthe very difficult question - as to how health relates to development. At one level the question admits of a simple answer: surely the enhancement of the health of people must be accepted more or less universally to be a major objective of the process of development. But this elementary recognition does not, on its own, take us very far. We have to ask many other questions as weil. How important is health among the objectives of development? ls health best promoted through the general process of economie growth which involves a rising real national income per capita, oris the advancement ofhealth as a goal to be separated from the process of economie growth perse? Do ali good things go together in the process of development, or are there choices to be made on the priorities at stake? How does our concem for equity reflect itself in the field ofhealth and health care? 1 shaH have togo into these issues also. However, to motivate what is perhaps the most basic issue, let me begin with the report of a very old conversation between a husband and wife on the subject of eaming more money. It is, of course, not

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unusual for couples to discuss the possibility of eaming more money, but a conversation on this subject from around the eighth century B.C., nearly 3000 years ago, is of sorne special interest. As reported in the Sanskrit text Brihadaranyaka Upanishad, Maitreyee and her husband Yajnavalkya are discussing this very subject. But they proceed rapidly to a bigger issue than the ways and means ofbecoming more wealthy: how far would wealth go to help them get what they want? Maitreyee, the wife, wonders whether it could be the case that if''the who le earth, full ofwealth" were to belongjust to her, she could achieve immortality through it. That is the question. "No", responds Yajnavalkya, "like the life of rich people will be your life. But there is no hope of immortality by wealth". Maitreyee then remarks, "What should 1 do with that by which 1 do not become immortal?" Maitreyee's rhetorical question has been cited again and again in lndian philosophy to illustrate both the nature of the human predicament and the limitations of the material world. 1 have too much scepticism of other-worldly matters to be led there by Maitreyee's worldly frustration, but there is another aspect of this exchange that is of rather immediate interest to economies and to understanding the nature of development. This concems the relation between incomes and achievements, between commodities and capabilities, between our economie wealth and our ability to live as we would like. White there is a connection between opulence, on the one hand, and our health, longevity and other achievements, on the other, the linkage may or may not be very strong and may weil be extremely contingent on other circumstances. The issue is not the ability to live forever on which Maitreyee - bless her soul - happened to concentrate, but the capability to live really long (without being eut offin one's prime) and to have a good life white alive (rather than a life of misery and unfreedom)- things that would be strongly valued and desired by nearly ali of us. The gap between the two perspectives, that is, between an exclusive concentration on economie wealth, and a broader focus on the lives we can lead, is a major issue in the conceptualization of development. As Aristotle noted at the very beginning of The Nicomachean Ethies (resonating weil with the conversation between Maitreyee and Yajnavalkya 3000 miles away): "wealth is evidently not the good we are seeking; for it is merely useful and for the sake of something else". The usefulness ofwealth lies in the things that it allows us to do- the substantive freedoms it helps us to achieve, including the freedom to live long and to live weil. But this relation is neither exclusive (since there are significant other influences on our lives apart from wealth), nor uniform (since the impact ofwealth on our lives varies with other influences). It is as important to recognize the crucial role ofwealth on living conditions and on the quality of life, as it is to understand the qualified and contingent nature of this relationship. An adequate conception of development must go much beyoild the accumulation of wealth and the growth of gross national product and other income-related variables. Without ignoring the importance of economie growth, we have to look weil beyond it. The ends and means of development require examination and scrutiny for a fuller understanding of the development process; it is simply not adequate to take as our basic objective merely the maximization of income or wealth, which is, as Aristotle noted, "merely useful and for the sake of something else". For the same reason economie growth cannot be treated as an end in itself. Development (as 1 have tried to argue in my forthcoming book, to be entitled "Development as Freedom") has to be primarily concemed with enhancing the lives we lead and the freedoms that we enjoy. And among the most important freedoms that we can have is the freedom from avoidable ill-health and from escapable mortality. It is as important to understand the qualified and contingent nature of the relationship between economie prosperity and good health as it is to recognize the crucial importance of this relationship, qualified and contingent though it may be. Let me illustrate the conditional nature of the relationship with sorne empirical examples. It is quite remarkable that the extent of deprivation for particular groups even in wry rich countries can be comparable to that in the so-called Third World. For example, in the United States, African Americans as a group have no higher - indeed have a lower- chance of reaching advanced ages than do people born in the immensely economically poorer economies of China or the Indian State of Kerala (or in Sri Lanka, Jamaica or Costa Rica). Since 1 do not have the opportunity of showing you any overhead projection in this hall, you have to imagine the picture of the relative life expectancies yourself. 1 presented charts on this in my article entitled "The economies of life and death" in the Scientific American in 1993, which show how the African Americans as a group are overtaken in terms of the proportion of survival by sorne much poorer people in the world. Even though the income per capita of American blacks in the United States is considerably lower than that of the American white population, they are, of course, very many times rich er in income terms than the people of China or Kerala (even after correcting for cost-of-living differences). In this context, the comparison of survival prospects of African Americans with th ose of the very much poorer Chinese, or Indians in Kerala, is of particular interest. African Americans tend to do better in terms of survival at low age groups (especially in terms of infant mortality) vis-à-vis the Chinese or the Indians, but the picture changes over the years. It tums out that Chinese men and those in Kerala in India decisively outlive

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American black men in terms of surviving to older age groups. Even African American women end up having a similar survival pattern for the higher age groups as the much poorer Chinese, and decidedly Jower survival rates than the even poorer Indians in Kerala. Soit is not only the case that American blacks suffer from relative deprivation in terms of income per head vis-à-vis American whites, they also are absolutely more deprived than the low-income Indians in Kerala (for both women and men), and the Chinese (in the case of men), in terms of living to ripe old ages. The causal influences on these contrasts (that is, between living standards judged by income per head and those judged by the ability to survive to higher ages) include social arrangements and community relations such as medical coverage, public health care, elementary education, law and order, prevalence of violence, and so on. The contrast on which 1 have just commented takes the African American population as a who le, and this is a very large group. Ifinstead we consider African Americans, in particular deprived sections ofthe community, we get an even sharper contrast. The recent work of Christopher Murray and his colleagues show how very different the survival rates are for American people in different countries. If, for example, we take the African American male population in, say, the District of Columbia, St Louis City, New York, or San Francisco, we fmd that they fall behind the Chinese or the Keralan at a remarkably early age. And this despite the fact that in terms of income per head, which is the focus of attention for standard studies of growth and development, the African Americans are very much richer than the poor population with whom they are being compared in terms of survival patterns. These are striking examples, but it would be right also to note that, in general, longevity tends to go up with income per head. That is a point which has to be accepted. Indeed, this is the case even within particular countries studied by Chris Murray and others. Is there something of a contradiction here? There is really none. What must be understood is the following. Given other factors, higher income does make an individual or a community more able to avoid premature mortality and escapable morbidity. But other factors are not, in general, the same. So income is a positive influence, and yet- because of the variation of other factors (including medical facilities, public health care, educational arrangements, etc.)there are a great many cases in which much richer people live much shorter lives and are overtaken by poorer people in terms of survival proportions. It would be just as silly to claim that higher income is not a contributory factor to better health and longer survival as it would be to assert that it is the on/y contributory factor. Also, on the other side, better health and survival do contribute, to sorne extent, to the ability to earn a higher income, given other things - a point also emphasized by the Director-General in her report - but th en again we have to remember the fuller picture that other things are not necessarily given. Perhaps the relationship between health and survival, on the one hand, and per capita income levels, on the other, is worth discussing a bit more, since literature on the subject is sometimes full of rather misleading conclusions. The point is often made that while the rankings of longevity and per capita income are not congruent, nevertheless if we take the rough with the smooth, theo there is plenty of evidence in intercountry comparisons to indicate that by and large income and !ife expectancy move together. From that generalization, sorne commentators have been tempted to take the quick step of arguing that economie progress is the real key to enhancing health and Jongevity. Indeed, it also has been argued that it is a mistake to worry about the discord between income-achievements and survival chances, since - in general the statistical connection between them is observed to be quite close. Is this statistical point correct, and does it sustain the general inference that is being drawn? The point about intercountry statistical connections, seen in isolation, is indeed correct, but we need further critical scrutiny of this statistical relation before it can be seen as a convincing ground for taking income to be the basic determinant ofhealth and longevity and for dismissing the rel evance of social arrangements, going beyond income-based opulence. It is interesting, in this context, to refer to sorne statistical analyses that have recently been presented by my colleagues, Sudhir Anand and Martin Ravallion. On the basis of intercountry comparisons, they find that !ife expectancy does indeed have a significantly positive correlation with GNP per head for the poorer countries, but that this relationship works mainly through the impact ofGNP on incomes, specifically ofthe poor, and public expenditure, particularly in health care. In fact, once these two variables are included on their own, as independent variables, in the statistical exercise, little extra explanation cao be obtained, indeed none, from including GNP per head as an additional causal influence. Indeed, with poverty and public expenditure on health as explanatory variables on their own, the statistical connection between GNP per head and !ife expectancy appears to vanish altogether. It is important to emphasize that this does not show that !ife expectancy is not enhanced by the growth ofGNP per head, but it does indicate that the connection tends to work particularly through public expenditure on health care, and through the success of poverty removal. Much depends on how the fruits of economie growth are used. This also helps to exp lain why sorne economies such as South Korea and Taiwan have been able to raise !ife expectancy so rapidly through economie growth, while others with similar record in economie growth have not achieved correspondingly in the field of longevity expansion.

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The achievements of the East Asian economies have come under critical scrutiny, and sorne fire, in recent years, because of the nature and severity ofwhat is called the "Asian economie crisis". That crisis has indeed been serious, and also it does point to particular failures of economies that were earlier seen mistakenly - as being comprehensively successful. Nevertheless, it would be a serious error to be dismissive about the great achievements of the East and South-East Asian economies of Japan, Korea and China over severa) decades, which have radically transformed the lives and longevities of people in these co un tries. I go into the positive and negative aspects of the East Asian experience more fully in my forthcoming book on development as freedom, but will not pursue them further here. Briefly, for a variety ofhistorical reasons, including a focus on basic education and basic health care, and early completion of effective land reforms, widespread economie participation was easier to achieve in many of the East and South-East economies in a way it has not been possible in, say, Brazil or in my own country India or Pakistan, where the creation of social opportunities have been much slower and have acted as a barrier for economie development. The expansion of social opportunities has served as facilitator of high-employment economie development in East Asia and has also created favourable circumstances for reduction of mortality rates and for expansion of li fe expectancy. The contrast is sharp with sorne other high-growth countries - such as Brazil - which have had almost comparable growth of GNP per head, but also have quite a history of severe social inequality, unemployment and neglect of or inequality in public health care. The longevity achievements ofthese other high-growth economies have moved more slowly, although remediai action is now being taken, including in Brazil, which is very welcome. There are two interesting and interrelated contrasts that I wish to emphasize. The first is the disparity between different high-growth economies, in particular between those with great success in raising the length and quality oflife (such as South Korea and Taiwan), and those without comparable success in these other fields (such as Brazil). The second contrast is between different economies with high achievement in raising the length and quality oflife, in particular the contrast between th ose with great success in high economie growth (such as South Korea and more recently China), and those without much success in achieving high economie growth (such as Sri Lanka, pre-reform China, or the Indian state of Kerala). I have already commented on the first contrast (between, say, South Korea and Brazil), but the second contrast too deserves po licy attention. In our book, Hunger and Public Action, Jean Drèze and I have distinguished between two types of successes in the rapid reduction of mortality, which we called respectively "growth-mediated" and "support-led" processes. The former process works through fast economie growth, and its success depends on the growth process being wide-based and economically broad (strong employment orientation has much to do with this), and also on the utilization of the enhanced economie prosperity to expand relevant social services, particularly health care, education and social security. In contrast with the "growth-mediated" mechanism, the "support-led" process does not operate through fast economie growth, but works through a programme of skilful social support of health care, education, and other relevant social arrangements. This process is weil exemplified by the experiences of economies such as Sri Lanka, pre-reform China, Costa Rica, or the Indian state of Kerala, which have had very rapid reductions in mortality rates and enhancement of living conditions, without much economie growth. In the case of China, the growth experience is primarily in the post-reform period. The "support-led" process does not wait for dramatic increases in per capita levels of real income, and it works through priority being given to providing social services (particularly health care and basic education) that reduce mortality and enhance the quality of life. In a comparison on which I have commented elsewhere, we may, for illustrative purposes, look at the gross national product per head and li fe expectancy at birth of six countries (China, Sri Lanka, Namibia, Brazil, South Africa and Gabon) and one sizeable state (Kerala). Even though it is a state within a country (India), it has a large population (30 million), somewhat larger than Canada. Despite their very low levels of in come, the people of Kerala, or China, or Sri Lanka enjoy enormously higher levels of life expectancy than do the much richer populations ofBrazil, South Africa or Namibia, not to mention Gabon. Even the direction of the inequality points oppositely when we compare Kerala, China and Sri Lanka, on one side, with Brazil, South Africa, Namibia and Gabon, on the other. Since li fe expectancy variations relate to a variety of social opportunities that are central to development (including epidemiological policies, health care, educational facilities, and so on), an income-centred view is in serious need of supplementation, in order to have a fuller understanding of the process of development. These contrasts are of considerable policy relevance, and bring out the importance of the "support-led" process. People in poor countries are, of course, persistently disadvantaged by many handicaps; the picture is one of diverse adversities. And yet, when it cornes to health and survival, perhaps nothing is as immediately important in many poor countries in the world today as the Jack of elementary medical services and provisions ofbasic health care. The nature and reach ofpervasive deprivation of biomedical services is brought out most vividly by Paul Farmer's recent study, Infections and Inequalities: the Modern Plagues. The failures apply to perfectly treatable diseases (such as cholera, malaria, etc.) as weil asto more

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challenging ailments (such as AIDS and drug-resistant tuberculosis). But in each case, a major difference can be brought about by a public determination to do something about these deprivations. Surprise may weil be expressed about the possibility offinancing "support-led" processes in poor countries, since resources, it may be argued, are surely needed to expand public services, including health care and education. The need for resources cannot be denied in any realistic accounting, but it is also a question of balancing the costs involved against the benefits that can be anticipated in human terms. It must be emphasized that financial prudence is not the real enemy here. Indeed, what really should be threatened by financial prudence, not to mention conservatism is the use of public resources for purposes where the social benefits are very far from clear, such as the massive expenses that now go into the military in one poor country after another (often very many times larger than the public expenditure on basic education or health care). It is an indication of the topsy-turvy world in which we live today that the doctor, the schoolteacher or the nurse feels more threatened by financial conservatism than does the general and the air marshall. The rectification of this anomaly calls not for the chac;tising offinancial prudence, but for a fuller accounting of the costs and benefits of the rival claims. In a different context, namely the programmes outlined by the Director-General, the same applies to smoking. For the costs in terms of loss of revenue to the government are often much clearer than those of future savings on medical care required for illnesses caused by smoking, not to mention the human costs of suffering and death associated with the habit. The very important issue of the contrast between military expenditure and health care also relates to two central aspects of social living, in particular the role of participatory politics, and the need to examine economie arguments with open-minded scrutiny. If the allocation ofresources is systematically biased in the direction of arms and armaments today, rather than in the direction ofhealth and education, the remedy ofthat has to lie ultimately in informed public debate on these issues, and on the role of the public in seeking a better deal for the basic requirements of good living, rather than efficient killing. Nothing perhaps is as important for resource allocation in health care as the development of informed public discussion, and the availability of democratie means, for incorporating the ]essons of a fuller understanding of the choices that people in every country face. With regard to economie scrutiny, it is particularly important to see the false economies involved in an argument that is often presented against early concentration on health care. Lack of resources is frequently articulated as an argument for postponing socially important investments until a country is already richer. Where (as the famous rhetorical questions go) are the poor countries going to find the means for "supporting" these services? This is indeed a good question, but it also has a good answer, which lies very considerably in the economies of relative costs. The viability of this "support-led" process is dependent on the fact that the relevant social services (such as health care and basic education) are also very labour intensive, and thus are very inexpensive in poor - and low-wage - economies. A poor economy may have less money to spend on health care and education, but it also needs less money to spend to -pr<)vide the same services, which wouid cost much more in the richer countries with higher-wage economies. Relative priees and costs are important parameters in determining what a country can afford and we do need clear-headed economie analysis here. Given an appropriate social commitment, the need to take note of the variability of relative costs is particularly important for social services in health and education. So what conclusions do we draw from these elementary analyses? How does health relate to development? The first point to note is that the enhancement of health is a constitutive part of development. Those who ask the question whether better health is a good instrument for development, seeing development as economie growth, may be overlooking the most basic diagnostic point that good health is an integral part of good development; the case for health care does not have to be established instrumentally by trying to show that good health may also help to contribute to the increase in economie growth, although it does do just that. Second, given other things, good health and economie prosperity tend to support each other. Healthy people can more easily earn an income, and people with a higher income can more easily seek medical care, have better nutrition, and have the freedom to lead healthier lives. Third, "other things" are not given, and the enhancement of good health can be helped by a variety of actions, including public policies (such as the provision of epidemiological services and medical care). While there seems to be a good general connection between economie progress and health achievement, the connection is weakened by severa] policy factors. Much depends on how the extra income generated by economie growth is used, in particular whether it is used to expand public services adequately, especially in health care, and to reduce the burden ofpoverty. Growth-mediated enhancement ofhealth achievement goes weil beyond mere expansion ofthe rate of economie growth. Fourth, even when an economy is poor, major health improvements can be achieved through using the available resources in a socially productive way. It is extremely important, in this context, to pay

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attention to the economie considerations involving the relative costs of medical treatment and the delivery ofhealth care. Since health care is a very labour-intensive process, low-wage economies have a relative advantage in putting more - not less - focus on health care. Finally, the issue of social allocation of economie resources cannot be separated from the rote of participatory politics and the reach of informed public discussion. Financial conservatism should be the nightmare of the militarist, not of the doctor, or the schoolteacher, or the hospital nurse. Ifit is the doctor or the schoolteacher or the nurse who feels more threatened by resource considerations than the military leaders and advocates ofmilitary expenditure, then the biarne must at least partly lie on us, the public, for )etting the militarist get away with these odd priorities. Ultimately, there is nothing as important as informed public discussion and the participation ofthe people in pressing for changes that can protect our lives and liberties. The public has to see itself not merely as a patient, but also as an agent of change. The penalty of inaction and apathy can be illness and death. The PRESIDENT: Thank you Professor Sen for a very stimulating and inspiring presentation. On behalf of the Assembly, I wish to thank you warmly for having honoured us with your presence. (Applause/Applaudissements)

W e shall have a short pause to allow our distinguished guest to leave the Hall. 1 wou Id ask ali delegates to remain seated.

LOOKING AHEAD FOR WHO AFTER A YEAR OF CHANGE: REPORT OF THE DIRECTOR-GENERAL (INCLUDING THE WORLD HEALTH REPORT 1999) (resumed) L'A VENIR DE L'OMS APRES UNE ANNEE DE CHANGEMENT: RAPPORT DU DIRECTEUR GENERAL (Y COMPRIS LE RAPPORT SUR LA SANTE DANS LE MONDE, 1999) (reprise)

The PRESIDENT: Before we start the review of item 3, I would cali the delegates' attention to resolution WHA50.18, recommending that delegates should limit their statements to five minutes and that statements should give special attention to the theme of The world health report 1999, namely "Making a difference". Delegates wishing to report on salient aspects oftheir health activities could make such reports in writing for inclusion in the record, as provided for in resolution WHA20.2. Delegations wishing to participate in the debate are requested, if they have not done so already, to anno un ce the ir intention to do so, together with the name of the speaker and the language in which the speech is to be delivered, to the officer responsible for the list of speakers. Before we proceed, I wish to inform you that the speakers list will be closed today at 12:00. Should a delegate wish to submit- in order to save time - a prepared statement for inclusion in extenso in the verbatim records, or whenever a written text exists of a speech which a delegate intends to deliver, copies should also be handed to the officer responsible for the list of speakers in order to facilitate the interpretation and transcription of the proceedings. Delegates will speak from the rostrum. In order to save time, whenever one delegate is invited to come to the rostrum to make a statement the next delegate on the list of speakers will also be called to the rostrum, where he or she will sit until his or her time to speak has come. In order to remind speakers of the desirability ofkeeping their address to not more than five minutes, a system of lighting has been installed; the green light will change to amber on the fourth minute and finally to red on the fifth minute. Before giving the floor to the first speaker on my list, I wish to inform the Assembly that the General Committee has confirmed that the list of speakers should be strictly adhered to, and that inscriptions should be handed to the Office of the Assistant to the Secretary ofthe Assembly, or during Plenary to the officer responsible for the list of speakers. The list of speakers will be published in the Journal. I would like to remind those delegates who have to leave Geneva and are not able to deliver their speech before they leave that they can ask for their text to be published in the records of the Assembly. The debate on item 3 is now open.

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The first two speakers on the list are Bangladesh and the United Republic of Tanzania, who will speak on behalf of the Southem African Development Community: Angola, Botswana, Democratie Republic ofthe Congo, Lesotho, Malawi, Mauritius, Mozambique, Namibia, Seychelles, South Africa, Swaziland, Zambia and Zimbabwe, and on behalf of his own country. The delegates of these Member States will be seated on the rostrum. May 1 invite them to come to the rostrum. 1 give the floor to the delegate ofBangladesh. Dr YUSUF (Bangladesh): Mr President, excellencies, distinguished delegates, ladies and gentlemen, it is a great pleasure for me to share ideas with you on The world health report 1999. The report, entitled "Making a difference", recognizes the need for changes in the health sector in the context of prevailing health situations. At the outset 1 wish to congratulate the Director-General on taking this pragmatic step to sensitize the health planners on this issue. It is undoubtedly an attempt to bring lasting changes in the health sector. Supported by strong political commitments, dynamic leadership and vision this can ensure considerable gains in social and economie fields, along with improvement in status ofhealth of the people. The developing countries have identical goals, like reduction of poverty, improvement of living standards and investment for human resource development. Most of the countries do not have adequate resources and technical capabilities to achieve them and need support from the development partners. In a situation of scarce resources, more emphasis is now given to the balance between public and private sector fmancing. Direct govemment intervention is needed in the developing countries to finance public health activities and essential health care services, nutrition, and reproductive health services and protecting people from catastrophic diseases. Ali these need reform in the health sector. Bangladesh has already initiated widespread reform. A sector-wide management approach has been adopted for the delivery of an essential service package, with priority for women, children and the poor. Within this framework we envisage developing cast-effective methods and innovative partnerships with nongovemmental organizations and the private sector. One of the main messages that The world health report emphasizes is our future commitment to deployment of resources in a more rational way to fulfil pressing needs. WHO has over 50 years' experience of working for mankind. 1 strongly believe that countries would greatly benefit from the guidelines provided in this report. While, globally, health status has improved over the last few decades, still we have many more challenges to face. We do hope to overcome these obstacles and bring substantial changes in the health sector of our nations in the near future. Finally, 1 offer my heartiest thanks and gratitude to WHO for bringing out this report and also thank the Director-General, Dr Gro Harlem Brundtland, in particular, for taking this pragmatic step in setting reforms. What we need to do now is to make efforts for successful implementation of the recommendations of the report. Mr CHIDUO (United Republic ofTanzania): Madam President, Madam Director-General, honourable delegates, ladies and gentlemen, 1 feel very privileged to represent the Southern African Deve!opment Community (SADC) in addressing the Health Assembly. Ali in ali we are 14 Member States, as announced by the President. On behalf of the SADC Member States and on my own behalf, 1 would like to congratulate the Director-General on her report and express our support. With regard to health status, the SADC Member States share common features of high mortality rates, an increased burden of infectious diseases, low nutritional status and ali other health indicators signi:tying a poor leve! of development. There are differences among co un tries or communities within the Member States, but the general picture is th at of poor health status. W ith respect to the increased inequity in access to drugs and modem biotechnology between developed and developing countries, it is likely that such issues will continue to feature on the international health po licy agenda for the foreseeable future in SADC. Of late, health problems in the region have been aggravated by ongoing civil strife within sorne Member States. These wars- in Angola, the Democratie Republic of the Congo, Burundi and Rwandahave had devastating effects on the supply of food and on the spread of disease and violence among refugees and the populations of recipient countries. Ail ofthese sufferings contribute to deteriorating health conditions among the populations of the affected Member States. Changing climatic conditions that began in 1998-1999 with the El Nifio rains and La Nifia have resulted in a fall in food production, leading to famine and an increase in water-bome diseases in the region.

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Diseases which were considered epidemies in the 1970s are now becoming endemie, e.g. cholera and meningitis. Moreover, these countries are facing a wind of change in the organization and management ofhealth services based on health-sector reform strategies. The reforms as we understand them do not comprise global formulae, and there is no predetermined, tested way of implementing them. As a result, co untries of sub-Saharan Africa, including SADC countries, which have scarcely the resources to provide routine basic minimum health services, have sometimes to invest in health reforms whose outputs and outcomes are not certain. Furthermore, most of the suggestions for reforms are geared more towards implementing and improving clinical services than towards preventive services. A balance of these two equally important services in the jigsaw is even more difficult in these countries because of the ir dependence on external resources. Investors in health development in these countries prefer to carry out a number of pilot and research projects before providing support for the alleviation of ill-health in communities. The pilot and research projects may consume both material resources and time at the expense of a general improvement in health service delivery. Against the background of all these problems relating to health systems and diseases, the technical issues that were addressed by the WHO Executive Board at its l 03rd session are of equal importance to the SADC region. 1 would therefore like to take a few minutes to apprise you of the position in the region regarding those issues. On the Tobacco Free Initiative, the danger oftobacco smoking to the health ofsmokers and passive smokers need not be emphasized. All technical reports that are available point towards the existence of an association between tobacco smoking and diseases related to tobacco. Tobacco control activities in the SADC region are made more difficult by the fact that tobacco is grown, processed and consumed in the region. Its production in most of the Member States is indirectly supported by the governments, which benefit from the revenue it generates through taxation. Nevertheless, sorne steps have been taken in the region to control the consomption of tobacco, including the use of fiscal policies, government guidel ines stipulating that all tobacco advertising should be accompanied by a warning, and the development of legislation. The region has yet to challenge the power of the multinationals in these endeavours. Two devastating epidemies threaten the lives oftens of millions of people worldwide. The first of these epidemies is caused by HIV, which leads to AIDS. The impact of AIDS is greatest in sub-Saharan Africa, where 83% of AIDS deaths worldwide have occurred and nearly 21 million people are currently living with HIV. In most SADC Member States, the data show that 40% to 50% of hospital beds are occupied by HIV/AIDS patients. Tous, this is more than an urgent public health issue; it is an emergency. The second epidemie is caused by tuberculosis, which already kills three million people worldwide, annually. HIV1 AIDS and tuberculosis are closely associated. Like most of the co untries of sub-Saharan Africa, SADC Member States face the problem of how to provide, with severely limited economie resources, the best level of care and support for all th ose affected by HIV1AIDS and tuberculosis. This is one of the most daunting challenges facing governments throughout sub-Saharan Africa, and SADC in particular. Malaria remains the major health problem in the world, exposing about 40% of the who le world population to risk. It is estimated that l 00 million people suffer annually from malaria in Africa south of the Sahara. ln Tanzania, malaria is the leading cause of morbidity and mortality and accounts for about 31% of all outpatient attendance. The situation is not different in other SADC Member States. The global political commitment to malaria control, which was lost after the 1969 official declaration ending the campaign for malaria control and eradication, has been revived. In June 1997 the Assembly ofHeads of State and Government of the Organization of African Unity issued the Harare Declaration on malaria prevention and control in the context of African economie recovery and development. The Assembly pledged to support the implementation of the global and regional strategies recommended by WHO. In 1998, our heads of State and government committed themse1ves to Roll Back Malaria, a new and expanded initiative by WHO aimed at reducing malaria mortality by 50% by 2025. The SADC countries have made considerable progress in the achievement of poliomyelitis eradication. They adopted the global goal of poliomyelitis eradication following the 1996 Yaoundé Summit, at which African heads of State and government declared their support for the poliomyelitis eradication initiative. The initiative is reducing the incidence ofpoliomyelitis in SADC Member States. SADC countries were among the 36 countries which implemented national immunization days in 1997. President Nelson Mandela of South Africa was at the forefront of the "Kick polio out of Africa" campaign, which emphasized social mobilization for the success of the immunization days. Sorne SADC countries are now part ofthe poliomyelitis-free zone being formed in South Africa. No wild poliovirus is being reported from Botswana, Malawi, Namibia, South Africa, Swaziland, Zimbabwe, or, most recently, from Tanzania. SADC Member States would like to acknowledge the efforts made by WHO, UNICEF,

A52JVR/4 pag~36

Rotary International, USAID and other international organizations to provide support, both technical and financial, for our endeavours to eradicate poliomyelitis. Finally, the serious impact of iodine deficiency upon the health and development of individuals and societies in our region makes the control of iodine deficiency disorders one of the key health priorities. Most countries in the SADC region have made steady progress during the decade towards universal salt iodization. We are committed to eliminating iodine deficiency. Implementation ofthis policy has required advocacy and communication, in order to persuade key opinion-formers to act. These have included politicians, civil servants, salt producers and traders, and the public. The supply of iodized salt in Africa has increased from less than 5% in most markets in 1990 to more than 60% in most countries. Despite this remarkable achievement, many countries still face a set ofbarriers that threaten to delay the effectiveness of the ir programmes and limit the chance of long-term elimination of iodine deficiency. Madam President, honourable delegates, what I have presented to you is just a sketch of our health activities within SADC countries. Dr SHALALA (United States of America): Madam President, Madam Director-General, distinguished delegates, it is an honour once again to address the Health Assembly. Let me first congratulate our President and the Director-General for their outstanding and thoughtful presentations. Not long after the First World Health Assembly, an American historian wrote that leadership is the ability to give direction. If that is true, theo we have certainly witnessed strong leadership in the initial work of our new Director-General. Over the past year, she has set a new direction for WHO that has the potential to make this Organization the pre-eminent global force for health in the twenty-first century. Her administration has initiated structural changes that have made WHO more responsive and more focused. lt has forged new international partnerships to fight international threats like malaria and tobacco, and it has put health firmly on the global agenda. Dr Brundtland's initial work proves that we have a new Director-General who is seizing the opportunity to change things for the better. But we gather here not just to celebrate new leadership or past accomplishments, but to chart a course for the future. We are the first leaders of the new millennium. We, the leaders of WHO, must ask ourselves what will be our agenda for public health? In what direction will we go? 1 be lieve the answer is threefold: we must continue the fight against infectious disease; we must find new ways to battle noncommunicable disease; and we must be ready to respond to emerging public health challenges. When it cornes to battling infectious disease, we know what we must do. W e must recognize that diseases respect no border or boundary. We must form global partnerships and strengthen global systems. We must link up our national and regional surveillance systems. We must strengthen public health infrastructures. We must harness health experts from every organization and nation into effective teams led by WHO; and we must hasten the exit of killers like malaria, tuberculosis, AIDS and poliomyelitis from the world stage. The United States is firmly committed to working in partnership with WHO to achieve our goal ofpoliomyelitis eradication by the end of2000 and to ensure the success of the new Roll Back Malaria campaign and the Stop Tuberculosis project. We are also fmnly committed to the leadership ofUNAIDS. But it is not just infectious diseases that pose significant public health challenges; noncommunicable diseases continue to be the leading cause of death and disability. We must find new ways of educating our citizens to prevent them. We must find ways to ensure that women have full access to health services across the entire arc of life- while not neglecting the important issues of maternai mortality, of female genital mutilation and of violence against women. And we must also find ways to protect our children from the dangers of the new epidemie- tobacco. By the middle of the next century, tobacco is predicted to be the leading cause of disease burden in the world - causing about one in eight deaths. In the United States, we are redoubling our efforts to curb childhood tobacco use. And we are pledged to working with WHO to achieve the goals of its recent!y inaugurated Tobacco Free Initiative- and to participating in the negotiations for the framework convention. In addition, we are prepared to share with the world our data base on the health effects of tobacco - and this will eventually include tobacco industry documents. But as we tackle the public health challenges of today - like tobacco - we must also be ready to address those that may emerge - challenges like bioterrorism. An obscure threat just a few years ago, bioterrorism has only recently emerged as one of the thorniest problems of the post-Cold War era. The threat has undeniably changed and evolved - so we must be ready to change and adapt our response. And since microbes spread across boundaries of culture, language and territory, we must work together to prepare for an incident that - we hope - will never happen.

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Bioterrorism is just one more world health problem that requires a world health solution. Because we all share a common future - we must all stand on common ground. So the challenge of leading WHO into the millennium - ofleading it in the right direction - does not only be long to the Director-General, or to the able staff of WHO. It belongs to all of us - to every nation - to every organization - to every individual. Rich or poor, North or South. Together, let us pit our wits and our wills and our resources to the task at hand to make a difference and to ensure that the new century will be a time ofhealth and hope for every woman, man and child in our global family. Professor SALLAM (Egypt):

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As The world health report 1999 indicates, limited resources must be utilized more efficiently to address the increasingly diverse health issues of today. From this point of view, we fully support the position of the Director-General, Dr Gro Harlem Brundtland, who has been actively directly the reform of WHO. The reform process which Dr Brundtland has been leading since taking office last July has been truly remarkable and deserves high praise. Under the current unstable global economie situation, United Nations organizations such as lLO have wisely and responsibly committed themselves to a po licy of zero nominal growth. In order to increase programme budgets for countries in greatest need, administrative costs must be rationalized and brought under control We greatly appreciate the fact that Dr Brundtland's reform process is headed in this direction, particularly because it is apparent that a zero real growth budget is not realistic under the prevailing global economie situation. We canalisee that a zero real growth budget would require Member States to increase their assessed contribution, leading to hardship due to further suppression of already stringent national budgets. We strongly hope that Member States recognize these critical points and form a consensus to adopta zero-nominal growth policy for the 2000-2001 budget. The importance of priority setting of projects cannot be overemphasized, given our limited resources. The suffering caused by malaria, addressed by Dr Brundtland as one ofWHO's top priorities, can be seen in 300 to 500 million clinical cases and one million deaths each year. We agree that fighting this disease is one of the most important global public health issues. At last year' s Birmingham summit meeting, Mr Hashimoto, who was our Prime Minister at that time, presented a report on global parasite control, entitled "The global parasite control for the 21 st century", to contribute to the global fight against parasitic diseases including malaria, by proposing control strategies, based on our past experiences in conquering them. We are fully promoting this Hashimoto Initiative and will also actively support WHO's priority project "Roll Back Malaria" in line with our Hashimoto Initiative. The Tobacco Free Initiative is another high priority WHO initiative. Tobacco is a very important cause of many kinds of noncommunicable diseases, and it is said that four million people die of diseases related to tobacco each year. ln line with the Tobacco Free Initiative, WHO will hold the International Conference on Tobacco and Health in Kobe, Japan, this November, utilizing the resources of the Kobe WHO Centre for Health Development. We are pleased to note that with the attendance of Dr Brundtland, the Government of Japan has high expectations for this important event and will actively support the organization of the conference to ensure its success. We are also pleased to note that, owing to the strong support of Member States, Dr Omi was inaugurated as the Regional Director for the Western Pacifie last February. Thanks to the invaluable support given to him by Member States, Dr Omi was able to promote reform at the regionallevel as soon as he assumed office. We trust that through the reform process at headquarters and in the regions, WHO will become a stronger organization that is even more active and effective in the promotion of public health across the globe. We pledge that the Government of Japan will continue to work closely with WHO to "Make a difference". Professor STARODUBOV (Russian Federation): llpo<Peccop CTAPO.zzyJ>OB (PoccnifcK~ <l>eAepaQH51):

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Mrs CAPLAN (Canada): Mr President, Dr Brundtland, ministers, excellencies, ladies and gentlemen, it is a real honour for me to share with you the thoughts of the Canadian delegation as we begin the last Health Assembly of the century. Last year, we applauded Dr Brundtland's election as the fifth Director-General of WHO, and we beard with satisfaction the high priority she intended to give to the hattie against two of the worst global public health scourges, namely tobacco and malaria. Canada welcomed the Director-General's commitment to making a difference, by focusing on priorities with new approaches, new partnerships and new energies. We also welcomed her commitment to transparent, effective and accountable administration. One year later, we are pleased to note that many of the reforms we have been calling for are being implemented in Geneva and throughout WHO. But as we ali know, changing a large organization is never easy, especially within the United Nations system. Our experience with change in Canada has shown us that the keys to success lie in good information, in developing appropriate levels of accountability, and doing this with transparency at every stage. We also know that the leve) of change and growth which the Director-General's programme calls for requires resources. We believe that these revenues can be found. Member States must continue to do their part. We also believe that there is room for the absorption of cost increases through efficiency savings by the Organization itself. But it is not enough to rely on changes in the WHO Secretariat to improve the effectiveness of our Organization and prepare it to respond to the challenges of the twenty-first century. WHO cannot do everything. What it can and should do, it often cannot do alone. We support Dr Brundtland's cali for partnership and collaboration with other organizations, both public and private sector. We encourage WHO to create better linkages and focused dialogue with members of the United Nations family such as UNDP and the Bretton Woods Institutions. Tbese will help deliver a more targeted health programme which better reflects regional and country-specifie needs. We also encourage Dr Brundtland to look at how WHO might tap into the knowledge and expertise that affinity groups such as the Commonwealth and La Francophonie might be able to offer WHO in its quest to improve global health for ali. For Canada, the fundamental and unique role of WHO is to mobilize the energies ofMember States to respond to global health threats. For us, the basic function of our Organization is to develop and promote international health norms and standards which allow effective international health actions. We strongly support the implementation of national programmes based on quality and equity of access. It is for that reason that Canada appreciates the high importance given by the Director-General to the normative work

A52/VRI4

page42

of WHO in setting global standards in ali relevant areas ofhealth. We are particularly conscious of the work of WHO in improving the programmes on pharmaceuticals, including strengthening its relations with the W orld Trade Organization in this and other areas. Canada has established clear priorities for our work with WHO. We believe that the expansion of publicly funded and publicly administered health systems is essential for WHO if the tests of equity and sustainability are to be met. Health is not a commodity; it is a right. We must work to ensure that the children of the world grow up with access to health and quality health services which are measured by their needs, not by their wealth, or lack of it. The Director-General has noted that poverty is our greatest challenge. We believe that public health systems can play an important role in mitigating the damaging effects ofpoverty. We cali this distributive justice, and as Professor Sen has noted distributive justice is an important determinant of health. Canada, and this Assembly, are also called upon to respond to the invitation of the Director-General to tackle one of the worst global health catastrophes- the tobacco epidemie- through WHO's Tobacco Free Initiative. We view this as an opportunity for WHO and its Member States to invest in global health. We support the Director-General and echo her cali at this meeting and at the Ninth International Conference of Drug Regulatory Authorities for content and design controls over tobacco products. It is in this spirit that Canada has made voluntary contributions to WHO to help strengthen national anti-tobacco strategies and to develop the framework convention for tobacco control. We also share the Director-General's priorities with regard to poliomyelitis and malaria. The poliomyelitis campaign offers us a unique opportunity to rid the world of a disease which has caused suffering in both developed and developing countries. The Roll Back Malaria project must succeed if WHO is to be seen as a leader in health. 1 would note that these diseases have a disproportionate effect on the world' s children. Finally, noncommunicable diseases can be viewed as the new frontier ofhealth and development. One with which we are not yet equipped to deal. Canada believes that WHO has a unique role to play in meeting the challenges in this area in the new millennium. Canada will continue to invest in WHO, as active participants in its deliberations, technical discussions and through voluntary contributions to those priority areas outlined above. Canada, with Member States and international partners, will support WHO to invest in priority interventions of critical global significance. As the Director-General has so often said, together, we can make a difference. Professor WANG Longde (China):

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•*·~~~~1*ili ~1f1 ~9tm\. i~HM. Mrs FISCHER (Germany): Madam President, Madam Director-General, ladies and gentlemen, 1 have the honour to take the floor on behalf of the European Union. The central and eastern European countries associated with the European Union, which are Bulgaria, the Czech Republic, Estonia, Hungary, Lithuania, Poland, Romania, Slovakia and Slovenia, and the associated country Cyprus, align themselves with this statement. The first half of 1999 is Germany's turn to hold the Presidency of the European Union. This circumstance affords me the very special honour of speaking to this Assembly as the incumbent President of the European Union's Council ofHealth Ministers. It also gives me the opportunity to make a number of basic statements about the current state and future perspectives of European Union health policy and, in doing so, to address in particular the relationship between the European Union and WHO. The Treaty of Amsterdam entered into force on 1 May this year. This was a decisive step towards further integration in the Union but, at the same time, better conditions were created for the strengthening of health po licy and health matters within the European Union. The new Article 152 of the Treaty of Amsterdam gives a central place and primacy to the requirement of ensuring a high level of human health protection in the definition and implementation of ali Community policies and activities. European health policy must, in addition, become more visible and comprehensive to the general public. lt must be responsive to the citizens' needs and concerns. The increasing interlinking of our economies, including globalization, the changes in the technological environment, especially in the area of information techno1ogy, the financial problems facing our health care systems as a result of demographie and labour market factors, the changing values in society, the growing mobility of our populations and, as a result, the emergence ofhealth hazards, often on an international scale- these are ali factors which pose comparable challenges to ali our health systems. The conclusion is that the European Union and WHO can play a supportive role in the quest for solutions the decisive prerequisite for any European public health policy. A European public health po licy will facilitate the early detection of problems and hazards and will be able to furnish a basis on which common future perspectives and options for action can be elaborated and developed. A public health policy at European level will also be able to create transparency and give orientation, not only to the 15 Member States, but also to the applicant countries. Such a policy must encompass ali areas of activity which can have an influence on, and contribute to health. One key area is development; the European Union is, and will remain a major actor in development aid and humanitarian assistance throughout the world. Secondly, the European Union has continued its efforts to promote environmental health and is looking forward to making further progress in this field at the forthcoming London ministerial conference. Thirdly, the Community has adopted under the German Presidency its fifth Research and Technology Development Programme, which has increasing funding for health research. Research under this programme will have to better serve health policy needs, and it is open to the participation of a large number ofthird countries. Given this perspective, there is a need for even closer collaboration between WHO and the European Union, above and beyond the cooperation which already exists on a number of individual programmes. The visit paid to the Commission by the Director-General, Dr Brundtland, on 6 and 7 January 1999, and the upgrading of the WHO Office in Brussels, have set the right course for improved cooperation. Correspondence of 1982, which hitherto constituted the basis for cooperation, will be revised and adapted to suit the changed circumstances. 1 am therefore optimistic that it will soon be possible to lay the foundations for more intensive collaboration between WHO and the European Union. This does not mean, however, that agreement does not already exist on a number of important issues. One of the items on the agenda of this Health Assembly is, for example, combating tobacco abuse. The Member States of the European Union welcome the initiatives taken by WHO in this regard. They

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welcome them not least because there is broad agreement about what needs to be done to turn the tide on smoking, considered to be the biggest self-imposed burden on health. The European Union has taken a number of legislative measures in this area, which is open for closer cooperation in the future. Another example, which is also to be discussed here in the coming days, is WHO's revised drug strategy. The Member States of the European Union support the resolution before us, which they have actively helped to elaborate. This resolution provides an appropriate basis for establishing an equilibrium between health needs from the public health perspective and the legitimate interest ofthe industrial sector. Finally, the Member States ofthe European Union fully support the reform process initiated by the new Director-General, Dr Brundtland, since taking office less than a year ago. Since the 15 Member States of the European Union are members of WHO, they are all intent on pursuing much closer cooperation between both organizations with a view to achieving the expected synergistic effects. As President of the Council, 1 wish to assure you that the Council ofMinisters will most certainly support these efforts. Professor REINER (Croatia): Madam President, Madam Director-General, distinguished colleagues and delegates, the report presented by Madam Director-General and this year's World health report are immensely promising and call for energetic action. They show we have really new and strong leadership of WHO. The slogan "Making the Difference" is a challenging one because it could be interpreted as referring not only to making the difference inside WHO but to WHO continuing to decrease current differences in health status as well as the economie and social differences that exist at alllevels, global, regional and country. Our one WHO has to respond to the ongoing process of transition and transformation on all these levels. WHO has achieved many successes during the past 50 years. But it has also faced a degree of crisis during the last decade. So we cao be really satisfied listening to Dr Brundtland's report and reading the summary of The world health report 1999. We cao feel that it is WHO's firm intention to strengthen its role and reinforce its leadership in world health. It must be stated that this renewed leadership will be properly based on partnership relations with many other organizations in the world, which are fortunately taking more and more interest in the world's health and health systems. We all also hope that the new structure introduced at WHO will enable the Organization to achieve its many noble and important goals more successfully. We welcome new action introduced, such as the Roll Back Malaria project, Health Systems Development, and especially the Tobacco Free Initiative, in the hope that we will really have a binding document, a convention for tobacco control in the near future. Distinguished delegates, after these global points allow me to say something concerning my region, Europe. All of us in Europe who are active in WHO have for sorne years been very enthusiastic about so much needed reform ofWHO and the renewal ofits Constitution. This Constitution was an advanced and forward-looking document at the time of its first adoption more than 50 years ago. 1 cannot refrain from mentioning here that my fellow countryman Professor Andrija Stampar was one of its authors. However, the many changes that have taken place since theo at an unprecedented pace require new approaches. New approaches are present in the normative strategies and functions defined for WHO for the next century that will ultimately enable WHO to play a more appropriate role for the entire world's population. The decisions recently adopted have already started to bring about corrections to disproportionate and non-objective budget distribution. We are particularly satisfied with this issue as it has also opened the question ofplacing WHO's regional arrangements on a new basis and directing funds to countries in greatest need. Although we have not achieved definitive solutions we have taken a huge step forward from adopting a programme budget based on almost no criteria but tradition, impression, intuition and inertia, to a programme-based budget supported by objective and independent criteria. Europe, more than any other continent except Africa, needs and would like to re-address sorne other issues as weiL We are expecting further advancement in the health status ofthe populations of the most developed European countries as well as quick action aimed at preventing further degradation of the health status in sorne other parts of Europe, particularly the countries in transition. Europe is a region with many strong and active intergovernmental organizations, such as the European Union and the Council of Europe. All these organizations are more and more interested in health issues. Sorne of them have excellent healthoriented, constructive programmes which encourage us to think of ways to improve coordination and cooperation between them and WHO, in Europe as well as globally. Our common goal in Europe has to be pan-European health, which is to become a counterpart to the general political trend of creating closer ties among countries in Europe, and which might definitely be the best prevention against misunderstandings and political or armed conflict. In striving towards peace and stability we very much support the thesis that one of the most efficient instruments towards such noble aims

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is health, as health does not know, nor could know, any boundaries and is an issue of much broader importance with an impact on State security, economy and so on. 1 would also Iike to outline briefly how my country, the Republic of Croatia, is looking ahead after the years of change. 1 would like to remind you that my country, like ali the other countries in transition, has gone through tremendous changes in the last eight to nine years, economie, social, demographie and even epidemiologie changes. These processes cali for necessary organizational transitions in ali parts of human life, creating the new circumstances we live in. A Iso, the demands conceming the health of our population have altered accordingly, therefore changes must occur, and this is exactly what has been called "making the difference". 1 would like to emphasize that despite sorne economie difficulties, health systems in my country can and must ensure exactly what has been promoted as primary goals ofhealth. As set forth in the Ljubljana Charter on Reforming Health Care in 1995, those are the equity, efficiency and constant bringing about ofhealth gains. Mrs FLOOD (Saint Lucia): Madam President, colleague ministers, distinguished delegates, Madam Director-General, 1 am pleased and honoured to bring greetings on behalf of our group of Caribbean nations known as CARICOM. We congratulate Dr Maria de Belém Roseira on her election as President of this Assembly. We extend warm greetings to you, Dr Gro Harlem Brundtland, on your first year of leadership which bears significance for our region as we present! y have a notable number of women in the capacity of ministers of health. Additionally, this reality of representation we also note is juxtaposed with your own expressed proactive views on the need for contributions from women in our political and institutionallives. The reality of the dawning of a new millennium has its significance, not just for the passage of time but because it also forces us to focus on an end and a subsequent beginning. It forces us to examine where we are, what we have achieved and what is our vision for the future. An examination of the joumey of this Organization from the very start shows that the positive advances are tremendous. Within the short span ofyour period at the helm, Madam Director-General, we can also say that already positive winds of change are blowing within the corridors of WHO, and the Caribbean has already felt the first wave of change in the management and functioning of WHO. We hope that this levet of dynamism that has brought the organizational refocusing of WHO will meet the needs of small island States such as ours. There are key priorities for ali our Members and these priorities have been defined in the proposed programme budget for 2001-2002, in which one of the most important programmes is Roll Back Malaria. Malaria, a top priority for WHO, is endemie in sorne countries in the Caribbean and has re-emerged in other countries where it was eradicated. The threat to economie development in Guyana, Suriname and Belize is real, while the possibility of reintroduction in other countries of CARICOM poses a threat to the tourism industry; we look forward therefore to the extension of the Roll Back Malaria initiative to the Caribbean countries. Other priorities are the Tobacco Free Initiative, the paying of more attention to the delivery of higher quality of care for children, adolescents and women, and support for countries in the quest for access to affordable and high quality essential drugs. And to the above and other set priorities we must add the issue ofHIV/AIDS. During my recent attendance at a major AIDS conference in Houston, Texas, it was gratizying to hear from the experts at the cutting edge of HIV1 AIDS research that the development of a cocktail of drugs is greatly increasing the survival period for individuals who have contracted AIDS. This sense of euphoria soon turned to despair when I recognized that so many of WHO Member States cannat from their annual budgets afford even one day's supply of the required drugs to treat their infected populations, much less that required for one year. WHO must recognize the extent of this global tragedy, how it is decimating nations, and address it as a matter ofurgency. We are concerned about the situation regarding HIV/AIDS and sexually transmitted diseases in the Caribbean, which collectively has one of the highest rates in the increase of incidence in the world. Guyana, Haiti, plus Trinidad and Tobago are seriously adversely affected by this tragedy. As noted above, in my own experience the global response, mainly because of economie constraints and prioritization, stilllags behind in addressing the needs of th ose countries that are most affected by the epidemie, and there is a need for more international support to these countries to develop their capacity to respond effectively to the epidemie. While intersectoral response is necessary, the health sector has an imperative to lead in the expanded response to the epidemie, and this must be reflected in the work and foc us of WHO. We are pleased to see that WHO will be adopting a more strategie approach to work within and with countries. The financial resources for health do lie overwhelmingly within countries as shown by the fact that only 1% to 1.2% ofhealth spending from low- and middle-incarne countries cornes from development assistance, but we must be cognizant of the fact that the strategie placement of this spending by institutions such as WHO is of paramount importance. In many instances, this support may be the only incrementai

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amount that is imperative to lay the foundation for future growth, capital expansion and rationalization of our health services. International organizations such as WHO should be constantly reminded that microstates such as those found in the Caribbean are particularly vulnerable to externat economie shocks, threats to their sovereignty and security, to environmental hazards and other ecological disasters. In addition, there are certain globalization trends that have a potential adverse impact on health and development, such as the issues related to compliance with the World Trade Organization agreements. The recent short-sighted WTO ruling which adversely affects the vital banana industry in sorne of our Member States is a prime example. Currently the primary challenge facing our countries is that of generating sufficient economie growth to improve the social conditions of our people. In the Caribbean, we view health as an integral part of this development. This commitment is expressed in a variety offashions and is largely shaped by the financial resources, or should I say, lack of financial resources available to our individual countries. In sorne countries such as my own, Saint Lucia, as much as 15% of the national budget is spent on health; in other Caribbean countries, there is considerable evidence to suggest that even in the face of competing priorities our governments have been attempting to ensure that health is placed at the fore front. Because of increased cost, changes in disease patterns and demographie shifts, we are in danger of losing the gains of that health status wh en compared with our brothers and sisters in the developing world. These achievements include the eradication of poliomyelitis and measles. The irony of the situation is that a paradox has been created by these good results - success equals a drop on the parity list for our countries and a subsequent reduction of fun ding for technical assistance and other forms of aid, which will result in an undermining of the positive results attained and the quality of life we now enjoy. There is an interesting parallel here with the development of economies in that the expansion of the middle class signifies improved overall economie health of an individual country. Countries like ours are in the middle class of the world economie order. The more we are in number the greater the health of the world economy. The more developed countries must accept the fact that just as if any country will pursue negative policies to abandon its middle class, with a subsequent negative impact on the overall economy, so too the world economy will suffer if the more developed countries abandon and curtail aid to the middle level economies such as ours. From a purely self-serving point of view, the more developed countries should therefore be aware that our falling levels of development, including health sector development, equate to less export markets for them, more desperate illegal immigrants knocking on their doors, and an overall drop in the world's stability. Developed countries therefore need to invest more in WHO and the promotion of health in developing countries in their own interests and that of humanity. It is therefore of concern that sorne countries insist that a WHO budget should be restricted. We feel that this Health Assembly must mandate the Director-General of WHO to increase ber advocacy for more resources to be invested by developed countries in promoting health in developing countries. In 1984 the Caribbean Cooperation in Health initiative (CCH), a mechanism for increasing collaboration and promoting technical cooperation among countries in the Caribbean, was introduced by the conference of ministers responsible for health. This initiative was reformulated in 1996 for the period 1998-2003 to highlight the areas of regional priority in health and to set concrete and achievable targets. These priority areas range from environmental to family health. Although these areas of priority may be similar for many nations, the CCH initiative is unique because, while giving a regional focus to health sector reform, it allows for sharing expertise, pooling of resources, and accessing and optimizing externat resources. The overall concept of the CCH initiative is that we in the Caribbean must help ourse lves and one another to improve health in the region. Our efforts, as embodied in the CCH initiative, are consistent with the goals, themes and concepts advanced in The world health report 1999, as the Organization seeks to reposition itselffor the twenty-first century. We endorse the steps being taken by the Organization to improve the world's health, focusing on those countries where the burden of disease is greatest. We caution, however, that WHO needs to continue its shift from its strong disease-led orientation, and to strengthen its capacity to intervene on the social front and on changing organizational cultures and the behaviour patterns of users and providers of health services. In the summary of The world health report 1999, the following is noted, and I quote: "The purpose of this work is to improve people's lives, to reduce the burdens of disease and poverty, and to provide access to responsive health care for ali. WHO must never lose this vision. Thanks to the support of Member States and the commitment of staff, WHO is beginning to see results on the ground. The next report will tell how WHO bas made a difference and show the measurable improvements that have been achieved as the world moves into a new century". We in the Caribbean wholeheartedly concur with the above and reiterate that throughout the operation of this Organization there must be quality assurance and assessment, plus on-time measurement of results. As 1 have said in another forum, we must focus on function and not just form. WHO staff and consultants must take on the result-oriented responsibility that

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Member States have given them the authority to carry out. If the above is accomplished, then the start of the new millennium will not just mark the sterile passage of time but will be a dynamic measurement milestone in the success ofhumankind's cooperation in the area ofhealth. Mr SJOBERG (Sweden): Madam President, Dr Brundtland, distinguished delegates, 1 congratulate you and your VicePresidents on your election to lead this important meeting. Last year's World health report gave us the opportunity to take stock of the achievements of the past 50 years. This year's Report challenges us to look ahead and to debate what action we must take to meet the vision of a reduced burden of disease and poverty. My Government welcomes the Director-General's ambition to sharpen the focus of WHO. A corporate strategy for one WHO is emerging. No doubt this will reinforce the work of the regional and country offices. It will also forma basis for partnerships with other United Nations agencies and international actors. Sweden would like to see a strong WHO that can fulfil its role as the lead agency in international health. The Director-General and ber staff have made a commitrnent to make a difference: in po licy direction, in organization, in administration and budgeting, as well as in high-quality, outcome-oriented action. My Government lends its full support to this renewal. The reforms the Director-General bas now set in motion are both impressive and necessary. Not only to restore trust and confidence in WHO, but also to prove that the United Nations system can and will respond to Member States' requests for improved efficiency. The aim ofreform must be to do more and better, and not merely to spend Jess. Consequently, Sweden supports zero real growth of the regular budget and will contribute voluntary funds on a high level to make it possible to meet the objectives of the total programme budget for the next biennium. It is my Government's strong wish that WHO should regain its place at the centre of the health sector development agenda. It is indeed not easy to put health concerns right at the heart of economie policy-making. It is up to us, ministries of health, together with WHO, to prove that an economy is not sound if it leads to rising levels of poverty or increased health disadvantages for certain groups. Quite the contrary! lnvestrnent in health is one ofthe main avenues towards poverty eradication. We are all aware that WHO has bad difficulties in bringing together facts from its vast pool ofknowledge into health system po licy products. Therefore, the new cross-cutting project Partnership for Health Sector Development must be given high priority within the Organization, not ]east at country level. To break the cycle of poverty and disease, we must focus on children and young people. In accordance with the Convention on the Rights of the Child, interventions must reach all children. The failure to recognize reproductive health needs and the rights of young people bas meant that many of them are becoming parents far too early or are infected by sexually transmitted diseases and HIV. This situation must be changed! Roll Back Malaria and the Tobacco Free Initiative are two new important partnership projects. The framework convention on tobacco control will be instrumental in placing health interests firmly before other interests. The ambition to link up with other partners must also include increased WHO contributions to the joint UNAIDS effort to combat AIDS. In both high-resource and low-resource settings, we deal to a large extent with the same problems. We have to be fast-leaming and creative in using available interventions as well as developing new ones. WHO's centre-of-excellence function stands for our collective knowledge on how health can be improved. To this end, it is essential that WHO bas a clear research policy. The interdependence between countries is increasing. We know today that communicable diseases are here to stay as significant health problems all over the world. No organization other than WHO could secure the imperative global surveillance mandate. Therefore, it is important to improve the system for reporting and early waming. The Director-General bas proposed objectives and structures for the way ahead to reduce the health gaps within and between countries. The dedication of all staff members to jo in in this effort is highly commendable. AH ofyou, please be assured ofSweden's full support. Mr KAL WEO (Kenya): Madam President of the Fifty-second World Health Assembly, Madam Director-General, distinguished delegates from Member States and other collaborating institutions, ladies and gentlemen, please accept our best wishes as you steer the deliberations of this Assembly and during your term as President of the current session of the Health Assembly. It is our hope that, as we prepare to enter the twenty-first century, the many technical and health matters listed in the provisional agenda of this Assembly will be addressed through strategies that are based on global partnership within the framework of health development.

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The health sector in Kenya is already witnessing this partnership. For instance, the evolution and implementation of health sector reforms in Kenya since 1989 has been a collaborative effort between the Government, the community, the private sector, nongovernmental organizations, and donors, as weil as United Nations organizations such as WHO. In particular, WHO, in collaboration with other donors, is at the moment supporting the development ofKenya's national health strategie plan covering the period 19992004 and the implementation of essential public health packages at the district level. Kenya has been implementing primary health care and health sector reform activities for the past 20 and 10 years respectively. First, may I share with you our positive experience in primary health care. Sorne of the most notable achievements include increased community participation in the financing and management ofhealth-related activities and programmes. Other achievements include increased access to health services, with approximately 77% of the population now residing within a 5 kilometre radius of a health facility, compared to 45% 20 years ago before the Alma-Ata movement was launched. May I take this opportunity to emphasize the fact that, following the introduction of primary health care and health sector reform, communities are now playing leading roles in problem identification, implementation, and monitoring and evaluation of health programmes. Kenya is also implementing a number of reform measures in the health sector. First, we are restructuring the basic institutional arrangements to make them res pond to the reform agenda which aims at improving the provision of health services. We are also undertaking a review of the existing health legislation to make it more responsive to contemporary health demands. Secondly, my Ministry has shifted resources towards promotive and preventive health care activities in our health programmes. Thirdly, we are vigorously exploring alternative financing mechanisms, including the overhaul of our national hospital insurance fund into a comprehensive national health insurance scheme. These reform measures are being pursued within the broad aims ofKenya's health policies, which are to promote equity, enhance efficiency, improve the quality of services and enhance consumer satisfaction. Our sectoral development efforts hinge on the overall performance of our economy. In recent years, Kenya has registered a sluggish rate of economie growth. The overall impact has affected the government' s ability to deliver health services effectively. Secondly, the emergence of the HIV/AIDS pandemie has resulted in unprecedent disease pressures on our health care system, a situation that has been worsened by resurgent health problems such as tuberculosis. Thirdly, despite our concerted efforts in implementing family planning programmes, our population growth continues to strain the resources that are meant for our health services. We are confident that sorne of the constraints could constitute agenda items for discussion by Member States as a strategy for promoting horizontal technical cooperation in health sector reform in developing countries. We are optimistic that the enhanced cooperation will in turn contribute towards the realization ofWHO's global goal of obtaining health for ali in the twenty-first century. In conclusion, may 1 emphasize the fact that efforts aimed at the promotion of horizontal technical cooperation in health sector reforms among the developing countries will be frustrated if such cooperation is restricted only to health issues. A way out is for developing countries to "hinge" such efforts to broader and sustainable socioeconomic and political arrangements. Such an approach will provide the relevant framework for positively focusing on development aspects of health care, such as global coalition, intersectoral collaboration, development of regional health groupings and joint action against poverty among other roles. Finally, Kenya supports the reforms and initiatives proposed by the Director-General. El Dr. AGUINAGA (Pern): Distinguida sefiora Presidenta de la 52" Asamblea Mundial de la Salud, distinguida doctora Gro Harlem Brundtland, Directora General de la Organizaci6n Mundial de la Salud, sefiores delegados: El Informe sobre la salud en el munda 1999: Cambiar la situaci6n, resalta la oportunidad, el desafio y la responsabilidad de nuestra sociedad por culminar la primera década del siglo XXI con una adecuada priorizaci6n y provision de aquellos servicios e intervenciones de salud que mejor contribuyen a la reducci6n de la carga de enfermedades y condiciones discapacitantes que aquejan a la poblaci6n, especialmente a los mâs pobres. Trabajar en salud en un pais como el nuestro, el Pern, significa enfrentar perfiles epidemiol6gicos marcadamente diferentes, siendo sus caracteristicas principales la diversidad y la desigualdad. Esta situaci6n agrega una mayor complejidad a los retos que en términos generales plantean las megatendencias al trabajo en salud, es decir no s6lo el enfrentamiento de la pobreza sino también la busqueda de la equidad. En ese marco, las estrategias e intervenciones desarrolladas en la ultima década por el Gobiemo peruano han comenzado a mostrar importantes logros en salud, los cuales, ademâs de indicadores epidemiol6gicos o demogrâficos, comprendieron mejoras en los recursos disponibles, nuevas condiciones juridicas y la estabilidad en las politicas relacionadas con ella, buscando la atenci6n a los sectores men os protegidos y mâs vulnerables de la sociedad.

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Como sostiene el informe presentado, el esfuerzo conjunto de los paises debe hacer posible la expansi6n del conocimiento y las capacidades generadas por nuestros sistemas de salud, para enfrentar la amenaza emergente de las enfermedades cr6nicas y no transmisibles, asi como el «programa inacabado» de la lucha contra las enfermedades infecciosas y los problemas ocasionados por las complicaciones de la gestaci6n y el nacimiento, los estilos y condiciones de vida poco saludables, la malnutrici6n y las limitaciones de acceso de los mâs pobres a los servicios de salud. El tabaquismo es presentado como ejemplo de la amenaza emergente de las enfermedades cr6nicas y no transmisibles. El Peru ha tenido avances en la lucha antitabâquica, reflejados en diversas normas legales que regulan la publicidad y en el impulsa de iniciativas multiinstitucionales e intersectoriales de convocatoria e informaci6n a la poblaci6n, las que se articulan a una estrategia integral de promoci6n del bienestar, la calidad de vida y un medio ambiente saludable. Pero definitivamente, como todos conocemos, el control de esta pandemia requiere una respuesta global e integral por parte de la comunidad intemacional, por lo que respaldamos la iniciativa de la OMS y de la OPS en esta direcci6n. En relaci6n al «programa inacabado» de la lucha contra las enfermedades infecciosas, a la par de importantes avances obtenidos para la eliminaci6n del sarampi6n y el tétanos neonatal, asi como en el control de la tuberculosis, tenemos que profundizar la lucha contra la malaria y la fiebre amarilla. Como resalta el informe, estas enfermedades tienen un carâcter multifactorial, vinculândose a condiciones sociales, econ6micas, geogrâficas o climâticas, pero también a sistemas de salud que aim no logran ser suficientes en la respuesta a estos problemas. El Informe sobre la salud en el mundo nos convoca alrededor de una «nueva universalidad», entendida como la cobertura para todos, pero s6lo sobre la base de una adecuada priorizaci6n de las intervenciones que respondan mejor a las necesidades de salud de nuestros pueblos. En este sentido, el Gobiemo peruano avanza hacia una estrategia de aseguramiento progresivo que guarda relaci6n con el cielo de vida de la poblaci6n. A nive! del aseguramiento publico, resalta el valor social del Seguro Escolar Gratuito y del Seguro Matemoinfantil. Estas propuestas se apoyan en la decisi6n institucional de articular los programas de salud matemoinfantiles y los de enfermedades transmisibles, orientando su accionar a un abordaje integral en la atenci6n de salud de la persona. Nuestra intervenci6n se enmarca en los objetivos de lucha contra la pobreza, promoci6n de un desarrollo humano sostenible y en la bllsqueda de una mayor eficacia, calidad y eficiencia en la atenci6n de salud. Para el cumplimiento de estos prop6sitos es necesaria la participaci6n de la comunidad organizada y de los distintos actores sociales vinculados a la acci6n sanitaria. Estos procesos, y las lecciones que de ellos se desprendan, consideramos, sefiora Presidenta, que se veran enriquecidos gracias a la decisi6n de la Organizaci6n Mundial de la Salud de establecer el nuevo programa de Pruebas Cientificas para las Politicas de Salud, que contribuirâ a la formulaci6n y evaluaci6n de politicas para el desarrollo de los sistemas de salud en beneficia de la poblaci6n. Sefiores delegados: En el umbral del nuevo milenio, el Peru se auna a la convocatoria de la Dra. Gro Harlem Brundtland para que conjuguemos visi6n, compromiso y liderazgo en la lucha por alcanzar mâs y mejor salud para nuestros pueblos. Muchas gracias. Mr EZHILMALAI (India): Madam President, Madam Director-General, distinguished delegates, ladies and gentlemen, at the outset may 1 congratulate the new President and the Director-General for their excellent presentation of the situation prevailing in the present century and the projections set out as we move closer to the new millennium. It is with a sense of pride that 1 address the Fifty-second World Health Assembly today. Representing 16% ofthe world's population, 1 am conscious of my country's immense achievements, but also of the challenges that daunt us in the years ahead. Five decades ago, when we won our Independence, literacy levels were abysmally low, nearly three-quarters of the population were below the poverty line, with a !ife span not exceeding 32 years, and negligible human resources or scientific manpower. Since then, the average !ife span has doubled, the number of persans below the poverty line reduced to one-third, food security has been achieved, a large reservoir of scientific and skilled man power has been created, and over 80% of the people provided with access to safe water. The expansion of the health infrastructure throughout the country has greatly helped us to achieve high levels of immunization of children, a decline in fertility and death rates, and a significant increase in !ife expectancy. In view of such an expansion and investment in health, we have been able to achieve significant results, namely the eradication of smallpox and guinea-worm, and the elimination of poliomyelitis, yaws and leprosy within the next two to three years. As we near the end of one millennium and enter the next, our past attainments and technological achievements make me still more optimistic about the future.

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In this I am glad to see the direction given by the Director-General, Dr Brundtland, in revitalizing WHO with new initiatives and vigour. Under her determined stewardship and generalship, WHO will be strengthened to face the emerging challenges that confront the regions of the world. I have read The world health report 1999: Making a difference, with interest. In making a difference, I do hope Dr Brundtland will use her special position to persuade the developed countries to share technology on terms that will enhance the health-giving capacity of the rest of the world. One of the challenges that faces lndia is to reduce interstate differentiais, and in arder to achieve this we continue to implement the minimum needs programme. Out of 12 programme components, six relate directly to health: rural health, rural sanitation, rural water supply, rural housing, nutrition, and improvement of slum environments. The foc us is on the poor sections of society who predominant! y live in rural areas and urban slums. The financial provision for the minimum needs programme cannat be diverted to other programmes or schemes. This programme has received further impetus with the two constitutional amendments that have enabled devolution of authority to the bands of the people by entrusting responsibility to elected local bodies. Rapid detection, containment of epidemies, strengthening oflocal capacity and selective vector control backed by continuous monitoring are sorne of the major plans on which this US$ 200 million project is based. 1 also applaud the second cali for action from WHO which addresses immunization against poliomyelitis. I am glad to inform the Assembly that on two dates in December 1998 and January 1999 lndia succeeded in vaccinating 135 million children, a world record ofwhich we are justly proud. One of the most daunting tasks ahead of us is to control the spread of AIDS. A new programme negotiated for the period 1999-2002 seeks to co ver the needs of the high- as weil as the low-risk groups by using nongovernmental organizations extensively. Sorne of our achievements since we last addressed the Assembly in elude the initiation of a national programme for control of dengue, disease surveillance and phased diethylcarbamazine coverage for filariaendemic districts. Leprosy is poised for elimination by the year 2000. The tuberculosis programme, and particularly the adoption of the directly observed treatrnent, short course (DOTS) strategy, is being closely monitored, particularly as its linkage with AIDS manifests itself. The highest priority has been accorded to protecting the public from food-borne diseases, and the supply of essential drugs at affordable priees is a policy commitment which is achievable. The reproductive and child health project seeks the reduction of maternai morbidity, promotes the use of contraceptive as per choice, without being weighed down by targets, augments facilities for safe deliveries and caters for the treatment of reproductive tract infections. Greater attention is being paid not merely to women's health in terms ofbiological factors but also those impacting on their social, economie and cultural status. Now 1 take the opportunity of repeating a request 1 made to the Director-Generallast September wh en she visited India. Wh ile reiterating what was decided at the last meeting of the health ministers of the South-East Asia Region 1 requested the Director-General once again to establish an effective focal point equipped to recognize and draw on the full potential of traditional medicines. A large proportion of the population of many developing countries relies mainly on traditional practitioners for care needs. Although WHO has stated over the years that the Organization promotes the integration oftraditional medicine into the national health care system, WHO must set up a forum and mechanism to develop technical guidelines and international standards, particularly in respect of herbai medicines. There has to be an international understanding and an agreement on policies, regulations, registration and standards. 1 request WHO to give time and attention to this important area endorsed by 10 co un tries of the South-East Asia Region. Finally, wh ile conflicts of power and competition among rival groups have been a phenomenon witnessed by the people of the world, there is every need to see that health policies are determined in an international climate which evokes an ethical and emotional response. Essential public health functions cannat be relegated to the private sector orto agencies who Jack the mechanisms to safeguard equity. We, as leaders and policy-makers, have to determine and put in place the building blacks that will shape the health of millions of people in the twenty-first century. With foresight and decisive action, we can create a better world for our people, particularly as large numbers will be added to the cohort of the elderly, and noncommunicable diseases will cali for attention and increased deployment of scarce resources. It is in this context that meaningful international cooperation in health can help countries. I recall the old saying that "Health is a matter oftime, but it is also a matter of opportunity". Each one of us has been fortunate in having that opportunity. In the words of Benjamin Disraeli, "The health of a people is really the foundation upon which ali their happiness and ali their powers as a State depends". Before 1 con elude, let me express our support for the reform process initiated by the Director-General of WHO, and I hope that together we can make a real difference.

A52/VR/4 page 51

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Versi6n completa del discurso pronunciado por el Dr. Mazza en forma resumida.

A521VRI4 pag&52

desarrollado una profunda y progresiva reforma sectorial, cuyos resultados e impacto en el medio sanitario permiten afrrmar que la estrategia utilizada es apta, factible y viable en re lac ion con los objetivos propuestos. Entre las principales reformas implementadas destacan el programa nacional de garantia de calidad de la atencion médica, el modelo de hospital publico de autogestion, la reconversion de la seguridad social, el control sanitario de alimentos, medicamentos y tecnologia médica, la vigilancia epidemiologica y el control de las enfermedades, poniendo especial énfasis en los programas de prevencion destinados a disminuir los riesgos evitables de enfermar y morir, especialmente dirigidos a poblaciones marginadas y de pobre:za estructural, y en aquellas situaciones biopsicosociales consideradas potencialmente riesgosas. Nuestro accionar sanitario se orienta fundamentalmente hacia el hombre y la familia; se basa en criterios de equidad, solidaridad, ética biomédica, eficacia, eficiencia, calidad y en la defensa de la dignidad de la persona humana. El objetivo central de las politicas de salud, implementadas explicitamente en nuestro pais a partir de 1992, es lograr la meta de Salud para Todos y por todos en el menor tiempo posible, con eficiencia y el mayor beneficio para toda la poblacion mediante el desarrollo de un modelo humani:zado de atencion médica integral, que por sus caracteristicas se constituye en un elemento fortalecedor de la democracia participativa. Nosotros también, como lo sefiala el informe de la Directora General, miramos hacia el futuro, teniendo en cuenta las debilidades y fortale:zas de nuestro sistema, asi como los problemas e inconvenientes que debimos superar al frente del Ministerio de Salud. Comprometidos con la Organi:zaci6n Mundial de la Salud, que pertenece a los Estados Miembros que la integran, queremos reiterar en estos momentos algunos de los conceptos ya sefialados en Asambleas anteriores, y que mantienen plena vigencia En tai sentido consideramos que el apoyo de la OMS al desarrollo sanitario de los paises siempre debe concretarse respetando las pautas y valores culturales de los mismos. Ese apoyo debe ser canali:zado a través de las oficinas regionales y responder a las necesidades de salud detectadas por los respectivos ministerios de cada pais, quienes de ben ser, necesariamente, los interlocutores vâlidos con la Organi:zaci6n, con el fm de evitar interferencias y conflictos no deseados a nivel de los propios paises. El respeto de estas reglas de juego claras y definidas garanti:zan el éxito del accionar de la Organi:zaci6n, en el marco de la responsabilidad directa e indelegable que tienen los ministerios de salud. Es por ello que en el marco de los cambios introducidos en este ultimo afio por la Directora General, insistimos en la necesidad de avan:zar en el mejoramiento del proceso técnico y administrativo de gesti6n de la Organi:zaci6n y en la definici6n de âreas prioritarias. Entendemos que se deben profundi:zar los cambios estructurales y programâticos para ponerlos al servicio de las necesidades de los paises, lo que redundarâ directamente en el nivel de salud de la poblaci6n. También queremos destacar que el sector salud es un sistema abierto, muy complejo, fuertemente interrelacionado con el medio, con multiples factores intra y extrasectoriales que interacruan no siempre en forma positiva sobre el mismo, lo que exige reorientar el accionar con el fm de disminuir la incertidumbre y de evitar al mâximo los posibles conflictos que se puedan generar por la falta de una adecuada articulaci6n y coordinaci6n entre la Organi:zaci6n y los respectivos ministerios de salud. En este orden de ideas consideramos que la actual Constituci6n de la OMS sirve adecuadamente a los fines para la cual fue creada y no visuali:zamos la necesidad de enmendarla en estos momentos. El uso racional de los recursos y una cooperaci6n técnica consensuada con los Estados Miembros constituyen componentes esenciales para asegurar el éxito del trabajo en conjunto. Los cambios mundiales y la globali:zaci6n de la economia exigen poner especial atenci6n en mejorar la eficiencia de la Organi:zaci6n, tai como lo destacamos en las Asambleas Mundiales de la Salud de los anos 1996 y 1997 y, dado que los paises no estân en condiciones de reali:zar mayores aportes, proponemos que el nuevo presupuesto de la Organi:zaci6n debe tener un «crecimiento nominal cero», controlando para ello los costos operativos innecesarios. Por ello, consideramos que una de las estrategias a tener en cuenta debe ser, cuando resulte indicado, el de promover la cooperaci6n técnica horizontal entre paises que tienen las mismas caracteristicas sanitarias, los mismos problemas y las mismas raices socioculturales. Nuestra delegaci6n comparte ampliamente la propuesta de mejorar la situaci6n sanitaria, reducir la desigualdad en materia de salud; responder mejor a las expectativas legitimas; mejorar la eficiencia; proteger al individuo, a la familia y a la comunidad y mejorar la equidad en el financiamiento y en las prestaciones de la asistencia sanitaria, propuestas en el Informe sobre la salud en el munda 1999. Asimismo consideramos de marcado interés profundi:zar el estudio de los ternas propuestos en el informe, con el fin de mejorar los resultados sanitarios y de avan:zar en las iniciativas dirigidas a «Racer retroceder el paludismo» y «Liberarse del tabaco». Debemos encarar entre todos un anâlisis critico de lo reali:zado y consensuar una propuesta sistémica frente a la compleja problematica que enfrenta el sector salud en la actualidad. La transicion demografica, la transici6n epidemiol6gica, los cambios culturales, los problemas socioecon6micos y, en particular, los avances cientificos y el desarrollo tecno16gico, configuran un nuevo

A52NR/4 page 53

escenario que exige una nueva forma de pensar y de actuar en salud desde la 6ptica de las necesidades y demandas de la poblaci6n, y no s6lo desde la oferta de servicios. Es por ello que reiteramos que es responsabilidad primaria de la Organizaci6n contribuir a la formulaci6n de los modelos de atenci6n médica, asi como los de organizaci6n y financiamiento, con anticipaci6n a los cambios. El desafio es grande y ha llegado la bora de pasar a la concreci6n de los hechos, mediante una estrategia institucional consensuada con los Estados Miembros. Muchas gracias. Dr AL-CHATT! (Syrian Arab Republic):

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A52JVR/4 pagt! 54

The PRESIDENT: Before we adjoum, may 1 remind you that the three round tables scheduled to meet today will commence this aftemoon at 14:30. The Committee on Credentials will also meet at 14:30 in Room VIL Also, at 13:00, there will be a briefing meeting in Room VII on "Global surveillance of communicable diseases" and in Room XIX, a briefing meeting on "Curbing the epidemie: govemments and the economies of tobacco control". The next plenary meeting will be held on Wednesday at 9:00. The meeting is adjoumed.

The meeting rose at 13:15. La séance est levée à 13h15.

A52/VR/5 page 55

FIFTH PLENARY MEETING Wednesday, 19 May 1999, at 9:00 President: Mrs Maria de Belém ROSEIRA (Portugal)

CINQUIEME SEANCE PLENIERE Mercredi 19 mai 1999, 9 heures Président: Mme Maria de Belém ROSEIRA (Portugal)

FIRST REPORT OF THE COMMITTEE ON CREDENTIALS 1 PREMIER RAPPORT DE LA COMMISSION DE VERIFICATION DES POUVOIRS 1 The PRESIDENT: Today, the Assembly will consider the first report ofthe Committee on Credentials which held its meeting yesterday, Tuesday, 18 May, and the chairmanship of Dr C.T.O. Otto (Palau). The report is contained in document A52/32 which you have ali received. Does the Assembly wish to comment? Is the Assembly prepared to adopt the report of the Committee? 1 give the floor to the delegate of Pakistan. Mr QAZI (Pakistan): Thank you, Madam President. The Pakistan delegation has read the report of the Credentials Committee and would like to draw attention to a factual and legal inaccuracy it contains with regard to Afghanistan. The report proposes that the Health Assembly should recognize the validity of credentials presented by Afghanistan, among other countries. The issue of the credentials of Afghanistan was considered at length by the Credentials Committee of the fifty-third session of the United Nations General Assembly; the Committee decided, and 1 quote: "to defer a decision on the credentials of representatives of Afghanistan on the same basis as taken at the fifty-second session". This decision is contained in paragraphs 7, 8 and 9 of document A/53/556 ofthe General Assembly. In accordance with Articles 58 and 63(2) of the Charter of the United Nations, the United Nations shaH, and 1 quote: " ... make recommendations for the coordination of the policies and activities of the specialized agencies." We had hoped that the Credentials Committee of the Assembly of the World Health Organization, a specialized agency of the United Nations, would have reflected the true situation prevailing in the United Nations General Assembly with regard to the credentials of Afghanistan. This would have brought the report of the Credentials Committee of the Health Assembly in conformity with the Credentials Committee report of the fifty-third session of the United Nations General Assembly. It would also have made the report of the Credentials Committee of this Assembly factually and legally correct. As this has not been done, we are constrained to disagree with the Committee's proposai that we recognize the validity of the credentials presented by Afghanistan. We would like therefore to enter a reservation on the report of the Credentials Committee ofthe Fifty-second World Health Assembly with regard to Afghanistan. We request that this statement be incorporated in full in the records of this plenary session. Thank you. 1 1

See reports of committees in document WHA52/1999/REC/3. Voir les rapports des commissions dans le document WHA52/1999/REC/3.

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The PRESIDENT: I thank the delegate of Pakistan. The objection will be fully reflected in the report of this plenary meeting. If you agree with this, we can adopt the Committee report. I see no objections. The first report of the Committee on Credentials is therefore adopted. Before adjouming this plenary, I would like to inform the Assembly that at 13:00 a technical briefing will be held on "Change in WHO" in Room VII. Another technical briefing will also be held on "WHO humanitarian action in South Balkans" at 13:00 in Room XIX. At 9:30, the ministerial round tables will commence. Discussion Group A on "Finding the money: dilemmas faced by ministers" will be held in Room XVII and Discussion Group B on the same topic will be held in Room XXIII. "HIV/AIDS: strategies for sustaining an adequate response to the epidemie" will be held in Room XVIII. This aftemoon, as I have an important engagement, the second and third Vice-Presidents will replace me. The next plenary will be held at 14:30 this aftemoon simultaneously with the second meeting ofCommittee A. The meeting is adjoumed.

The meeting rose at 9:15. La séance est levée à 9h15.

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SIXTH PLENARY MEETING Wednesday, 19 May 1999, at 14:30 President: Dr T.J. STAMPS (Zimbabwe) later: Dr E.F. EHTUISH (Libyan Arab Jamahiriya)

SIXIEME SEANCE PLENIERE Mercredi 19 mai, 14h30 Président: Dr T.J. STAMPS (Zimbabwe) puis: Dr E.F. EHTUISH (Jamahiriya arabe libyenne)

LOOKING AHEAD FOR WHO AFTER A YEAR OF CHANGE: REPORT OF THE DIRECTORGENERAL (INCLUDING THE WORLD HEALTH REPORT 1999) (continued) L'AVENIR DE L'OMS APRES UNE ANNEE DE CHANGEMENT: RAPPORT DU DIRECTEUR GENERAL (Y COMPRIS LE RAPPORT SUR LA SANTE DANS LE MONDE, 1999) (suite) The PRESIDENT: 1 am pleased to take over the presidency and we shall continue with the debate of item 3. The next two speakers in my list are the delegates of the Libyan Arab Jamahiriya and Turkey. 1 give the floor to the delegate ofthe Libyan Arab Jamahiriya. Dr E.F. EHTUISH (Libyan Arab Jamahiriya):

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Mr SUNGAR (Turkey): On behalf of the Minister of Health of Turkey, who is unable to attend the Assembly because of domestic political developments, I would like to express my Government's best wishes for success to the World Health Assembly and wish to convey our congratulations to the President and the other officers of the Assembly on their election. I would also extend my Minister's best wishes and appreciation to the Director-General and her staff, particularly for the excellent world health report which we have studied with great interest. This year's report, "Making a difference", evaluates the current health issues and challenges in an objective manner and highlights new approaches and new strategies to face these challenges. In this respect the report echoes most of our concerns. We are approaching the end of the twentieth century with considerable gains in health. The major emphasis on the critical role of primary health care has paved the way in the last quarter of the twentieth century to this success. The primary health care approach has made it possible for us to assess realistically the needs of the communities we are serving in order to pinpoint the real issues and to set up rational policies. The goals we set in Alma-Ata had a considerable impact on our health policies and, despite sorne shortcomings, the primary health care approach has visibly influenced policy changes. Thanks to this approach, major successes were recorded in the fight against diseases and mortality. The threat of infectious and, particularly, vaccine-preventable diseases were reduced or became controllable. Major progress was made in healthy environments and water and sanitation. Healthy lifestyles were introduced into our health agenda. Rises in life expectancy at birth and fall of the infant and child mortality rates are clear evidence ofwhere we have made headway. However, the demographie changes in our societies have introduced further challenges into our health agenda in the form of a new set of diseases. These challenges, coup led with the economie burdens, are calling for a restructuring of health systems. We observe that, while the achievements of health administrations in facing the challenges ofthe double burden of diseases were commendable, successes in restructuring health systems through rational use of scarce resources feil short of expectations. In many countries, the reform efforts lost sight of the primary health care objectives and were shaped up un der the tenets of globalization, market economy and liberalization. We believe that, under the new leadership, WHO would play a more active advocacy role to achieve the broad goal ofbetter health for ali, guiding these reform efforts in line with the objectives set out in The world health report 1999. I would like to reiterate here our congratulations to Dr Brundtland and her team for their objective assessments with regard to achievements in health in the twentieth century, as weil as the vision presented to us for the next decade. The four interconnected corporate strategy them es for the future work of the

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Organization, as identified in the report, should be the basis of the new WHO vision. We feel that, although ali of these themes have importance, the finding that WHO needs to be more effective in supporting health systems development should enjoy priority in WHO's future work. Be fore concluding my statement, 1 would like to express our appreciation for the efforts of the Director-General in reshaping WHO and endowing it with a new vision and a more aggressive advocacy role to place health in the centre of the development agenda. We are encouraged by the determination of the new leadership to work in and with the regions and the countries more closely. The report points to the fact that, despite the remarkable gains in health, darker legacies in the form of regional conflicts bring uncertainty to our new vision and continue to be a source of misery. Since the last decade we have indeed been witnessing enormous misery in different parts of the world, including Europe. And obviously 1 am referring to Bosnia and Kosovo. These regional conflicts are not only causing great humanitarian problems but at the same time affecting negatively internai stability and inflicting irreparable damage to the economie, social and cultural fabric of the countries, with long-lasting effects on the health care systems. WHO, in the European Region, is faced with the challenge of redoubling its efforts in the crisis- and conflict-prone countries. We believe that WHO's response in this regard should be supported by ali regions. A display ofOrganization-wide international solidarity is absolutely essential. Our common goal is to improve the health status of ali peoples, to alleviate the burdens of poverty and sickness, and to assure that ali people have sufficient access to health care. WHO will continue to enjoy ali our support as long as it serves to achieve these goals. Mr FARMAKIS (Greece) (interpretation from the Greek): 1 Mr President, Madam Director-General, fellow delegates, ladies and gentlemen. 1 would like to begin my intervention by congratulating the President and the Vice-Chairmen on their election and wishing them every success in their tasks during the Fifty-second World Health Assembly. Allow me also to congratulate the Director-General on The world health report 1999, which gave us important action guidelines on which we should focus our policies and activities for the development and improvement of health in our countries. The conclusions and the guidelines included in this report form the frame in which the actions of WHO and the activities of our countries must be integrated. Th us, one of the most crucial aspects of the report is that, regardless of the efforts pursued during the last two decades and the positive progress seen in many countries, one of the most significant problems in the field ofhealth, probably the most serious one, is the inequities existing between the populations who have improved their health status and th ose who are still suffering from high levels of disease. As stated in the report, it is not a co incidence that diseases coexists with poverty. The problem to be faced is how the transition from the negative cycle of disease and poverty to the positive cycle ofhealth and prosperity is to be achieved. We are called upon to refer to our national experience which might have global application to co un tries facing similar conditions. Greece be longs to the group of countries which have the advantage ofhigh life expectancy. The health improvement ofthe population is due to specifie measures, like the fight against communicable diseases, such as malaria during the l950s, as weil as to the general improvement of living conditions. Habits and lifestyles, nutrition and environmental conditions, as weil as the improvement ofhealth care services, realized during the last two decades, have certainly contributed to this situation. The risk of deterioration of the good health indicators of the Greek population always exist, for example, those related to the reappearance of communicable diseases, such as tuberculosis and poliomyelitis, for many reasons, especially the displacement of people, and to harmful habits like smoking. For ali the above reasons, we have to develop public health services and upgrade their infrastructure. Primary health care needs to be improved and extended. These are our po licy priorities. Another sector that needs special action is the field of mental health. We agree with the statement in the report about the necessity of governments to maintain a leading and regulatory role and to endeavour to increase financing and upgrade the health services. 1 would also like to express our approval of the guidelines that the Director-General bas presented for the development of the activities of the Organization for the new millennium. Allow me to declare that we fully support the policies of WHO and the Director-General's efforts as described in The world health report. 1 would have been glad to have been able to finish my short intervention at this point. Unfortunately, the events happening in the broader area in which my country is situated, force me to remind ali ofyou that the essential condition for development, well-being and health, is peace. My country is making every 1

In accordance with Rule 89 of the Rules of Procedure.

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possible effort to cope with the problems of the refugees as weil as for ending the conflict. I do hope that ali ofyou agree that the war actions in the Balkans and in Europe have to stop as soon as possible, so that there will be no more destructions, deaths, negative ecological consequences and misery. We express our satisfaction at the fact that WHO has been actively involved in supporting efforts to protect the health of the population in the region. We are sure that these efforts will continue with the assistance of the Member States. Professor MOELOEK (Indonesia): Madam Director-General, honorable delegates, my delegation wishes to congratulate the President on her election and the Director-General for her comprehensive report on WHO achievements thus far and for the future. As we are about to enter the new millennium, we can look back with pride at the tremendous progress which has been achieved in the health status of ali countries, not least in my own country, Indonesia. As a result of intensive efforts, infant and child mortality rates have been drastically reduced. Access to health services has improved even for those living in remote and poor areas. Nonetheless, the coming decade poses further health challenges. First, we must ensure that those who have not yet been reached by this progress can soon benefit from it. Second, we must prepare for the epidemiological transition and an increase in chronic diseases and injuries. This cannot be accomplished by health ministries al one and therefore requires the building up of the necessary partnerships between the various sectors concerned. Thus, we need to renew our efforts and dedication to guarantee the health of our populations. The recent political changes and the spirit of reform which have characterized the past year in Indonesia have led us to focus on a new vision and mission for health development in the country. This new vision and mission is entitled Healthy Indonesia 201 O. The Ministry of Health should no longer be seen as the sole provider of curative services for the population. We must now concentrate on preventive and promotive health initiatives. While the Ministry of Health has, in the past, emphasized preventive programmes such as immunization, these initiatives must be expanded to other areas. These include environmental health, improved water supplies, the prevention of accidents, both on the road and at the workplace, and discouragement ofunhealthy lifestyles such as tobacco consumption. This will require the Ministry ofHealth to work closely with other sectors in advocating the key steps they need to take in order to improve health. To achieve this, good health must be seen as the result of development efforts in ali sectors, which requires political commitment at the highest level. While we are striving to move as quickly as possible in the field of health prevention and promotion, there are still weaknesses in our capacity to ensure the access of ali Indonesians to quality basic health services. The major challenges here involve health financing. How can we develop effective financing systems to provide and deliver quality care in an efficient and cost-effective manner? In order to provide these services, Indonesia is presently attempting to develop a managed care system. The challenge to achieve Healthy Indonesia 20 l 0 will require the support of the international community. We look to WHO to lead the international support for these initiatives. International experience and data can be used to strengthen our advocacy for the involvement of ali sectors in health development. Technical guidance and support should help us develop the most effective methods for strengthening health promotion and prevention. WHO can strengthen partnerships with donor health agencies and promote these new approaches to health development. Finally, we urge other Member countries to jo in us in this new dedication to make health promotion and prevention our foremost priority. If many countries set goals and strategies for this new approach, the momentum will be strengthened, providing the truly worldwide dimension to basic healthcare which we expect to achieve in the next decade. Le Professeur GUIDOUM (Algérie): Monsieur le Président de séance, Madame le Directeur général, Excellences, honorables délégués, Mesdames, Messieurs, je tiens tout d'abord à me joindre aux délégués qui m'ont précédé à l'effet de présenter au Président mes félicitations pour son élection à la tête de cette Cinquante-Deuxième Assemblée mondiale de la Santé. Son expérience et sa compétence augurent de la réussite de cette réunion. Les rapports qui nous ont été présentés hier matin, particulièrement celui du Dr Brundtland, Directeur général de l'OMS, permettent de constater avec satisfaction que la tenue de cette Assemblée de la Santé marque une date importante dans la reformulation des problématiques de la santé, les perspectives et les enjeux, les dilemmes, les partenariats pour le développement du secteur sanitaire, ainsi que les programmes de prévention et de soins de santé de base, l'intersectorialité et, bien entendu, les changements

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structurels. Le recentrage de la santé dans l'action internationale pour le développement, fondé sur l'intangibilité du principe de l'équité, constitue effectivement, à mon sens, l'une des matrices devant caractériser l'approche de la santé. En Algérie, des progrès notables ont été enregistrés ces dix dernières années en dépit des turbulences socio-économiques qu'a connues le pays. L'espérance de vie est passée de 61 ans en 1981 à 69 ans en 1999, et la mortalité des enfants de moins de cinq ans est de 52 pour 1000, soit un gain de plus de trente points en dix ans. Le taux de mortalité maternelle, même s'il reste pour nous inacceptable, a toutefois été réduit de 30% grâce à un suivi soutenu des grossesses et à une diminution du risque hémorragique. Enfin, nous sommes sur la voie de l'éradication de la poliomyélite puisque, pour la deuxième année consécutive et avec un système de surveillance performant, nous n'avons enregistré aucun cas. Des actions intersectorielles ont permis d'obtenir des résultats significatifs en matière de santé scolaire, universitaire et en milieu du travail. Il en est de même pour ce qui est de la lutte contre le SIDA, où la prévention, à laquelle participent dix-huit départements ministériels, permet de contenir la progression de l'épidémie. Cependant, en dépit de tous les efforts consentis, force est de constater que la santé demeure une résultante du développement socio-économique : les maladies à transmission hydrique, par exemple, quoique en régression, continuent cycliquement de générer des surcoûts dans la prise en charge sanitaire. Les mêmes phénomènes caractérisent les effets de l'habitat insalubre, du chômage, de l'exclusion sociale. Les services de santé payent la rançon du développement, ce qui n'est ni juste, ni moral. On peut citer notamment les maladies cardio-vasculaires, les accidents de la route qui constituent, hélas, un véritable fléau, et les affections respiratoires dues entre autres à la pollution industrielle. L'intersectorialité est indiscutable dans le principe, la santé pour tous étant l'affaire de tous. Sa mise en oeuvre opérationnelle, cependant, n'est pas toujours, loin s'en faut, à la mesure des attentes et cet état de fait ne contribue qu'à culpabiliser davantage des services de santé déjà éprouvés par les contraintes financières qui risqueraient de compromettre la préservation des équilibres macroéconomiques. Des formules audacieuses doivent être élaborées et mises en place. Il conviendrait d'agir de manière à consacrer le principe du fauteur-payeur. Les dilemmes que nous avons abordés lors des tables rondes ministérielles d'hier et de ce matin m'ont permis -et je remercie le Directeur général de cette initiative efficace et originale -d'exprimer ce qui détermine en dernière instance la politique de santé. L'exemple du coût de la prise en charge des malades du VIH/SIDA par le schéma de la trithérapie illustre on ne peut mieux les limites objectives de la capacité d'un système à assumer pleinement ses obligations vis-à-vis de la prise en charge de certaines pathologies comme l'insuffisance rénale avec des séances très onéreuses d'hémodialyse, la greffe de la moelle, sans omettre d'évoquer les coûts de l'acquisition des moyens d'exploration, d'imagerie médicale et de leur nécessaire maintenance. Sur ce point, je tiens à souligner l'effort consenti par les pouvoirs publics. En effet, la contribution du citoyen aux frais d'hospitalisation et de consultation trouve rapidement ses limites objectives. Le rôle des assurances sociales en matière de fmancement des services de santé et de remboursement des frais médicaux et d'hospitalisation pose le dramatique problème de l'équilibre entre l'assiette des cotisants et les dépenses incompressibles opérées. Dès lors, actualiser les tarifications et les valeurs monétaires des lettres clefs reviendrait inéluctablement à asphyxier la sécurité sociale et à compromettre les prestations sociales. Tout choix en matière de santé est douloureux, et exige une implication de l'ensemble des acteurs pour la formulation des priorités et des axes majeurs devant imprimer la dynamique dans le domaine de la santé. C'est ce qui a été fait en Algérie avec la tenue, du 26 au 28 mai 1998, des assises nationales sur la santé qui ont regroupé les représentants des professionnels de la santé, des usagers, du mouvement associatif, des syndicats, des secteurs d'activités et des institutions concernés. Ces assises se sont traduites par l'adoption consensuelle de la charte dite de la santé et d'une série de recommandations qui font l'objet d'un traitement par un comité de suivi. Parmi les recommandations figurent en bonne place la réafftrmation du principe de la prise en charge par l'Etat de l'action de prévention et de lutte contre les maladies épidémiques et endémiques, la gratuité des soins pour les démunis sociaux et l'engagement d'une prise en charge par les pouvoirs publics des dépenses relatives à la prise en charge des urgences, des maladies chroniques et de la formation. Dans mon pays, le dénominateur commun des actions menées s'articule autour de l'objectif "sécurité-santé", particulièrement autour du binôme "mère-enfant" qui constitue la pierre angulaire du dispositif. Il ne s'agit pas tant de traiter uniquement des effets, mais de dégager des consensus sur un ensemble de mesures devant permettre d'exercer une action sur les causes des différents problèmes qui puisent leur explication dans la dégradation du pouvoir d'achat, l'exclusion scolaire, l'exclusion sociale, l'habitat précaire et qui conduisent à la violence. C'est ce contexte qui interpelle sur l'impérieuse nécessité de la formulation et de la mise en oeuvre d'une stratégie "sécurité-santé". Cette démarche a fait l'objet de plusieurs rencontres et séminaires, dont notamment ceux tenus respectivement à Alger en septembre 1997

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et à Constantine en décembre 1998, organisés conjointement avec l'OMS. La sécurité-santé s'articule prioritairement, mais non exclusivement, autour du binôme mère-enfant, de la santé scolaire et de la santé communautaire. Le Directeur général a souligné la simultanéité de la création de l'OMS et de l'adoption de la Déclaration universelle des droits de l'homme. Gageons que l'avenir de l'OMS après une année de changement s'inscrive résolument dans le cadre de la résolution de l'Assemblée générale des Nations Unies décrétant l'année 2000 comme année de la culture, de la paix et de la non-violence. Je vous réitère la pleine détermination d'oeuvrer dans le cadre des axes et des réformes que vous avez engagés et je formule l'espoir qu'à l'orée du troisième millénaire puisse germer l'esprit d'un nouvel ordre sanitaire mondial. Professor SHEMER (Israel): Mr President, Madam Director-General, distinguished delegates, ladies and gentlemen, it is with great pleasure that 1 address the Health Assembly for the second time. On behalf of my delegation, 1 wish to congratulate the President on her election to preside over this Assembly. Modem health care services are based upon moral and ethical codes. The patient-doctor relationship, the informed consent and the clinical trial codes are ali part of an expanding awareness that supports the fight against ailments ofboth the human body and mind. Taking into account The world health report and the ministerial round tables in which you are participating, 1 decided to discuss the realm of !essons leamed from the Israeli national health reform. Firstly, 1 would like to provide you with sorne basic Israeli health data: our population numbers approximately 6 million citizens; approximately 8% of our GNP is spent on health expenditure; life expectancy for women is 79.9 years, and for men 76.3 years; the average infant mortality for the population is 6.3/1000 live births. In 1995 the new National Health Insurance Law was passed in Israel. One of its basic elements is the basket of national health services which is a list of services and technologies that are covered by the National Health Insurance Law. The Law stipulates that the Minister of Health has the right to direct the addition of a service to the health services, provided that it does not add to the cost of the overall health services. Until 1998, only a cost comparison was made; the addition of a new medicament required additional budget funding, unless the new drug replaced an old one used for the same indication, the cost ofwhich was identical or higher. In many cases a cost-benefit analysis would show that despite the high acquisition cost of the new medicine, and the need for additional funds, there was an enormous saving in hospitalization days or alternative technologies which offset the cost of the drug. In such a situation, health funds would be obligated to use the new medication without the need for additional budget funding. Another problem was the addition of indications for a drug already included on the drug list; if the new indication was added automatically to the list, there could be a significant rise in the cost of the medication. In 1998, based upon les sons learnt since the conception of the law, it was decided by the ministers ofhealth and of finance to reform the process by which new technologies are included. A public committee consisting of senior physicians, senior health policy-makers, lawyers and representatives ofvarious public sectors, chaired by the Director-General of the Ministry of Health, was given the mandate to allocate additional funds. This public committee utilizes ali available knowledge, based on technical reports assessing medical and economie evaluations, to produce an ethical and social distribution for new technologies taking into account the shortage of available funds. We are waiting to see the impact of these changes on the reform process and hope that we are heading in a positive direction for the bene fit of the Israeli population. We continue to leam from our trials, errors and deliberations. 1 be lieve that WHO can play an important role in this sensitive area of management of medical technology, where conflicts between medical advance and economie considerations might influence judgements and decisions. WHO should play a leading role in implementing new medical technology in health care services throughout the world. Furthermore, WHO can assist each country to accommodate its special needs according to its cultural, social, ethical and political values and to maximize the utilization of its resources. 1 would like to conclude by expressing the hope that WHO will continue to work to alleviate the health problems of populations throughout the world, in a spirit of cooperation and goodwill. Last and not least, Israel hopes that WHO will become involved in promoting health and raising collaboration in the field of medicine in the Middle East. Mme BETTON! BRANDANI (Italie) : Monsieur le Président de séance, Madame le Directeur général, Mesdames et Messieurs les délégués, permettez-moi avant tout de féliciter personnellement et au nom du Ministre de la Santé, Mme Bindi, le

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Président et les Vice-Présidents de cette Assemblée ainsi que les Présidents des commissions pour leur élection, et de leur assurer le plein soutien de la délégation italienne. L'Assemblée mondiale de cette année - la dernière du xxe siècle - constitue une occasion pour souligner les progrès accomplis par la santé internationale durant les dernières années de ce siècle et pour réaffirmer les engagements et les responsabilités face aux défis et aux difficultés qui doivent encore être affrontés. Les excellents rapports du Directeur général attirent précisément l'attention sur le fait qu'il est nécessaire que la santé soit un point focal pour le développement et représente un investissement social indispensable pour la croissance économique des pays et pour la sauvegarde et le respect des droits de l'homme, de la liberté et de la démocratie. A propos des progrès accomplis par la santé internationale, je voudrais mentionner l'éradication de la variole, qui illustre en effet l'importance de la collaboration internationale et le rôle déterminant de l'OMS. Au seuil du XXIe siècle, une autre conquête importante est à notre portée: l'éradication de la poliomyélite. C'est un objectif d'une grande valeur scientifique, qui n'est malheureusement pas encore tout à fait atteint. Le nouveau Plan sanitaire national italien, intitulé "Un pacte de solidarité pour la santé", contient des points importants qui reflètent bien les principes et les priorités énoncés dans le Rapport sur la santé dans le monde, 1999. Les objectifs principaux du Plan sanitaire national sont les suivants : renforcer l'autonomie décisionnelle des utilisateurs, promouvoir l'utilisation appropriée des services de santé, diminuer les inégalités face à la santé, favoriser des comportements et des modes de vie plus sains, poursuivre l'intégration sociosanitaire et relancer la recherche. Suivant les principes des stratégies définies dans le rapport du Directeur général, le Plan sanitaire national souligne l'importance de la collaboration intersectorielle dans le domaine de la santé. Cette collaboration vise à créer des alliances avec des secteurs qui ont un impact direct sur la santé, comme ceux de l'environnement, de l'instruction publique, des transports, de l'industrie et du commerce. Sur le thème de la solidarité, je crois qu'il est important de se souvenir d'un aspect aussi actuel que délicat : le vieillissement progressif de la population mondiale. Il s'agit là, pour de nombreux pays, d'une question sociosanitaire de grande portée qui requiert des interventions intégrées, tant pour la prévention que pour le recouvrement de la santé, et l'élimination des déficits fonctionnels et, par conséquent, des désavantages sociaux qui peuvent en dériver. Les objectifs du Plan sanitaire national italien prévoient, entre autres, la promotion du maintien et la récupération de l'autosuffisance des personnes âgées, selon le concept du "vieillissement actif', et le développement de formes d'interventions qui puissent se substituer à l'hospitalisation et qui soient suffisamment intégrées dans la société. Le concept de solidarité nous force à réfléchir sur un problème qui, malheureusement, continue à affliger l'humanité au seuil du XXI" siècle: l'insuffisance de l'assistance et de l'aide humanitaires, tout particulièrement grave dans le domaine de la santé. Permettez-moi de rappeler la connaissance acquise dans ce domaine par 1'Italie. Les tristes séquelles liées aux conflits armés et leurs répercussions sur la santé des populations voient désormais engagés notre coopération sanitaire, nos institutions et le monde du volontariat, dont le rôle et la participation méritent tout notre soutien et toute notre reconnaissance. Comme on le sait bien, l'Italie, avec d'autres Etats Membres, considère que le Département Secours d'urgence et action humanitaire, qui a été utilement confirmé dans le processus de restructuration de l'OMS, pourrait intervenir aussi sur le terrain face à des situations de crise. En ce qui concerne l'immigration, l'Italie applique une politique d'hospitalité et d'accueil qui a pour objectif de faciliter l'insertion et la régularisation des immigrés, lesquels ont droit, entre autres, à l'assistance sanitaire gratuite sur tout le territoire national. Notre Plan sanitaire prévoit en même temps que toute vaccination assurée à la population italienne soit étendue également à la population immigrée. Un mot encore sur les deux initiatives prioritaires citées dans le rapport du Directeur général :Faire reculer le paludisme et Pour un monde sans tabac. Je désire avant tout exprimer mon estime et mon soutien envers le projet Faire reculer le paludisme. Le paludisme a malheureusement acquis dans de très larges parties du monde les caractéristiques d'une maladie sociale. La détérioration progressive de la situation requiert donc des interventions urgentes et appropriées. Nous partageons l'approche qui vise à combattre le paludisme par le biais d'un renforcement des systèmes de santé dans les pays d'endémie, afin de créer les bases d'une continuité d'action indispensable à une lutte efficace contre cette maladie. Cette initiative bénéficie déjà de la collaboration de mon pays, grâce à des engagements de coopération sanitaire, tout aussi bien qu'à travers une collaboration technique avec les institutions italiennes. En ce qui concerne 1' initiative Pour un monde sans tabac, je voudrais confirmer l'engagement du Ministère de la Santé dans la lutte contre le tabagisme à partir des mesures concrètes prévues dans notre Plan sanitaire national. Cette action vise à réduire le nombre de fumeurs et la quantité journalière de cigarettes consommées, en vouant une attention toute particulière aux adolescents et aux femmes enceintes. Monsieur le Président de séance, permettez-moi de conclure en exprimant le grand intérêt et les attentes de l'Italie en ce qui concerne le processus de réformes internes entrepris par l'OMS. Nous savons qu'un tel processus requiert du temps, mais l'orientation imprimée par le Directeur général nous paraît être la bonne, surtout pour ce qui a trait aux efforts pour limiter les dépenses administratives, concentrer les

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ressources sur des activités techniques et développer ultérieurement les capacités, les compétences et l'expérience du personnel de l'Organisation. Pour ce qui est des bureaux régionaux, je souhaite exprimer l'estime du Ministère italien de la Santé pour le travail accompli et pour l'excellente collaboration en cours avec le Bureau régional de l'Europe. C'est avec plaisir que l'Italie se prépare à accueillir au mois de septembre, à Florence, la quarante-neuvième session du Comité régional européen de l'OMS.

Mr DE SILVA (Sri Lanka): Mr President, your excellencies, distinguished delegates, at the outset may 1 take this opportunity to congratulate our dynamic Director-General, Dr Gro Harlem Brundtland, for the conceptual clarity and the practical orientation of the vision contained in her forward-looking report to this Assembly. Sri Lanka has had Uni versai A duit Franchise from 1931, and systems of uni versai health care and education, free at the point of delivery, since it gained Independence in 1948. These social welfare policies have accounted for the steady improvement in the national health indicators such as infant mortality, maternai mortality, a life expectancy in excess of70 years and a literacy rate exceeding 90% for both men and women. The theme of The world health report, "Making a difference", is particularly appropriate in the context of the Sri Lankan Govemment's recent initiatives in the health sector. Her Excellency the President of Sri Lanka has given creative leadership and direction to a special task force appointed to make proposais on a comprehensive national health po licy and strategies to meet the challenges of the coming millennium. The report of the task force provides a framework for govemment action and reforms in the health sector and is being progressively implemented. With increasing longevity and improvement in people's living standards and health, the Govemment has had to contend with a double burden of disease. At the same time, recent advances in medical science and technology and the inevitable publicity associated with such advances, create an apparent demand for them, coup led with the expectation that the Govemment should provide them, free of charge, as in the past. The scars of mental and physical trauma resulting from terrorist violence, including landmine injuries, will be heavy burdens on the Govemment health care system for several years to come. Rapid transformation from a predominantly rural agricultural and plantation economy towards one characterized by increasing urbanization, emigration for foreign employment, an increasing influx of tourists, and graduai industrialization are sorne of the other circumstances that the govemment of a developing country such as Sri Lanka has to contend with in formulating health po licy and strategies, if it is to make a real difference. The Sri Lanka Govemment remains committed to continue the policy offree health care services to the needy, weil into the next millennium. We are also aware of the important role that the private sector plays in providing health care facilities. While encouraging private sector health services, the Government also believes that the nongovemmental organizations and community organizations must be permitted to play an active role in the health care delivery system. The Government has given high priority to eradication of malaria and malnutrition, control of HIV1 AIDS, control of noncommunicable diseases, and minimization of the dreadful harm from tobacco and other addictive substances. 1 am happy to state that Sri Lankais in the forefront of actions taken to combat epidemies oftobacco-related diseases. They inelude the formulation of national po licy and strategy; increase in the priee of cigarettes; legislation to ban ali promotion and advertising of brand nam es, logos and other symbols of tobacco; a massive island-wide multi-media campaign banning tobacco smoking, and the sale and promotion oftobacco-based products in ali State institutions; prohibition on government departrnents or institutions from accepting sponsorships for any purpose from those who promote tobacco smoking; and instructions to the electronic and print media to adhere to a code of behaviour regarding ali tobacco promotion. Mental health, pesticide and herbicide poisoning, self-harm and suicide, traffic accidents and occupational health are also receiving priority attention. A monthly programme, "Suwa Udana" (Dawn of Health), with full community participation, launched by the Ministry of Health to deliver quality health care to most deprived areas of the country, coupled with provision of specialist curative services and health education, is now being actively implemented. Sri Lanka believes that in "making a difference", the traditional systems of medicine such as Ayurveda, which is still used by large sections of the people, particularly in the rural setting, needs to be developed. Complementary systems of medicine such as homeopathy, which has proved to be costeffective, should be recognized and fostered. Our Government has already taken a comprehensive set of measures in this regard. Although Sri Lankais still a developing country beset with sorne of the daunting challenges which 1 have referred to earlier in my statement, the Government will retain its dominant role in providing health care for the people, maintaining and regulating standards of care, and formulating health po licy and strategy

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at the national leve!. In conclusion, we are also grateful to organizations such as WHO, UNICEF, UNFPA, World Bank, Asian Development Bank and other bilateral donor countries and agencies for the assistance extended to us in developing our health care services. We look forward to the ir continued support for our efforts to meet the challenges in order to "make a difference", as envisaged by WHO. El Dr. DOTRES MARTÎNEZ (Cuba): Distinguidas delegadas, distinguidos delegados: El énfasis del Informe sobre la salud en el munda 1999 es seguramente compartido por los aqui presentes. Infelizmente no alcanzamos la salud para todos en el afio 2000. Los objetivos prioritarios de la Organizacion dirigidos hacia la solucion de estos aspectas deberian contar con el respaldo de los gobiernos y deberiamos insistir en la responsabilidad estatal sobre la salud integral de los pueblos. Coïncidente con los enfoques de la OMS, Cuba, a raiz del azote de los huracanes Georges y Mitch al Caribe y Centroamérica, elaboro un plan de salud integral para la situacion sanitaria poshuracan y para contribuir a la reconstruccion de esos paises. Los gobiernos de Centroamérica solicitaron a la comunidad internacional medidas para la rehabilitacion y reconstruccion de sus paises trâgicamente afectados. Cuba apoyo de inmediato las siete medidas de los gobiernos centroamericanos, cancelo la deuda contraida por Nicaragua de 50 millones de dolares y expreso su disposicion a poner gratuitamente al servicio de dichos paises por el tiempo que se requiriese todo el persona! médico necesario. Como no puede haber reconstruccion y desarrollo economico sin un programa integral de salud en una region donde mueren en conjunto cada afio mâs de 50 000 personas, en su inmensa mayoria menores de 5 afios que podrian salvarse con un costo economico relativamente modesto, Cuba propuso que, si uno o varios paises que dispongan de mâs recursos aportan los medicamentos necesarios, Cuba estaria dispuesta a enviar el persona! médico que hiciera falta para llevar a cabo a corto y mediano plazo un programa integral de salud en los paises afectados. Suponiendo que hayan perecido, entre muertos y desaparecidos, 30 000 personas, sumando El Salvador, Guatemala, Honduras y Nicaragua, con el programa que mi pais propone podrian salvarse cada afio tantas vidas como las que se perdieron en el huracan Mitch, entre elias las de no menos de 25 000 nifios de 0 a 5 afios de edad. Con relacion a Haiti, se ejecuta un programa similar de cooperacion con 400 médicos y trabajadores de la salud tras el paso del huracan Georges. A pesar de que no se ha recibido todavia ning(m aporte especial de paises industrializados, este programa de colaboracion médica, con la ayuda de diversas organizaciones no gubernamentales, los modestos recursos de los paises afectados y las contribuciones de nuestro propio pais, cuyos recursos como se conoce son escasos, comienza a ser ya una prometedora realidad. Se encuentran en estos momentos trabajando en los lugares mâs reconditos casi 1100 médicos y técnicos de la salud en Be lice, Guatemala, Haiti, Honduras y Nicaragua, y existe la disposicion de enviar cuanto persona! sea necesario en forma gratuita y por tiempo indefinido. De igual forma, Cuba elabora un ambicioso programa de cooperacion médica con los paises mâs necesitados de la zona comprendida entre el desierto del Sahara y el Africa subsahariana; en Nigeria se encuentra el primer grupo de médicos. A nuestro juicio, dicho programa demostrarâ como puede hacerse mucho con poco. Seria imposible lograr las elevadas metas que son accesibles con un minimo de recursos en medicamentos sin el valioso e imprescindible apoyo de la OMS, que recabamos y estamos seguros de recibir a tono con el informe presentado. Cuba, como ha explicado nuestro Presidente, cuenta con un alto indice per câpita de médicos entre todos los paises del mundo. Este programa prevé, ademâs, la formacion, también gratuita, en la Escuela Latinoamericana de Medicina, especialmente creada para este plan. Cuba ha ofrecido 1900 becas para 15 paises de América Latina este primer afio y unas 1250 nuevas becas anualmente. Hoy 1209 estudiantes procedentes de regiones apartadas de Bolivia, Ecuador, El Salvador, Guatemala, Honduras, Nicaragua y Republica Dominicana ya estân recibiendo un curso preparatorio. En las proximas semanas llegaran mâs de 600 procedentes de otros paises de América Latina. Con relacion a Africa, tomando en cuenta la distancia bernos expresado nuestra disposicion a cooperar con profesores en el desarrollo de centros para la formacion de médicos. Somos conscientes de que nuestro aparte es modesto, pero no ignoramos que el hecho de que lo realice un pais pobre y con grandes dificultades economicas como Cuba se convierte en un estimulo para todos los que, disponiendo de mâs recursos, puedan contribuir en la medida en que lo requieran y lo merecen los paises mâs pobres y sufridos de América, Africa y el resto del mundo. Sefior Presidente: Mi pais pone en manos de la comunidad internacional y de la OMS este plan y llama a todos a contribuir de una u otra forma para mejorar las condiciones de vida de los pueblos mâs requeridos de apoyo. Permitame concluir mi intervencion con las palabras del Presidente cubano Fidel Castro al analizar el impacta de los desastres naturales y los efectos de la pobreza. Cito: «El huracan permanente de la pobreza y el subdesarrollo mata cada afio decenas de miles de centroamericanos cuyos cadâveres no aparecen en las imâgenes de television flotando en las aguas o envueltos en el lodo

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conmoviendo al mundo. Son enterrados en silencio por sus familiares sin que nadie se entere. El problema ahora no es s6lo llorar por los que han muerto, sino ocuparnos de salvar a aquellos que silenciosamente mueren cada afio». Este concepto, setlor Presidente, distinguidas delegadas y delegados, es aplicable a muchos paises del mundo. Muchas gracias. El Sr. ROMAY BECCARiA (Espafia): Setlor Presidente, setlores ministros, distinguidos setloras y setlores: En primer lugar quisiera rogarle, setlor Presidente, que baga llegar a la Sra. Maria de Belém Roseira mi mas cordial felicitaci6n por su nombramiento como Presidenta de la 528 Asamblea Mundial de la Salud. Me resulta muy grato participar en calidad de Ministro de Sanidad y Consumo del Gobiemo de Espafia en esta Asamblea Mundial de la Salud en la que, atendiendo a la sugerencia de la Directora General, Dra. Gro Harlem Brundtland, trataremos de reflexionar sobre la salud mundial en este final de milenio y sobre los retos y prioridades a los que deberemos atender en los pr6ximos afios y que necesariamente debemos relacionar con los profundos cambios producidos en el orden politico, social y sanitario. Centrândonos en el âmbito sanitario, observamos que la mayoria de los paises han puesto en marcha sistemas asistenciales acordes con su historia, su realidad social y su capacidad financiera. Sin embargo, con independencia de las caracteristicas propias de cada sistema sanitario, todos los paises nos enfrentamos a problemas comunes derivados de los cambios en los patrones de morbimortalidad, el envejecimiento poblacional, los altos costes de la sanidad y la necesidad de reorientar las actividades asistenciales hacia las auténticas demandas y requerimientos de los ciudadanos. La respuesta ante estos retos no es unica y tiene que adaptarse a las peculiaridades e idiosincrasia de cada sociedad, a su grado de desarrollo y a sus antecedentes hist6ricos. A pesar de todas estas circunstancias, en todos los procesos de reforma sanitaria actualmente en marcha subyace un elemento com6n, como es la b6squeda de una mayor eficiencia y rentabilidad social, lo que a su vez debe traducirse en mejoras en la equidad de los servicios de salud. El desarrollo de las ciencias de la salud y los nuevos descubrimientos en el campo de la genética han dado origen a nuevas formas de intervenci6n en los procesos de reproducci6n humana y han abierto nuevas posibilidades en la prevenci6n y tratamiento eficaz de numerosas enfermedades vinculadas a defectos genéticos, pero también han planteado nuevos conflictos que deben ser resueltos desde s6lidos esquemas éticos y juridicos, cuya normativa habrâ que establecer sin vulnerar las tradiciones culturales y creencias de los paises. Igualmente, el avance tecnol6gico esta permitiendo espectaculares resultados en el âmbito de los trasplantes de 6rganos y tejidos, en las técnicas de diagn6stico o en la obtenci6n de medicamentos cada vez mas eficaces. No obstante, no hay que olvidar que siguen subsistiendo enfermedades de enorme trascendencia, como la malaria o el SIDA, que unidas a la Jucha contra el tabaquismo ocupan un lugar prioritario dentro de los programas de la OMS. Este complejo panorama nos lleva necesariamente a coincidir con el criterio de la Dra. Brundtland de la necesidad de un cambio de estrategia en los planteamientos de la OMS. Compartimos el criteria de la Organizaci6n en el sentido de que este cambio supone un nuevo concepto de la universalidad de la asistencia sanitaria, entendida como el compromiso que asume el Estado de hacer efectivo el derecho de los ciudadanos a acceder a una asistencia sanitaria de la mayor calidad y eficacia, Jo mas equitativa posible y que incluya un conjunto de prestaciones acordes con las necesidades de salud y adecuadamente analizadas, en las que junto a los criterios de efectividad, eficiencia y coste-beneficia, se incluya la evaluaci6n en términos de utilidad social. Los cambios demogrâficos, en especial los que estân produciéndose en las sociedades desarrolladas, hacen imprescindible la implantaci6n de programas de atenci6n sociosanitaria que permitan dar la adecuada respuesta sanitaria y social a los procesos cr6nicos y degenerativos. Gracias a los avances sanitarios y sociales, se han logrado mejoras significativas en la esperanza de vida de nuestras poblaciones. El objetivo para el futuro sera lograr no s61o una vida mas larga, sino en mejores condiciones, con el menor numero de discapacidades y limitaciones posibles. En consecuencia, creemos, al igual que la Dra. Brundtland, que la OMS puede y tiene que renovarse: mayor responsabilidad y transparencia, menor burocratizaci6n y mas receptividad frente a un mundo en acelerada mutaci6n han de ser sus principales objetivos. Los beneficios del proceso cientifico y tecno16gico deben distribuirse adecuadamente. Setlor Presidente: He intentado expresarles en mi intervenci6n los criterios de mi Gobiemo ante la realidad politica y social actual. Nuestra primordial preocupaci6n debe ser tanto la humanidad en su conjunto como los individuos que la integran. Consideramos legitima la aspiraci6n de todos los pueblos a tener acceso al bienestar y a la salud. Antes de finalizar, quisiera transmitir a esta Asamblea la preocupaci6n del Gobiemo espafiol, compartida por los paises hispanoamericanos, por el deteriora en el cumplimiento de las disposiciones que regulan el estatuto del idioma espafiol en la OMS y los retrasos que en demasiadas ocasiones se producen

A52JVR/6 page67 en la traducci6n de los documentos de la Organizaci6n al idioma espafiol. Debo por ello reiterar nuestra petici6n en el sentido de que la OMS mantenga y refuerce el apoyo en recursos materiales y humanos para que nuestro idioma tenga, en pie de igualdad con todos los demâs, el tratamiento previsto en las normas vigentes de la Organizaci6n. Muchas gracias. Dr KIM (Republic ofKorea): Mr President, Madam Director-General, distinguished delegates, ladies and gentlemen, on behalf of the delegation of the Republic ofKorea, firstly let me congratulate Mrs Maria de Belém Roseira on her election as President of this World Health Assembly. Let me congratulate the Director-General, Dr Gro Harlem Brundtland, for her strong and innovative leadership in the work of WHO and for her efforts to "make a difference" by reaching out, working together and building a partnership. My sincere appreciation goes to Professor Amartya Sen for the stimulating address on "Health in development", in which he referred to my country many times. I am happy to note that he was complimentary. One of the most pressing concems ofKorea and other nations over the last couple ofyears has been the severe economie crisis which has affected countries at alllevels of development. As health policymakers, we are ali aware of the effects ofthese financial turmoils on the health and welfare of our peoples. This sad situation makes us even more aware of the inevitable links between economie development and health. In the past, we have been too concemed with economie success and neglected the investment in health and welfare which should go to those who have helped make the economie success stories possible. Economie development must proceed with development of health and welfare services. As the Director-General has emphasized in the "new universalism", govemment agencies other than health must be involved in the total integrated movement of economie, health and welfare processes. Developmental drawbacks such as environmental degradation, excessive unplanned urbanization, the loss oftraditional family ties, ali have an impact on the health of the individual, and ali sections ofthe community should work together to minimize or eradicate these difficulties. The private health and industrial sectors must be involved more and nongovemmental organizations have to play an important part in helping countries cope with the possibly negative aspects of economie development. Financial restraints and shrinking public revenues caused by the economie crisis also mean that health and welfare services must be provided in a more cost-effective way. Korea, for example, is now exploring the expansion of "home nursing services" in an effort to reduce the cost of treatment of patients needing relatively uncomplicated long-term care or who cao be cared for in the home rather than in a hospital. This is only one example ofhow we can help control the increasing costs ofhealth care. WHO and Member States can work together to explore ways of meeting the new needs for health and welfare services in this age of national and international financial instability. Together we can perhaps develop new policies which willlead to more cost-effective health care and better integration of economie and welfare developments, and will take more account of the poor and marginal sections of the community. I know that these issues have been a concem of the Organization and ofMember States in the past, but the new world financial order makes these responsibilities more pressing than ever before. This is the last Health Assembly before the millennium. By working positively together, with a revitalized Organization and a reformed administration, we cao meet the challenges of the next century. Let us make sure that we keep our promises to the peoples of the world to make this new century a happier and healthier one. Mr SERRA (Brazil): Mr President, Madam Director-General, delegates, almost one year has elapsed since Dr Brundtland and her stafftook office. It seems timely to express the support of the Brazilian Govemment to the changes that have so far been promoted and to the enormous efforts Dr Brundtland and her team are making to include health issues among the priorities of the world political and economie agenda. We also congratulate their endeavours to show that an efficient health care system constitutes an important factor for any development strategy. AU initiatives to improve the health sector must be regarded as investments and not as current expenditures that put more burdens on national budgets. This change of focus is definitely a considerable advance, and we encourage WHO to proceed firmly with the task of convincing govemmental decision-makers to adopt this approach. I should add that we fully agree with the report wh en it analyses the role of govemment and the private sector on health care. In Brazil, the private sector is and will be supplementary to the public one, not only because the Brazilian Constitution so establishes, but also because 40% of the population cannot afford private services.

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In relation to the measures proposed, we are convinced that the Roll Back Malaria project must have a global coverage, since the incidence of the disease is not limited to a determined region. I do believe WHO is willing to consider this programme on a worldwide basis, and therefore, we support this perspective with great enthusiasm. Other important global priorities, that in our view should be supported by ali other countries, are the initiative against tuberculosis, the control of poliomyelitis and the control of iodine deficiency disorders, which have produced very promising results. We would like to focus now on The world health report; my comments will be related to sorne of our recent achievements. In the process of fostering development through health the Brazilian Govemment has adopted a strategy of investing more decisively in primary health care and promotion of healthy Iifestyles. The per capita expenditure in these areas has increased 80% between 1996 and 1999, and even more in the poorest regions. Financial incentives are being provided to local govemments to implement programmes, such as that on community health workers, the family health programme, pharmaceutical assistance, and for the control of ali forms of malnutrition. W e already have 83 000 community health workers in more than 3500 municipalities and more than 3000 family health teams. Our goal is to reach a total of20 000 teams assisting around 69 million people throughout the Brazilian territory by 2002. We also recognize the importance of gender issues in the process of development and their close link with health. In partnership with PAHO and other international agencies, we are improving matemity care through the Safe Motherhood project. Among other actions, a maximum proportion of caesarian sections per hospital was established, as weil as an increase in payment for natural births. As a consequence, we have noticed in a very short term a decrease of approximately 13% of caesarian surgeries. In 1998, we launched a national cervical cancer screening campaign, the largest so far in Brazil, examining 3 250 000 women. Another central idea of the report is the need for health systems to define priorities and select interventions. One of our priorities is the prevention and control ofHIV/AIDS, and the main aspect we want to emphasize is the provision of free drugs to ali HIV-positive and AlOS patients. Thanks to this action we have decreased the number of deaths caused by AlOS by 48% in Sâo Paulo and 32% in Rio de Janeiro, two cities that concentrate around 36% ofthe total number ofnotified AlOS cases in Brazil. An initiative that has been very successful for its humanitarian and social impact, and that has also rationalized the use of available resources, is the national campaign for the elderly. For instance, we have managed to vaccinate more than 7 million people over 65 years of age against influenza and tetanus, covering more than 80% of the Brazilian elderly population. The Brazilian Govemment is also promoting training programmes in geriatrie treatment and care to health professionals and to informai caregivers, enabling them to assist and counsel elderly people. A significant measure that will certainly have a strong impact on the Brazilian health system is the recent regulation of private insurance and health plans. In this area, I must say that the Brazilian Govemment is implementing its regulatory mandate emphasized by the Director-General in her report. A Iso in the area of control and supervision, a national agency for sanitary surveillance has recently been created to control medicines, food, chemotherapeuticals, blood and blood products, tobacco products, cosmetics, agrotoxics and others. It has a modem structure, characterized by its administrative independence, stability of its board of directors, and financial autonomy. Regarding leprosy, in the last 12 years its prevalence has been reduced by 66%. We are developing a strategy in order to have less than one case for each 10 000 people by the beginning of the next century. The control of malaria, tuberculosis and other important endemie diseases in Brazil as weil as the eradication of measles and neonatal tetanus will be greatly supported this year by an agreement with the World Bank. Finally, a tobacco control programme was established with legislative actions and educational campaigns, mainly targeting youth. The Brazilian Govemment is training professionals in 3000 municipalities to implement actions in schools, health units and work places. The remarks I have just presented reveal a very high level of symmetry between the actions in Brazil and the priorities defined by WHO. We expect that WHO will continue to lead with great efficiency and sensibility the destiny of public health in the world, and Brazil is ready to join forces to face the challenges ahead in the coming millennium. The future generations are counting on our commitments and sincerity of intentions.

Dr E.F. Ehtuish (Libyan Arab Jamahiriya), Vice-President, took the presidential chair. Le Dr E.F. Ehtuish (Jamahiriya arabe libyenne), Vice-Président, assume la présidence.

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Dr SUKAROMANA (Thailand): Mr President, distinguished delegates, ladies and gentlemen, I first express my sincere thanks to you in offering me this great honour to say a few words at this prestigious moment ofthe Health Assembly. During the past decade this Assembly and the Executive Board of WHO proposed and agreed on severa) resolutions to improve the efficiency and transparency of WHO. We are waiting to see the results. In this connection, 1 would like to commend the great effort of our Director-General, Dr Gro Harlem Brundtland, to bring about real changes. From these resolutions, she is indeed making a difference, starting from within the Organization itself, and we appreciate that. 1 am sure we ali agree that the final goal in making a difference is the reduced gap between the health of the better off and the poor. This means particularly the rapid improvement of the physical, mental, social and spiritual well-being of people in the poorer developing countries. This should be the priority of making a difference. Ali possible obstacles, which may result from globalization, trade liberalization, political conflicts, war, natural disasters, including intellectual and financial imperialism, have to be collectively and effectively tackled and solved. It is thus very clear that in order to achieve this goal, the health sector needs to work very closely with other sectors. This also means that WHO needs to work closer with other international organizations. This may be part of the concept for partnership of health development, which is also a Cabinet project of the DirectorGeneral. Nevertheless, this is not enough. The recent changes in the global political climate and rapid advancement in international communications result in the current regional structure of WHO being somewhat of an antique: our regional structure is definitely outdated. To give you just one example, the 10 Asian countries and the six Mekong-basin countries belong to two regions of WHO, South-East Asia and Western Pacifie. It is thus very difficult for these countries with geographical as well as cultural proximities to work together under the current WHO structure. To make a difference means both to reform the structure of WHO headquarters and its relationship with other international organizations and also to restructure its regional configuration. In addition, innovative horizontal mechanisms for countries in different regions of WHO to work together on certain specifie health development activities should be promoted. These horizontal mechanisms are Iike the horizontal threads that are interwoven into the vertical threads to forrn a strong piece of world health cloth. It is this strong world health cloth that will keep us warrn, sheltered and trying to make a difference. Sorne examples of these horizontal relationships have been initiated, for example, technical cooperation among Asian countries on pharmaceuticals, the Asian Subcommittee on Health and Nutrition, and severa) Mekong-basin health development projects. I thus would like to see WHO working closely with other international development organizations to support the creation of more of these horizontal mechanisms. The Cabinet project on Partnerships for health development should focus its efforts and budget on supporting and strengthening this horizontal trend. The second important issue in regard to making the difference is the prioritization of our efforts towards high priority health problems and determinants. 1 would like to give strong support to the DirectorGeneral in focusing her efforts on a few Cabinet projects, for example the Tobacco-Free Initiative and Roll Back Malaria. These are definitely important killers, particularly in the developing world. Nevertheless, I would like to see concrete evidence that shows our real and serious commitrnent to this priority. The best indicator is the budget that we allocate to these priorities in Thailand. We have just finished forrnulating our plan of action for the WHO country programme for the year 2000-2001. We decided to create separate plans for these two priorities, which comprise 10% of the WHO country activities budget. We are going to do the same thing in our intercountry programme for the South-East Asia Region, in particular for Roll Back Malaria. We agree totally with the Director-General to focus on the African Region. However, our region also has a high burden of malaria and is the main exporter of multiple drug-resistant malaria. The South-East Asia Region should also be the focus of attention. Mr President, it is clear from the proposed programme budget of the WHO headquarters that US$ 42 million, or 14% of headquarters' regular budget, is allocated to communicable and noncommunicable diseases, including these two priorities. There is no clear budget allocation specifically for these two Cabinet projects. This of course may not make much difference in bringing about the changes that we aim for. It is also clear evidence that we tend to think and talk more than being prepared to really perform. This is not the first time that we have talked about making a difference. Nevertheless, few results have been achieved so far. I do hope that this Assembly will be the beginning of our pooled efforts to build up our solidarity to make a real difference. 1 am also quite convinced that under your leadership, and with the solidarity of our Member countries and support of an efficient, transparent and better calibre staffunder the Director-General, we will make severa) great and real differences in bridging the health gap in the new millennium.

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M. CIAV A TTA (Saint-Marin) (interprétation de 1'italien) :1 Monsieur le Président, Mesdames et Messieurs les Ministres, honorables délégués, je suis particulièrement heureux de m'exprimer au nom de la République de Saint-Marin devant cette Assemblée, dont le rôle est notamment d'examiner le Rapport sur la santé dans le monde, 1999 -Pour un réel changement. Tout d'abord, je voudrais présenter au Dr Gro Harlem Brundtland, Directeur général de l'OMS, les salutations de notre Gouvernement et de notre pays tout entier. Le cadre général de la situation mondiale, spécialement dans les pays les plus industrialisés, montre que la durée de vie augmente de plus en plus, accentuant ainsi les différences par rapport aux pays en développement et entre le Nord et le Sud, où la pauvreté, les guerres et les maladies compromettent gravement l'espérance de vie de millions d'hommes, de femmes et d'enfants. Le bien-être et le haut niveau de développement qui caractérisent l'économie de Saint-Marin ont certainement contribué à prolonger l'espérance de vie moyenne de la population, et l'on enregistre aujourd'hui un pourcentage de personnes de plus de 65 ans supérieur à celui des jeunes de moins de 15 ans. La conséquence la plus immédiate de ce phénomène est la nécessité de rester en bonne santé le plus longtemps possible. Grâce à une politique sociale qui insiste depuis bien des années sur les thèmes de la prévention et de l'assistance aux couches sociales les moins favorisées, les recommandations de l'OMS ne prennent pas Saint-Marin au dépourvu. C'est en fait sur ces prémisses que l'on a établi, pour la première fois dans notre pays, le "Plan sanitaire", qui est actuellement soumis à l'approbation des instances politiques. Il s'agit d'un instrument de programmation valable pour les cinq prochaines années et proposant des lignes directrices pour les réformes et les mises à jour qui seront nécessaires dans le domaine de la santé et de la sécurité sociale. L'objectif premier du Plan est la prévention, qui est de la responsabilité de l'Etat, ou bien, conformément aux recommandations de l'OMS, la promotion de modes de vie sains, ce qui exige une meilleure éducation et une information correcte en ce qui concerne la nutrition et l'activité physique, les risques liés à la consommation de tabac et d'alcool, et l'importance de l'application stricte de la législation relative à la sécurité et à l'hygiène sur les lieux de travail. Cela signifie aussi combattre par des actions spécifiques les affections principales qui sont aujourd'hui, selon les relevés les plus récents, les maladies cardio-vasculaires et le cancer, sans oublier les accidents du travail et les maladies professionnelles. Il faut aussi améliorer l'environnement par des interventions spécifiques concernant l'air, l'eau, les aliments, les rayonnements et les déchets et renforcer la protection des sujets les plus faibles par des initiatives destinées à combattre le phénomène de la toxicodépendance, à soutenir les personnes atteintes d'incapacité et à offrir les services nécessaires dans les phases de la vie où l'individu est le plus vulnérable, à savoir l'enfance et la vieillesse. J'aimerais aussi souligner que l'un des projets les plus importants des cinq prochaines années, déjà approuvé par notre Gouvernement, consiste à établir un centre de cancérologie hautement spécialisé, en vue de compléter le cycle des thérapies médicochirurgicales existantes qui font partie de nos services. Enfin, pour que le système de santé puisse fonctionner de manière satisfaisante, il est nécessaire que l'appareil administratif soit efficace et fonctionnel. Dans ce but, des réformes sont actuellement en cours d'élaboration. En outre, par suite des variations dans les tendances démographiques, la République de Saint-Marin est en train d'affronter le problème d'une réforme du régime de retraite, qui devra poursuivre deux objectifs principaux : garantir les droits déjà acquis par les citoyens en activité et garantir en même temps le droit à la retraite des nouvelles générations. Nous croyons, tout comme l'OMS, qu'un pays ne peut se permettre de consacrer ses ressources à des interventions de qualité médiocre qui aboutiraient à des activités médiocres. Il ne s'agirait que d'un gaspillage inutile. Le principe de la solidarité, que tout système sanitaire doit respecter et qui prélude à un "nouvel universalisme" dans le domaine de la santé, ne signifie pas "tout donner à n'importe qui", mais diversifier les interventions sur la base des exigences réelles, selon une politique planifiée et clairvoyante. Nous sommes convaincus que cela est fondamental, même face aux situations sanitaires d'urgence causées par les guerres en cours dans plusieurs parties du monde et qui demandent toute notre attention, en particulier celle des Balkans, où une population tout entière vit une tragédie ethnique que nous n'aurions plus voulu voir après la Seconde Guerre mondiale. Face aux nombreux besoins de la population du Kosovo et compte tenu du contrôle sanitaire imposé par l'arrivée des réfugiés dans les différents pays d'Europe, seuls des systèmes de santé efficaces seront en mesure d'offrir cette solidarité qui ne s'exprime pas par des mots, mais plutôt par des interventions qualifiées. C'est aussi dans cette voie que chaque Etat devra s'engager en priorité absolue.

Conformément à l'article 89 du Règlement intérieur.

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El Dr. TAPIA (México): Sefioras y sefiores delegados: Antes de iniciar mi intervencion quiero felicitar a la Secretaria de Salud de Portugal por su eleccion como Presidenta de esta Asamblea, y asimismo expreso el reconocimiento a la Dra. Brundtland por el informe que nos ha presentado el dia de ayer, el cual es, a la vez, punto de partida de nuevos desafios. En nombre del Gobierno de México y del Secretario de Salud, expreso el honor que representa dirigirme desde esta alta tribuna a quienes encabezan el esfuerzo sanitario a nivel mundial. La propuesta de la Dra. Brundtland representa una nueva vision delliderazgo que la Organizacion Mundial de la Salud esta Hamada a asumir y a construir para enfrentar con éxito los retos del proximo milenio. Doctora Brundtland: El liderazgo que usted propone, México lo asume, ya que creemos que la unica forma legitima de garantizar acciones de salud es fundamentarlas en las necesidades de las comunidades, de los paises y de las regiones, reconociendo que en todos los paises, independientemente de su nivel de desarrollo, han surgido reivindicaciones de participacion y accion colectiva que ya no aceptan recetas verticales, ni de gobiernos ni de organizaciones. Este nuevo liderazgo se construye a partir de redes en la comunidad misma, con los organismos, incluso en los organismos no gubernamentales y en el sector privado, pero que debe de estar dirigido siempre en el âmbito nacional por los gobiernos; y en el internacional por los Estados Miembros. Doctora Brundtland: Quiero subrayar que México es su socio, no solo por ser Estado Miembro, sino porque comparte su conviccion de impulsar un cambio profundo que ponga a la salud en el centro de las politicas publicas, para alcanzar buenos resultados sanitarios, para tener sistemas de salud con mayor eficacia, y lomas importante, generar un impacto en la salud de los pueblos. Nos parece afortunada la eleccion de la malaria en el campo de las enfermedades transmisibles y el control del tabaco en el de los padecimientos no transmisibles, como epidemias a contener, como el gran marco de trabajo al que habra que dirigir los esfuerzos mundiales, pero no debemos olvidar que entre estos dos extremos existe una amplia gama de enfermedades que demandan atencion, y por ende de una definicion de prioridades. Asimismo, México se suma al esfuerzo global contra la poliomielitis, no solo de palabra, sino con hechos, y pone a la disposicion de la OMS la experiencia acumulada de casi 10 anos de haber erradicado este grave padecimiento. Sefioras y sefiores delegados: Para enfrentar los retos sanitarios que el Informe sobre la salud en el munda 1999 destaca es importante recordar que contamos con una estrategia valida y efectiva para todos ellos, que es la promocion de la salud, y que consideramos que es importante ver de manera mas explicita en los futuros documentos de esta Organizacion. Debido a que tenemos una firme conviccion en la importancia de la creacion de redes de cooperacion, proponemos la creacion de la Alianza Global de Promocion de la Salud, Alianza que pretende iniciar con un compromiso a nivel ministerial. Esta Alianza se bara realidad en la Quinta Conferencia Mundial de Promocion de la Salud, que se celebrara en México en junio de 2000 y que es una muestra clara de los cambios que realmente harân la diferencia. Muchas gracias. Dr HOLCÂT (Czech Republic ): Mr President, distinguished guests, ladies and gentlemen, thank you very much for the invitation to the Fifty-second World Health Assembly. We welcome very much the ongoing WHO reform and fully support your vision of"one WHO". A change in the way of global thinking as weil as ofworking as a team will help us to improve health care management in the Czech Republic. Preparation for accession to the European Union will dominate Czech politics throughout the forecast period. The main problem is to prepare the changes in the Czech legislation. Key health policy issues for accession process are the following: rationalization of the network ofhealth establishments; substantial improvements of control activities; standardization of technologies, human resources, and diagnostic and therapeutic procedures; strengthening of occupational health services in line with the lLO Convention 161; toughening of drug po licy to decrease the influence of the pharmaceuticallobby; strengthening the position of the hygiene services, including occupational health and food industry surveillance; and legislative work for change of our health legislation within the framework of the European Union. Here are examples of health indicators with international comparisons. Since 1990, life expectancy at birth has risen fast, but is still about four years below the average of the European Union and slightly below its lowest level. The Czech Republic bas the second highest value of life expectancy among accession countries. In 1997 life expectancy at birth increased to 70 years for men and to 77 for women. The infant mortality rate bas been continuously decreasing in the last years and in 1998 was reported to be 5.2 per 1000 live births. Maternai mortality is close to the average ofthe European Union and was 2.2 per 100 000 live births.

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The leading cause of death is cardiovascular diseases, which account for about 55% of ali deaths in the Czech Republic. The standardized death rate for th ose under 65 years of age for cardiovascular diseases has decreased since 1990, but still far exceeds the worst in the countries of the European Union. Premature morta1ity caused by cancer has been declining during recent years, but is still weil above the worst observed in countries of the European Union. The proportion of deaths from ma1ignant tumours was 24.8%. Lung cancer mortality is decreasing from re1atively high levels, with an increasing incidence of colorectal carcinoma, malignant melanoma, as weil as mammary carcinoma in women. Mortality from injuries and poisoning has slowly been declining since 1990 and is currently close to the highest observed level for the European Union. In general, the situation with respect to communicable diseases is similar to countries of the European Union. Vaccine-preventable diseases are weil under control. HIV infection and AIDS are still at a very low level as compared with most countries of the Union. Estimates of daily smoking prevalence in the adult population show a decline during recent years to slightly below the average for the European Union. Alcohol consumption increased in 1989 and in 1994 it reached 10 litres of pure alcohol per person per year, being slightly above the European average. To conclude this very short summary of health of the population of the Czech Republic it is important to report our priorities for future collaboration with WHO. From the beginning of the year 2000 the Czech Republic will start to implement on the national leve) WHO health-for-all strategy "Health 21 ", with special focus on integrated health promotion and disease prevention issues, especially for cardiovascular diseases and for malignant tumours. Mr A. ABDULLAH (Maldives): Mr President, distinguished delegates, ladies and gentlemen, august Assembly, I wish to take this opportunity to commend the Director-General for her world health report. We strongly support her reform initiatives and look forward to seeing their positive results benefit mankind. She has shown great vision and leadership for practical action, clearly demonstrated in her priority initiatives, particularly the Roll Back Malaria project and the Tobacco Free Initiative, which are of critical importance to our regions where millions of people suffer and die as a direct result of these two scourges. I also thank our Regional Director for his invaluable support and guidance. The millennium is upon us. When we look around we may be forgiven for believing that we are entering a future full of conflict and strife. Daily we see ali manner ofwoe and catastrophe; such events are more newsworthy and take precedence over the many accomplishments man is recording every day. There is no doubt that the millennium will bring tremendous health-related challenges; the signs are indeed visible. Our obligation is to turn these challenges into triumphs. The role of WHO has become increasingly important in achieving this metamorphosis. Our challenges have become even more complex. Many remain technical, such as dealing with disease, developing new cures, new ways of integrating man and the environment. These in themselves have become more urgent, acute and costly, but certainly achievable. However the political and commercial challenges are more difficult to address: the equitable distribution ofhealth, dealing with the pressures of multinational commerce, an equitable quality of li fe, finding the balance between health and commercial interests, ensuring wealth is not created at the expense ofpoverty. An example of the type of challenge is demonstrated by the Director-General's Tobacco Free Initiative. How do we persuade a commercial interest to cooperate in a campaign, the end result ofwhich may not be in their best interest? Great achievements have been made during the short lifetime of WHO. Health has generally improved and expectations have risen. But we are far from finished; a great deal more has to be done to achieve even basic health care in many parts of the world, let al one global equity of health care. The disparity between the wealthy and the poor countries has to be bridged; we must get to the point where we understand that health care is a human right not a commodity. The advocacy and leadership role of WHO must continue, expanding with greater emphasis on prevention, health education and awareness. Advocacy at the policy leve) will have little benefit without proper knowledge and understanding at the leve) of implementation. Additionally, a public that is properly informed and with a desire to seek knowledge will provide the single most positive effect on health. The developing countries must seek to reach the awareness position ofthose more fortunate countries, so that a man chooses not to smoke because he is fully aware of the effect it wiii have on his health; a yard is kept tidy so that mosquitoes have no place to breed, or a woman prefers not to have a large family because she knows it is not good for her health. Like everything else in this ever-changing world, we must keep abreast of events or try to stay ahead of the game. This is certainly true in the area of education and knowledge. We need to embrace modern

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technology and use it to our advantage in getting the proper messages to the people that need to hear and will react to it. It is a technology that has to be targeted to the young who most need to hear our message. It is with their lives that they will forma healthy future. We must do ali we canto ensure that the future does not suffer from their lack ofknowledge. We must ensure that our programmes are as glamorous as the advertising campaigns. We must make health trendy, something that people realize can be influenced by decisions they make. There is much more to achieve. We must extend health education and awareness programmes to more effectively target the young, so that they can better assume responsibility for their lives and that of the ir children and families. At the same time, we must address health-related environmental issues such as water supply, sanitation, the dangerous effects of global warming, ali very difficult issues for low-lying island nations like ours. In conclusion, may I thank you very much for WHO's rewarding cooperation. I look forward to seeing our partnership growing stronger in the able hands of our Director-General. Working together we can make a real difference, and go into the new millennium as a stronger and healthier community. Professor WHITWORTH (Australia): Mr President and distinguished delegates, I would like to begin by thanking our Director-General for the breadth and depth of the reforms, which have been initiated in this very sgort time. The changes now being implemented are embraced wholeheartedly by Australia and we wish to signal our enthusiasm to continue to work with Dr Brundtland to ensure that WHO continues to "make a difference". The central theme of the Director-General's report is that human health should be placed at the core of the global development agenda. 1 agree that health underpins ali other aspects ofhuman and economie development. In this context, Australia's Minister for Foreign Affairs recently released our policy on health in Australia's aid programme. The policy recognizes the clear evidence that shows poverty and ill health are linked, and that good health is a cast-effective investment in development, and prioritizes action to help break this poverty-ill health cycle. The generation and application of new knowledge about diseases and the ir control has been pivotai in the progress we have so far made towards health for ali. But we need to take this one step further. The generation and application of knowledge of the determinants of health, not just the causes of disease, is necessary ifwe are to ensure the most equitable and efficient use of our health resources in the future. By way of example, I will comment on the experience of Australia in applying the principles of evidence-based po licy and decision-making to the funding of health services and products, and more recently, to population health activities. Evidence-based decision-making can be defined as the systematic application of the best available evidence to the evaluation of options and to decision-making in clinical, management and policy settings. It is the best foundation for an effective and efficient health system. Australia has readily embraced this principle. Australia was perhaps one of the frrst countries in the world to require proof of improved cost-effectiveness before new pharmaceuticals can be eligible for govemment subsidy, in addition to the usual requirements for safety and efficacy. W e have introduced a systematic approach, with information from economie evaluations, into decisions about whether new drugs should be added to the Govemment subsidised national pharmaceutical benefits scheme. The process has not immediately reduced Australia's overall expenditure on pharmaceuticals. It has, however, ensured that Govemment funding is used for the most cast-effective interventions, and has enabled us to guarantee a high level of public safety. Drawing on the experience gained by evidence-based policy for pharmaceuticals, Australia has also recently established a Medical Services Advisory Committee to provide expert advice on the safety, efficacy and cost-effectiveness of new medical technologies and procedures. A favourable assessment, according to strict criteria, is required before new medical services and technologies can be listed on the medicare benefits schedule, which in tum establishes eligibility for govemment subsidy. The process ofintroducing evidence-based decision-making into Australia's health system, has not been easy. A multidisciplinary approach is required, scientific rigour is essential and perhaps most importantly, not ail resource allocation decisions are related to efficiency - equity is also a key consideration. A health system should have available the best evidence to support decisions at alllevels and in ail contexts. In Australia we see the next frontier in evidence for population health. In the recent federal budget the Govemment announced the establishment of a "population health evidence base advisory mechanism". Recognizing that population health is characterized by diverse interventions with varied theoretical underpinnings, this initiative will start with methodological development. We anticipate it will lead to a systematic approach to reviewing evidence and propagating the implementation and uptake ofthat evidence in po licy and practice. The population health evidence base advisory mechanism will target those

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areas where the greatest gains in health are likely to be made. Assessment of cost-effectiveness of interventions will ensure best use of available resources. Australian efforts in tobacco control represent an example ofhow overwhelming evidence of public health harm has led to comprehensive health interventions. Australia has a strong record of achievement in tobacco control. We have implemented a tobacco advertising ban and aState Government has dedicated a portion of the taxes raised from tobacco products to fund anti-tobacco activities, including replacement oftobacco sponsorships. We have a widespread commitrnent to tobacco control with a ministeriallevel coun:cil of health and law enforcement ministers, at both state and federal levels, to ens ure a coordinated national effort in tobacco control. The Tobacco Free Initiative is crucial. It reflects the magnitude of the evidence requiring concerted global action as weil as action by individual countries. Australia is committed to assisting with the implementation of the Tobacco Free Initiative. Discussion of the Tobacco Free Initiative today is also particularly timely as it coïncides with the release of the World Bank's report on governments and the economies of tobacco control. The report clearly demonstrates that it is in the economie interests of governments to take action on tobacco as weil as the more obvious public health interest. lt outlines a number of strategies that can be adopted to overcome the arguments that tobacco control will cost governments in the short and longer term. Australia welcomes the release of the report to assist implementation of comprehensive tobacco control action plans. We emphasize the Western Pacifie Region in this context, given the seriousness of the tobacco pandemie in our Region, with two-thirds of the world's smokers estimated to be in Western Pacifie Region countries. Finally, returning to the Director-General's report, Australia particularly commends Dr Brundtland for the introduction into the new organizational structure of the Evidence and information for policy cluster. We ali need to follow this lead. By basing our collective efforts on the best available evidence we will have the greatest chance of achieving real and lasting health gains. 1 know that this is not an easy task, but everything is possible. If we have sufficient will, we have made the first step towards establishing sufficient means. Dr F ARHADI (Islamic Republic of Iran): In the Name of God, the Compassionate, the Merciful: I would like, at the outset, to congratulate the President on her well-deserved election as the President ofthe Fifty-second World Health Assembly. My congratulations also go to other members of the Bureau. 1 should thank the Director-General and her colleagues for the informative and thought-provoking annual report. We are grateful to the Director-General for her undertakings since coming to office, including the Tobacco Free Initiative, and assure her of our full support. Since last year, WHO has gone through significant structural changes that in our view will strengthen its capacities to respond to the new and emerging challenges at the turn of the millennium. These changes should be continued and extended to the Organization's country Representatives to ensure attainment of better cooperation for addressing health problems in the field, which in turn would promote global public health. Increasing globalization and enhancement of communications have brought with them participation of non-State actors, including individuals, local communities, nongovernmental organizations and the private sector in decision-making at alllevels. The problems of spiritual and material destitution, injustice, poverty, discrimination, unhealthy lifestyle, emerging and re-emerging diseases and insufficient resources cannot entirely be solved without close collaboration and active involvement of ali these partners. Moreover, Member States should allocate a larger portion of the ir GNP to health activities in order to provide more financial resources to address health problems. The initiative ofthe President of the Islamic Republic oflran to mark the year 2001 as the year for dialogue among civilizations was adopted by the Fifty-fourth General Assembly of the United Nations in 1998. The General Assembly resolution on this subject calls on the United Nations system to contribute to the objectives of this initiative through planning ofvarious activities. In this respect, we strongly hold that this dialogue should involve discussions on ethical and human values that contribute to the promotion of health worldwide. Through centuries, positive norms such as justice, caring for other, sharing with others and assisting the poor and needy have enabled societies to cope with health problems. We invite the Director-General to explore ways and means ofWHO's participation in this endeavour. Meeting the country's primary health care needs could be taken as one of the world's successful models. Comprehensive health care services in a new concept integrating prevention and curative services, research and medical education are thus being implemented in three provinces of Iran as a pilot plan with the· collaboration of the Regional Office for the Eastern Mediterranean as weil as of public and private sectors. We shall soon share our experiences in these areas with other countries. One ofthe principles of change in both global and WHO health policies should be priority changes in order to meet new and emerging needs. We believe nutrition and food safety should be considered as

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one ofthe important health priorities. We ourselves have accorded a high priority to this aspect ofhealth in our Third Socioeconomic Development Plan. At present our globe is suffering from many political and economie problems which threaten the sustainability and promotion of health. I should, in conclusion, make a reference to the ongoing ethnie cleansing in Kosovo, entailing numerous health problems. I need also to cali for a substantial increase in international assistance, specially the provision of health care services to alleviate the human suffering of Muslim Kosovars. Dr DEGUARA (Malta): Mr President, honourable colleagues, delegates, I am sure I am echoing the view ofthose present that the election of Dr Bruntland to the post of Director-General of WHO has brought about an innovative perspective and approach to health issues. I am sure that under her strong leadership WHO will continue to affirm itself as the leader in world health matters. Economie development and advances in medical technology have made it possible to achieve advances in !ife expectancy and a quality oflife never dreamt ofby our predecessors. However, these hard won improvements are being threatened by emerging infections, lifestyle-related noncommunicable diseases, demographie shifts and conflicts. In the face of such threats we cannot afford to be complacent. The world health report 1999: Making a diffèrence shows us ali the way forward to address these issues. My country endorses this vision as we have done with the European Region's Health 21 strategy. Malta's indicators are among the best in Western Europe. The life expectancy in menis 75 years and that in women 79 years. As a result Maltais facing the same problems being experienced by the most developed countries. Our birth rate is decreasing and by the year 2020 the elderly will constitute 25% of our population. Given this scenario the great challenges facing us over the next decare are, first, to ensure adequate funding for the sustainability of our health systems, and secondly to ensure good quality of life for our elderly. In facing these challenges we have to make certain that basic principles such as ethical consideration, equity and solidarity are respected when drawing up our priorities for action. These in fact were the guiding principles in the drawing up of our national health po licy document back in 1994. This document "Health Vision 2000" emphasizes the importance of multisectoral collaboration and healthy alliances as a vital channel to bring about the desired health improvements. In particular, the priorities of combating the tobacco epidemie and health systems reforms and development recognized within The world health report have been highlighted as a priority area in our own national health po licy. With regard to tobacco control, in spite of implementing many of the advocated strategies such as public awareness campaigns, the introduction of smoking cessation clinics and drastically increasing the priee of cigarettes, not only have we failed to achieve the desired reduction in tobacco consumption but the number of young women smokers continues to increase. Moreover, our lower socioeconomic groups have been shown to be more adversely affected by the tobacco epidemie, a clear confirmation of the link between poverty and ill health. We therefore welcome the wider strategy advocated in the Director-General's report, the Tobacco Free Initiative. Another priority area which we are actively addressing is health systems development and reform. In Malta our health care system offers universal coverage free at the point of use. Our primary health care system needs strengthening and we are also currently in the process of constructing a new general hospital to replace the existing out-dated facilities. Striking the right balance between investrnent and preventive and curative services has never been an easy task. While there is consensus on the long-term benefits of investment and preventive services, the public assesses the quality of the service by the high technology curative interventions provided today. On the other hand, the prevailing view amongst many is that increasing health care funding is the only solution. I am convinced that we must not let ourselves be conditioned by these beliefs. The growing concem that the progressive rise in health care expenditure might be reaching unsustainable levels was echoed by many ministers during the round table conferences ofyesterday and today. Our reforms are directed towards need-driven, outcome-oriented, evidence-based service provision. This type of approach is essential to ensure that our scarce human and financial resources are utilized to target unmet needs in areas where the greatest health gains are possible to achieve. Strengthening our efforts, from preventing illness and disability to concerted health promotion initiatives, will remain one of our main long-term strategies. We shall continue to improve our primary health care services to serve as the main channel for these reforms. We believe that a useful strategy to adopt is to seek and encourage partnerships with the private health sector. We strongly maintain that this hasan important role to play in service provision, but duplication of services has to be avoided. We therefore agree with the philosophy of a new universalism in health care provision as expounded in The world health report. It is essential to strive to achieve national consensus amongst ali stakeholders in health care, namely the

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politicians, health care professionals and the general public. By pursuing the above strategies 1 am convinced that we shaH be translating the report, "Making a difference", into reality. Fina1ly, it is reassuring to realize that we do not face these issues in isolation, 1 would like once again to thank Dr Bruntland for bringing to the fore these issues of common concern. We need to be able to support each other in tackling these most cha11enging issues. There is strength in unity and no doubt it is strength that we require to be able to place health at the top of any nation's agenda where it rightly deserves to be. El Dr. RODRÎGUEZ OCHOA (Venezuela): Sefior Presidente, sefiora Directora General, amigas y amigos: Compartimos el documento de nuestra Directora General y los logros y cambios funcionales realizados. Asimismo felicitamos el apreciable aumento de la participaci6n de la mujer en la Organizaci6n. Tai como expres6 el delegado de la Federaci6n de Rusia, para hablar con propiedad de los sistemas de salud es indispensable tener muy en cuenta las caracteristicas hist6ricas y socioecon6micas de cada pueblo, porque el perfil de salud de un pais con alto desarrollo es muy distinto del de otro con mediano o poco desarro11o, lo que determina que las prioridades a establecer sean muy distintas. Debemos privilegiar la salud y la vida y no la curaci6n de la enfermedad, particularmente en los paises poco desarrollados, para lograr estândares de bienestar que otros paises ya lograron. Por tanto, hay que dar prioridad a las actividades de promoci6n de la salud, prevenci6n de las enfermedades y atenci6n médica de primero y segundo nivel. En consecuencia, se impone establecer como politica la atenci6n integral en las redes ambulatorias de salud. Ning(tn sistema de salud es perfecto. Pero los mejores, incluyendo a paises desarro11ados como el Canada, Espafia e Inglaterra, y otros men os desarro11ados como Costa Rica y Cuba, garantizan eficientemente la cobertura universal y no discriminatoria. Para e1Io, su financiamiento debe ser solidario. En relaci6n a la insuficiente competencia del Estado para prestar todos los servicios y a todas las personas, no creemos aconsejable la transferencia de los recursos publicos ni de los sectores contributivos de la economia formai a administradoras privadas de fondos de salud, porque favorece la privatizaci6n de los servicios y las distorsiones que la globalizaci6n de los mercados generan en un bien publico tan esencial como la salud y la vida. Incluso es bien conocido, por ejemplo, que el propio presidente Bill Clinton plante6 a su Congreso la necesidad de reformar el sistema de salud de su pais por ser muy costoso, inequitativo y menos eficiente que el de varios paises; su Congreso no aprob6 esa solicitud. La globalizaci6n de los mercados en materia de salud distorsiona de manera grave e inevitable el derecho a la salud de las poblaciones no desarro11adas, ya que por ser ellucro la principal motivaci6n del modelo privatizador se privilegian las intervenciones curativas y hospitalarias. Ante esa opci6n proponemos la globalizaci6n de la solidaridad entre los pueblos, que en salud significa garantizar a todos los ciudadanos el acceso universal y sin discriminaci6n a los recursos principales que la humanidad ha conquistado en este campo a lo largo de su existencia. Estamos convencidos de que si en materia de salud se globaliza la solidaridad y no el mercado, daremos un paso gigante en la soluci6n de las angustias de nuestros pueblos. Planteamos la necesidad urgente de invertir en obras de saneamiento bâsico ambiental a cambio de deuda externa. Ciertamente conviene tanto a los paises desarrollados como a los otros tener un mundo sano. Los paises mas desarrollados han sido los primeros causantes del grave dafio ecol6gico universal. Basta citar que el consumo energético promedio de los habitantes de los paises desarrollados es aproximadamente 15 veces superior al de los no desarro11ados. Invertir entonces en saneamiento ambiental a cambio de deuda externa es un negocio razonablemente justo. Es necesario encontrar vias para la disminuci6n de los costos de los medicamentos, particularmente para la diabetes, las enfermedades cardiovasculares, el SIDA, algunos antibi6ticos y equipos de hemodialisis. Apoyamos asi la resoluci6n EB103. Rl del Consejo Ejecutivo de la OMS, de enero de 1999. En relaci6n con los avances tecnol6gicos y terapéuticos, la OMS debe ser el organismo que valide oficialmente sus bondades. Por ultimo, el paludismo: Venezuela tiene experiencia s6lida desde 1936. Nuestra escuela internadonal de malaria cumpli6 56 afios. El paludismo es una causa de subdesarro11o, particularmente en paises donde no existe una organizaci6n id6nea para combatirlo. Estamos de acuerdo en que la estrategia mas importante hoy dia es combatir el parâsito, impulsando el diagn6stico y el tratamiento precoz, capacitando al persona! de salud y a los residentes de las localidades malarigenas. Sin embargo, también es necesario el control integral del vector, particularmente en areas hiperendémicas o de alta endemicidad donde no baya existido un sistema eficiente de combate integral del paludismo. Muchas gracias.

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page77 Mr HASHMI (Pakistan): Mr President, the year 2000 holds special significance for WHO. Twenty-one years ago we proclaimed the goal ofhealth for ali by the year 2000. ldealiy, by now ali of us should have reached the happy state of complete physical, mental and social well-being. We have made important strides, smallpox has been eradicated. We are winning the fight against poliomyelitis. Life expectancy and other health indicators have also been moving in the desired directions. Y et, the scale of the task left undone is enormous. As we have overcome old foes like smalipox and poliomyelitis, we face newer, even more deadly ones, such as the HIV1 AIDS virus. Even diseases thought to be on the decline such as tuberculosis and malaria have rebounded with renewed resilience and increased resistance to established therapies. We are also confronted with a disturbing paradox. The developing world still suffers from high levels of morbidity and mortality due to the traditional communicable diseases. At the same time the incidence of the so-calied rich people's diseases such as heart disease and diabetes are also increasing in the developing countries. The essential issue before us is equity. While a wealthy minority is benefiting from the fruits of new technologies and high cost health care, the majority of the wor'ld population is living in distress and misery. This should not be acceptable tous. We are therefore greatly heartened that our Director-General, in her first statement to the Executive Board, said that the developing world carries 90% of the disease burden, yet poor countries benefit from only 10% of resources that go to health. We derive encouragement from her declaration that universal access to quality health care will remain the major principle for the work of WHO. 1 would venture to make a few suggestions as our contribution to the debate: (i) base reforms in the health sector on equity. We should endeavour to stop inequalities in income and in access to health care within and amongst nations. WHO must assume its leadership role, and focus more attention on alleviating maldistribution of resources. Health care should be available at affordable cost from any medical institution on a global base. This should be the part of the basic human rights of a sick person; (ii) promote the concept of social responsibility for health: health programmes cannat succeed without a motivated public to make proper use ofhealth services. Moreover, people must promote their health with their own actions and efforts. More emphasis thus has to be laid on public health education and health promotion; (iii) increase investment for health development. Many developing countries are spending too little on health care. WHO should play its role in motivating States to increase their budget for health. Countries should be made to realize that better health is free counsel for economie development; (iv) develop altemate financing ofhealth care. Many countries are looking towards WHO for advice and assistance. WHO must take the initiative and develop models towards this objective. We would also like to place on record our support for the Director-General's request for the adequate financing of WHO and its programme. The zero nominal growth budget should be the least that should be accepted by the WHO Member States. Finaliy, 1 would like to register our appreciation of the good work being done by WHO in the context of the Kosovo crisis, particularly with respect to the hundreds of thousands of refugees in Albania and Macedonia. La Sra. McCOY SANCHEZ (Nicaragua): Distinguido sefior Presidente; honorables sefiores miembros de la Mesa; honorables delegados, sefioras y sefiores: Es un honor para mi poder dirigirme a esta magna 523 Asamblea Mundial de la Salud en nombre de los hermanos pueblos de Belice, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, Panama y la Republica Dominicana, y en su nombre y representaci6n felicitamos a la sefiora Presidenta pQr su nombramiento. La década de los afios ochenta represent6 para la regi6n latinoamericana la década perdida en lo econ6mico, lo social y lo politico. A partir de los afios noventa se consolida la democracia en la mayoria de los paises latinoamericanos. Durante los ultimos afios, los paises centroamericanos, incluyendo aquellos afectados por conflictos bélicos, han continuado su inversi6n social, principalmente en el sector salud. Estos esfuerzos se han visto reflejados en logros significativos en el campo de la salud principalmente: reducci6n de la mortalidad infantil; incrementa de la cobertura de inmunizaciones para nifios menores de un afio de edad, particularmente para sarampi6n (cabe sefialar que debido a esta cobertura nuestra subregi6n centroamericana sera la primera regi6n libre de sarampi6n en el mundo); erradicaci6n del virus salvaje de la polio; reducci6n de las muertes por enfermedades infecciosas; incrementa del acceso al agua potable; e incrementa de la expectativa de vida. Cuando la subregi6n centroamericana se encontraba inmersa en un proceso sostenido de crecimiento econ6mico, logrando grandes avances en salud, educaci6n, justicia social, saneamiento ambienta~ hace su aparici6n en el mes de octubre pasado el desastre natural mas grave de la regi6n centroamericana, afectando directamente a los mas pobres y

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afectando la buena marcha de los programas de desarrollo. Esto ha obligado a los paises centroamericanos a reorientar los recursos destinados al desarrollo humano a atender las necesidades inmediatas de reconstrucci6n y rehabilitaci6n. Los pafses que conforman la regi6n sanitaria de América Central y la Republica Dominicana tenemos una alianza estratégica desde hace varias décadas, constituyendo asf un modelo de solidaridad y esfuerzo conjunto ante el reto de implementar estrategias comunes ante el proceso salud/enfermedad de la poblaci6n y de apoyar las contingencias sanitarias de los pafses que conforman esta regi6n. A lo largo de los anos bernos fortalecido la gesti6n conjunta de proyectos de cooperaci6n extema para el desarrollo sanitario y humano de los habitantes de la regi6n. A pesar de las diferencias sanitarias entre nuestros pafses, bernos trabajado de manera coordinada ante intereses comunes, por lo que el proceso de integraci6n de Centroamérica y la Republica Dominicana no es circonstanciai ante los efectos de los desastres naturales vividos en los ultimos meses. Han pasado casi siete meses desde la catâstrofe provocada por el huracân Mitch. En este periodo los paises afectados y sus poblaciones han hecho grandes esfuerzos para superar los aspectas mas criticos de la emergencia, contando con la valiosa ayuda de la comunidad intemacional. El huracân Mitch, junto con las inundaciones y deslizamientos de lodo, cost6 la vida a unas 10 000 personas y dej6 a mas de un mill6n de familias sin hogar; destruy6 o produjo dafios considerables a 3600 escuelas; arras6 con âreas de cultivo y ganaderia vitales para la economia de estos paises y devast6 la infraestructura basica de la regi6n. Mas alla de la pérdida irreparable de vidas humanas, el impacto sobre la producci6n y la infraestructura que sustenta la misma implica un severo retroceso en el proceso de desarrollo de la regi6n. Los esfuerzos iniciales de la salud se han orientado a la atenci6n inmediata de las personas afectadas, a la vigilancia epidemiol6gica, al manejo de residuos s61idos, a la desinfecci6n del agua, la higiene de los alimentas, la salud mental y al control de vectores, entre otros. Gracias a estas intervenciones, producto del esfuerzo propio y la solidaridad intemacional, se controlaron los brotes epidémicos. Sin embargo, es importante resaltar que, no obstante nuestra capacidad de respuesta, se hace necesario continuar invirtiendo en salud, y para esto es importante seguir contando con la cooperaci6n intemacional. Los paises centroamericanos y de la regi6n estamos convencidos que la cuttura de prevenci6n y los planes integrales de manejo ambiental que bernos adoptado nos ayudarân a evitar pérdidas de la magnitud de las provocadas por el paso de los huracanes Mitch y Georges y otras contingencias sanitarias en el futuro, dada la variabilidad climâtica de este afio, el fen6meno de La Nina y la amenaza de nuevos huracanes. Los ministros de salud centroamericanos y de la Republica Dominicana bernos asumido un importante liderazgo en las comisiones nacionales y en los esfuerzos subregionales. En este sentido, bernos tenido varias reuniones de carâcter regional y en la ultima reuni6n realizada en Managua, los dias 8 y 9 de abril, acordamos presentar dos proyectos subregionales a Estocolmo relacionados con la mitigaci6n y prevenci6n de desastres naturales y otro relacionado con la negociaci6n conjunta para medicamentos especiales. Se estân produciendo progresos en las tareas de reconstrucci6n, pero aun quedan muchos problemas por resolver. Los gobiemos centroamericanos han elaborado planes nacionales y subregionales para la reconstrucci6n y transformaci6n social de sus paises, con el objetivo de disminuir la vulnerabilidad ante futuras catâstrofes y posibilitar un desarrollo sostenible que reditUe en beneficia de la mayoria pobre de la poblaci6n. Los paises centroamericanos y de la regi6n ya bernos iniciado este proceso de reconstrucci6n con nuestros propios medios, pero dada la magnitud de los efectos necesitamos de la cooperaci6n extema. La pr6xima reuni6n en Estocolmo es s6lo un comienzo. Durante la misma, los paises centroamericanos presentaremos los planes para la reconstrucci6n y transformaci6n de nuestros paises, mientras que las naciones donantes y los organismos multilaterales de cooperaci6n técnica y financiera, o sea nuestros socios en este proceso de desarrollo, tendrân la oportunidad de definir sus aportes. Esperamos que la reuni6n de Estocolmo resulte en el apoyo necesario en la cooperàci6n que requerimos. La solidaridad con América Central hasta ahora mostrada por gobiemos, instituciones e individuos de todo el mundo ha sido impresionante. Los paises de Centroamérica y la Republica Dominicana desean en esta Asamblea reiterar su agradecimiento por esta solidaridad. Nada podrâ reemplazar las pérdidas humanas que afectaron a incontables familias centroamericanas, pero esta tragedia puede convertirse en un punto decisivo para el desarrollo de la regi6n. Los representantes de estos paises remarcamos también la importancia de proseguir el proceso de integraci6n regional, no s6lo en lo que se refiere al comercio y a la salud, sino también a nivel de infraestructuras y medio ambiente, como por ejemplo en la administraci6n y mantenimiento de las cuencas hidrogrâficas compartidas. Por lo anteriormente descrito, expongo a los distinguidos delegados y a su honorable Presidenta los siguientes considerandos con el objetivo de que los mismos puedan ser reflejados en una resoluci6n de esta Asamblea: 1) que las consecuencias sin precedentes del huracân Mitch afectan a los paises centroamericanos y ponen en serio riesgo las condiciones de medio ambiente y desarrollo

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humano sostenible en esa parte del mundo; 2) que el efecto econ6mico provocado por el huracân Mitch agrava la situaci6n de desempleo, lo cual puede tener consecuencias sociales negativas, también para la salud y el desarrollo, que tanto preocupan a esta Organizaci6n y a nuestros gobiemos; 3) que, dadas las serias limitaciones que afectarân a los paises centroamericanos debido a una excesiva reducci6n en sus recursos econ6micos y de otro tipo, solicitamos a los hermanos paises Miembros de esta Organizaci6n que expresen su solidaridad con nuestros pueblos afectados por el huracân Mitch apoyando la solicitud de asistencia inmediata y sustantiva, instando a los Estados Miembros a proporcionar o continuar proporcionando la asistencia y los recursos requeridos por los paises centroamericanos, directamente o a través de la Organizaci6n Mundial de la Salud y su Oficina Regional para las Américas. En este contexto solicitamos a ustedes el invaluable apoyo de todos a un proyecto de resoluci6n que presentaremos en la comisi6n correspondiente. Asimismo, solicitamos a la Directora General que difunda esta resoluci6n dentro del sistema de las Naciones Unidas y otros organismos intemacionales apropiados. Que Dios les bendiga. Muchas gracias. Mr NGEDUP (Bhutan):

Mr President, distinguished delegates, ladies and gentlemen, on behalf of the Bhutanese delegation, and on my own behalf, I would like to extend to you and the members of the Bureau our warmest congratulations upon your election. Mr President, I feel it a great privilege and honour to represent my country at this Fifty-second World Health Assembly, which is the last one before the next millennium. We cao be justly proud that the century we will be leaving behind shortly has been marked by far reaching medical, scientific, and technological advances beyond our wildest dreams. And yet, sadly, these wonders have also failed to touch the lives of a large segment of the world's population. It is in this context that my delegation welcomes The world health report 1999 which sets clear guidelines and directions for the twenty-first century with a peoplecentred approach. The visionary report will indeed usher in a new era that will shape health care and management to greater heights. Making a difference is a darion cali to govemments and peoples to make collective efforts to strengthen the health and well-being of the citizens of the twenty-frrst century. The oftrepeated statement that diseases know no political boundaries, and that our world is reducing to a global village, makes us realize how vulnerable we really are. Therefore, I fully agree with Madam Roseira's statement that health is everybody's business. Rich or poor, strong or weak, big or small, the sooner we come to this realization the safer our world will be. According to The world health report 1999 one billion people have yet to profit from the fast-changing living standards, economie development, lifestyles, and health status. Among these, we must not lose sight of the small least-developed and disadvantaged group of countries. The yardstick of genuine development is when development filters down to the poorest of nations and the poorest ofpeoples. WHO's reform process must therefore give special attention to these marginalized groups, through strengthening collaborative activities at the country level. The Director-General and WHO deserve our appreciation for preparing the innovative report. The report raises many ideas and proposais. These proposais will have far-reaching implications and will require time to be absorbed, reflected upon and analysed. They have also to be assessed in the context of national capacities and capabilities. My delegation welcomes the emphasis being placed on the two Cabinet projects: Roll Back Malaria and the Tobacco Free Initiative. My delegation is confident that the same wisdom will prevail in the case of other equally important health problems. Bhutan too is responding to the cali for innovative approaches in the twenty-first century. In this regard, I would like to mention the establishment last year, with the help of WHO, of a health trust fund, which is a cost-sharing mechanism that will seek to ensure sustainable and timely availability of critical vaccines and essential drugs. While there could be many approaches to ensuring sustainability, Bhutan believes that the idea of trust funds deserves support as it represents an effective collaborative effort at a time when resources are shrinking and needs increasing. 1 take great pleasure in informing this august Assembly that our nation is celebrating the Silver Jubilee ofthe King, His Majesty Jigme Singye Wangchuck. Our King bas selflessly dedicated his !ife to the service of his people for the last 25 years. Unprecedented social economie progress during this period has visibly improved the health and the well-being of the Bhutanese people. It is therefore fitting that the country this year is making a determined and collective effort to honour the King by launching various programmes involving ali segments of society in order to further promote His Majesty's goal of gross national happiness. ln conclusion I would like to pay tribute to Dr Gro Harlem Brundtland for the many initiatives taken by her to make WHO a vibrant and dynamic organization. 1 wish her every success in her endeavours and assure her of our country's continued and dedicated support.

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Dr NASHER (Yemen): Mr President, distinguished delegates, ladies and gentlemen, may I first of ali thank and congratulate the Director-General, Dr Brundtland, for her excellent report which highlighted great accomplishments, radical reforms, clear and well-defined directions and priorities like Roll Back Malaria and the Tobacco Free Initiative, which we fully support. Yemen, my country, is one ofthe least developed in the world. We have many health problems, sorne ofthe worst health indicators and the least resources. The Yemen Ministry ofHealth is doing what it can to tackle health problems by instituting health systems that attempt to make the most efficient use of its limited resources and to expand its resource base, and during the last two years the Ministry ofHealth has designed and begun implementation ofhealth sector reform. That, we feel, will help us do a better job of tackling sorne of our health problems. The main elements of the reform are: decentralization of planning, decision-making and financial management; a redefinition of the role of the public sector with a stronger emphasis on policy regulation and public health, and establishment of limits to its role as a service provider; the district health system approach; community co-management ofhealth systems; costsharing; reform ofthe essential drugs policy and realignment of the logistic system for drugs and medical supplies; decentralized outcome-based management system from the central to the community level, with an integrated focus on gender; hospital autonomy and eventual basic health facility autonomy; intersectoral cooperation; encouragement of responsible participation by the private sector and nongovernmental organizations through appropriate policy design and regulation; encouragement of innovation; and a sector-wide approach to donor funding and programming, with a stronger role for the Ministry ofHealth in coordinating donor assistance. Among the many health problems the Ministry ofHealth is tackling, the priorities are as follows: communicable diseases- malaria, tuberculosis, hepatitis and AIDS; noncommunicable diseases such as heart disease and cancer; as weil as road traffic accidents, civil violence and arms-related fatalities, smoking, reproductive health, family planning and safe mothèrhood. As I stated earlier, Yemen is doing what it can with a very limited resource base, but it cannot fight this hattie alone. First, it needs international support for its health sector reform. This is the challenge within Yemen. Secondly, it needs developed countries to recognize the need for globalization of the fight against disease. This is the global challenge. The first aspect of this global challenge bas to do with research and development in vaccines and drugs against diseases that affect mostly developing countries. This should be encouraged with the help of the developed countries and other multinational partners. This is good for developing countries like Y emen but also for the developed world. Though many communicable diseases are still confined to poor and developing countries, developed countries can still be inflicted with these same diseases through international travel. In addition, it is legitimate, because the traffic of disease goes in both directions: from the developing to the developed world and vice versa. Thirdly, poverty leads to poor health and to the destruction of the environment which affects the global village in its entirety. Therefore, there must be a global strategy to protect the environment, with the rich helping the poor to overcome poverty, health problems and environmental destruction. They, indirectly, protect themselves from the future hazards of ali of the above. And, on the verge of the millennium, you cannot say this does not concern me. Now the globe equals the village, let us save our village for the sake of our future generations. WHO, under its strong and dedicated leadership, the World Bank, the other world health leaders and other agencies, need to join forces to help the poor reduce poverty, improve health status, reduce environmental destruction in order to make Mother Earth a safe haven for future generations. May I conclude by quoting the Director-General, Dr Gro Harlem Brundtland when she said yesterday: "With cool heads and warm hearts, we can make a difference." The PRESIDENT: a.........k...ll ...lh.:::...... .LW\ ~\ ~LAA.il ...u:. y

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.d..-kJI-~)J l..t$:. ~ ~J .a..WI . ~ \............ ' V, i · a;;WI d..-kJI -.::...û.J The meeting rose at 17:30. La séance est levée à 17h30.

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SEVENTH PLENARY MEETING Thursday, 20 May 1999, at 9:00 President: Mrs Maria de Belém ROSEIRA (Portugal) later: Mr S.U. YUSUF (Bangladesh)

SEPTIEME SEANCE PLENIERE Jeudi 20 mai 1999, 9 heures Président: Mme Maria de Belém ROSEIRA (Portugal) puis: M. S.U. YUSUF (Bangladesh)

LOO KING AHEAD FOR WHO AFTER A YEAR OF CHANGE: REPORT OF THE DIRECTORGENERAL (INCLUDING THE WORLD HEALTH REPORT 1999 (continued) L'AVENIR DE L'OMS APRES UNE ANNEE DE CHANGEMENT: RAPPORT DU DIRECTEUR GENERAL (Y COMPRIS LE RAPPORT SUR LA SANTE DANS LE MONDE, 1999 (suite) The PRESIDENT: May 1 begin by thanking Dr Ehtuish and Dr Stamps for having replaced me yesterday afternoon. At 9:30 this morning, 1 have to hand over the presidence to Mr S.U. Yusuf, the fourth Vice-President, because of an unavoidable engagement. Before we continue with our work, 1 wish first to report on the discussions at the General Committee which held its second meeting yesterday afternoon. The Committee considered the programme ofwork ofthe Assembly until Friday, 21 May, and agreed to make the foliowing proposais to the Assembly: this morning, we can complete the discussion of item 3. Committee Ais at present holding its third meeting. On adjournment of this plenary, Committee B will hold its second meeting. This afternoon at 14:30 both Committees A and B will meet. At 17:00 today, the Plenary will hold its eighth meeting to deal with item 8, Awards. On Friday, both Committees A and B will meet in the morning and afternoon, keeping in mind that at an appropriate time, Committee A may meet to consider the appropriation resolution wh en there is no meeting of Committee B so that ali participants may attend the meeting ofCommittee A. At 17:30 the General Committee will hold its third meeting. We shali now return to item 3 and continue with the list of speakers. The next two speakers on my list are the delegates of Myanmar and Democratie People's Republic of Korea. 1 give the floor to the delegate ofMyanmar. Mr KET SEIN (Myanmar): Madam President, Madam Director-General, honourable ministers, distinguished delegates, on behalf of the Government and the people of the Union ofMyanmar, 1 would like to convey warm greetings to you ali. Aliow me to join the other delegations in expressing my heartfelt congratulations to the President on her unanimous election to the highest office ofthe presidency of the Fifty-second World Health Assembly. The changes at WHO headquarters during 1998 have been remarkable and 1 would like to express my support for the new organization and management structures initiated by the Director-General. Myanmar's health policy focused on the provision of equitable health care with universal coverage, accessibility, multisectoral and community involvement, appropriate technology and cost effectiveness. To ensure that ali citizens are assured oftheir basic rights to health and health care, reforms have been encouraged, including the development of alternative health care financing.

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WHO's inputs, policy guidance and technical assistance have been crucial in enhancing the health status of the population. I would like to express my appreciation to WHO for supporting health programmes in my country. Myanmar is weil on its way to achieving its goals of elimination of leprosy, public health problems, and poliomyelitis by the year 2000. Malaria still reigns as a leading cause of mortality and morbidity in Myanmar. As part of the regional framework a Roll Back Malaria initiative was initiated last year. This has mobilized multisectoral involvement and development of partnerships among government sectors, agencies and in communities. However, considerable assistance and technology inputs are needed to sustain the initiatives, strengthen human and institutional resources, expand laboratory information services and tackle the problem of multidrug resistance. In disseminating information, communication and education activities are also required for promotion of persona! protection methods. Myanmar has adopted the Declaration on health development in South-East Asia in the twenty-first century as the basis for the formulation of the next cycle of the national health pian which is to begin in the year 2001. We are ali facing the double burden of disease: communicable and noncommunicable diseases; among the noncommunicable diseases, tuberculosis accounts for the major portion of the disease burden. Thus we welcome the Tobacco Free Initiative as an important means for reducing the present and future effect oftobacco on health. Widespread dissemination of information, including education against the use of tobacco, has been provided as an integral part of comprehensive health promotion activities. Much support and cooperation will be necessary to facilitate and implement the Tobacco Free Initiative. In Myanmar the implementation of the ASEAN programme on essential drugs has ensured the public's access to safe, effective, affordable, easily accessible and good quality drugs. Drugs laws with regard to registration, procurement, storage, distribution and quality assessment have been promulgated, which also cover traditional medicines commonly used in Myanmar. In conclusion, Myanmar will continue to work in collaboration with the health technology and pharmaceutical clusters. Professor CHOI CHANG SIK (Democratie People's Republic ofKorea) (interpretation from Korean): 1 Mr President, frrst, 1 would like to express my congratulations to the President and Vice-Presidents of this Health Assembly. 1 also extend my warm congratulations to the Director-General for her energetic activities in the development of world health and for her wonderful report presented in this meeting. Taking into account the successes achieved and tessons leamed in the past work of WHO, the Director-General analysed in detail the existing and emerging challenges to world health and formulated strategie directions to cope with them in the next century. Recognizing that these directions have reflected the realities of the present world and the regional health situation, my delegation sincerely hopes that they will contribute to the development ofhealth worldwide and in the South-East Asia Region in particular. Last year the health sector in my country was seriously affected by natural disasters and by the economie difficulties derived from them. These difficulties gave rise to the recurrence of diseases like malaria, which were eradicated long ago in my country, and to an increase in cases oftuberculosis which had been considerably reduced. Furthermore, the status of mother and child health has been seriously threatened. The result has been that the system of uni versai, complete free medical and advanced home doctor care, under which the State takes full responsibility for the people's health, has been faced with serious challenges. To tackle these challenges, we established a firm partnership with other sectors in the govemment, as mentioned in the Declaration on health development in South-East Asia in the twenty-first century, and made joint efforts to prevent the transmission of diseases. At the same time, we took active measures to treat emerging diseases in good time. In particular, last year, with the·support of WHO, we implemented the epidemiological surveillance of malaria and tuberculosis throughout the country and took preventive measures. Practical measures were also taken to improve the nutritional status of children. I would like to take this opportunity to express my sincere thanks to WHO for its generous assistance to our health development, in spite of its recent financial difficulties. Through last year's work, we have come to feel more deeply the need for strengthening preventive work and the vital importance of the government's regulatory role in making rational use of a limited health budget and financial resources for the priority areas. This year, we are planning to give priority to the protection of mothers and children, especially those under the age of five, and to concentrate our efforts on them. In the meantime, we will be actively engaged in endeavouring to eliminate many communicable diseases, including malaria and tuberculosis, and will promote an extensive tobacco-free campaign, thus steadily improving the people's health.

In accordance with Rule 89 of the Rules of Procedure.

A52/VRn page83

Dr. ARAFAT (Palestine):

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A52JVR/7 pag~84

objetivos trazados y que requieren una lucha sistemâtica y persistente para su disminuci6n. Otra perspectiva a tener presente es la de dar una mayor eficiencia al uso de los recursos de los organismos intemacionales, mediante el direccionamiento de un mayor porcentaje hacia el cambio efectivo de la situaci6n de las poblaciones meta, antes que en procedimientos burocrâticos. Existen muchos desafios. En el Paraguay, pais en vias de desarrollo con una pobreza creciente, se ha defmido una politica y planes que consideran a la salud como eje fundamental del desarrollo humano sostenible, para sustentar el desarrollo arm6nico del pais. Se han tenido progresos en la situaci6n de salud, pero se hace imperiosa la necesidad de mayores recursos extemos para sostener los avances. Se debe revisar la distribuci6n de los recursos de los programas de salud de los organismos de las Naciones Unidas, buscando mantener los recursos para aquellos paises que han logrado mejorar su situaci6n y no premiar la ineficiencia, dando mayores recursos derivados de los primeros para aquellos que no los han sabido utilizar eficazmente. La Politica Nacional de Salud del Paraguay tiene como fmalidad impulsar la reforma sanitaria mediante la reorganizaci6n de los servicios de salud, el fortalecimiento de la rectoria del Ministerio de Salud, el desarrollo del Sistema Nacional de Salud, la movilizaci6n y ejecuci6n de recursos financieros y de nuevos modelos de aseguramiento a la poblaci6n, la descentralizaci6n y el impulsa de los procesos de promoci6n a fm de aumentar la cobertura de los servicios, agua y saneamiento, y de controlar las principales enfermedades transmisibles y no transmisibles. Nuestro gran reto en salud es extender la cobertura de servicios a un tercio de nuestra poblaci6n, que no tiene acceso a una atenci6n en salud oportuna y de calidad. Por lo tanto, impulsaremos la aplicaci6n de la estrategia de atenci6n primaria que permita llegar a las comunidades con servicios y prograrnas, dando prioridad a la poblaci6n rural y a la de âreas marginales urbanas. La atenci6n al control y eliminaci6n de las principales enfermedades transmisibles y no transmisibles como el sarampi6n, tétanos neonatal, enfermedad de Chagas, rabia humana, dengue, paludismo, cancer del cuello uterino y marnas, asi como las enfermedades cardiovasculares, constituye una meta prioritaria Se harâ mediante el desarrollo de un sistema de vigilancia epidemiol6gica en el nivellocal, con participaci6n de la comunidad organizada, buscando detectar oportunamente los posibles brotes epidémicos e interviniendo râpidamente para controlar su propagaci6n. Impulsamos la reforma sanitaria para garantizar la sostenibilidad de las acciones de extension de cobertura y de control de enfermedades. Muchas gracias.

Mr S.U. Yusuf (Bangladesh), Vice-President, took the presidential chair. M. S.U. Yusuf (Bangladesh), Vice-Président, assume la présidence. The PRESIDENT: 1 continue with pleasure the discussion of item 3 of the agenda, and cali upon the delegate of Malaysia. Mr ALI MOHAMED RUSTAM (Malaysia): Mr President, distinguished delegates, ladies and gentlemen, 1 would first of alllike to congratulate the President and the officers of the Bureau on their election to these esteemed positions. The Malaysian delegation would also like to jo in other speakers in thanking and congratulating the Director-General on her enlightening report entitled "Looking ahead for WHO after a year of change". As we cross the threshold into the twenty-first century, a developing country like Malaysia will have to bear the burden of dealing with infectious diseases and chronic noncommunicable diseases like cancers, cardiovascular diseases, diabetes and tobacco-related ailments. In addition, we are faced with problems that accompany rapid industrialization, and conditions that come with an ageing population. W e need to look at the experiences of industrialized countries in responding to these challenges, and WHO will help to facilitate this. It is our fervent hope that the expansion and application of new knowledge about diseases and their control will reduce mortality, morbidity, and disability and enhance the quality of !ife throughout the entire !ife span. We wholeheartedly welcome the report's assertion of the need to invest in expanding the knowledge base, as this will provide tools for continued gains in the twenty-first century. However, while looking at the experiences of the developed countries as a reflection ofwhat we might face in the future, Malaysia will not forget the difficulties which we have ourse ives faced in the past. Therefore, we are firmly committed to sharing our experiences with other developing countries, especially in the field of health and how it relates to the process of development.

A52/VR/7

page85 It is aptly remarked in the Director-General's report that limits exist on what a government cao finance and on its capacity to deliver services. The government theo bas to establish its priorities so that the policies and strategies decided upon will ensure maximum benefit to the people within the limited resources available. Our Government bas also affirmed its advocacy ofhealth as a social responsibility and health was made an integral part of the national development process. If investment in health bas alleviated poverty, let us now find appropriate and effective strategies to save the same people from the clutch of diseases of affluence. We support the Tobacco Free Initiative that WHO is developing. The dedication of one chapter to this shows WHO's grave concern over the issue, and this is justifiable. Tobacco addiction will probably remain a major public health problem in the next decade. We agree that a global response and global commitment to its control is the answer to this growing menace. Within a country, tobacco control demands multisectoral involvement of both government and nongovernment bodies because the issues involved are complex and sensitive. It is noted that the fight against infectious diseases in the past bad successes and failures. The world has eradicated smallpox and is now almost succeeding in eradicating poliomyelitis, leprosy and measles. However the threats of other diseases like dengue haemorrhagic fever, malaria and cholera are still real. Initiatives like building on current efforts at the local, national, regional and global levels and sharing experiences with countries which have successfully eradicated malaria should be given due emphasis. The same strategy should be adopted for the control of other major infectious diseases. In this connection, as a concrete example of our beliefthat developing countries cao and should help one another, we are willing to share our experiences in the successful control of malaria. We also be lieve that the need to exert extra vigilance over new and emerging infectious diseases is warranted. In this regard, we are grateful to the rapid response of WHO to our cali for assistance during the recent outbreak of a new hendra-like virus in certain areas of Malaysia. The same gratitude goes to other countries that have also rendered invaluable assistance throughout the outbreak. In conclusion, we reiterate that we support WHO's efforts in reviewing the challenges in world health and in looking at their implications when recommending new approaches, priorities and work in the years to come.

Dr KRAG (Denmark): Mr President, ministers, Madarn Director-General, esteemed colleagues, ladies and gentlemen, after taking office in July last year, the Director-General of WHO, Dr Gro Harlem Brundtland, bas led this Organization into a process of profound change. This reform process is difficult and often painful, but it is necessary. Denmark supports and encourages the Director-General to continue to pursue her vision of a future WHO regaining its position as the lead agency in health in cooperation and dialogue with ail partners concerned. For this vision to come true, the process of change bas to maintain its inclusive character. This process is still ongoing; it will only be brought to full completion if ail parts of WHO are able to work towards one common goal. ln arder to do so, WHO has to develop into one fully unified and coherent entity with clear objectives and priorities. We, too, wish to see one WHO. Let me briefly comment on sorne very important issues which are currently being contemplated by a reformed WHO. Denmark fully supports the objective of a WHO working more effectively and supportive for, in and with countries. Denmark would like to see WHO become a more reliable and effective supporter of countries as they reform and restructure their health sectors. We agree that WHO should regain its place at the centre of the health sector development agenda and should become a more effective supporter of the development ofhealth systems. We are pleased that the Director-General yesterday announced that WHO is ready to join the United Nations Development Group and called for stronger interagency cooperation. Denmark welcomes the active participation of WHO in the process of the United Nations Development Assistance Framework and would like to see WHO fully engaged in the United Nations reform at country level. In 1998 Denmark contributed to the Health Renewal Fund in arder to support WHO's reform process. The success of WHO's continued efforts of reform and restructuring will play an important rote for the future Danish voluntary contributions. It is of crucial importance to maintain the focus of WHO on areas where the Organization bas its strength, knowledge, skills, comparative advantages and where its leading role is indisputable. The Director-General's summary underlines the important fact that many determinants of better health lie outside the health system itself. Health development is closely associated with achievements in other areas, especially social welfare, environment, housing, education, employment and working conditions. In these areas WHO must take into account responsibilities and capabilities of other partners. ln the social area, for example, it is evident that the health sector and the health professionals have an obligation to bring

A52/VR/7

page86

supportive evidence of the impact on health stemming from poverty, deprivation, loneliness, broken families, Jack of network, insecurity and other social problems. On the other band, WHO and the professionals in the field ofhealth should neither take the lead in, nor the responsibility for, solving social policy problems in our societies. Social policy bas its own legitimacy and needs no crutches. In fields like these, outside the health sector itself, WHO intends to serve as active and informed advocates ofhealthfriendly policies. Denmark warmly supports this balanced approach that will indeed consolidate the supportive and collaborating attitude of the Organization, building and concentrating on basics in the field ofhealth. Dr PIA TKIEWICZ (Po land): Mr President, distinguished delegates, ladies and gentlemen, allow me first of ali, on behalf of the delegation of Poland and myself, ta congratulate ali our colleagues who have been elected ta the highest offices of the Fifty-second World Health Assembly, and particularly to Madam Maria de Belém Roseira, the President of the Assembly. Allow me also to extend our congratulations to Dr Brundtland and ber staff for the concise but comprehensive report, The world health report 1999, as weil as ber presentation on "Looking ahead for WHO after a year of change". As we are ali aware, many Member States ali over the world are engaged more or Jess intensively in the process of the reform of their health care systems, trying to respond to the growing expectations and demands oftheir population, as weil asto the growing financial constraints in health expenditure. The same applies to WHO, where the process of the reform was also initiated several years ago and was subjected ta severe financial constraints. In Po land we have also decided to accelerate the pace of reform and this year we have introduced a new system ofhealth care financing based on health insurance and with elements of a market for providers. W e welcome and commend Dr Brundtland' s initiative on "making a difference" as indicated clearly in the subtitle of The world health report 1999. We agree that the health problems we Member States and WHO are facing today, and the challenges we will face tomorrow, are enormous, and therefore we ali need ta focus on priorities. We welcome the Roll Back Malaria project and the Tobacco Free Initiative as major representative elements of the double burden of disease. But the spectrum ofhealth care is very wide and accepting priorities we are ali obliged ta continue our everyday efforts. This spectrum starts with: (a) pure public goods, for example immunization and other preventive care, health promotion, food handling, sanitation, communicable diseases control, school health and many other public health functions; (b) diseases due to lifestyles and unhealthy behaviour or special risks which, in addition to smoking, include alcohol or drug abuse, pollution of ali kinds, injuries and accidents; (c) sociomedical care ofthe elderly and chronically ill, as we remember for this year especially; ( d) diseases in the realm of statistical certainties like th ose related ta age, gender or poverty; (e) ali other diseases that happen throughout the who le life of each individual, and may be called chance occurrences. This wide spectrum ofhealth care services indicates clearly that public health functions play an important part in the provision ofhealth care and that health professionals, in determining their current and future obligations, have to consider striking a balance between individual and community health care and between curative and preventive, promotive and restorative care. The importance of appropriate utilization of available resources as the main issue in health care delivery is full y recognized, and we are aware that even with the most effective utilization of resources not ali things can be publicly financed. But we are also aware that pressures on public resources ta address problems of illness and to support the provision of public health services will not diminish. This is why we look forward ta WHO leadership and guidance. Dr MUBARAK (Iraq):

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Le Professeur RA TSIMBAZAFIMAHEF A (Madagascar) : Monsieur le Président de séance, Mesdames et Messieurs les délégués, Madame le Directeur général, Mesdames et Messieurs, c'est pour moi un grand honneur de prendre la parole au nom des Ministres de la Santé des pays suivants: Bénin, Burkina Faso, Cameroun, Congo, Côte d'Ivoire, Gabon, Guinée, Mali, Mauritanie, Niger, République centrafricaine, Sénégal, Tchad, Togo et Madagascar. Monsieur le Président de séance, permettez-moi tout d'abord de féliciter le Président pour son élection à la tête de la présente Assemblée, ainsi que le Directeur général pour le début du processus de changement au sein de l'Organisation ces dix derniers mois. Nous avons pris connaissance avec intérêt du contenu du rapport annuel 1999 sur la santé dans le monde. Il en ressort que des progrès réels ont été accomplis dans l'amélioration des conditions sanitaires des citoyens de la planète.

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Nous voulons cependant insister sur les défis qui nous attendent pour un réel changement, dans l'espoir qu'ensemble nous pourrons trouver les solutions qui nous permettront non seulement de consolider les succès acquis, mais aussi de définir des stratégies pour promouvoir la santé des populations de nos pays. Comme il est dit dans le Rapport sur la santé dans le monde 1999, on assiste à la résurgence de certaines affections et à la progression des maladies non transmissibles, au nombre desquelles les maladies cardio-vasculaires, les troubles mentaux et les pathologies liées au phénomène naturel du vieillissement. En effet, pendant les dix dernières années, nos pays ont connu, chaque année, des épidémies de maladies transmissibles émergentes ou réémergentes. Pendant ce temps, l'appui des partenaires au développement a permis d'amoindrir les conséquences néfastes de ces situations urgentes, créées notamment par la méningite cérébro-spinale, la rougeole, le choléra, la fièvre hémorragique à virus Ebola, la fièvre de Marburg, la fièvre jaune et le VIHISIDA. La coopération sanitaire internationale devrait donc continuer à se développer. Pour ce faire, il apparaît nécessaire de formaliser davantage les procédures d'intervention de manière à systématiser le réflexe de riposte efficace à ces épidémies, parce que la maladie ne connaît pas de frontières. Cette coopération doit mettre particulièrement l'accent sur le VIHISIDA. En ce qui concerne le développement cohérent des systèmes de santé, il est essentiel d'optimiser les interventions. Cette optimisation nécessite un réel changement dans la manière de procéder. Ainsi, il sera certainement judicieux- le Directeur général l'a bien souligné -de mettre l'accent sur un nombre limité d'interventions facilitant du coup la possibilité d'obtenir un impact réel et observable sur le développement sanitaire des pays. Je voudrais énumérer quelques-unes de ces mesures : la réduction de la charge de morbidité et de la mortalité subséquente, la mobilisation des moyens de lutte efficace contre les menaces potentielles, la mise au point d'un système garantissant l'équité dans l'accès aux soins de qualité pour donner à chacun selon ses besoins, et une exploitation judicieuse des connaissances acquises dans les domaines de la santé et de la science. Dans cet esprit, l'OMS doit assurer son rôle de leadership en encourageant une utilisation rationnelle des ressources au lieu d'un emploi par programme, comme c'est le cas maintenant, ce qui a limité les initiatives novatrices de nos pays. La plus grande autonomie prônée par le Directeur général devra s'accompagner d'une plus grande possibilité de négociation dans la planification et l'emploi des ressources pour la santé. En fin de compte, une plus grande exigence quant aux résultats à atteindre sera de rigueur. Le projet Faire reculer le paludisme donne une occasion concrète de développer cette nouvelle approche par des initiatives de proximité dans la promotion de la santé au bénéfice des plus nécessiteux. Ainsi, nous souhaitons que l'Afrique, qui a déjà lancé son initiative adoptée par les chefs d'Etat et de gouvernement du continent, puisse avoir un programme directement géré par la Région africaine elle-même en termes de moyens matériels et humains et de stratégies, à l'exemple des programmes de lutte en cours contre l'onchocercose et la dracunculose, avec l'aide de la communauté internationale. La lutte contre le tabagisme est incontestablement un des grands défis à relever. En 1996 est entrée en vigueur une résolution de l'Assemblée mondiale de la Santé préconisant que tous les vols aériens soient des espaces non fumeurs. Il nous semble que ce résultat soit encore loin d'être acquis du fait des profits réalisés par le commerce du tabac et de son effet pervers, qui est la "contribution effective" mobilisée par l'industrie du tabac en faveur de la "promotion du sport". Nos gouvernements apporteront le soutien politique nécessaire à cette lutte, qui sera certainement longue et peut-être plus difficile que celle contre les maladies infectieuses. Le changement dans la gestion de l'OMS doit également se traduire par l'équité et la responsabilisation des personnels cadres de l'Afrique. Un accent particulier doit être mis sur leur développement adéquat. Sur ce plan, nous demandons que le Directeur général fasse un plaidoyer auprès des autres partenaires pour soutenir nos plans de formation. Par ailleurs, il faut une équité accrue dans la mise à disposition simultanée des documents dans toutes les langues de travail de notre Organisation et la traduction simultanée s'impose dans toutes les conférences où au moins deux langues statutaires sont représentées. Enfin, la nouvelle réforme de l'Organisation doit permettre une répartition équitable des ressources financières basée sur les besoins réels des pays de notre Région, pour qu'ensemble nous puissions apporter les changements souhaités. Dr SONIN (Mongolia): At the outset, allow me to congratulate the President and Vice-Presidents on their election to those high offices of the Health Assembly. We are speaking here today, almost at the end of the twentieth century which was the original deadline for achieving our strategie goal: health for ali. In these particular circumstances, 1 am pleased to

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acknowledge that the world health status has improved in general, and that significant progress and achievements in the health of the population have occurred in my country. However, we still have sorne health concerns, and many governments like my own are facing new challenges in health care and are making an effort to respond to them effectively within limited resources. It seems to me that health care reform, which may be described as a process of planned and systematic change to attain well-defmed health goals, encompasses common health development features in the different countries. Reform has many objectives, such as improved quality of services, equitable access, consumer satisfaction and financial sustainability. We need to analyse the effects ofreform to assess these changes. 1 think that it is now the time in many countries to look beyond illness and disease to wellness and positive health, and to focus on the responsibility of individuals for the ir own health and the health of the community. The Government ofMongolia is strongly committed to providing equitable and good quality health servicès to ali citizens and it is weil reflected in the national health policy, pursued during the economie and social reform process over the past several years. Our national health policy provides a vision for comprehensive health reform by defining the following four main policy directions: first, a new philosophy for health system development based on preventive rather than curative medicine; secondly, wide community participation and involvement of individuals and families in improving their health status, as weil as improved intersectoral collaboration; thirdly, decentralization and improved health services management targeted at better effectiveness and economie sustainability of the health system; finally, equity in the provision of health services by defining responsibilities at ali levels, and by strengthening financial information systems to improve accountability. We ali know that given the right circumstances, people have the potential to make long-term differences in their health. Therefore, it is our role to provide support in achieving this by creating favourable conditions and the right environrnent and by promoting preventive health measures and health education. In this regard, the Government ofMongolia wishes to thank WHO for the valuable support and assistance it has given in the past within a new framework of health development and the WHO global agenda. 1 am pleased to note that our technical collaboration and emphasis are gradually shifting from a disease-centred approach to public and preventive health, while maintaining effectively and adequately a health service delivery system, through rationing the health structure and facilities and training health personnel. 1 hope that this Fifty-second World Health Assembly will focus on the present health challenges and that WHO will collaborate intensively with the Member States in the areas that are relevant to the needs of the twenty-first century. Finally, 1 would like to inform you that the Government ofMongolia highly values and recognizes the vital importance of the Director-General's policy address at the last Executive Board session and ofher efforts to reorganize the structures and functions of WHO to improve communication and transparency. We also appreciate the changes that support her policies at regional and country levels, as illustrated by the Regional Director's policy directions for the WHO Western Pacifie Region. 1 wish them ali success. Le ProfesseurCIOCALTEU (Roumanie): Monsieur le Président, Madame la Directrice générale, chers confrères, Mesdames et Messieurs, c'est un grand honneur pour moi et pour la délégation de la Roumanie de transmettre mes sincères félicitations et souhaits de succès à Mme Maria de Belém Roseira pour son élection à la présidence de la Cinquante-Deuxième Assemblée mondiale de la Santé, fonction qui implique une grande responsabilité. De même, je félicite les distingués Vice-Présidents de l'Assemblée et les Présidents des deux commissions, tout en exprimant ma conviction que, sous leur direction compétente, les travaux de notre réunion déboucheront sur des résultats bénéfiques pour l'état de la santé dans le monde. Je voudrais également remercier le Dr Gro Harlem Brundtland, Directrice générale de l'OMS, et son équipe de leur immense effort pour organiser dans de très bonnes conditions la présente Assemblée, qui nous offre un cadre propice à d'amples débats sur des thèmes spécifiques. J'aimerais commencer par une citation de Rainer Maria Rilke, un poète qui rn' est très cher : "Heure, tu t'éloignes de moi, ton battement d'ailes me déchire. Seul : que faire de ma voix ? de ma nuit ? de mon jour ?" Ce que je voulais dire par là, c'est que l'amélioration de 1' état de santé, en Roumanie comme partout, n'est possible que si vous, les Etats Membres de l'Organisation mondiale de la Santé, restez près de nous. Restons ensemble pour le bien-être commun, pour la santé de nos frères du monde entier. On ne peut pas réussir tout seul. Dieu n'est qu'un, quelle que soit la façon dont nous nous représentons son image ou la langue dont nos prières se servent.

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La récente visite en Roumanie du Saint-Père, qui nous a rappelé toutes ces choses, est une preuve -s'il en était encore besoin - de notre ouverture aux valeurs occidentales, au bien, au beau, à la vérité, à Dieu. Nous sommes égaux devant Dieu, soyons-le devant la souffrance et la maladie ! C'est pour cela que je pense, chers confrères, que nous aurions besoin d'un code déontologique médical international, initiative que l'OMS pourrait coordonner. La délégation de la Roumanie apprécie hautement le rapport présenté par le Dr Brundtland, qui a fait une profonde analyse de la situation particulière où l'on se trouve à présent, c'est-à-dire où, dans presque tous les Etats Membres, se produisent des changements du système de santé. Des changements se produisent, d'ailleurs, à l'intérieur de l'Organisation elle-même - des changements positifs -,et je tiens à exprimer une fois de plus l'appui de la Roumanie à la réforme dont 1' initiative revient à Mme la Directrice générale. Les efforts de l'OMS pour améliorer l'état de santé sont appréciés dans notre pays aussi; ils se traduisent tant par des actions de caractère général que par des activités visant à la solution des problèmes prioritaires. Ainsi, la réforme du système de santé en Roumanie, en cours d'application, suit les principes que le rapport a mentionnés. Il est méritoire que notre Organisation ait saisi l'importance du moment et que, par son adaptation, elle contribue à l'amélioration de la santé dans le monde entier. C'est pour cela que les quatre thèmes de la stratégie collective proposée sont réalistes et qu'ils vont marquer les actions que nous menons tous. La nouvelle doctrine de "l'universalisme" mentionnée dans le rapport est favorable à la diversité et à l'implication du secteur privé dans la fourniture de médicaments et de matériels aux prestataires de services. Cette doctrine présente aussi un intérêt particulier pour notre pays en transition, transition économique qui nous fait ressentir plus que jamais la nécessité d'une bonne utilisation des ressources limitées dont nous disposons. A propos des ressources, nous tenons aussi compte de l'expérience nécessaire pour réaliser et gérer convenablement des programmes de santé; l'assistance de l'OMS nous est très utile. L'approche plus stratégique des activités dans les pays et avec eux se retrouve aussi dans le programme de coopération à moyen terme entre la Roumanie et le Bureau régional OMS de l'Europe, qui représente, lui aussi, un cadre de référence pour nos priorités. On peut dire que les réseaux thématiques organisés par l'OMS nous donnent la possibilité de participer activement au modelage des stratégies sanitaires nationales, et surtout régionales. Tout récemment, nous avons élaboré des programmes concernant, entre autres, la tuberculose, le cancer, la mortalité infantile et la promotion de la santé. Nous venons aussi d'élaborer une stratégie antitabac, qui -nous l'espérons -produira un impact; elle insiste surtout sur l'interdiction de la publicité et de toute forme de promotion du tabac, mesure qui semblait impossible il y a quelques années. La réforme et ·les programmes de santé ont été récemment évalués, remaniés et renforcés conformément à la nouvelle loi relative à la santé publique. Nous avons aussi établi un programme national intersectoriel de lutte contre l'infection à VIH et le SIDA, programme qui, de concert avec d'autres mesures spécifiques, a conduit à la disparition des contaminations nosocomiales, comme celles qui ont déclenché l'accident épidémiologique des années 1988-1989. Comme je l'ai déjà dit, dans tous les domaines où nous sommes intervenus pour améliorer la santé de la population, nous avons reçu l'assistance technique et l'appui de l'OMS. De cette manière, le rôle important et l'utilité de notre Organisation ont été démontrés une fois de plus. En écoutant le rapport de la Directrice générale, nous nous sommes rappelé beaucoup de points qu'elle avait discutés avec les hommes politiques de Roumanie, et je me rends compte que maints problèmes qui se posent à nous vont trouver une solution dans les futurs programmes de l'OMS. Ces problèmes auxquels la Roumanie doit faire face n'ont pas de caractère spécifique ou singulier; ils ne correspondent pas à des situations isolées. On peut les retrouver, d'une manière ou d'une autre, dans plusieurs pays ou Régions, et c'est pour cette raison que je dois aussi souligner le rôle positif que le Bureau régional de l'Europe a joué et continue à jouer. Dans ce contexte, je pense que le développement de la collaboration entre deux ou plusieurs Etats Membres serait une source commune d'avantages, où l'on peut puiser des solutions adaptées aux besoins de chacun. Au nom du Gouvernement de la Roumanie, j'exprime le désir et la volonté de notre pays de participer à de tels programmes et d'apporter son concours pour que les moyens les plus efficaces de résoudre les problèmes de santé soient trouvés. Nous voyons dans la santé l'expression de l'un des droits de l'homme et un élément fondamental pour bâtir une société civile, aussi lui accordons-nous une attention particulière. Et, en pensant à ce qui se passe maintenant sur ce continent, pas tellement loin de nous, je voudrais ajouter ces quelques mots, toujours de Rilke :

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"Qu'est-ce donc qui nous empêche de croire (puisque ainsi nous sommes posés et éparpillés) que haine et misère et tout ce dont nous sommes la proie n'ont en nous qu'une demeure temporaire ?" El Dr. BUSTOS ALONSO (Uruguay): Es un honor dirigirme a esta 528 Asamblea Mundial de la Salud, en el marco del Informe sobre la salud en el munda 1999. Quiero felicitar en primer término a la sefiora Directora General por este informe, donde no s6lo se abordan los ternas desde una perspectiva sanitaria y técnica, sino que también estân contemplados los aspectas humanos. Como el informe lo indica, las circunstancias en el mundo han cambiado los ultimos anos y lo seguiran hacienda. Por lo tanto debemos abordar los problemas del crecimiento con equidad a largo plazo. Debemos conciliar la eficacia de la economia con la politica social. Los problemas sociales estân en nuestras agendas de trabajo, pero debemos sumar cada dia mas gente que comprenda que si no tenemos la capacidad de hacer frente a los aspectas sociales, si no contamos con planes de largo aliento, si no contamos con instituciones s6lidas, sera dificil asegurar un desarrollo sostenible y equitativo. En mi pais bernos completado la transici6n epidemiol6gica y demogrâfica. Unos de nuestros principales problemas son hoy en dia las enfermedades cardiovasculares. El consuma de tabaco es alto. Hay aproximadamente 4800 muertes prematuras por ano. Preocupados por esto, el ano pasado decidimos realizar una encuesta nacional sobre consuma de tabaco. Un uruguayo de cada cinco fuma. Uno de cada tres es hombre. Uno de cada siete es mujer. Los hombres que mas fuman tienen instrucci6n basica, pero en las mujeres, contrariamente, son las de instrucci6n superior las afectadas. Conocida la realidad, el Gobierno, a través del Ministerio de Salud Publica, ha preparado un proyecto de ley actualmente en el Parlamento que, entre otras cosas, prohibe vender tabaco a los menores de 18 anos, regula la publicidad, reserva lugares para fumadores en espacios cerrados, etc. No obstante, mientras aguardamos la aprobaci6n de esta ley, el poder ejecutivo ha puesto en vigencia dos decretas: uno vinculado a la prohibici6n de fumar en las oficinas publicas, y otro al etiquetado de los envases de tabaco en el cual debe lucir que fumar es perjudicial para la salud. Otro tema que nos preocupa, y mucho, es el VIH/SIDA. Con la promoci6n de medidas preventivas y con la aplicaci6n del triple plan, hemos logrado detener el crecimiento y mejorado la sobrevida de los pacientes con SIDA. Asi como también, tratando a la mujer embarazada, reducir la infestaci6n vertical. A pesar de ser un pais con un porcentaje de producto bruto interna destinado a la salud relativamente alto como es 10%, en el ano 1985 la mortalidad infantil era de 30,4 por 1000. Que era inaceptable para esa cifra de inversion. Con el fortalecimiento en el sector publico de la estrategia de atenci6n primaria de salud enfocada a la mejora de la calidad de la atenci6n prenatal en el nivel adecuado, el tratamiento precoz de las infecciones respiratorias agudas, la promoci6n de la lactancia natural, la mortalidad infantil hoy ha descendido a 16 por 1000. Registramos un nivel de cobertura de inmunizaciones que puede defmirse como muy bueno: vacunaci6n gratuita contra tuberculosis, poliomielitis, meningitis por Haemophilus injluenzae tipo B, triple viral, difteria, y tétanos. Hace cuatro anos agregamos la vacuna contra la gripe, a la que se anadi6 este ano también la vacuna contra la cepa Sydney. Hemos podido cubrir en este otofio a mas del 70% de nuestros mayores de 65 anos. Es un pais libre de c6lera, también libre de transmisi6n de paludismo, aunque se registran peri6dicamente casos importados en personas que viajan al exterior, como los contingentes militares en misiones de paz, los cuales estân siendo tratados. Pero también tenemos un alto indice de accidentes, especialmente de trânsito, un alto porcentaje de patologias tumorales que traen aparejados altos costos, con decisiones y procedimientos que no son eficientes. Sefior Presidente, nos comprometemos a continuar trabajando para contribuir a visualizar y mejorar este lado de la sociedad para, desde una perspectiva global, poder ofrecer a nuestros nifios un mundo mas deseado y justo: un mundo donde se reduzca la pobreza y la desigualdad. Muchas gracias. Le Dr RWABUHIHI (Rwanda) : Monsieur le Président de séance, Madame le Directeur général de l'OMS, Mesdames et Messieurs les Ministres, chers collègues, distingués délégués, Mesdames et Messieurs, c'est un grand privilège pour moi de prendre la parole ici pour remercier la grande famille de l'OMS et ses autorités pour leurs efforts dans la lutte pour la santé de l'humanité, pour leurs efforts dans la lutte pour la vie. Il y a seulement cinq ans, mon pays, le Rwanda, a vécu la forme la plus extrême de négation de la vie, de négation de la santé: le génocide. Ce qui est déplorable, c'est que la communauté internationale n'a

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pas voulu s'opposer au génocide rwandais alors qu'elle en avait les moyens, tous les moyens. Aujourd'hui, le Rwanda est confronté aux innombrables conséquences de cette tragédie : la reconstruction d'un pays et d'une économie anéantis, la protection de la sécurité des populations contre les idéologues du génocide, la réhabilitation des rescapés, la restauration de la justice indispensable pour la réconciliation nationale. Sans être exhaustif, voici le tableau exceptionnel de la situation dans laquelle nous devons en plus affronter les défis que vous avez évoqués, Madame le Directeur général, et que nos services de santé doivent aussi affronter. Ce contexte exceptionnel a été pour nous l'opportunité de réformer notre système de santé dans le sens de la décentralisation, avec quatre orientations prioritaires : améliorer la qualité des soins de santé, renforcer et organiser la participation de la communauté, assurer l'accessibilité géographique et financière des services de santé, et consolider l'organisation et la gestion des services et de nos maigres ressources. Nous disons modestement "orientations prioritaires", car il est particulièrement difficile pour nous de définir des priorités là où tout, absolument tout, est prioritaire. Pour ce qui concerne les programmes spécifiques, il faut saluer le projet Faire reculer le paludisme, car il est très ambitieux, vu le poids de cette maladie. Mais il faut reconnaître aussi la sagesse de ce projet : en effet, il s'agit seulement de faire reculer le paludisme et non de l'éradiquer, comme on a pu le prétendre dans les années 60. Cette sagesse est sûrement un gage de bons résultats à venir. Quant au SIDA, je dois dire que j'ai été surpris d'entendre des délégués dire avec une certaine fierté que, chez eux, cette maladie n'est pas un gros problème de santé publique. J'ai même eu un peu peur, car nous sommes presque tous passés par là. Au Rwanda, le SIDA a bien sûr profité de la guerre, du génocide et des inoubliables déplacements de plus de 7 millions de personnes, sans dire que les programmes de prévention ont été interrompus pendant plus d'un an. Le taux de séroprévalence est passé en quatre ans de 2 à 11% dans les campagnes rwandaises. Devant l'immensité du problème, nous ne pouvons pas grand-chose tout seuls. C'est pour cela qu'avec les Ministres des pays de la région des Grands Lacs, une initiative heureuse vient d'être lancée : GLIAA (Great Lakes Initiative against AIDS), dont la première action, déjà commencée, est la surveillance et la prévention du SIDA le long des grands axes routiers transfrontaliers entre les grands ports et les différentes localités de cette région. Devant l'énormité des problèmes à affronter, la faiblesse de nos moyens propres, le fardeau de la dette extérieure dont une partie a servi à acheter les armes du génocide, les bailleurs de fonds ont tendance à se décourager et ils nous disent: "On ne peut pas vous aider ad infinitum". Le génocide est un crime contre l'humanité, toute l'humanité, votre humanité aussi. Il ne s'agit pas d'aider le Rwanda, mais il faut avec nous réparer le tort qui vous a été fait en tant qu'humanité. Il ne s'agit pas d'une question de générosité, mais d'un problème moral pour que le Rwanda accède au même niveau que beaucoup d'autres pays dans la lutte contre la maladie, dans la lutte pour la vie, dans la lutte pour la santé. Le Dr MARQUES DE LIMA (Sao Tomé-et-Principe): Monsieur le Président, Madame le Directeur général, illustres délégués, Mesdames et Messieurs, au nom de la délégation de Sao Tomé-et-Principe et en mon nom personnel, permettez-moi de féliciter Mme Maria de Belém Roseira pour son élection à la présidence de cette Cinquante-Deuxième Assemblée mondiale de la Santé. Je suis sûr et certain que, menés sous sa compétente direction, les travaux de cette Assemblée seront couronnés de succès. Je ne peux pas omettre de féliciter et de remercier Mme le Directeur général pour l'excellent rapport qu'elle nous a présenté sur la situation de la santé dans le monde en 1999. Ce rapport met en relief les progrès considérables accomplis dans le domaine de la santé au cours du xx• siècle, progrès qui constituent un motif d'espérance pour le XXI• siècle qui est à notre porte. Nous avons réussi à éradiquer l'une des maladies les plus mortelles de l'humanité, la variole; certaines maladies infectieuses sembleraient être sous contrôle; nous avons réalisé des avancées notables dans l'amélioration de l'espérance de vie, notamment dans les pays en développement. Mais le rapport nous montre aussi des éléments qui doivent constituer de sérieux motifs d'inquiétude pour l'OMS et les pays Membres. Permettez-moi de m'arrêter sur trois de ces éléments. Le premier est le paludisme, qui continue à imposer aux populations un lourd fardeau de morts et de souffrances. Son retentissement négatif sur le développement socio-économique des pays les plus touchés est bien connu. Il est important de souligner ici que la majorité, si ce n'est la totalité, d'entre eux sont des pays en développement pour acquérir la notion de la relation intrinsèque entre cette maladie et le sous-développement et pour avoir conscience qu'il n'y a pas de raison plus pressante que celle-là pour que la lutte contre le paludisme soit adoptée comme la priorité des priorités. Nous avons à notre disposition des connaissances, des moyens et des techniques pour faire face de façon satisfaisante à cette calamité. Il devient nécessaire d'agir avec détermination de sorte que ces connaissances, ces moyens et ces techniques

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soient mis à la disposition des populations les plus nécessiteuses. Au nom du Gouvernement de Sao Tomé-et-Principe, il me plairait de manifester ici notre total engagement dans l'initiative Faire reculer le paludisme, lancée par le Directeur général de l'OMS. Le deuxième est l'épidémie d'infection à VIH/SIDA qui poursuit son action dévastatrice, particulièrement en Afrique où le nombre de personnes séropositives et de malades ne cesse d'augmenter. Tandis que des efforts sont déployés pour produire des vaccins qui soient efficaces contre la maladie, nous devons explorer au maximum les possibilités offertes par l'information et l'éducation pour la santé dans le changement d'attitudes et de comportements à risque qui facilitent sa dissémination si nous ne voulons pas compromettre de façon irréversible le processus de développement économique et social du continent. Le troisième découle de la détérioration de la situation économique et son corollaire, l'augmentation de la pauvreté, problème vraiment préoccupant dans beaucoup de pays. Nous savons que la pauvreté est en même temps génératrice et conséquence du mauvais état de santé des populations, et nous sommes d'avis qu'investir dans la santé des populations les plus pauvres et défavorisées est un des principaux moyens pour atténuer la pauvreté. L'instabilité politique et la prolifération des conflits régionaux conduisant à la déstabilisation profonde des sociétés et des pays où ils ont lieu constituent aussi des éléments pertubateurs qui, s'ils n'étaient pas jugulés, compromettraient gravement tout l'effort à venir pour améliorer la santé dans le monde. D'où notre idée que le plaidoyer pour la paix devrait aussi être une des actions de l'OMS devant les instances internationales. Monsieur le Président, rendre possible l'accès à des soins de santé de qualité à toute la population, et particulièrement aux groupes les plus vulnérables, de façon à garantir l'équité dans la prestation des services est un propos qui doit être poursuivi et qui devra nécessairement impliquer notre questionnement sur la manière dont nous gérons nos systèmes de santé. La réforme du secteur sanitaire est indispensable et urgente. Il s'agit d'une action qui doit être dynamisée fondamentalement par les pays eux-mêmes et qui comptera, nous n'en doutons pas, avec tout l'appui de l'OMS. Dr MANANDHAR (Nepal): Mr President, your excellencies, ministers of health, Director-General, participants in the World Health Assembly and distinguished guests, I fee! honoured to have this excellent opportunity to address this auspicious gathering, a gathering of very distinguished and learned delegates from Member co untries of the World Health Organization. I am also happy, because this happens to be the Fifty-second World Health Assembly, the last Assembly of the millennium. My country, the Kingdom ofNepal, is proud to be a Member of this noble and credible Organization. Nepal became a Member of WHO in 1953. The WHO country office was established in Nepal in 1954 and works closely with the Govemment ofNepal to implement and strengthen the national health programme. Nepal initiated the expansion of her basic health services during the early 1970s. The Alma-Ata Conference on primary health care provided added impetus. The Government ofNepal also started the integration ofthe basic minimum needs programme with that ofhealth. In brief, WHO's aims ofhealth for ali by the year 2000 is implemented in the true sense as an integral part of total human development. Our national health policy aims at addressing the priority health problems of the people through the expansion of primary health care facilities, bringing about balanced human development, balanced population growth, poverty alleviation and an equitable distribution of socioeconomic benefits to the people. I am happy to say that in achieving our goals and objectives, N epal has the full support of WHO. The Government ofNepal appreciates very much the work of WHO and would like to offer our wholehearted thanks. As we enter the new millennium, let us take a glanee at the past to see what successes we have achieved and what failures we have encountered. Let us look into a new horizon, a new hope for the future. As one of the !east developed countries in the world, Nepal could make sorne progress in the provision of basic health care for her people. The areas of improvement are: in the prevention and control of communicable diseases; in reproductive health care; in the nutritional status of the people; and in other health conditions in general. We participated in the global poliomyelitis eradication campaign, organizing national immunization days with broad participation of the people and nongovernmental organizations. Being a signatory to resolution WHA44.9 and the Regional Committee resolution, Nepal also participated in the attainment of the goal of elimination of leprosy as a public health problem. The leprosy elimination campaign was successfully implemented in 27 districts of the country. However, challenges for the future are still immense. First, our health systems, as weil as infrastructure required for the effective delivery of health services within the country, need to be strengthened. Secondly, as a consequence of economie structural adjustrnent programmes, the country bas

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to struggle to fulfill the growing demand in an efficient manner. These reform processes are marred by the growing costs of health services. The everyday increasing need for health care, availability of new technologies in treatrnents and rising public expectations all exert financial pressures on the government. Therefore, it is urgently required that we review our total health needs, the resources available and plan accordingly. The maternai mortality, child mortality and in general the mortality and morbidity among the poor is quite high, particularly because of tuberculosis and other communicable diseases. There is stiJl an immense need in investrnent in the reduction of maternai mortality. Malaria is emerging as a more serious threat to our socioeconomic development, particularly in the Terai and other low altitude areas. Nepal is AIDS, although its multiple effects have so far been minimal. not spared with the global problem of HIV1 The potential impact of emerging and new diseases in Nepal can be quite damaging, particularly for the economie development of the country, as it is weil known that Nepal is one of the tourist destinations of the world. Risky behaviour and unhealthy environments pose great threats to our people, and even worldwide. Tobacco use is widespread, not only among men but also among women and children, among the population of the cities and urban areas, in villages and even in remote billy areas. We have already introduced measures to curb the use of tobacco by implementing the banning of advertisements of tobacco and tobacco-related products in all the electronic media of the country. Taking into consideration the challenges and the limited resources available, priority setting is a must. The Government cannot provide everything and to everybody. Thus, although it is accountable for the health of its people, partnerships and alliances with other players in health care, such as the private sector, community organizations and other social organizations, will have to be encouraged. We also require support from international agencies in this regard. We realize that the present day global economie and political situation also directly influences us, particularly in health care development, intersectoral coordination, and formulation and implementation of overall plan and policies. May 1 be allowed to conclude with the remark that WHO has shown itselfto be a very reliable source of high quality advice and support. 1 hope that such support will continue in the days ahead, assisting and enabling us to provide better health services to our people, placing health at the centre of the national development agenda. We believe that together we can make a difference. Together we have to make sure that hope will predominate over uncertainty in centuries to come. Last, 1 wish the Director-General success in "making a difference" and in the changes in WHO. Mr NUAMAH DONKOR (Ghana): Mr President, Vice Presidents, Director-General, distinguished delegates, on behalt:ofthe Assembly ofHealth Ministers of the West A:frican Health Community (WAHC), 1 wish to congratulate the President and Vice-Presidents on their election to office and also the Director-General and her staff on a comprehensive report and for steering this great Organization successfully in the past 10 months. lt has been a :fruitful year of reorganization and restructuring of the Organization to make it more responsive and relevant to the expectations of all peoples globally. The effect of the Director-General's transformation of our Organization has had a far-reaching impact, particularly as regional offices have responded to the change. ln-country programmes in the Member countries of W AHC are beginning to respond to the felt needs of their countries. With increased decentralization of authority, programme implementation has taken a positive turn. Member countries of the West A:frican Health Community continue to respond positively to the call to "roll back malaria" in the West African subregion as a highly commendable initiative of WHO, and have been participating actively in the development of strategie plans initiated by the WHO Regional Office for Africa. lt is our intention to cooperate fully with WHO in putting into place well-designed and resultoriented strategies to ensure that we really "roll back malaria". The effects of malaria on the economies and development programmes of our countries are enormous, as will be further revealed by the studies now under way in sorne of our countries to quantifY and document the negative effects of malaria on the social and economie development of our peoples. The subregion has made remarkable progress in surveillance and epidemie control, particularly in averting epidemies of cerebrospinal meningitis and yellow fever. The main challenge is to continue to maintain alertness over time, even when epidemies do not occur. Subregional and intersectoral collaboration are needed to prevent epidemies, as cross-border problems can undermine country levet efforts. The AIDS scourge is still with us in the West A:frican subregion, though programmes are being implemented to stem the tide, using an intersectoral and multidisciplinary approach. Steps are being taken AIDS, especially amongst youths, using appropriate health to increase the levet of awareness of HIV1 education and social mobilization strategies. We are currently witnessing a resurgence oftuberculosis due

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to a number of interrelated factors, such as political strife and its negative effect on the health sector, an increase in HIV/AIDS cases, and malnutrition and poverty. We welcome the interest being shown in tuberculosis in the subregion by sorne of our development partners and acknowledge the accompanying funding being made available for research. The emphasis on local input and involvement is welcomed, as we do have the relevant manpower and expertise to undertake the required research. Prevention of communicable diseases continues to be our concem as we intensify immunization programmes in a bid to ultimately eradicate diseases such as measles, poliomyelitis, neonatal tetanus, whooping cough and diphtheria. The resurgence ofmeasles in sorne of our countries needs to be studied and controlled. The potency and effective duration of the vaccines need to be appraised and immunization programmes generally strengthened. The gains of the WHO Onchocerciasis Control Programme in the West African subregion are being felt in our countries. We congratulate WHO and our other development partners for successfully implementing a programme that will impact positively on the lives of generations to come. It is our hope that the current success will be sustained. Buruli ulcer seems to be appearing over an ever increasing geographical area in the subregion. Epidemiological mapping, treatment facilities and research are important elements of the response that is required. Whilst gender issues continue to take centre stage in our health sector reforms, human resource development, improved access and quality ofhealth services and involvement of the private sector in health matters are equally being addressed. An appropriate balance between private and public sector involvement must be achieved in order to decrease the huge financial burden of the health sector on the strained economies of our countries. The debt burden of our countries dictates that we look for alternative strategies to finance our health care programmes. Donor response to our health programmes, with its danger of overdependence and risk of unsustainability, is reaching saturation point, and we are therefore being challenged to look inwards to finance the health sector. What we need is supportive collaboration by donor and technical aid agencies, with WHO taking the lead in fostering the right kind of collaborative support. We are equally aware of the flight of ali categories of health professional from the subregion, particularly from the countries just emerging from war, to the developed countries. Unless this haemorrhage ofhealth professionals is addressed the health sector reforms, which must be built on solid human capital, will be meaningless. We are also aware of the serious neglect of hospital and hospital services, and the consequences to the health delivery system. Though an expensive undertaking, hospital and hospital services, development and rehabilitation should nevertheless be properly defined in the context of a well-articulated policy and strategie framework. WHO must again play a leading role in defining the role ofhospitals. We appreciate the role that traditional medicine can play in our health care delivery system, as a large percentage of our peoples, particularly in the rural areas, still patron ize traditional medicine practitioners. Steps are being taken to formalize the practice, with the introduction of appropriate controls and legislation, to ensure safety and efficacy of the products used. While the inadequate supply of pharmaceuticals continues to be a major concem, research and development of relevant pharmaceuticals is stilllimited and their high cost encourages the influx offake and expired products. Finding ways to ensure the availability of effective and affordable pharmaceuticals and other inputs therefore constitutes a major challenge for the subregion. Regrettably, political upheavals, civil conflicts and wars, with their attendant negative effects on the health sector, continue to bedevil many countries in the West African subregion. The problems ofrefugees, orphans, abandoned children and displaced persons have compounded the enormous burden placed on the health services. We pray for lasting peace in the subregion, in the hope that in an atmosphere of peace, appropriate rehabilitation and reconstruction of the health facilities can take place for the benefit ofthose who did not create the problems in the first place. We cali on our development partners to respond positively in complementing our efforts to evolve a new era of peace which would yield great dividends for the health sector. As we eagerly approach the dawn of the twenty-first century, we are aware of the tremendous gains that could be achieved from the increasing use of the "information superhighway". The demographie and epidemiological changes currently taking place in our countries invite us to fashion responses that will address these changes. Sorne ofthese: care of the elderly, new and emerging diseases, noncommunicable diseases and violence as a public health concem, have received relatively little attention in the past, but we need to address them now because oftheir potential effects on the lives of our peoples. Being aware of the need for collaboration and cooperation in health matters and to meet the challenges of the new millennium, we in the West African subregion have decided to merge the two existing subregional health organizations for francophones and anglophones in West Africa to form the West African Health Organization. Steps have been taken to implement the relevant protocol signed by

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our Heads of State and Government. Disease knows no boundaries. The global trend today is one of collective responsibility and action. Collective action by countries in our subregion would yield higher dividends in addressing certain health problems than for individual countries to keep going it atone. We in the West African subregion do realize that we need each other to tackle the many diverse health problems effectively. Severe economie problems facing ali our countries dictate that sharing costs would ease the burden ofproviding comprehensive, accessible, affordable and quality health care services to ali our peoples. We look forward to active collaboration between our two organizations both at the levet of the African Region and at headquarters. We in the West African Health Community will continue to subscribe to the fundamental ideals of WHO and wish the Organization, under the distinguished leadership of the Director-General, success in ali its undertakings. Mr MONO (Papua New Guinea): Mr President, Madam Director-General, excellencies, ladies and gentlemen, I have the honour to represent the island nations of the Pacifie: Cook Islands, Federated States ofMicronesia, Fiji, Kiribati, Marshall Islands, Nauru, Niue, Palau, Papua New Guinea, Samoa, Solomon Islands, Tonga, Tuvalu and Vanuatu, in presenting our response to The world health report 1999: Making a diffèrence. First, on behalf of the delegations from the Pacifie Islands let me congratulate the President and ali the elected office bearers at this Fi:fty-second World Health Assembly which is also the last Health Assembly of the twentieth century. We have every confidence that you will successfully lead our deliberations and we assure you of our support. We wish to congratulate the Director-General and her staff for the preparation and presentation of The world health report 1999: Making a diffèrence. The report is concise, clear and evidence-based as it expounds the tessons to be learned from the past and the challenges to heed for the future. We are especially encouraged by your new directions for WHO leadership in health as we enter the new millennium. In particular, we welcome the emphasis that has been placed on the Roll Back Malaria project and on stemming the tide of tobacco consumption. Nearly half of the Pacifie people are still at risk of malaria today and we trust that rolling back malaria will also roll back in its wave the scourge of other vector-borne diseases such as dengue and dengue haemorrhagic fever which, together with malaria, threaten the health and economie development of our island nations. We are very encouraged that, finally, a global effort of the magnitude of a framework convention is going to be put in place to fight tobacco use head-on. In previous Assemblies we have been among those who have pleaded for assistance in the fight against this product which, much like other instruments of killing, will indeed kill when used as intended and yetis marketed with the strength of billions of dollars, attracting ruin to vulnerable lives and damaging economies through addiction to tobacco. Records show that we in the Pacifie region have more than our share of tobacco consumption per capita and more than our share of the ill-health resulting from our addiction to tobacco, both in its smoking and chewing forms. It has been difficult for us to live up to. our responsibilities under the Convention on the Rights of the Child, to protect our children from this form of exploitation oftheir youth, innocence and vulnerability. We resent the targeting of the East Asia and Pacifie regions by the multinational tobacco companies as a measure of making up for their losses from current litigation in the United States of America and elsewhere. We resent being forced, through our addiction, to support the tobacco industry's payment of such litigation. We, therefore, welcome the framework convention on tobacco control. We will participate to the fullest extent that we canin its development, to ensure that the usual tactics oftobacco industries to divide and conquer, to diffuse the health message, to sabotage our efforts by funding sorne aspects of our work through sport, pharmaceuticals or salary supplements and other means, are made known and prevented. There is one other major issue of concern to the Pacifie nations which was not addressed in The world health report, perhaps due to limitation oftime and space, or perhaps as the Director-General said in her speech, we cannot do everything. This is the issue of global climate change and its impact on the ocean and its life, and in turn its impact on our lives and development. The ocean connects us to each other and provides much of the resources that sustain our daily lives. Its health and sustainability is of utmost importance to us. The El Niiio and La Nina events oflast year took a severe toll on the reefs of our islands. The tsunami that hit my own country, Papua New Guinea, claimed thousands of lives and devastated severa) communities. Many of our atoll inhabitants live in constant threat of global warming and excessive tide changes. Global warming and climate changes are "global challenges that demand a global response" and we look forward to WHO to assist us on this. The Pacifie Island nations welcome the reforms made by Dr Brundtland within the WHO structure and with respect to leadership for the days to come. We in the Western Pacifie Region also welcome the changes that are being made by our new Regional Director, Dr Omi. Under his leadership the Pacifie Island nations are poised to strengthen the resolve for health for ali under the conceptual framework of the

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Healthy Islands initiative, which was adopted by the ministers and directors ofhealth in 1995, and reviewed and strengthened in 1997 and 1999. In the most recent meeting of ministers and directors of health in March 1999, the Regional Director presented his position for future work in health in the Western Pacifie Region, under his leadership. The paper was not unlike The world health report 1999. It challenged us to get more done with Jess, to seek more evidence to support our claims, to develop our own resources, human and otherwise, with technical support from the Regional Office. Based on the review of the Healthy Islands initiative and the Regional Director's vision, the Pacifie Island nations health leadership, in a document called "Palau Action Statement", renewed their commitment to make the next millennium healthier for inhabitants of the islands. The "let's get to work" cali of the Director-General bas been beard and the Pacifie Islanders respond together with the Regional Director, "Yes, together we can get the job done". El Dr. PARDO EVANS (Costa Rica): Distinguida sefiora Presidenta, sefiora Directora General, sefiores miembros de la Mesa, sefiores jefes de delegaci6n, sefioras y sefiores: Para mi constituye un verdadero honor presidir la delegaci6n de Costa Rica ante este importante foro y tener la oportunidad de presentar un respetuoso y cordial saludo a todos los presentes en nombre del Gobiemo de Costa Rica. Deseo felicitar a la sefiora Presidenta y demâs dignidades electas en esta 528 Asamblea Mundial de la Salud y felicitar a la Directora General, Dra. Gro Brundtland, por su visi6n de lo que debe ser la Organizaci6n Mundial de la Salud y la forma como esta abordando la reestructuraci6n tecnicoadministrativa de esta Organizaci6n. Estamos convencidos de que el liderazgo demostrado durante estos ultimos meses por la Dra. Brundtland no s6lo ha revitalizado a la Organizaci6n sino que ha demostrado que los Estados Miembros debemos jugar un papel activo dentro de la instituci6n. Las metas y la visi6n de la Directora General responden a la problemâtica mundial de la salud y llevan a la Organizaci6n a jugar un papel fundamental de liderazgo en la transformaci6n de las condiciones de vida y del desarrollo humano en todos los paises. El Gobiemo recoge con aprecio las reformas que se estân dando en el seno de la Organizaci6n Mundial de la Salud. Compartimos por convencimiento propio la necesidad de tener una gesti6n mâs eficiente, responsable y con una mayor sensibilidad a los cambios en este mundo en constante mutaci6n. El Estado costarricense es consciente de que para lograr cambios en las condiciones de salud y de desarrollo es necesario hacer profundas transformaciones de carâcter politico, econ6mico y social, lo cual requiere decisiones y medidas cuyos efectos son en su mayoria visibles en el mediano o en el largo plazo. El estado de salud que Costa Rica ha alcanzado en este momento es producto de decisiones adoptadas y mantenidas durante los ultimos 50 anos, y eso ha permitido que actualmente tengamos una expectativa de vida al nacer superior a los 76 anos, una mortalidad infantil de 12 defunciones por cada 1000 nacidos vivos, que hayamos erradicado el analfabetismo y que tengamos cobertura universal de la seguridad social y de los servicios de salud y educaci6n. Coincidimos con el planteamiento de la OMS y de la propia OPS en que, aun con este perfil de desarrollo, tenemos, no solamente Costa Rica sino el mundo entero, el reto de la eliminaci6n de la pobreza, de las desigualdades sociales como unica forma de lograr un desarrollo pleno y una calidad de vida compatible con los mâs caros intereses del ser humano. Por lo tanto, apoyamos de manera decidida todos los esfuerzos de la OMS que desde su âmbito de responsabilidades pueda hacer para que las transformaciones sean una realidad. Costa Rica es un pais respetuoso de los derechos humanos. Bien decia la Dra. Brundtland en su intervenci6n ante esta Asamblea que el derecho a la salud es un derecho humano fondamental. En este sentido, Costa Rica ha contribuido con decisi6n y fratemidad a la salud de América Central al brindar a miles de inmigrantes en situaci6n de ilegalidad migratoria en nuestro pais, especialmente a medio mill6n de nicaragüenses, atenci6n médica gratuita y también educaci6n gratuita con todos los derechos iguales que asisten a los nacionales. La amnistia migratoria decretada para todos los centroamericanos presentes en Costa Rica antes del 9 de noviembre de 1998 ha permitido que todas estas personas se unan al esfuerzo econ6mico de un servicio social universal por medio de sus cotizaciones. Sin duda alguna estas cuotas contribuirân a mejorar ailn mâs nuestro sistema de salud. Nos comprometemos a apoyar la gesti6n de la Directora General para la implementaci6n de los mandatos que surjan de esta Asamblea y nos comprometemos también a trabajar firme y solidariamente con los demâs paises en procura de un mejor futuro para la salud de nuestros pueblos. Muchas gracias.

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Dr BARAKZAI (Afghanistan): Mr President, Madam Director-General, dear colleagues, ladies and gentlemen, I would like to take this opportunity to thank WHO for the efforts made in handling the health problems around the world and especially in Afghanistan. In May the national poliomyelitis campaign started in Afghanistan, with the help of WHO, UNICEF and nongovernmental organizations. This immunization prevents children from being handicapped in their future life. I would like to mention sorne of the problems in Afghanistan: fighting lasting over 20 years, foreign intervention, destruction ofhealth clinics, hospitals and rural health centres. Ali these affect the health of the people. Many people were killed by bullets, and a great many by diseases, especially among women, children, and the elderly. Everyone knows what is going on in Afghanistan. Our problems during and after the collapse of the communist regime; foreign interference, internai conflict, natural disasters, including two recent earthquakes in Takhar and Badakhshan, causing internai migration, and poor socioeconomic conditions are the main causes ofhealth problems. Three generations of our people have not had proper health care, especially the women and children. Women make up more than half of the population, but do not take part in the socioeconomic life ofthe country. I can say that in sorne areas they are not even allowed to breathe and be free. At the same time, female medical personnel are not active in the country, and there are no health facilities for females. Our clinics, hospitals and rural health centres are ali destroyed. There is no data for establishing statistics of diseases, and no active programme for prevention of disease in Afghanistan. I think it is difficult for us to follow the WHO programme for the eradication of communicable diseases by the second millennium. Added to this, there are problems of drug-resistance which increase day by day. Drug-resistant cases of malaria are on the increase. At the same time, the incidence of Plasmodium falciparum malaria is widespread in the country, causing many deaths among the young and the elderly. Tuberculosis is also drug resistant, due to insufficient therapy and internai migration, as there is no follow-up care. This may become a big concern for us and WHO because ofthreat of the spread ofthese drug-resistant diseases to neighbouring countries. So far for the solving of the problem in Afghanistan, we know that our neighbouring countries can help to solve the problem - especially Pakistan, who has an influence on the Taliban to bring them to a compromise. We hope WHO, UNICEF and nongovernmental organizations and governments will help us in the following: campaign against infections diseases; campaign against diarrhoeal diseases; campaign against acute respiratory infectious diseases; immunization; training of medical personnel at different levels; collection of data and statistics of diseases; supply of drinking-water; reduction of vitamin deficiency diseases, especially blindness, among children and supply of iodized salt to prevent goitre; reduction of poverty and malnutrition; and provision of emergency medical facilities for mine casualties and war injuries. And last but not least, we are grateful to those who are already helping us, especially WHO, UNICEF and nongovernmental organizations. We hope other governmental organizations will iilso take part in the reduction of the humanitarian catastrophe in Afghanistan. The new reform by the Director-General will be reflected in the lives and health of our women. Dr KIYONGA (Uganda): Mr President, honourable ministers, the Director-General, distinguished delegates, ladies and gentlemen, The world health report 1999 has ably reviewed the accomplishments and challenges in world health and points to the unfinished agenda being carried forward into the twenty-first century. Most notable, among the items of the unfinished agenda, are the growing inequalities between the developed and developing countries. While the developed world will have less and less of the burden of infectious diseases, the poor developing countries will continue to contend with a double burden of disease arising from both the infectious and noncommunicable diseases. The delegation ofUganda wishes to commend the Director-General's comprehensive but concise and focused report. The vision for the twenty-first century is clear and the innovations for sustaining effective change have been laid before us. Nevertheless, Uganda wishes to propose that the agenda for the developing countries should accord special attention to the areas described below. HIV -vaccine development: The devastating effects of the AIDS pandemie are most felt in the developing countries, especially in sub-Saharan Africa. Although present efforts in prevention and control of the effects of the disease have shown positive results in Uganda, the most sure way of eradicating the problem lies in research and development of a vaccine against lllV infection. Evidence to date shows that there is very little effort being made to develop an lllV vaccine for developing countries. The impediments

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to date are both economie and political. I am glad to announce to this august Assembly that Uganda bas this year made a modest start in participating in the testing of an HIV-vaccine candidate. We cali upon the rich countries to give this matter greater attention. Roll Back Malaria: It is gratif)'ing to note that complacency over the leading cause of morbidity and mortality in the tropics bas been replaced by a greater determination to combat the problem. In this respect the efforts ofthe Director-General are commendable, and need the support of ali of us. The Organization of African Unity leaders have adopted a resolution, making their commitment to the Roll Back Malaria initiative. In order not to Jose momentum, it is urgent that funding for the Roll Back Malaria initiative should be expedited, and should cover increased access to health services by the populations in the developing world. Increased efforts in general communicable disease control: Despite the epidemiological transition beginning in most developing countries, there is a need to maintain focus on control, prevention or elimination of communicable diseases still prevalent in the poor countries. Uganda is participating fully in the global effort to eradicate poliomyelitis. We are involved in coordinating cross-border efforts to mop up this scourge in our region. Investment in communicable disease control should be maintained and increased to ensure elimination ofthese diseases globally. Stronger coordination of development aid: Health development in poor countries will continue to require development aid from several partnerships with both the North and the South. For efficiency and optimal results from such partnerships, there is a need to strengthen and institutionalize mechanisms that would reduce duplication and encourage focused utilization of resources for jointly agreed upon national priorities. The sector-wide approach to health development should be encouraged to bring about change from the projects approach that is still prevalent in most of our countries. In conclusion, Uganda is committed and determined to strive for better health at the national, regional and globallevels in partnership with the Member States of WHO. Uganda recognizes and commends the difference that the new leadership of WHO bas already made and looks forward with renewed hope and faith in this important arm ofthe United Nations system. Ms AMAHA (Ethiopia): Mr President, Madam Director-General, distinguished delegates, at the outset allow me to congratulate the President and the other officers of the Bureau on their election. I also wish to express my delegation's appreciation to the Director-General for ber dynamic leadership during the last 10 months. The health policy of my country was launched in September 1993, after receiving Government approval. This policy is based on the following principles: democratization and decentralization of the health system; development of the preventive and promotive components ofhealth care; development of an equitable and acceptable standard ofhealth service that will reach ail segments of the population, within the limits of resources available; promotion and strengthening of intersectoral activities; promotion of activities and practices conducive to the strengthening of national self-reliance in health development, by mobilizing and maximally utilizing internai and external resources; working closely with neighbouring countries, and regional and international organizations to share information and strengthen collaboration in ali activities contributing to health development, including the control of factors detrimental to health; provision of a scheme ofhealth care for the population according to ability to pay, with special assistance mechanisms for those who cannot afford to pay; and promotion ofthe participation of the private sector and nongovemmental organizations in health care. This policy framework is a result of careful assessment of the factors behind most of our health problems and the genuine need to resolve them in the shortest possible time. To make the implementation ofthese policies easier, health care strategies have been drawn up. A number of other social sector policies designed to complement the health interventions have also been developed. Among these, the education policy, population policy, and Ethiopian women's policy are worth mentioning. A health plan that aims at achieving the goal of uni versai access to health care in the next two decades bas been developed. The first five-year plan is now being implemented. This plan was developed on the principles of the sector-wide approach. It brings together ali stakeholders, including the Government, the donors, the private sector, nongovernmental organizations and the community at large, involving them ali, right from problem identification through the development of the plan, to implementation, monitoring and evaluation of the programmes. Ethiopia continues to be affected by epidemie outbreaks. During the past few years malaria outbreaks have claimed many lives. The threat of cerebrospinal meningitis bas been great during the past few months, requiring intensive surveillance and preparedness. The HIV/AIDS epidemie and the problem oftuberculosis are in the forefront of our health problems. We are also among the few countries in the world where paralytic poliomyelitis continues to wage war on our young children.

A52/VM page 101 Although we have huge health problems, we believe we are on the right track in terms of policy, strategies and the approach we have adopted towards their resolution. We will continue to need enhanced resource support in our endeavours. This is particularly true for implementing the Roll Back Malaria project, mitigating the effects ofHIV/AIDS, treating tuberculosis and preparing for epidemies. In conclusion, 1 would like to urge WHO to mobilize the necessary resources to assist our efforts to deal with these buge problems 1 have attempted to bring to your attention. Monseftor LOZANO BARRAGÂN (Observador de la Santa Sede): Seftora Directora General de la Organizaci6n, Dra. Gro Harlem Brundtland, seftora Presidenta de la 52• Asarnblea Mundial de la Salud, Sra. Maria de Belém Roseira: La delegaci6n de la Santa Sede manifiesta su aprecio por los esfuerzos que esta Organizaci6n, junto con otros profesionales de la salud publicos o privados, lleva a cabo para que la atenci6n sanitaria basica llegue a todos los habitantes de la Tierra aun en las condiciones extremas de guerra y catâstrofes de todo género. El abismo que separa a las poblaciones ricas de las pobres resulta particularmente profundo y dramatico en materia de salud. La asistencia a los enfermos de VIH/SIDA por parte de los agentes de salud cat6licos, que segün una estadistica reciente cubre el24,5% del total de las actividades del sector, alcanza a las regiones mas inaccesibles y a los nucleos sociales mas marginados. Una vez mas se debe repetir el llamado a los politicos y profesionales de la salud para que se empeften en hacer plenamente accesibles los medicamentos y las terapias mas avanzadas a todos los enfermos de SIDA; no s6lo a los mas pudientes, sino también a los mas pobres y desprotegidos. Ademas del ingente trabajo realizado por los innumerables agentes de salud vinculados a la Santa Sede, ésta se esfuerza para que todos los miembros de la Iglesia Cat6lica y todas las personas de buena voluntad tomen conciencia de su responsabilidad social universal. Como gesto prâctico y simbolo de un compromiso solidario, recientemente ha promovido la iniciativa de •un dia sin humo•, con la intenci6n de que los fumadores, a la vez que reflexionaban sobre el dafto propio y ajeno causado por el tabaco, destinarao el ahorro personal, fruto de la abstenci6n, a ayudar a los enfermos de VIHISIDA y a sus familias. Tal gesto ademas se inscribe en la promoci6n general de los valores espirituales y familiares, que es condici6n indispensable para lograr estilos de comportamiento solidario en favor del bienestar y salud de todos. Asimismo, la Santa Sede desea acompaftar a la OMS en sus esfuerzos por erradicar las principales enfermedades infecciosas, en especial frente a la tuberculosis y al paludismo, a conseguir modos de vida que disminuyan las incidencias de otras como la depresi6n, y por aumentar la responsabilidad frente a otras causas de muerte o invalidez, como los accidentes viales. El servicio de la deuda externa de los paises mas pobres ocupa los recursos que serian necesarios para una adecuada asistencia sanitaria nacional. La Santa Sede quiere aprovechar esta ocasi6n para reiterar su constante apelo a la comunidad internacional para que no deje la oportunidad del cierre del segundo milenio sin resolver este grave problema. Interpela a este respecto a los responsables de la politica y la economia mundial. Las naciones mas industrializadas han anunciado en los ultimos meses nuevos planes para ser eficaz, reforzar y ampliar el programa HIPC (paises pobres fuertemente endeudados) dando un corte defmitivo al grave problema fmanciero de la deuda externa de los paises menos desarrollados. En pro de una verdadera cuttura de la vida y de la salud, la Santa Sede hace votos por que estos planes y prop6sitos se lleven a cabo de modo eficaz, generoso e inmediato. Muchas gracias. M. DECAZES (Observateur de l'Ordre de Malte) : Monsieur le Président, je souhaite tout d'abord adresser au nom de l'Ordre de Malte à Mme de Belém Roseira, Ministre de la Santé du Portugal, mes très sincères félicitations pour son élection à la présidence de la Cinquante-Deuxième Assemblée mondiale de la Santé, ces félicitations étant également formulées à votre intention, Monsieur le Président, et à celle des autres membres du bureau qui ont été élus pour l'assister dans sa tâçhe si importante. Je salue aussi Mme le Dr Brundtland, Directeur général de l'OMS, ainsi que tous les Ministres de la Santé et autres distingués délégués qui prennent part à ces assises annuelles. Mesdames, Messieurs, permettez-moi de vous indiquer que l'Ordre souverain de Malte célèbre cette année le neuf centième anniversaire de son activité, qui a débuté à Jérusalem par la création d'un hôpital destiné à accorder des soins, tant à la population locale qu'aux pèlerins de passage dans cette région. Aujourd'hui, sa mission hospitalière demeure et s'étend à tous les continents conformément à sa vocation initiale. Celle-ci est du reste formellement inscrite dans sa Charte constitutionnelle dans les termes suivants: "L'Ordre exerce son activité institutionnelle envers les malades, les pauvres et les réfugiés dans

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le domaine hospitalier, y compris l'assistance sociale et sanitaire, sans distinction de religion, de race, d'origine ou d'âge." Cette longue expérience permet aujourd'hui à l'Ordre d'apprécier à sa juste valeur le plan d'action contenu dans le Rapport sur la santé dans le monde, 1999 - Pour un réel changement et précisé par le Directeur général dans son allocution en séance plénière, ici même. Dans l'accomplissement de ses activités traditionnelles, l'Ordre participe de longue date à la lutte contre la lèpre. Ses programmes dans ce domaine sont conduits par le Comité international de l'Ordre de Malte pour l'Assistance aux Lépreux (CIOMAL), en coordination avec les autorités des pays concernés. Aujourd'hui, nous nous réjouissons qu'une thérapeutique moderne permette enfin d'envisager l'éradication de cette maladie si invalidante. La coordination de nos efforts est assurée par le CIOMAL, qui, sans s'écarter de sa priorité, la lutte contre la lèpre, a ouvert un nouveau programme de lutte contre la transmission verticale du VIH de la femme enceinte à son enfant, suivant en cela les recommandations de l'ONUSIDA. Dans le cadre de la Fondation de l'Ordre de Malte à Dakar, un programme pilote a été élaboré avec les autorités sénégalaises, lequel, à terme, pourra être étendu à d'autres pays où l'Ordre est présent au travers d'infrastructures et d'activités médicales. Ces mesures nous paraissent correspondre aux différents souhaits exprimés par le Dr Brundtland, à savoir accorder une aide particulière aux femmes en intensifiant les efforts de prévention du SIDA et, à cet effet, développer des liens de partenariat avec les instances concernées. Une autre activité importante de l'Ordre, consistant en la distribution de dons de médicaments, nous a amenés à participer aux consultations organisées par l'OMS pour en établir les nouveaux principes directeurs. Nous nous félicitons de cette coopération et espérons donc voir l'adoption par cette Assemblée de la résolution EB103.Rl sur la stratégie pharmaceutique révisée. Monsieur le Président, avant de conclure, permettez-moi de mentionner encore l'actuelle et significative participation de l'Ordre à l'assistance médicale aux populations victimes des tragiques événements se déroulant dans la région des Balkans. En étroite coopération avec les acteurs humanitaires présents dans la région, l'Ordre a mis en place plusieurs hôpitaux et camps de réfugiés, assure une distribution importante de médicaments et de fournitures sanitaires, et dispense des soins de base par l'intermédiaire de ses équipes médicales. Ainsi, par l'ancienneté de son engagement envers l'humanité souffrante et par l'étendue géographique de ses actuelles activités d'assistance, l'Ordre de Malte s'efforce de rester fidèle à sa vocation initiale, tout en adaptant ses actions aux évolutions des techniques scientifiques et en regrettant que les moyens dont il dispose soient bien modestes au regard des situations de détresse qui l'interpellent. M. COLLA (Belgique) :1 Monsieur le Président de séance, Madame le Directeur général, Mesdames et Messieurs, comme 1' on pouvait s'y attendre, cette Cinquante-Deuxième Assemblée mondiale de la Santé est résolument placée sous le signe du bilan. De bilan, il en a été question pendant toute cette année du cinquantième anniversaire de l'OMS, mais aussi, et surtout, dès l'ouverture de notre session, lors de la présentation des rapports du Conseil exécutif et du rapport d'activité du Dr Brundtland et de son équipe. La question qui se profile dès lors à l'horizon est la suivante: "Et maintenant, quel avenir pour quelle santé publique?". Les réaménagements intervenus dernièrement au sein de l'Organisation - et qui, au premier abord, ont parfois été perçus comme retentissants -constituent certainement une bribe de réponse. C'est en effet cette volonté d'anticiper sur l'avenir qui a mené le nouveau Directeur général à se pencher sur le propre fonctionnement de son institution avec l'ambition de bâtir, par le biais d'une réforme administrative progressive, les fondations d'une meilleure gestion et d'une meilleure communication. Ces réformes arrivent en outre à un moment où toute la communauté internationale exprime des attentes et des exigences claires quant aux nombreux enjeux auxquels doit faire face l'Organisation, des enjeux qui sont encore "péniblement" exacerbés par les crises politiques, comme celle du Kosovo. Faut-il rappeler que les violations des droits de l'homme ont des effets graves sur la santé? Prenons le seul exemple de la violence conjugale, dont le coût social pèse lourdement sur la vie des personnes touchées et sur toute la collectivité. Que dire alors de la violation des droits de l'homme au niveau des nations ? Ce thème a d'ailleurs fait l'objet d'une récente conférence, organisée à Strasbourg par le Conseil de l'Europe. Bref, si l'on y regarde de plus près, les réformes proposées par le Dr Brundtland coïncident bel et bien avec le développement même du concept de santé publique. La santé publique est un tout qui doit être Le texte qui suit a été remis par la délégation de la Belgique pour insertion dans le compte rendu, conformément à la résolution WHA20.2. 1

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considéré en rapport avec ses nombreux déterminants, d'où l'approche transversale des programmes. De par ses impacts tant humains que socio-économiques, la santé publique est un enjeu pour la société tout entière et se doit d'occuper une place centrale dans tous les domaines d'activité, d'où l'intensification des contacts avec les autres partenaires internationaux. La santé publique revêt par essence un caractère international qui nécessite de réels processus de collaboration, d'où la redynamisation des réseaux d'experts et d'institutions. A travers cinquante ans d'histoire, l'Organisation a subi une évolution durant laquelle le quasimonopole médical a fait place à des équipes pluridisciplinaires; l'approche a été élargie jusqu'aux concepts des soins de santé primaires et de la santé pour tous. Entre-temps, des succès remarquables ont été obtenus dans la lutte contre les maladies transmissibles. Un exemple parlant : celui de la tuberculose. La tuberculose est un réel problème de santé publique dont l'importance semblait avoir diminué au cours des dernières décennies. Actuellement, pourtant, son incidence augmente dans les pays développés comme dans les pays en développement, et ce à la suite des mouvements rapides de population, de la marginalisation de certains groupes et de son association fréquente avec le VIH/SIDA. Dans les actions envisagées, il paraît donc de plus en plus indispensable de remonter à la source (exemple d'une action conjointe entre la province d'Anvers et la région de Léningrad). "Il ne sert à rien de combattre sur un seul terrain, en laissant autour de soi des mines prêtes à exploser." Or cette approche globale, seuls les organismes internationaux sont à même de la coordonner. Rappelons-nous les épisodes de l'épidémie de fièvre d'Ebola ou de la crise de la vache folle. Ce sont là quelques moments forts où la communauté internationale a ressenti clairement la nécessité d'une OMS forte, qui s'appuie sur une chaîne d'acteurs allant des centres et experts aux alliés "silencieux" que sont les ministères de la santé publique des Etats Membres. Ce qui est vrai pour les maladies transmissibles l'est aussi pour les domaines de la santé directement liés aux évolutions de la société. En déclarant l'année 1999 Année internationale des personnes âgées, l'Organisation des Nations Unies a enjoint tous les gouvernements à tenir compte d'une donnée essentielle dans leur politique: l'accroissement du nombre de personnes âgées nécessite une adaptation profonde de toutes les sociétés. Car il est temps de mettre fin ici à deux préjugés par trop ancrés dans nos conceptions : la personne âgée est plus qu'une personne à aider; la problématique du vieillissement touche aussi les pays en développement. Une belle illustration de ces deux axes est donnée par le cas de la maladie d'Alzheimer: de plus en plus, les liens entre les générations et le suivi des aidants prennent leur importance dans une pathologie lourde de conséquences familiales; plus encore, de nombreux programmes de santé, y compris dans les pays en développement, ont dû intégrer ce paramètre - la prévalence de la maladie d'Alzheimer chez les personnes de plus de 65 ans est estimée à entre 5 et 10%. Toujours dans le même ordre d'idées, en avril dernier, Bruxelles a accueilli le premier colloque conjoint OMS/Union européenne relatif à la santé mentale. Pour rappel, les troubles mentaux figurent parmi les principales causes de morbidité et d'incapacité dans le monde. Et dans trop de pays, la promotion et les services et soins de santé mentale en sont encore réduits à leur plus simple expression. Lors du colloque, trente-huit pays, en particulier les Etats Membres de l'Union européenne ainsi que la plupart des pays d'Europe centrale et orientale, ont réfléchi à la meilleure manière de concilier les deux axes de la promotion et des soins et sont arrivés à dégager un consensus sur les problèmes de santé mentale en Europe. Bien évidemment, l'Organisation n'a pas seulement un rôle à jouer en temps de crise. Il est aussi remarquable de voir comment l'OMS parvient à fournir les normes techniques et les modèles qui deviennent la source d'inspiration des Etats Membres, dans divers domaines de la santé publique. En la matière, on peut parler de véritable plus-value. En effet, s'il est vrai que, mis bout à bout, les efforts nationaux peuvent parfois apporter des débuts de solution, il est aussi et surtout réel qu'aujourd'hui, les problèmes de santé sont - si l'on ose dire inversement proportionnels aux ressources budgétaires. Quelles que soient les options que nous envisageons dans nos "hémicycles de réflexion", nous devons de toute façon tenir compte des possibilités financières. En ce sens, le développement de modèles pouvant servir à plusieurs pays évite de répéter l'effort, et permet donc à moyen et long terme de faire des économies. Permettez-moi d'ouvrir ici une succincte parenthèse sur la création, à Bruxelles, du Centre européen pour la Politique sanitaire. Ce Centre, qui est une émanation directe du Bureau régional OMS de l'Europe, revêt une importance capitale pour les futures politiques européennes de santé publique. Il s'agit concrètement d'analyser les politiques de santé appliquées dans les différents pays, d'organiser la consultation des pays demandeurs de bonne politique et de bonne pratique, et .de mettre en place des formations à l'intention des décideurs politiques et des formateurs. En somme -et c'est sur cette formule que je fermerai la parenthèse - c'est en mettant en commun les connaissances que l'on pourra aussi mettre en commun les ressources financières.

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Et si l'on va plus loin dans cette approche concertée, on peut également soutenir que c'est l'ensemble des politiques et des programmes de santé publique qui doivent être conçus en partenariat. Je citerai ici un exemple que la Belgique a suivi de près : il s'agit de l'accès aux médicaments essentiels en Afrique australe. Un groupe directeur composé de représentants de l'OMS, de l'Afrique du Sud et de la Belgique s'est réuni pour définir les lignes d'une nouvelle politique des médicaments en Afrique, y compris l'amélioration de l'accès de la population, l'échange d'informations et l'élaboration de législations nationales. Outre leur apport personnel dans cette action, les deux Etats impliqués se sont également lancés dans un plaidoyer auprès d'autres Etats européens et africains. Ainsi, par exemple, il a été convenu que la Belgique fournirait une assistance bilatérale au Mozambique, dans le cadre de ce projet. Cette assistance pourrait notamment se concrétiser par l'application de nouvelles techniques d'information telles qu'Internet. Dans la société de l'information dans laquelle nous vivons, tous les pays doivent avoir un minimum d'accès aux données, car c'est cet accès qui empêchera que ne se creuse sans cesse le fossé latent entre pays dits industrialisés et pays en développement. Ici s'achève le message de la délégation belge devant la Cinquante-Deuxième Assemblée mondiale de la Santé de l'OMS. Nous souhaitons résumer comme suit les axes de réflexion qui permettront d'envisager le devenir de la santé publique et autour desquels nos futurs débats doivent s'articuler: une nouvelle utilisation des structures et des moyens existants, la participation active de la population, le rétablissement des liens entre science et politique, et le recours à l'intersectorialité. Autant d'approches qui visent à replacer la santé au centre des préoccupations et d'en faire une valeur qui prime sur toutes les autres, y compris la propriété intellectuelle, la valorisation personnelle et le mercantilisme aveugle. Certes, tout ceci requiert quelque changement dans les mentalités, mais c'est à ce seul prix que notre santé aura un avenir.

Dr KA TZAROV (Bulgaria): 1 Mr President, Madam Director-General, delegates and guests, ladies and gentlemen, on behalf of the Bulgarian delegation I would like to express our appreciation and support for the statements, ideas and recommendations presented in the working documents of the Fifty-second World Health Assembly. The importance and complexity ofthe health and health care problems has been indicated in the context of the global economie, political and social processes. The general spirit of Assembly discussions can be outlined as "optimistic realism". It is true that health problems are extremely serious and nowadays are connected to the very survival ofhumanity. It is also true that from a political and organizational point ofview, the health care sector is one of the most sophisticated sectors in every country. It is true that in a number of countries and regions health care is facing problems generated by other sectors. But it is also true that today humanity has at its disposai knowledge, technologies and resources which can help in finding a solution to the problems through adequate coordination of resources and targeting them to priorities. Thus we come to partnerships for health - a clearly manifested need for the present, and even more important for the future. In this context I would like to inform you briefly about the current tendencies in Bulgarian health care. Over the last three years, the Bulgarian Government is implementing a programme for sustainable democratie development of the country, stabilization of the market economy and formation of a civil society. This process is carried out in conditions of severe economie difficulties, recently hindered even more by the complicated political situation in the Balkans. However, although working in these restricted circumstances, the country is implementing a radical health care reform, aimed at suspension of the negative tendencies in the health status of the nation, increasing the efficiency of the health care system and implementation of the standards and approaches adopted in the European Region. A number oflegislative acts have been adopted, such as the Health Insurance Act, and the Act on Professional Organizations of Physicians and Stomatologists. The Act on Health Care Facilities will be voted soon. Based on the new legislation, radical changes are under way in health care financing, decentralization of management, increasing the autonomy of health care establishments and rationalization of health care structures. A number of programmes targeted at health promotion and disease prevention priorities have been put into force in collaboration with other sectors, nongovernmental organizations and local administrations. Serious attention has been given to the health problems of ethnie minorities, especially to the Roma community. Clear and substantial priorities and goals, definite directions and approaches have been formulated in the new health strategy and policy.

The text that follows was submitted by the delegation ofBulgaria for inclusion in the verbatim records in accordance with resolution WHA20.2.

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In this regard, 1 would like to express our gratitude to WHO and the Regional Office for Europe, to the European Union and its organs, the World Bank and other international agencies for the support that bas been provided, and is still being provided to our country. Along with this, 1 would like to stress that we consider the "partnership for health" policy to be extremely important both in its international and local aspects. We are interested in regional programmes for collaboration and in the establishment of new effective partnerships. We consider most important the collaboration with WHO, not only in the implementation ofthe health-for-all policy for the twenty-first century, but also in the context of support to the Bulgarian health care reform and to the process of integration into European structures and harmonization with European Union standards and requirements. In conclusion, 1 would like once again to emphasize the clear political will of the Bulgarian Government to implement health care reform in the country for the well-being of the Bulgarian nation. Mr GUNNARSSON (lcelandV Mr President, Madam Director-General, distinguished delegates, ladies and gentlemen, allow me to congratulate the President and the officers of the Fifty-second World Health Assembly on their election. Congratulations are also extended to the Vice-Presidents, the Chairmen of the main committees and other officiais. My delegation would like to extend its appreciation to the Director-General, Dr Gro Harlem Brundtland, for ber leadership and ber eminent work for WHO. 1 would also like to assure ber of the Icelandic delegation's constructive cooperation in the coming years. Allow me also to congratulate the Director-General and ber staff on the concise but comprehensive report represented to us, The world health report 1999. The report clearly provides a review of the new priorities of the Organization, emphasizing that vision, commitment and global leadership are needed to improve the health situation. As emphasized in most recent world health reports, the struggle against ill-health must be fought on two main fronts: infectious diseases and chronic, noncommunicable diseases. Our attention should be focused on the fact that current prospects are extremely serious in many developing countries, which will most likely come under greater attack from both types of illnesses. The history of WHO over half a century is indeed a story of successes. Improvements in child health, great emphasis on safe motherhood, family planning programmes, and improvements in public health and health promotion are examples of successes: others are the introduction of the essential drugs concept, improvements in working conditions, increased research, education and training ofhealth personnel, and greater availability of vaccines. Over the years, WHO bas positively influenced health policy in Iceland and the development of our health care system. At the beginning of the 1970s Iceland started building up a comprehensive primary health care system. This task was supported by constructive advice from WHO. As demonstrated in our health statistics, this system bas undoubtedly led to progressive improvements in health of the entire population. At this Assembly this year's The world health report 1999: Making a diffèrence reviews the accomplishments and challenges in world health and emphasizes the tasks and priorities for WHO in the years to come. The world health report is a document ofhigh standard and we are especially pleased to see the emphasis which is now laid on health system development, rolling back malaria, combating the tobacco epidemie and the strong commitment to health as a fundamental human right. I would like to conclude my address by assuring you, once again, of the commitment of the Government of Iceland to contribute to constructive efforts to fulfil WHO's noble mission to improve health for ali people of the world. Dr DURHAM (New Zealand): 2

The health of a nation underpins its well-being and standard of living. The role of the government as principal fun der of health services continues to be important, because it seems the best way to meet efficiency and equity objectives in securing health gains. In the face of new technology, ageing populations and rising consumer expectations, priority-setting is one of the central challenges facing governments in ail countries. Governments do have a responsibility to ensure that priorities are set to ensure the best possible health gains for available resources. Priority-setting is about aligning government priorities for health and disability services and the money it is prepared to spend on these services, with the decisions 1 The text that follows was submitted by the delegation of lceland for inclusion in the verbatim records in accordance with resolution WHA20.2. 2 The text that follows was submitted by the delegation of New Zealand for inclusion in the verbatim records in accordance with resolution WHA20.2.

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that individual health and disability professionals make for individual patients or population groups. This poses a fundamental challenge to the way governments, policy-makers and health professionals work together. New Zealand has recent experience with its National Health Committee which has been set up under statute to advise the Minister ofHealth on which health and disability support services should have priority for public funding; who should receive those publicly-funded services first; whether the right services are going to the right people, in the right way and at the right time; and whether they are the most effective services, the best value for money, and going to the people who would most benefit. The National Health Committee advocates that services should be evaluated according to the following principles: evidence of benefit or effectiveness, value for money, fairness, and whether services accord with the values of the communities. A range oftools is available for evaluating cost-effectiveness, for example, quality-adjusted life years and disease-adjusted !ife years as used in the World Bank's burden of disease. Systematic evaluation of the evidence is then required, given that yet another challenge arises in turning that information into a format that assists in decision-making at ali levels. Clinicat practice guidelines and health technology assessment reports have been successful in New Zealand and are being weil utilized. Priority-setting is a dynamic process. Incorporating community values into decision-making is particularly difficult as community values change over time. There will always be difficult trade-offs. Attention should be paid, therefore, to informing the public and health and disability providers, in depth, about any prioritization process, and to improving knowledge and understanding ofbroad issues involved in determining priorities and specifie issues in making particular decisions. In addition, identified priorities need continuous review and renegotiation as evidence emerges or changes. WHO has undertaken important priority-setting and has decided on Roll Back Malaria and the Tobacco Free Initiative. New Zealand supports WHO in setting these priorities. In particular, the framework convention on tobacco control is close to our hearts, as although New Zealand is recognized by WHO as having a comprehensive tobacco control strategy and has been successful in halving tobacco consumption since 1980, this success has not been shared evenly throughout the community. Fifty percent of Maori adults smoke, and progress in reducing smoking by women and young people has not been great in recent years. New Zealand looks forward to international protocols for addressing smoking by women, young people and indigenous people. New Zealand enthusiastically supports the proposai to develop a framework convention on tobacco control as part of the Tobacco Free Initiative and intends to play an active role in the working group. New Zealand supports priority-setting for maximizing health status and supports WHO in its priority-setting, particularly the focus on the framework convention on tobacco control. Le Dr Ponmek DALALOY (République démocratique populaire lao) :1 Monsieur le Président de séance, Madame le Directeur général de l'OMS, Excellences, honorables délégués, Mesdames, Messieurs, aujourd'hui, c'est pour nous un honneur et un plaisir de participer de nouveau à cette Assemblée mondiale de la Santé. Avant tout, je voudrais exprimer nos chaleureuses félicitations au Président et aux Vice-Présidents pour leur élection à leurs postes de haute responsabilité. Nous souhaitons que, sous leur sage et compétente direction, l'Assemblée soit couronnée de succès. A vrai dire, placée sous le signe d'un réel changement, l'Assemblée de la Santé revêt une importance particulière, car nous sommes au tournant du siècle. C'est aussi un grand défi pour nous. Malgré ce défi, il est clairement démontré que, si nos actions sont menées d'une façon clairvoyante et efficace, l'amélioration de la santé peut être obtenue avec des avantages socio-économiques considérables. Nous y croyons grâce à notre propre expérience. Malgré les grands changements de contexte qui, d'un côté, nous offrent plus d'opportunités, mais, de l'autre, nous imposent de nouveaux défis, notamment l'impact négatif de la crise économique et financière de l'Asie, notre pays a pu trouver son chemin en définissant et appliquant une politique judicieuse. La République démocratique populaire lao est un petit pays. Depuis son adhésion à l' ANASE, d'un pays sans littoral, il est devenu un pays de transit. Situé au centre de grands et dynamiques marchés, comme ceux de la Chine, du VietNam, du Cambodge, de la Thai1ande et du Myanmar, il est devenu le maillon qui permet l'intégration terrestre des pays du bassin inférieur du Mékong, et est de ce fait nanti d'un potentiel 1

Le texte qui suit a été remis par la délégation de la République démocratique populaire lao pour insertion dans le compte rendu, conformément à la résolution WHA20.2.

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de développement prometteur. Pays montagneux, riche en ressources naturelles encore inexploitées, il demeure sous-développé. Il est peu peuplé (4 800 000 habitants), habité par de multiples ethnies vivant de façon dispersée, et barré par d'énormes obstacles de communication (surtout en saison de pluie). Le niveau général de l'éducation, de la science, de la technique et de la gestion est bas. La différence reste grande entre la ville et les régions rurales d'accès difficile. La fécondité, la natalité, la mortalité générale, infantile et maternelle restent élevées, parmi les plus élevées de la Région du Pacifique occidental. Certaines épidémies persistent et les maladies les plus fréquentes sont les maladies infectieuses et parasitaires, telles que le paludisme, la dengue, les infections aigut5s des voies respiratoires, les maladies diarrhéiques, les six maladies infantiles évitables par la vaccination, la tuberculose, la lèpre, les parasitoses intestinales, la schistosomiase, etc. Et pour comble, nous sommes sous la menace du SIDA, des maladies sexuellement transmissibles, de la drogue, de l'accroissement des accidents de la circulation et de la multiplication des blessures par mines antipersonnel non explosées. Tout en étant menacés par les maladies transmissibles, nous assistons à la montée des maladies non transmissibles, dont le traitement est plus complexe et coûteux, ce qui fait que beaucoup d'entre nous sont allés se faire soigner dans les pays voisins. Les problèmes de santé sont caractérisés par un grand déséquilibre entre la demande, sans cesse croissante, pressante et immédiate, et l'offre, limitée à tout point de vue (personnel, expérience, fonds, équipements, etc.), déséquilibre qui est exacerbé par le processus de mondialisation. Soulager les souffrances des plus démunis est l'objectif le plus urgent, le plus juste, le plus humanitaire, le plus louable. La priorité ne peut être que la prévention, la prévention avant tout, à savoir la mise en oeuvre des soins de santé primaires avec leurs huit éléments fondamentaux. Cette politique est inlassablement soulignée et appliquée par l'établissement et l'extension du réseau sanitaire, aussi bien public que privé, et par la réalisation de projets de prévention verticaux d'importance stratégique. Notre Parti et notre Gouvernement ont toujours prôné une combinaison très étroite - ou organique entre le préventif et le curatif, comme il prône l'association entre la médecine traditionnelle et la médecine moderne. Pour cela, le pays s'est doté d'un réseau curatif: 2 hôpitaux centraux, 6 centres, 18 hôpitaux provinciaux, 131 hôpitaux de district et près de 600 dispensaires. Ce réseau est appuyé par un réseau de production et de distribution de médicaments tant modernes que traditionnels. Pour le changement, le changement de qualité, il nous faut créer les moyens : les moyens humains, les moyens financiers et, pour cela, les moyens organisationnels. C'est dans l'optique de cette tâche d'organisation que nous travaillons à renforcer nos capacités de coopération. Nous savons que notre chemin sera long et difficile. Mais nous sommes confiants dans notre avenir, confiants dans les changements réels. Mrs AHLUWALIA (International Federation of Red Cross and Red Crescent Societies): 1 The World Health Organization and the International Federation of Red Cross and Red Crescent Societies have recently decided to extend their long collaboration to yet another area, namely injury prevention and management. The focus will be on organizational capacity building and enhancing the ability of individuals, communities, governments and organizations to prevent and manage injury-related problems more effectively and cost-efficiently (particularly through partnerships, in areas as diverse as road use, home and workplace injuries or incidents, urban violence, landmine problems, etc.). The world health report 1999, in addressing the double burden of emerging epidemies and persistent problems, states that "injuries are a major public health concern because of the ir increasing significance within the global disease burden". Not only are deaths, injuries, and disabilities caused by accidents major public health problems, but they are also major social and economie problems. One excellent example that demonstrates the magnitude of this problem is road accidents, affecting ali countries, but the poor countries bear a disproportionate burden (nearly 70% of deaths caused by road accidents occur in developing countries). According to World Bank estimates accidents globally cost US$ 500 billion a year, resulting in losses of 1% to 3% of the annual gross domestic product. The cost to developing countries and to those in transition exceeds ali multilateral and bilateralloans and aid received by them. We have highlighted the fact th;;tt road traffic accidents are "a worsening global disaster destroying lives and livelihoods, hampering development and leaving millions in greater vulnerability". According to the studies undertaken by Harvard University for the World Bank and the World Health Organization, road accidents are likely to become the third leading cause of the burden of disease by the year 2020, after heart diseases and depression.

The text that follows was submitted by the International Federation of Red Cross and Red Crescent Societies for inclusion in the verbatim records in accordance with resolution WHA20.2.

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Governmental authorities have the primmy and ultimate responsibility for public health. However, they need not be alone in this task. lntersectoral and multidisciplinmy partnerships are needed between the different actors concerned with health promotion and provision at ali levels. The Red Cross and Red Crescent Societies, as the oldest and largest nongovernmental humanitarian organization, is conscious of the significant role that civil society will have to play in the twenty-first century to achieve the ideals of health for ali, offering the vast network of our 175 National Societies and more than 100 million volunteers and staffto respond to this cali. One ofthe most significant activities and tools the Red Cross and Red Crescent intends to use for injury and accident prevention management is our global first-aid programme. First-aid training seeks to educate the citizen on accident, injury and disease prevention and to train them in how to react in a helpful way to major or minor emergencies until skilled professional help is available. Helping people to help themselves, or the who le notion of first aid at the community level and by the members of the community, is an extremely effective and efficient tool at the service of health development, whose real value bas not been sufficiently recognized and acknowledged. Accordingly, in order to protect and save more lives, permit me to submit to you three suggestions for action: (1) to include first-aid training in the school curricula for ali ages through the necessmy legislation; (2) to provide opportunities for first-aid training for civil and public servants, workers, health professionals and volunteers; and (3) to form partnerships for injury and accident prevention and management programmes, including road safety, with ali concerned parties, governments, business and civil society, in particular with Red Cross and Red Crescent Societies, for the development of relevant emergency preparedness and response services, as weil as psychosocial and rehabilitation programmes. Through their collaboration, WHO and the Red Cross and Red Crescent will, among others, promote these partnerships. Allow me to cali on you as ministers of health to do the same with the national Red Cross and Red Crescent Societies in your countries. Early this year the World Bank took the initiative ofbringing together over 80 organizations (from the governmental, civil society, international finance and private sectors) to set up the Global Road Safety Partnership. The aim is to slow down the increase in road accident deaths, injuries and disabilities, and to strengthen and develop professional safety expertise in the developing world, through partnerships that promote collaboration and coordination of road safety activities. The membership is open to ali parties committed to the objective of this global partnership. The Red Cross and Red Crescent is hosting the secretariat of this partnership and this is another service that we are offering you. At the forthcoming International Conference of the Red Cross and Red Crescent which is a forum for discussing issues of common interest between the States and the Red Cross and Red Crescent Movement, we will repeat our appeal to your governments to join us to confront these global problems in partnership. The burden of g1obal heatth probtems on the already overstretched health resources is far too heavy for us not to try to compensate for this pressure with partnerships and feasible cost-effective community services such as first aid. Such global partnerships and advocacy for health are critical ingredients in the formula for making a difference. This collaboration between WHO and the Red Cross and Red Crescent can be a major instrument put at your disposai for preserving and restoring health, this fundamental right of ali human beings. Together let us keep our promise ofhealth for ali in the twenty-first century. This completes the list of speakers and our review of item 3. I shall now give the floor to the Director-General. Dr Brundtland, you have the floor. The DIRECTOR-GENERAL: Thank you. Let me first thank ali ministers and delegates for their interventions, which will be studied carefully and taken into consideration as a basis for our future work in many fields. 1 am, of course, also appreciative of the support that has been expressed for the change and renewal in WHO, and for your reflections and comments based on The world health report 1999: Making a diffèrence. It bas been good to observe ali the positive responses to the innovations that have been introduced at the Health Assembly this year. The ministerial round tables have been generally very weil received. Ministers have participated actively and contributed to pointed and lively debates on key issues confronting them. There was a genuine sense of open discussion and an exchange ofideas and practical experience. We will now be looking into and reviewing the experience, and looking at even further improvements based on this year's efforts. 1 believe that we can ali also Iearn from studying the many important points and observations that were shared between ministers during the round tables, and that they will prove fruitful in our future work.

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The PRESIDENT: Thank you, Dr Brundtland. After hearing the statements of the delegates, we are now in a position to express an opinion in the name of the Assembly regarding The world health report 1999. After hearing the comments ofthe various delegations, we have the clear impression that the Assernbly wishes to express satisfaction with the manner in which the Organization's programme for this year was implemented. Y our comments will be duly recorded in the records of the Assembly. We have now concluded our work for today. The next plenary will be held this aftemoon at 17:00. Committee B will now hold its second meeting. The meeting is adjoumed.

The meeting rose at 11:50. La séance est levée à 11h50.

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EIGHTH PLENARY MEETING Thursday, 20 May 1999, at 17:00 President: Mrs Maria de Belém ROSEIRA (Portugal) later: Dr E.F. EHTUISH (Libyan Arab Jamahiriya)

HUITIEME SEANCE PLENIERE Jeudi 20 mai 1999, 17 heures Président: Mme Maria de Belém ROSEIRA (Portugal) puis: Dr E.F. EHTUISH (Jamahiriya arabe libyenne)

AWARDS DISTINCTIONS The PRESIDENT: We shaH now take up item 8, "Awards". Excellencies, distinguished delegates, ladies and gentlemen, we are assembled here today for the presentation of the prizes awarded by the Darling Foundation, the Léon Bernard Foundation, the Jacques Parisot Foundation, the lhsan Dogramaci Family Health Foundation, the Sasakawa Health Prize and the United Arab Emirates Health Foundation. 1 have much pleasure in welcoming among us the distinguished winners ofthese prestigious prizes: Dr Jarbas Barbosa da Silva, representing the late Dr Agostinho Cruz Marques; Dr Vinod Prakash Sharma; Mrs Debbie Emma Choonga; Mr Boinkum Benson Konlaan; Professor Münevver Bertan; Dr Juan Guillermo Ortiz Guier; Dr Ayanda Ntsaluba, representing the lnstitute of Urban Primary Health Care, South Africa; Professor lsmail A. Sallam; and His Eminence Metropolitan Chrysostomos ofKition and Dr Kyriacos Veresies, representing the Centre for Education about Drugs and Treatrnent of Drugaddicted Persons, Cyprus. 1 am also very pleased to greet Professor Ihsan Dogramaci, the founder of the lhsan Dogramaci Family Health Foundation, Professor Kenzo Kiikuni, representing the Sasakawa Memorial Health Foundation, and His Excellency Dr Hamad Abdul Rahman Al Madfa, representing the founder of the United Arab Emirates Health Foundation. Presentation of the Darling Foundation Prize Remise du Prix de la Fondation Darling We shall start with the presentation of the Darling Foundation Prize. The Darling Foundation Medal and Prize are presented at the Health Assembly to a person or persons for their outstanding achievements in the pathology, etiology, epidemiology, therapy, prophylaxis or control of malaria. 1 am pleased to announce that the Executive Board of WHO, having considered the report of the Darling Foundation Committee, awarded the prize to Dr Agostinho Cruz Marques, from Brazil and to Dr Vinod Prakash Sharma from lndia. The achievements of the late Dr Agostinho Cruz Marques in combating malaria are remarkable. Over a span of 35 years he worked principally in the poorest and most needy regions in Brazil and held various key positions in the States of Acre, Amazonas, Rondônia, and Roraima. In 1977 he assumed the responsibility for nationwide coordination of ali antim.alaria activities, successfully dealing with the

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challenge of the disease and eventually reducing it to a considerably lower levet. Dr Marques was the author of a number of publications on malaria control. Dr Vinod Prakash Sharma's accomplishments have been of immense value in enhancing the understanding of malaria dynamics, the organization of situation-specifie control interventions, and the development of an integrated and ecologically sound cost-effective approach and method for malaria control. His work contributed substantially to the successful implementation of malaria control in severa} states of India. Dr Sharma is the author of a number of world-acclaimed publications on malaria. It is now with much pleasure that 1 invite Dr Barbosa da Silva on behalf of Dr Agostinho Cruz Marques and Dr Sharma to receive the prizes.

Amid applause, the President handed the Darling Foundation Prize to Dr Jarbas Barbosa da Silva, representing Dr Agostinho Cruz Marques, and to Dr Vinod Prakash Sharma. Le Président remet au Dr Jarbas Barbosa da Silva, qui représente le Dr Agostinho Cruz Marques, et au Dr Vinod Prakash Sharma le Prix de la Fondation Darling. (Applaudissements) The PRESIDENT: 1 now invite Dr Barbosa da Silva to address the Assembly. Dr BARBOSA DA SILVA: As the Director of the Brazilian National Centre for Epidemiology, and today also as a representative of the laureate, and of ali the Brazilian community of public health professionals, 1 feel honoured to receive this award presented by the Darling Foundation to Dr Agostinho Cruz Marques. Dr Marques dedicated his entire life to the control of malaria in Brazil. His work in the fields of epidemiology, medical care, research and teaching will not be forgotten. He has indeed left many followers, perhaps not as brilliant, but ali with a strong will and dedication to sustain his struggle against disease, in the pursuit ofbetter living standards for our people. Thank you very much. The PRESIDENT: Thank you, Dr Barbosa da Silva. I now invite Dr Sharma to address the Assembly. DrSHARMA~

Madam President of the Fifty-second World Health Assembly, Madam Director-General, excellencies, honourable ministers of health, distinguished members of delegations to the Fifty-second World Health Assembly, ladies and gentlemen, 1 wish to thank the World Health Organization for this high honour given tome by awarding me the Darling Foundation Prize for combating malaria in India. I am deeply indebted to the Indian Council of Medical Research, the Ministry ofHealth and Family Welfare, and the National Anti-malaria Programme of the Government of India for their unstinting support throughout my research career. The development of the bioenvironmental malaria control strategy has been realized through dedicated hard work and selfless service by the staff at the Malaria Research Centre. Malaria is dreadful. It kills routinely children, pregnant women, nonimmunes; and the sick are especially vulnerable. In poor nations, malaria is a major cause ofhigh mortality and a key element ofvicious cycles of poverty and ill-health. A major reduction from malaria had been achieved in many endemie countries; but it has returned with added vigour, entered new territories and has had an adverse impact upon the development and poverty alleviation programmes. In India malaria also adds additional weight to the already over-stretched social and health welfare programmes, effectively crippling local economies. Insecticide spraying to control malaria is harmful and produces diminishing returns. Developments designed to improve the national economy have led to the relentless march of man-made malaria. Over the past few decades peoples' own perception offighting malaria has changed, the wisdom of incessant spraying has been questioned; and societies have become more open, democratie and demanding. The return of malaria has become more aggressive and its control requires renewed attack based on local epidemiological determinants. In this context bioenvironmental methods to roll back malaria offer a sustainable, and in my experience, wise alternative. It is indigenous, ingenious, involves local populations in their own health care, and is environmentally sound. It adapts equally weil to both nature and changing scenarios of social progress. It is a strate gy in which the old and new jo in hands in a scientific frame, with the common aim of thwarting mosquito-borne misfortunes. This methodology is ideally suited for poor

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and developing nations, and offers a platform on which self-reliant and vibrant social structures can be built. Our work offers a more viable alternative to malaria control than complete re lian ce on insecticideand drug-based strategies, and 1 hope it will be applied in countries where malaria remains a killer. The PRESIDENT: Thank you, Dr Sharma.

Presentation of the Léon Bernard Foundation Prize Remise du Prix de la Fondation Léon Bernard The PRESIDENT: 1 shall now proceed to the presentation of the Léon Bernard Foundation Prize. This prize is given to a persan having accomplished outstanding service in the field of social medicine. The Léon Bernard Foundation Prize is awarded this year to Mrs Debbie Emma Choongo of Zambia. Mrs Choongo commenced her career as a registered nurse, then as a public health nurse. In 1989, as Principal Nursing Officer (Research), she was assigned to coordinate a women's project in rural communities of the Mambwa District, Zambia, called "Promoting health through women's functional Iiteracy and intersectoral action". The aim of the project was to assist local communities to find workable solutions to their problems by using available local resources through direct community participation. The main areas of activities were health, functionalliteracy, and income-generating activities. Mrs Choongo's personal commitment, creativity and communication skills have been instrumental in the achievement of remarkable successes in ali these areas. Under her impetus, the project has been so successful that this community is now regarded as a mode) for good community health practices, with information on this experience being disseminated to other communities. For her outstanding accomplishments, 1 now have great pleasure in presenting Mrs Choongo with the Léon Bernard Foundation Medal and Prize.

Amid applause, the President handed the Léon Bernard Foundation Prize to Mrs Debbie Emma Choongo. Le Président remet à Mme Debbie Emma Choongo le Prix de la Fondation Léon Bernard. (Applaudissements) The PRESIDENT: 1 invite Mrs Choongo to address the Assembly. Mrs CHOONGO: Madam President of the Fifty-second World Health Assembly, distinguished guests, ladies and gentlemen, I feel honoured to be the recipient of the Léon Bernard Foundation Prize in social medicine, the frrst of its kind to be bestowed upon a Zambian. On behalf of the Zambian Government and indeed on my own behalf, 1 wish to thank the World Health Organization and the Léon Bernard Foundation Committee for awarding this prize for outstanding service in social medicine. I feel sim ply overwhelmed by this gesture. 1 believe that there are many others out there better than 1, but their work has probably not been noticed. I have learned from my experience in social medicine that people's involvement in planning and decision-making is pivotai in achieving desired change in health and quality of life, even during times of crisis. Working in social medicine bas helped me to see more objectively sorne of the problems of vulnerable groups, such as low-income families, and their difficulties in finding alternative solutions. In a developing and highly indebted poor country like Zambia, implementing and sustaining community health initiatives is always a challenge, the major constraints being Jack of a financial base to expand and replicate initiatives. Zambia is spending more than 50% of its foreign exchange earnings on debt-servicing, thereby depriving its citizens of the much needed funds for improving health services. It is in this vein that ljoin the many Zambians and other countries advocating debt cancellation. From experience, I have found nothing more satiszying than helping to untie the knots that hold back the health and economie potential of the Jess privileged people in society. From my work 1 have fu fly leamed that one cannat succeed by operating from a platform far removed from the daily realities of people.

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It is necessary to understand and share their difficult circumstances through discussions, information dissemination and research for effective resource utilization. I would like to pay my special tribute to the communities that I have worked with for opening their doors and permitting this rich mutual sharing of opportunities to improve our health. My message is that community health programmes continue to be important, but nearly every nation is experiencing new health problems that demand fresh approaches to their solutions. I believe that every man, woman and child must have the opportunity and capacity for full health development and productivity. There is a need to empower communities with knowledge of and skills for key actions that may improve their health status. When people participate in health programmes they develop a sense of ownership, and they value the services more, and quickly learn to do more. This occasion is a driving force for me to work harder and serve as a mode!. I intend to dedicate myself to building the capacity of my fellow workers and communities through a participatory learning approach, which has a multiplier effect. I thank my Government for creating a conducive working environment, which enabled me to execute my work ably. It is my great pleasure once again to thank the World Health Organization and the Léon Bernard F oundation Committee for bestowing this prize upon me. Thank you and God bless. The PRESIDENT: Thank you, Mrs Choongo.

Presentation of the Jacques Parisot Foundation Medal Remise de la médaille de la Fondation Jacques Parisot The PRESIDENT: I now proceed to the presentation of the Jacques Parisot Foundation Medal. This Foundation was established for the purpose of awarding every two years a fellowship for research in social medicine or public health. The Fellowship was awarded last year to Mr Boinkum Benson Konlaan, from Ghana. Having gained a diploma in statistics from the University of Ghana, and a Master of Public Health degree at the University of Umeâ, Sweden, Mr Konlaan is currently pursuing doctoral studies at Umeâ University within an innovative project on cultural stimulation and health. The objective of the research he is undertaking under the Fellowship is to delimit individuals in the normal population who rarely attend cultural events, and to make a randomized, controlled experiment that would encourage them to do so more often. The individuals are being followed up with regard to the health-related effects. In a few minutes, Mr Konlaan will give us a brief outline of the results ofhis work. In the meantime, it is a privilege for me to present to him the Jacques Parisot Foundation Medal.

Amid applause, the President handed the Jacques Parisot Foundation Medal to Mr Boinkum Benson Konlaan. Le Président remet à M. Boinkum Benson Konlaan la médaille de la Fondation Jacques Parisot. (Applaudissements) The PRESIDENT: Mr Konlaan, you have the floor. MrKONLAAN: Madam President, ladies and gentlemen, as a Ghanaian working in Sweden, I have come to be lieve that the participation in the culturallife of any country is important for the well-being of its people. In the studies performed with the support of this fellowship I have come up with rather clear indications on its importance even for the survival of individuals. Secondly, we believe that a widening of intense cultural participation in ali social and ethnie groups could attenuate health inequalities between them. Our studies on participation in cultural !ife thus have the general aim of attenuating health inequalities. The background is an impressive difference in access and use of the cultural offer between socioeconomic and educational groups. If participation in the culturallife has a health impact, a new and important way of promoting equality in health could be to promote equity in the participation in culturallife. In our first studies we found that attending cultural events had a significant influence on survival for people after we had discounted other health determinants like smoking, incarne, education, social network,

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etc. In order to contribute to the discussion on causation we th en carried out an experiment where people were encouraged to increase their participation in cultural events. This was a randomized controlled investigation using a factoral design, where attending cultural events and taking easy physical exercise were tested simultaneously. Participants had responded to a postal questionnaire on their attendance at cultural events. Ofthese, 21 individuals (Il men, 10 women) were recruited into a two-month long experiment. The interesting fin ding was that the two ways of stimulation produced two different responses. A decrease in the levels of stress-related hormones was observed only in th ose subjects encouraged to attend cultural events. Physical exercise encouragement instead increased the "good" cholesterol. Obviously, there was a specifie effect apart from the general response to the attention or being observed. This was in fact to be expected from basic biological research. The way may have been opened to diminishing the health differentiai between social classes. We have been encouraged to continue the studies and will be happy to report on them in due course. The PRESIDENT: Thank you, Mr Konlaan.

Presentation of the Ihsan Dogramaci Family Health Foundation Prize Remise du Prix de la Fondation Ihsan Dogramaci pour la Santé de la Famille The PRESIDENT: I proceed now to the presentation of the Ihsan Dogramaci Family Health Foundation Prize. This prize is given to a person having accomplished service in the field of family health. I have pleasure in announcing that the Ihsan Dogramaci Family Health Foundation Prize has been awarded this year to Professor Münevver Bertan from Turkey. Professor Bertan has devoted her who le career to the promotion of family health. Included among her many exemplary achievements is the 1985 national immunization campaign of Turkey, which Professor Bertan was responsible for organizing, as technical adviser to the Minister of Health. This programme not only achieved high coverage, but also established a system for sustaining immunization, and became the mode! for the creation of the Turkish Intersectoral Committee on Child Survival and Development. Other notable achievements of Professor Bertan include the project on "Strengthening Clinical Family Planning Training in Medical Schools in Turkey" and the "Community Health Workers Project in a rural area of Turkey". In addition, she has also participated as principal investigator in severa! national and international collaborative research studies on diarrhoeal diseases, acute respiratory infections and other projects related to family health. Before presenting the prize to Professor Bertan, 1 invite Professor lhsan Dogramaci, the distinguished founder of the prize, to address the Assembly. Professor DOGRAMACI: Madam President, Madam Director-General, distinguished delegates, ladies and gentlemen, on behalf of the Foundation Committee, 1 would like to congratulate Professor Münevver Bertan, who has been singled out among many distinguished candidates as this year's recipient of the lhsan Dogramaci Family Health Prize. Professor Bertan is Professor ofPaediatrics and Public Health in the University ofHacettepe in Turkey. This is the first time in 19 years, since the establishment of the prize, that a Turkish national has been awarded this prize. Professor Bertan's work at the national and intemationallevel to improve the health and well-being ofwomen, adolescents and children makes her richly deserving of this recognition. She is an academie, a researcher, a teacher, social mobilizer, a supporter of nongovernmental organizations, a leader for the rights of children, a pioneer in the movement updating knowledge in paediatrics in the republics of Central Asia, a strong voice for adolescent health. Indeed, she is truly multisectoral. She has worked as a senior adviser with the Ministry ofHealth ofTurkey on immunization policies, while keeping up her duties on the Faculty Board ofthe School of Medicine and the University Council. She has been President ofthe European Society of Social Paediatrics, and Coordinator of the International Pediatrie Association; she serves as Secretary-General of the Turkish National Committee for UNICEF, and she was until recently a member of the Executive Board of WHO. Professor Bertan continues to serve on the scientific advisory boards of many institutions.

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She has been recognized by the Foundation Committee as an impressive team leader and an innovative capacity bu il der in public health, a strong advocate of children 's and women' s health and rights. Professor Bertan is awarded this prize for her active involvement in and contribution to health and development at the national and international leve!. It is my pleasure to congratulate Professor Bertan on behalf of the Foundation Committee. The PRESIDENT: In recognition ofher outstanding achievements, I have pleasure in presenting Professor Bertan with the Ihsan Dogramaci Family Health Foundation Prize.

Amid applause, the President handed the lhsan Dogramaci Family Health Foundation Prize to Professor Münevver Bertan. Le Président remet au Professeur Münevver Bertan le Prix de la Fondation lhsan Dogramaci pour la Santé de la Famille. (Applaudissements) The PRESIDENT: I now invite Professor Bertan to address the Assembly. Professor BERTAN: Madam President, Madam Director-General, distinguished delegates, ladies and gentlemen, it is a great honour and privilege for me to be present at this Health Assembly to receive the Ihsan Dogramaci Family Health Foundation Prize. This honour is not mine atone. I share it with the grass-roots service providers who work so hard to improve family and child health, and also with my colleagues who conduct studies in the community. This prize has a special meaning for me. In the first place, 1 have worked with WHO since 1972 as an adviser, principal investigator for many child health and family planning projects, as a member of the Scientific and Advisory Group of the Special Programme ofResearch, Development, and Research Training in Human Reproduction and most recently as Executive Board member from 1993 to 1996. Closer to home, 1 have the privilege of working in the university and children's hospital established by Professor Dogramaci who is an internationally known figure in child health and higher education and who was among the signatories ofthe WHO Constitution in 1946. I would like to take this opportunity to underline sorne of the anticipated challenges for the next millennium. The dramatic shift from rural to urban !ife styles will create more crowded settlements without safe sanitation, access to essential basic social services, adequate shelter and secure livelihoods. Economie and political crises will continue to give rise to millions of poor and vulnerable families, who depend most directly on public services and who long for a future with no war, violence or starvation, free from preventable acute and chronic diseases, including a healthy environment. As a paediatrician and public health person, 1 see that the human development agenda should focus on education, prevention and health promotion, especially in the three critical periods of !ife: pregnancy, infancy and early childhood and adolescence. Every child has the right to reach the age of six, healthy and able to learn. This is an investrnent that ali countries, rich and poor, must be able to make. Although a lot still remains to be done for them, infants and children have traditionally received more attention, so 1 would like to focus on older children, especially adolescents, those who will influence the health patterns and life styles of future generations. Just as a healthy intrauterine !ife is important to produce a healthy newborn, a successful adolescence is vital for a healthy and fruitful adulthood. Wide implementation of the Convention on the Rights of the Child, and a finn commitrnent to women's rights and human rights are also necessary to achieve better health and welfare in the next millennium. And we must not forget that violence spawns further violence, whereas peace brings peace. Child-friendly environments and adolescent-friendly communities will help to bring about a spirit ofunderstanding, peace, tolerance, and equality ofthe sexes among the world's peoples. Another important challenge will be genetics and ethics. Technological advances can help give us the power to solve problems, but we must be conscious of the fact that the same advances can raise serious ethical issues which must be tackled by the international community. It is my firm belief that a public health approach to the challenges facing us will serve to combat poverty and inequalities as weil as poor health. Each country must bring together its policy-makers and researchers in a cross-disciplinary approach to identify priorities for development in an ethical context. They must take into account how globalization affects human welfare. Their goal must be to develop

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policies aimed at reducing poverty, eliminating socioeconomic inequalities, and reforming the health and education sectors. The goal for the next millennium should be to strengthen the knowledge and practice of a public health approach to primary health care. In that way we cao attain health for ali, and we cao marshal ali for health, throughout the world. The PRESIDENT: Thank you, Professor Bertan.

Presentation of the Sasakawa Health Prize Remise du Prix Sasakawa pour la Santé The PRESIDENT: Distinguished delegates, ladies and gentlemen, I now come to the presentation of the Sasakawa Health Prize. This prize is awarded to individuals or institutions for outstanding innovative work in health development, and aims at encouraging the further development of such work. It is with pleasure that I announce that the 1999 Sasakawa Health Prize has been awarded to Dr Juan Guillermo Ortiz Guier, of Costa Rica, and to the Institute of Urban Primary Health Care, Bergvlei, South Africa. During a career that spans over 30 years, Dr Ortiz Guier's contribution to primary health care has been exemplary, both in terms of his accomplishments at country leve! and in fostering the primary health care movement worldwide. Having been involved in the development of a community hospital in the rural region of San Ramon since its inception in 1955, Dr Ortiz be gan in the earl y 1960s to organ ize home care for aged people in the same area, building up teams of physicians, nurses and other auxiliary personnel including social workers, to serve this programme. The programme, designed to provide access to appropriate health care for ali, was later to become known as "Hospital without Walls". In 1974, the programme was expanded to include the establishment of300 health posts throughout the country, and a year later the Social Security Fund created 400 primary health care teams to cover the who le country. At intemationallevel, Dr Ortiz was involved in the preparation of the Alma-Ata Conference in 1978 and has frequently been called upon to present his experience in many countries of the world. The prize money will be used in part to support a subprogramme of"Hospital without Walls" for aged people, entitled Hagar de Ancianos de San Ramon. It will also be used to support the creation and organization of health development committees in primary and high schools throughout Costa Rica. The Institute of Urban Primary Health Care, Bergvlei was established in 1990, initiated by the Alexandra Health Centre to carry out primary health care research and training activities. In 1997 it became and independent trust. The work of the Institute has helped to build the capacity and numbers ofhealth service personnel able to work in primary health care. Since 1994 its activities have extended beyond provincial and country boundaries to include neighbouring provinces and countries. The prize money will be used to expand the Institute's work through its local branch in KwaZulu, Natal Province. The Institute also intends to develop courses for other categories of health personnel involved in rehabilitation in K wa Zulu. The aim is to ensure that rehabilitation is truly regarded as one of the cornerstones of primary health care. Before pre sen ting the prize, I invite Professor Kiikuni to address the Assembly on behalf of the Sasakawa Memorial Health Foundation. Professor KIIKUNI: Madam President, distinguished winners of this year's different health prizes, Madam DirectorGeneral, distinguished delegates and friends, first of ali let me express my most sincere esteem and appreciation to ali my colleagues gathered here today for your tireless effort for the advancement of health and welfare of the people of the world. On behalf of the Nippon Foundation and Sasakawa Memorial Health Foundation, I would like to congratulate Dr Juan Guillermo Ortiz Guier of Costa Rica and the Institute of Urban Primary Health Care of South Africa, the recipients of this year's Sasakawa Health Prize, for the ir innovative effort and leadership which have inspired ali of us wh ose con cern is enhancement of health ofthe people ofthe world. The Sasakawa Health Prize was established in 1984 by a complete agreement between two unique leaders in health: Dr Halfdan Mahler, the theo Director-General of WHO, and the late Mr Ryoichi Sasakawa, the founder of the prize and the then Chairman of the Nippon Foundation. Creation

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of this prize was to demonstrate the strong commitment by the two leaders for betterment of health of people through individual and group efforts in primary health care. It was in the mid-1970s when Mr Ryoichi Sasakawa decided to support WHO's effort in leprosy elimination. Leprosy is a disease which bad been generally forgotten, but Mr Ryoichi Sasakawa was different. He bad a special concem and sympathy toward the sufferers of the disease. In those days, it was a disease with grave social consequences. Patients suffered not only physically but also socially and mentally. No other disease brings such agony and distress to its afflicted and their families as leprosy. WHO's definition ofhealth being the physical, mental and social and now spiritual well-being of people, elimination of leprosy will no doubt have a significant meaning in human history. Eliminating an age-old disease, however, requires tremendous effort by every sector of society. Maintaining political commitment, ensuring financial resources and planning and implementing the programme from the top to grass-roots levels is a formidable challenge. 1 must truly praise the DirectorGeneral for ber determination and leadership, soon after she took office, in calling for an intensified strategy to strengthen and accelerate leprosy elimination, in accordance with resolution WHA44.9 adopted in 1991. 1 would like to acknowledge the outstanding results which the global effort bas achieved to date. The use of multidrug therapy to treat and cure 1eprosy patients bas already reduced the global prevalence ofleprosy by 85%: from five million registered patients in 1985 to 800 000 today. The Nippon Foundation and Sasakawa Memorial Health Foundation are very pleased to be a part of this successful operation of the multidrug therapy drug delivery system, with our annual contribution of US$ 14 million. 1 am happy to inform the award recipients, and everyone else participating in primary health care in the world, that we have come near to the elimination of leprosy. But, we say in a Japanese proverb that when climbing Mount Fuji, even if we arrive at the ninth station, out of 10, we have only come half way. The final ascent demands the hardest work. Unless we intensify our efforts the abominable times may retum. W e must therefore be steadfast, as the achievement of our goal is in sight. Once we attain the goal, then we can tum our attention to strengthening primary health care in order to sustain the elimination and also to control and eliminate other public health threats. This is a unique opportunity and a challenge to mankind. Let us reaffirm our commitment to unite our efforts towards the elimination of leprosy, as a concrete and important element of the achievement ofhealth for ali. The PRESIDENT: Thank you, Professor Kiikuni. It is now my privilege to present the Sasakawa Health Prize to Dr Juan Guillermo Ortiz Guier, and to Dr Ayanda Ntsaluba, representing the Institute of Urban Primary Health Care.

Amid applause, the President handed the Sasakawa Health Prize to Dr Ortiz Guier and Dr Ntsaluba. Le Président remet le Prix Sasakawa pour la Sauté au Dr Ortiz Guier et au Dr Ntsaluba. (Applaudissements) The PRESIDENT: 1 now invite Dr Ortiz Guier to address the Assembly. Dr ORTIZ GUIER: Madam President, Madam Director-General, distinguished delegates, ladies and gentlemen, to obtain the Sasakawa Health Prize for primary health care is a great honour for my country, because in Costa Rica the communities have taken part in primary health care. We have created the well-known programme called "Hospital without Walls". This meant that the hospital projected its influence throughout the who le area, with ali the professional staff, technicians and other staff in different departments, who take part in preventive and curative medicine, education and community development, such as water supplies, obtaining small pieces of land for peasants to work, creating housing and cooperative milk societies for small producers, loans for agriculture in the programme zone with money from the Inter-American Development Bank, because we went to them and asked for it, and the establishment of the "Regional Productive Projects Association". The community constructed health posts with their own resources and sorne help from the Government. Intersectoral and interinstitutional actions were carried out for the health organization and development of patients. In primary and high schools we created committees for health and deve1opment, which took part in the programme. Later we did the same through social security, covering the whole

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country. The results of ali this were that the incidence of infectious diseases and parasitoses were lowered completely, and that infantile mortality and other health indexes were excellent. Our hospital was a community hospital working through a board of trustees with great hopes for the future. Later, in 1974, the Health Minister of my country created 300 health posts for the rest of the country, and following this obtained wonderful health indexes. My country th us became one of the first countries in Latin America with good health indexes. Later, when the Health Ministry became Health Rector, and when social security assumed preventive, curative and rehabilitation as a whole, the health posts became basic teams called "ebais" and we now have more than 800 in our country. This bas resulted in a wonderful improvement in the standard of care given to citizens in rural areas and periurban cities. Now, in 1998, Costa Rica bas an infant mortality rate of 12.111000. 1 believe that hospitals in the rest of the world, and particularly those in first line care must follow the example of the "Hospital without Walls" programme if they want to obtain a very active, excellent, vigorous and effective primary health care service. 1 be lieve that primary health care services can achieve the highest goals if the hospitals support them with the facilities they have in ali the ir areas of influence. 1 wish that God's will would be done on our planet Earth, that total harmony may reign, with health development and justice for ali mankind. We must from now on talk about globalization ofhealth, justice and development, and not only about economie globalization. In our programme "Hospital without Walls", the achievements were made possible because ali the team members and the organized community worked together with unified ideas and goals that were able to be transformed into actions. 1 have worked for 49 years in communities and in rural areas, and if 1 bad the opportunity of another life, 1 would work again in primary health care. 1 would now like to tell you in my own language something about "Hospital without Walls" that 1 felt in my own soul, and which is expressed in a poem which goes like this: En la profunda hondura humanitaria de la mente y del espiritu se forjaron las corrientes sociales en forma natural y asi se expresaron como el sol, como el aire y como el agua que aclaran, iluminan y dan vida, porque todos vivimos en el mundo comun. Asi también de nuestro intimo torrente surgieron mis ideales vigorosos y firmes como tanques de paz a romper las paredes del clasico hospital, abrazando en su am or toda el ârea rural y quedaron sembradas enfermeras en toda su extension. Como trombas de amor corrieron el mensaje, cambiando la actitud pasiva y conformista de nuestro campesino por la lucha constante de energia sin desmayo con la frente despierta e incisiva como llama encendida en noche oscura. Y toda la nifiez se protegi6 contra los monstruos vivos de la enfermedad infecciosa, la parasitosis intestinal y la desnutrici6n. Es la nueva actitud comunitaria que sigue la mujer desde su cuna y la prepara para ser la madre responsable, y vigila a su hijo desde que fue en el vientre pensando en un futuro ciudadano mas feliz y al completo desarrollo tu campesino luchador se organiz6 en tu pueblo con todo su derecho a respirar salud. Madam, 1 thank you for allowing me to quote, in Spanish, and in my own words, this poem on the occasion ofthis award. The PRESIDENT: Thank you, Dr Ortiz. 1 now invite Dr Ntsaluba to address the Assembly on behalf of the Institute of Urban Primary Health Care. Dr NTSALUBA: Madam President, Madam Director-General, distinguished delegates, it is indeed a great pleasure for me to receive this prestigious Sasakawa Health Prize on behalf of the Institute of Urban Primary Health

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Care. This is particularly so since one of my colleagues, Ms Rose Mazibuko, was a recipient of the same prize last year. It is indeed reassuring to realize that as South Africans labouring in the difficult conditions of our health systems transformation that we are not al one and that others recognize the value of what we are attempting to do. That it is the World Health Organization that has recognized us by awarding us this prize is ofhigh regard and a notable achievement in our history. This is indeed the highlight of the year for the lnstitute. The Institute of Urban Primary Health Care was formed in 1990 as a unit of the Alexandra Health Centre, based in Johannesburg, to carry out research and training activities related to primary health care in Alexandra and to gather information on the development of services and systems at the centre. Subsequently, the Alexandra Health Centre has been noted both in South Africa and abroad for its pioneering work in the establishment of comprehensive primary health care services and is regarded as a model for the country. The Institute has also been engaged in training primary health care nurses and mentors, committee-based rehabilitation facilitators, supervisors and managers, health advisers and homebased care givers. They have engaged in lobbying for the inclusion of community-based rehabilitation in national policy and for the recognition of community-based rehabilitation facilitators. With this award we hope to attract those persons or organizations that are interested in pioneering development initiatives for empowering communities to help interventions, to engage us in discussion, partnership and joint ventures for research and implementation, so that the lnstitute would continue to be relevant to the people of South Africa and our region. The Institute is grateful to the W orld Health Organization for this award and expresses its thanks not only on its behalf as an institute but also on behalf of the Alexandra Health Centre, from which the Institute emerged, the institutions and donors who have supported it and also to the people in the Govemment of South Africa. The funds associated with this award are needed, but we also look forward to working with this Organization on programmes with common objectives. Madam President, once more many thanks for this award.

Dr E.F. Ehtuish (Libyan Arab Jamahiriya), Vice-President, took the presidential chair. Le Dr E.F. Ehtuish (Jamahiriya arabe libyenne), Vice-Président, assume la présidence. The PRESIDENT:

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Amid applause, the President handed the United Arab Emirates Health Foundation Prize to Professor Sallam, to His Eminence Metropolitan Chrysostomos of Kition, and to Dr Veresies. Le Président remet le Prix de la Fondation des Emirats arabes unis pour la Santé au Professeur Sallam, à Son Eminence le Métropolite Chrysostomos de Kition et au Dr Veresies. (Applaudissements) The PRESIDENT:

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A52/VR/8 page 122

The PRESIDENT:

~~ ~~Ify _r.- ~? 4 Y.J.rJI a;~l ~t.,., _y.)i ~':a'IJ 'i"Y- .JP..UI ~t:.....S\1 1_;:..:;. .~ ~ ~..WI r._~J ui.J~I ~~ ~1 y _r ,y-~~ ~1 JI ..!..t..bLdl His Eminence Metropolitan CHRYSOSTOMOS OF KITION: We wannly thank you for your decision to present KENTHEA with the United A rab Emirates Health Foundation Prize. This decision constitutes a great honour, not only for the Cyprus Ministry ofHealth and ali members of KENTHEA, but also for ali the people of Cyprus. 1 would like to stress that this honour reflects on the entire population of Cyprus, because KENTHEA has managed in the space of five years to bring together under the same roof 32 volunteer organizations which are working hard to combat drugs and ali kinds of narcotic substances, in close collaboration with the Orthodox Church of Cyprus, the Ministry of Health, the Ministry of Education, the Ministry of Labour and Social Insurance and the Ministry of Justice, Cyprus University, youth organizations, educational organizations and the Parents' Association for Elementary and Secondary Education, as weil as with ali the municipalities and communities in the free part of Cyprus. The endeavours and efforts of KENTHEA are focused mainly on collecting information and localizing the extent and nature of the problems associated with narcotic substances, organizing suitable programmes to prevent these substances spreading, and also providing the necessary treatrnent and support for drug-addicted persons. For me, personaliy, and for ali members ofKENTHEA, this award is nothing more than a reminder of our obligations and the additional heavy duty to offer our help to our society, th us achieving the wellbring and health of those in need. We will exert ali our efforts in the cause of minimizing the use of narcotic substances. It is in this sense and with these thoughts that we accept this award. Once again we express our thanks and gratitude to the Worid Health Organization for honouring KENTHEA with the United Arab Emirates 1999 award. We regard this action as a great encouragement to our efforts and we promise you that we shali never give up and we will continue giving ali our love and help to ali those in need. A love that will, undoubtedly, lead to a healthy and happy life for ali the people. Thank you and God bless you. The PRESIDENT:

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Francesco Pocchiari Fellowship Bourse Francesco Pocchiari

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A52NR/8 page 123

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The meeting rose at 18:25. La séance est levée à 18h25.

A521VR/9 page124

NINTH PLENARY MEETING Monday, 24 May 1999, at 14:30 President: Mrs Maria de Belém ROSEIRA (Portugal)

NEUVIEME SEANCE PLENIERE Lundi 24 mai 1999, 14h30 Président: Mme Maria de Belém ROSEIRA (Portugal)

FIRST REPORT OF COMMITTEE B1 PREMIER RAPPORT DE LA COMMISSION B1

The PRESIDENT: Y ou have before you the first report of Committee B, contained in document A52/33. Please disregard the word "(Draft)" as the Committee approved the report without any amendments. The report contains five resolutions which we shaH proceed to adopt one by one. Let us now consider the first resolution entitled "Status of collection of assessed contributions". Is the Assembly willing to adopt this resolution? 1 see no objections, the resolution is therefore adopted. The second resolution is entitled "Arrears in payment of contributions: Latvia". Is the Assembly willing to adopt this resolution? 1 see no objections, the resolution is therefore adopted. The third resolution is entitled "Arrears in payment of contributions: Liberia". ls the Assembly willing to adopt this resolution? 1 see no objections, the resolution is therefore adopted. The fourth resolution is entitled "Members in arrears in the payment of their contributions to an extent which wouldjustif)' invoking Article 7 ofthe Constitution". Is the Assembly willing to adopt this resolution? 1 see no objections, the resolution is therefore adopted. The fifth resolution is entitled "Health conditions of, and assistance to, the Arab population in the occupied Arab territories, including Palestine". Is the Assembly willing to adopt this resolution? 1 cali upon the delegate of the United States of America. Mr BOYER (United States of America): Thank you Madam President. The United States of America voted against this resolution in Committee B. Although we will not cali for another vote in the plenary, we remain strongly opposed to this text. We would have no objection if this resolution were Iimited to the subject of the health of the Palestinian people. The United States shares the concems of others that the health status of the Palestinian people must be improved. To this end the United States has provided more than US$ 50 million in assistance to the Palestinians for child survival and maternai health programmes, and we are continuing this assistance. But this resolution goes far beyond health matters. At this Assembly we have bad solid substantive discussions on poliomyelitis, malaria, smallpox, tobacco and many other technical issues. In contrast, this resolution takes up inappropriate political issues. More than that, this resolution seems to poke a finger in the eye of the new Israeli Govemment. An approach such as this cannot hope to advance 1 1

See reports of committees in document WHA52/1999/REC/3. Voir les rapports des commissions dans le document WHA52/1999/REC/3.

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the bilateral discussions between Israel and the Palestinians, and it seems to run counter to the best interests of everyone. This is very strange indeed, and it is entirely inappropriate for this Assembly. The United States remains opposed to this text. Thank you Madam President. The PRESIDENT: I thank the delegate of the United States, and I now cali on the delegate oflsrael. Mr PELEO (Israel): Madam President, on 17 May this year, the people of Israel elected a new prime minister, Mr Ehud Barak. In the course of his victory speech, on 18 May at 2.30 a. m. Mr Barak said and 1 am quoting: "We know that it is imperative for our generation that fought Israel's war to do everything to strengthen the security of the State by progressing towards peace agreement." This Fifty-second W orld Health Assembly is the first meeting of a United Nations organization after the lsraeli elections, and what was the reaction of the Health Assembly to this reaffirmation of lsrael's dedication to peace? It is, unfortunately, another irrelevant exercise in the singling out and bashing oflsrael and the politization of the specialized agencies. Israel has considered asking for a vote on the resolution adopted on 20 May in Committee B, but has decided not to do soin view of the professional nature of this Assembly under the able leadership of the Director-General and in view of our hope that the progress which will be achieved in the coming year in the peace process will encourage the Palestinians, our partners in this long march towards peace and conciliation, not to raise this political draft resolution at the next Health Assembly. Israel has decided not to ask for a vote in spite of the unfortunate adoption of the resolution in Committee B. However, I want to make it very clear that Israel is opposed to the resolution, voted against it in the Committee, and therefore it was not accepted unanimously or by consensus. Progress for peace in the Middle East has always come as a result of direct negotiations. United Nations resolutions which aim to substitute for direct negotiations, or to prejudge them, can only damage the peace process. Let us ali rededicate ourselves to the support of the peace process and not waste our energies on political and onesided resolutions like the one before us. Thank you very much. The PRESIDENT: 1 thank the delegate of Israel. 1 now give the floor to the observer from Palestine. Dr KHOURI (Palestine): ..ÛJ

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A52/VR/9 page 126

SECOND REPORT OF COMMITTEE B1 DEUXIEME RAPPORT DE LA COMMISSION B1

The PRESIDENT: Let us now consider the second report of Committee B, document A52/34 refers; please deJete the word "(Draft)" as the Committee approved the report without amendments. The report contains three resolutions and one decision: We shall start with the first resolution entitled "Agreement between the World Health Organization and the Universal Postal Union". ls the Assembly willing to adopt this resolution? 1 see no objections, the resolution is adopted. The second resolution is entitled "Active ageing". ls the Assembly willing to adopt this resolution? 1 see no objections, the resolution is therefore adopted. The third resolution is entitled "Appointment ofthe Externat Auditor". ls the Assembly willing to adopt this resolution? 1 see no objections, the resolution is therefore adopted. Under agenda item 18, "Collaboration within the United Nations system and with other intergovernmental organizations", the Committee decided to request the Director-General to draw up an analytical report on WHO's participation in the United Nations Development Assistance Framework (UNDAF) exercise for consideration by the Executive Board at its 105th session in January 2000. Does the Assembly agree with this decision? 1 see no objections. lt is so decided. The second report of Committee B is therefore approved.

FIRST REPORT OF COMMITTEE A1 PREMIER RAPPORT DE LA COMMISSION A1

The PRESIDENT: We shall now consider the first report of Committee A contained in document A52/36; please disregard the word "(Draft)" as the Committee approved the report without amendments. The report contains three resolutions which we shall proceed to adopt one by one. The first resolution is entitled "Reimbursement of travet expenses for attendance at regional committees". ls the Assembly willing to adopt this resolution? 1 see no objections, the resolution is therefore adopted. The second resolution is entitled "Smallpox eradication: destruction ofvariola virus stocks". ls the Assembly willing to adopt this resolution? 1 see no objections, the resolution is therefore adopted. The third resolution is entitled "Roll Back Malaria". ls the Assembly willing to adopt this resolution? 1 see no objections, the resolution is therefore adopted, and the first report of Committee A is therefore approved.

TIIIRD REPORT OF COMMITTEE B1 TROISIEME RAPPORT DE LA COMMISSION B1

The PRESIDENT: We can now consider the third report of Committee B. You have received document A52/3 7. Please disregard the word "(Draft)" as the report was approved by the Committee without amendments. The report contains six resolutions and one decision which we shall proceed to adopt one by one. The first resolution is entitled "Support to Central American countries affected by Hurricane Mitch". ls the Assembly willing to adopt this resolution? 1 see no objections, the resolution is therefore adopted. The second resolution is entitled "Salaries of staff in ungraded posts and of the Director-General". ls the Assembly willing to adopt this resolution? 1 see no objections, the resolution is therefore adopted. Under item 15, "Management and financial matters: Appointment of representatives to the WHO Staff Pension Committee", the Committee decided to appoint Dr L. Malolo, delegate of Tonga, as a member of the WHO Staff Pension Committee, and Dr J.K.M. Mulwa, delegate of Botswana, as an 1 1

See reports ofcommittees in document WHA52/1999/REC/3. Voir les rapports des commissions dans le document WHA52/l999/REC/3.

A52NR/9 page127

alternate member of the Committee, the appointments being for a period ofthree years. Does the Assembly agree with this decision? I see no objections. It is so decided. The third resolution is entitled "Unaudited interim financial report on the accounts of WHO for 1998; report of the Externat Auditor; report of the Internai Auditor". Is the Assembly willing to adopt this resolution? I see no objections, the resolution is therefore adopted. The fourth resolution is entitled "Real Estate Fund". Is the Assembly willing to adopt this resolution? I see no objections, the resolution is therefore adopted. The fifth resolution is entitled "Amendments to Financial Regulations and Rules". Is the Assembly willing to adopt this resolution? I see no objections, the resolution is adopted. The sixth resolution is entitled "Scale of assessments for the financial period 2000-2001 ". Is the Assembly willing to adopt this resolution? I see no objections, the resolution is adopted, and the third report of Committee B is therefore approved.

SECOND REPORT OF COMMITTEE A1 DEUXIEME RAPPORT DE LA COMMISSION A 1

The PRESIDENT: We shall now consider the Second report ofCommittee A. This is contained in A52/38. Please disregard the word "(Draft)" as the Committee approved the report without amendments. The report contains two resolutions which we shall proceed to adopt one by one. The first resolution is entitled "Towards a WHO framework convention on tobacco control". Is the Assembly willing to adopt this resolution? I see no objections, the resolution is adopted. The second resolution is entitled "Revised drug strategy". Is the Assembly willing to adopt this resolution? I see no objections, the resolution is adopted, and the second report of Committee A is therefore approved.

THIRD REPORT OF COMMITTEE A 1 TROISIEME RAPPORT DE LA COMMISSION A1

The PRESIDENT: We can now consider the third report of Committee A (document A52/39) which contains one resolution: "Appropriation resolution for the financial period 2000-2001 ". Is the Assembly willing to adopt the resolution? I see no objections, the resolution is adopted, and the third report of Committee A is therefore approved.

EXECUTIVE BOARD: ELECTION [OF MEMBERS ENTITLED TO DESIGNATE A PERSON TO SERVE ON] ELECTION DE MEMBRES HABILITES A DESIGNER UN REPRESENTANT AU CONSEIL EXECUTIF

The PRESIDENT: Let us now consider item 7, "Executive Board: election". I draw your attention to the list of 10 Members, contained in document A52/35, drawn up by the General Committee in accordance with Rule 102 of the Ru les of Procedure. 1 In the General Committee's opinion these 10 Members would provide, if elected, a balanced distribution of the Board as a whole. These Members are, in the English alphabetical order: Belgium, Chad, Comoros, Congo, Côte d'Ivoire, Guatemala, India, Lebanon, Switzerland, Vanuatu.

1 1

See reports of committees in document WHA52/1999/REC/3. Voir les rapports des commissions dans le document WHA52/1999/REC/3.

A52/VR/9 pag~ 128

Is the Assembly prepared, in accordance with Rule 80 of the Rules of Procedure, to elect these 10 Members as proposed by General Committee? I see no objections. I therefore declare the 10 Members elected. This election will be duly recorded in the records ofthe Assembly. May I take this opportunity to invite Members to pay due regard to the provisions of Article 24 ofthe Constitution when appointing a person to serve on the Executive Board.

REPORTS OF THE MINISTERIAL ROUND TABLES RAPPORTS DES TABLES RONDES MINISTERIELLES

The PRESIDENT: We can now proceed to agenda item 5, "Round tables: lessons learned in world health". The chairmen ofthese round tables will now present oral reports on the four topics of the round tables. I give the floor to Mr Telefoni Retzlaff, First Vice-President, to present repmts on one of the round tables on the theme "Priority-setting in the health sector: challenges to ministers", and on the round table dealing with the theme: 1-llV/AIDS: strategies for sustaining an adequate response to the epidemie. Y ou have the floor Mr Telefoni Retzlaff. Mr TELEFONI RETZLAFF (Samoa): Thank you Madam President. It was a privilege and pleasure to chair these round tables and I be lieve we are ali in agreement that the initiative of the Director-General has been fully justified in that so much was learnt from these discussions. I have the pleasure to report frrst on one of the round tables on "Priority-setting in the health sector: challenges to ministers". The frrst conclusion of the round table was that priority-setting is a very complex, political process. The starting point for the discussion was the importance of focusing on the fundamentals of good public health and ensuring equity of access. However, the dominant theme thereafter was that priority-setting is a complex and primarily political process. Whilst ali participants recognized the need for more systematic, rational and transparent approaches, ministers have to cope with competing demands from different constituencies. There is a need to pay greater attention to what makes priority-setting difficult in the real world. In many countries ministers have to respond to individuals demanding special treatment, sometimes on a case-by-case basis. It is also difficult to insist on govemment priorities, if, at the same time, people are being required to pay for previously free services. The problem, of course, is that if ministers are pressurized into responding to individuals and special interest groups, priority-setting willlack transparency. In these circumstances, those who cannot articulate their needs are likely to lose out. The public judges govemment performance not by the health status of the population in five years' time but by how they are treated when they are admitted to hospital today. One cannot ignore the hospital sector just because primary care is a priority. The meeting heard many telling examples of the close correlation between closing hospitals and losing parliamentary seats. Furthermore, it is equally predictable that more wealthy groups will demand access to more sophisticated services and a wider range of treatments. Ministers need to respond to these demands if they wish to remain in office. The challenge is to ensure that private provision for the few does not divert resources or undermine systems that are designed to serve the rest of the population. Ideally, however, equal access to ali services should be available to ali peoples in ali countries. An assumption underlying the discussion was that ministers of health are able to set spending priorities but it was recognized that they are far from being the only actors. In countries with a heavy debt burden, for example, the overalllevel of resources for the social sector may be constrained. In addition, conditionalities imposed by lenders often influence how funds are spent within the health sector. It was also noted that in many countries the minister of finance is the main arbiter ofhow national funds are spent, and that ministries ofhealth have limited room to manoeuvre. There is a need to market health priori ti es in terms that will appeal to ministers of finance and others, and I would like to stress this very important need to market. 1 think it is very important that Dr Brundtland invited Dr Sen to give one of our opening addresses. Dr Sen' s message is very important here, in that good health is not just a part of economie development, but in fact is fundamental to economie development. Priorities are often based on explicit values such as universal access to health care. The problem arises when resources are insufficient to fund those values. Countries then have to start thinking about priorities within priorities. It is important not to forget that stated priorities have to be matched by actual patterns of spending. This is often more difficult in decentralized systems where central govemment has Jess control over local authorities. The second

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important section that was dealt with by the round table was that changing circumstances make the task of priority-setting even harder. In the developing world, not only are resources scarce but circumstances are also unpredictable. It is hard to stick to agreed priorities for government spending when emergencies arise through man-made or natural causes. Sometimes these emergencies are acute, for instance a major flood. AIDS. The HIV1 AIDS pandemie in Africa In other cases they are more insidious, as in the case of HIV1 has had a significant impact on patterns of spending. In countries affected by conflict, better health care may only be a priority for governments when peace has returned. Whilst government plans are for the long term - five to 10 years - short-term needs are often more pressing and determine actual resource allocations. For example, if in a small country the main national hospital is in disrepair it is hard not to divert funds in order to address the problem, even if the funds have to come from primary services. Only a few countries acknowledge the need for continuing systematic review of priorities. The financial crisis that bas affected East Asia bas not only made national priority-setting more complex, for sorne countries it bas also meant a cl oser relationship with don ors, many of whom bring their own sense of priorities to the table. In the countries of the former Soviet Union, the change has been even more dramatic. It is difficult to think about priorities at ali when your health budget bas declined from US$ 150 per person to just US$ 0.40 per person. It was suggested that in former command economies the first task is to change the attitude of the public and professionals who have previously been used to the State providing everything for free. Priority-setting requires that everyone recognizes that they have a responsibility to participate in difficult decisions about how scarce resources should be used. Sorne )essons from different national experiences: nothing succeeds like success. Having the capacity to demonstrate that government policies and priorities Iead to better health indicators makes it easier to stick to those priorities when they are opposed. Health needs vary in most countries. National-led priol'ity-setting must allow for local decisîon-making. The issue îs whether decisions should be made by clinicians and managers alone. An increasing body of experience suggests that public consultation is essential. Sorne of the countries said that they in fact bad national health consortiums or meetings once a year to fully consult the public. Building consensus around national priorities is critical, but sois leadership. It is part of the task of politicians to explain and defend spending decisions. Priority-setting must be geared to national circumstances but it is important to take on board international standards, particularly as a way of changing entrenched medical practices and, in sorne countries, overcoming a tendency towards national isolationism. Turning to the process of priority-setting, the ,suggestion in the background paper that there needs to be a shift in thinking in favour of processes, ensuring procedural rights rather than focusing exclusively on defining the precise nature of entitlements, was confirmed by the discussions. Priority-setting does not work without effective consultation. The question, however, is what makes consultation effective? One participant pointed out that ifyou ask superficial questions, you will get superficial answers. Consultation processes need to be weil designed. Furthermore, consultation should not be used just to rubber-stamp decisions that have already been made. The question was also raised as to how frequently consultation should take place, particularly when national circumstances are changing. Lastly, the round table discussed the role of donors. Are donors part of the problem or part of the solution? It was squarely recognized that donors influenced priority-setting in important ways. Two difficulties were identified. First, donors bring their own agenda to the table, which may run counter to national priorities. Second, donor funding is concentrated on particular types of spending, making overall national decision-making more difficult. Perhaps the dilemma could somehow be resolved by donors focusing on preventive or public health spending, as this allows the country to put its resources in providing health care. It was encouraging that most ministers thought that these problems could be overcome through longer-term and more robust partnership arrangements. Sorne ministers spoke explicitly about sector-wide approaches, but many others talked about the need for joint and negotiated priorities. A further way of increasing the effectiveness of development assistance is to ensure that it is provided not on an ad hoc basis but as part of an overall public expenditure plan, which identifies health as a priority sector. Finally, I would like to thank ali the ministers who participated in this round table. Y ou were committed, you contributed frankly, and you made the round table an unequivocal success. I also bad the privilege of chatring the round table on "HIV/AIDS: strategies for sustaining an adequate response to the epidemie". The situation in one southern African country, where a state of emergency bas been declared in relation to HIV1 AIDS, was presented to illustrate the challenges faced by governments and the health sector. High-level government commitment to HIV1 AIDS was identified as a prerequisite for an effective and sustainable national response. Other essential elements include community-based activities, a multisectoral approach and extensive public education. Deniai and complacency have seriously impeded timely and effective action. A key government responsibility is to AIDS at alllevels of the community. be the leading advocate of open and accepting attitudes towards HIV1

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Certain participants recognized that their countries responded for extraneous reasons far too late and this delay was costly in terms of the impact of the disease on their countries. The existence oftwo categories of citizens in relation to access to proven treatments should not be tolerated. The Fonds de Solidarité thérapeutique international has been established as a first step towards addressing equity of access to treatments. Countries require assistance from international organizations in negotiating lower prizes with industry. Industry involvement is necessary to broaden access to drugs for HIV/AIDS. In fact sorne of the more sophisticated treatments are so expensive they are only proving extremely frustrating to many of the countries in the developing world. Their citizens are leaming about them but countries can never afford to provide them. There is both a moral obligation and direct self-interest in supporting the development of a vaccine applicable to ali viral strains. However, there was agreement that the hope of a vaccine should never stail positive action which needs to be taken now. Funds made available from the global HIV/AIDS effort from both national and international sources are insufficient to meet the growing demand in HIV prevention, care and research. The round table also discussed the prevention of mother-to-child transmission ofHIV, which is seen by many as the priority intervention that should benefit from access to anti-retroviral drugs. Countries requested assistance in providing the full support required for mother-tochild transmission interventions. Notification of partners, with the agreement from the patient, is part of counselling procedures in certain countries. Guidelines have been issued on conditions that must be met for notification of partners by health professionals when explicit consent cannot be obtained. However, it was agreed that although the diseased person had his right to confidentiality, that person should be wamed that any knowing infection of innocent third parties from that point on could result in prosecution for manslaughter. lndeed manslaughter prosecutions have been successfully brought in many countries for such offences. Shared confidentiality in which a close friend or relative is involved with the consent of the person concerned in counselling was cited as an approach to increasing acceptance of disclosures to others, particularly innocent victims who may be infected. The involvement of people living with HIV/AIDS in advocacy and public education is important. Concern was expressed that the right to privacy of a person with HIV infection may supersede the rights of other people to be informed. The key to this issue lies in good counselling, leading to voluntary notification, and in fighting discrimination and stigma. Lastly, sorne ministers expressed concern that although increased efforts should be made to increase the total amount of spending on HIV/AIDS strategies, we should never lose sight of the need to continuously monitor the use of available funds. The "how" should be of as much importance and concern as the "how much". 1 would like to thank the Director-General for this initiative. 1 believe that this Assembly has resolved that the round tables should be continued and reinforced in future and 1 am fully in support of this. 1 would like also to thank ali the participants of this particular ministerial round table for an extremely lively, constructive, and no-holds-barred, debate on a very important issue. 1 appreciated being able to chair this meeting and 1 thank you, Madam President, for the opportunity to make these oral reports. The PRESIDENT: Thank you, Mr Telefoni Retzlaff. 1 now give the floor to Dr Abudajaja, who is reporting on behalf of the Second Vice-President, Dr Ehtuish, who chaired the other round table on "Priority-setting in the ; health sector: challenges to ministers" but who has unfortunately had to leave Geneva. Y ou have the floor, Dr Abudajaja. Dr ABUDAJAJA (Libyan Arab Jamahiriya):

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L~ o.h.JI ~\ ~.,Z Ji ~)_,.JI ~r JI ~~ ~} -f1 a.LAll uk-~1 t.,P y ':Ji ùW y. ~ J~ ~~~)_,.JI oJJ.j ~ .r-f.jl ~ ':J ~WI ;.k) ,y --4..WI J ,~l!ll 6,\:ü.JI .ùt5:....ll J~ '-:?"_,>::.JI JUi':J~ ~ l....:i 4-# ~ u\.:} J~ ~\ ~\ ,yJ . ~i t. L.pJ f.j1J J J..,W~ ~\ W~ ~_,>::.JI .k.b:JI ùi ,:r.> .)J .~1 Ji ~~\ jÎ ~WI u\.... jfyj ~ ~Jlk u':Jl>- ~ \....~ 4-iti Jl::l~J ,ù~f.j\ ,y ftS' j l>.WI ...w;i ~ j>--f.jl o~l ut>..~ ':JI ùti ,...L.ef.j\ ~_,.b ù~ \.... ~ u~_,JJf.jl uP\~1 oJJA ùl~l ,y illt.Sy J ~ ':JJ .~1 ~)_,.JI~~ ~...l>.Ü ~\ ~ o..UI-.!1 J J_;-WI (::" uy_,l Jf.j1 --4...b.ü J.:.$.,; ,y ~':J ,6.!\l!l\ a.\:ü.JI .~ J j...:-1_,:;..- _r ~ u~_,JJf.j\ ~~ ~ ùÎ 'I.Sf-Î ~,y ~J ~J..UI _r-t-..1~ .l:,:.f.j\ ~\,y ùÎ ~,~_,JI i~ 'ôJJ.r-P !.\~ ùl JJf.j\ (.$~1 :~\ .:r-t...b.ü JI~ \~J .~ ul)~l ~W~ ~_,li~\ c___,..k ~ ~ JUI.\ (.$~1 \....Î .6..-WI ~_,li~ _fll ts~~~ ~\ u\.k.LJI 4r j.&; ul)1 !.\~ ùl ~ ~..L..JI \..u. .)J -~_r-..WIJ .:r-t.r-_rll ._~f.j\ ~k ,y)} ~W\ ~ ùl.S'"' \~\ w JjW .~f.j\ ~L...Î .r-i ~Ï 'ô~\ ~ )1 JJw..:ll ~ ùÎ ol~ o_r-~1 o..UWI ~J>" ;.I}:JI J W\j ~L...al ;.IJ':JI t..? ~ ~l>. ~Y"' J JI ~ ~L... f.j1 u\....}-JI aiJJ J ~)_,li (.$1)1 ùl ,~1)1 6,\:ü.JI • ult~".>\l aAJ..UI ~\ --4...b.ü ~ ~~ oJ~ :r.?'_;ji ,y ':J~ a.JI_r:-':JI J_,A.-11 ùW ul.:L-JI ,~f.j\ r---l>- l.r-Î ~_,li ~_,lJf.j1 JJ>" .,1}11 J ~\j JI j.P _f)l ~J .uw.iLWI .,;~i ($.ill .r-f.jl ~ .:r- \;. _r:- ù~ ~ t. ti..UIJ JI.A.i':J~ ~\ ul)~l c__r.. ù\J .~i ~ jZ ':J 'ô~\.:)1 :.fJJ 4"4}JiJ uw _,>::.JI a....~ ù~ u~':JI ~ c;J.J.Aj~ ~t; ·c_kdl Ji- al~\ ~.r- .s.ji ~ ,~~~ ul..o..L.all } ~~".>U uP_r:;.; l..o~ uy_,l J f.j1 o~ ~\ ~ ~\ ul_r;. _;.JI ~ JI 1.$~y u\.:_,JJf.j\ --4...b.ü ~ I.,.,.~_,A.; ù"'JW ~WI u\.p.JI ùÎ 4.1 r-L-JI ,y ,a...-wl ;~f.j\ 6,\:ü.J\ -~JWI ê'" ù~f.j\ ~ t..? uP)~ ..û ~\ u\...pJ\...WI 'ô..U\.... JI 4JwÎ JJI..b....! c_._,k; ':JjÎ ~ .~ o.AA.z L....... ,JUi':JI :r- ~ t_I_,JI ~ ~WI u\.p.JI ,y~_,....;}\ :ffi \. . lpS' ,~~J ,~_,li u\.:} Jf.j1 ùl5:...':J~ ùÎ ;.\Jj_,JI ~ (.$ÎJ ùÛ J -~~ ...l..,.;,Î ~ ~_,li ~\ ~ ul)~l ~W\ ~ ~ c.!..I~J .~WJ d,jt.:_. ...w;iJ 1-L.eÎ J_,.bi as'l_r;. u~; 4.-\.t\ j')t>. ,y u~l o~ ~ ~\ ~~ 'ô JJ~ ~ ~~~ ~~ ~\ .:rs:l ~~ u~l.ki J ~\ ~LW\ ,y- 4>-\.r"' .,IJJ}I .~1 ~\ .!.\~ r ~ u\.:_,JJf.j\ The PRESIDENT: Thank you, Dr Abudajaja. 1 now give the floor to Dr Stamps, Third Vice-President, who chaired the round table on "Investment in hospitals: dilemmas faced by ministers". Y ou have the floor, Dr Stamps. Dr STAMPS (Zimbabwe): Madam President, Madam Director-General, ladies and gentlemen, colleagues and friends. It was my privilege to chair the meeting on "Investment in hospitals: dilemmas facing ministers". Among the multitude of issues raised, the ministers discussed whether govemments should divest themselves of service provision and altemately develop contractual arrangements with public and private providers. Optimal planning and management ofhospitals and hospital resources, the govemment's role and responsibilities in ensuring appropriate public and private balance, intercountry and regional cooperation in specialized service provision were also examined. The critical importance of explicit hospital policy in health sector reform was strongly emphasized, as weil as the need for balanced development of a health facilities network to reach remote and rural populations, and to improve the interface between hospitals and primary health care. It became apparent that there is no single package of solutions, and that simple replication of foreign approaches may result in additional burdens. Countries must be prepared to build on what they actually have, and restructuring of services should respond to country priority needs occurring within the framework of national capabilities and resources to ensure sustainability. Throughout the deliberations it was emphasized that govemments have a responsibility to provide quality health care to all their people which cannat be delegated, abdicated or avoided. Access to hospital care therefore has to be universal, equitable and affordable. Ministries should not divest themselves of this responsibility, even while they use the most relevant mechanisms, including the private for-profit and private not-for-profit agencies in civil society. A large proportion ofhealth care delivery is provided by the private sector, and especially not-for-profit providers, in many countries. Ministers were of the view that ministries should coordinate the overall national health policy and provide a framework for the private

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sector to participate in and positively contribute to the delivery of care for the entire population. The challenge identified by the ministers for achieving optimal health care delivery is to ensure a complementarity between public and private sectors, for-profit and private not-for-profit institutions and persona) contributions. lt was mentioned that regulation is necessary but it should not stifle innovation, and a system of appropriate incentives needs to be found. The issue of providing, versus purchasing, hospital services was deliberated and certain common issues were identified. It was stated that, where private providers are available and contracting is possible, it may be possible to curb costs and improve quality. However, concerns regarding equity and accessibility for the poor persist, and relevance of this particular issue for countries with a limited private sector is marginal. Key factors in making contracts work, both with private for-profit and private not-for-profit institutions, are institutional capacity, political determination and real competition in awarding contracts. Ministries also must have mechanisms to ensure quality and assess performance, and use appropriate methods and policies to improve equity and accessibility for ali those who need hospital services. Unanimity was expressed that the investment in hospitals is very significant, and examining investment strategies is imperative today to limit the extent of burden in the future. Hospital planning, management and sustainable operation bad however not received sufficient attention, especially in recent years, and an average assessment shows that annual costs of running hospitals correspond to about 30% oftheir capital cost. With regard to the question of who should manage hospitals, especially in view of the trend to increased autonomy, most ministers argued that a professional health-related background is preferable; however, the essential point is to have specifie management training and good management skills. In general, it was felt that good management should be guided by ethics, technical and administrative competence, and professionalism. Involvement of the community served in managing their hospitals is a critically important factor. A number of factors impeding efficient operation ofhospitals were mentioned by ministers. These included the Joss of skilled personnel due to poor career opportunities and insufficient remuneration, and the burden of maintaining physical assets and health care technology. The need for rational planning, acquisition and utilization oftechnology, especially with regard to expensive and sophisticated equipment, and provision of adequate maintenance services was emphasized. Severa) speakers presented innovative mechanisms for improved sustainability of hospitals, including cost-recovery schemes, revolving and special funds, and earmarked taxes, the overall effectiveness ofwhich bas not yet been fully assessed. New concepts, approaches, techniques and methodologies should be supported by evidence, so the voids in hospital research should be urgently filled. Ministers indicated that further studies should address the complexity of different types of hospital systems in a changing sociopolitical environment, including new financing mechanisms and advances in health technology. Challenges of globalization, redistribution and regulation will need urgent focused attention. Mechanisms and skills to cope with these challenges in the field ofhospital investment and management urgently need to be developed. WHO should collaborate with countries in exchanging ideas and experiences, and distilling lessons from successes and failures. A concerted international effort is required to support countries in this critical area Regrettably, too little time was available to discuss these topics meaningfully, and the political fallout of inefficient or unavailable hospital services was not discussed at ali. 1 add my thanks and of my group to the Director-General for ber initiative in this area, and while sorne refinement has to be made to enable more interaction between ministers when the Moderator assumes the roles of commentator and chairperson as weil as his primary functions. The PRESIDENT: Thank you, Dr Stamps. 1 now give the floor to Mr Salah Uddin Yusuf, Fourth Vice-President, who chaired the round table on "Finding the money: dilemmas faced by ministers". You have the floor, MrYusuf. Mr YUSUF (Bangladesh): 1 am pleased to be able to report to the plenary the results ofthe round table that 1 had the privilege to chair. Both sessions of"Finding the money: dilemmas facing ministers" covered similar critical issues. During the extensive and lively debate, a number of major points were stressed. Finding the money is only one side of the coin. Of equal importance is the management of that money to get the best results. It was clear that there is no universal blueprint for either finding more money or managing the money you have in the best way. It depends on the economie, politieal and demographie situation in the country. Nevertheless, there are many interesting and innovative strategies being deployed

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in different countries. WHO should analyse the evidence ofthose experiences in order to provide policy options to countries. In reality, policy needs in health are constantly moving targets, because of, for example, emergencies, new diseases and ageing populations. This makes finding the right balance between raising and spending the money much harder to achieve. Furthermore, ministers have to balance both political and technical priorities. Externat funding is important in many developing countries but cannot be a substitute for government finance. Severa) ministers reported innovative government-donor partnerships such as sectoral assistance and health trust funds. The case was also made for richer countries recognizing their responsibilities to poorer ones because of the resource problems generated by globalization. Severa) sources of funds and mechanisms for collection were described. These included governments, social security agencies, insurance funds. Out-of-pocket payments were said to be the )east desirable but not always avoidable. Options that share risks such as social insurance are more desirable but not always feasible. Ministers need to be able to defend the case that health spending is an investment when competing for their share of the government budget. User fees are one of the most difficult issues ministers have to deal with. Both poorer and richer countries have found that fees involve a conflict between the need to mobilize additional revenues and the need to ensure access to care by the poor. Exemptions for the poor have not worked weil in practice. Many different ways were described for trying to manage the money better. These included provider-side reforms such as greater hospital autonomy and performance contracts. Sorne ministries of health are moving towards a more regulatory rote and away from direct provision. Sorne are also moving from subsidizing the supply to subsidizing the demand for services, for example through patient vouchers. Other strategies include introducing new employment and incentive arrangements for health workers; cutting costs where possible, for example by using more generic drugs; and by investing more in preventive and primary-level care. Partnerships are being created to better use resources. There are examples of increasing regional cooperation between small countries, and attempts to generate partnerships between the public and private sectors. Thank you, Madam President, for allowing me to present the report of the round tables. 1 thank the Director-General for introducing the round tables, which 1 support, and 1 thank the delegates for their attention. The PRESIDENT: Thank you, Mr Yusuf. The Assembly bas now beard summary reports of the discussions on the round tables, and these will be included in the records of this Assembly. 1 wish to thank ali the Vice-Presidents for their assistance on this very interesting and stimulating innovation. It is gratif)'ing to note that this initiative will continue in future Assemblies with any necessary modifications as recommended for the reform of the Health Assembly. This completes our work for today. Immediately on adjournment of this meeting, Committees A and B will meet. The next plenary will be held tomorrow at Il :30. The meeting is adjourned.

The meeting rose at 15:45. La séance est levée à 15h45.

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TENTH PLENARY MEETING Tuesday, 25 May 1999, at 11:30 President: Mrs Maria de Belém ROSEIRA (Portugal)

DIXIEME SEANCE PLENIERE Mardi 25 mai 1999, 11h30 Président: Mme Maria de Belém ROSEIRA (Portugal)

SECOND REPORT OF THE COMMITTEE ON CREDENTIALS 1 DEUXIEME RAPPORT DE LA COMMISSION DE VERIFICATION DES POUVOIRS 1

The PRESIDENT: We shaH start by considering the second report of the Committee on Credentials. You have before you document A52/42 which contains this report. Does the Assembly have any comments? 1 see none. The report is therefore adopted.

FOURTH REPORT OF COMMITTEE B1 QUATRIEME RAPPORT DE LA COMMISSION B1

The PRESIDENT: Let us now continue with approval of the report from the main committees. We shaH start with the fourth report ofCommittee B. It is contained in document A52/40 and deals with one resolution. Please disregard the word "Draft" as the Committee agreed to the report without amendments. The resolution is entitled "Reform of the Health Assembly". Is the Assembly willing to adopt this resolution? 1 see no objection. The resolution is adopted and the fourth report of Committee B is therefore approved.

FOURTH REPORT OF COMMITTEE A 1 QUATRIEME RAPPORT DE LA COMMISSION A 1

The PRESIDENT: Let us continue with the fourth report of Committee A which is contained in document A52/41. Please disregard the word "Draft" as the Committee adopted the report without any amendments. The report contains three resolutions which we shaH proceed to adopt one by one. The first resolution is entitled "Poliomyelitis eradication". ls the Assembly willing to adopt this resolution? In the absence of any objections, the resolution is adopted. 1

See reports of committees in document WHA52/1999/REC/3. Voir les rapports des commissions dans le document WHA52/1999/REC/3.

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The second resolution is entitled "Strengthening health systems in developing countries". Is the Assembly willing to adopt this resolution? I see no objection. The resolution is adopted. The third resolution is entitled "Prevention and control of iodine deficiency disorders". Is the Assembly willing to adopt this resolution? In the absence of any objections, the resolution is adopted and the fourth report of Committee A is therefore approved.

A YEAR OF CHANGE: REPORTS OF THE EXECUTIVE BOARD ON ITS 102nd AND 103rd SESSIONS (continued) UNE ANNEE DE CHANGEMENT: RAPPORTS DU CONSEIL EXECUTIF SUR SES CENT DEUXIEME ET CENT TROISIEME SESSIONS (suite)

The PRESIDENT: We now come to the conclusion of item 2, "A year of change: reports of the Executive Board on its 102nd and 103rd sessions". Now that the main committees have finished their consideration of the Executive Board's reports, we are in a position to formally take note of these reports. From the comments which have been made, I take it that the Assembly wishes to commend the Board on the work performed and express its appreciation of the dedication with which the Board has carried out the tasks entrusted to it. In the absence of any comments, it is so decided.

SELECTION OF THE COUNTRY IN WHICH THE FIFTY-THIRD WORLD HEALTH ASSEMBLY WILL BE HELD CHOIX DU PAYS OU SE TIENDRA LA CINQUANTE-TROISIEME ASSEMBLEE MONDIALE DE LA SANTE

The PRESIDENT: I should like to draw the Assembly's attention to the fact that, under the provisions of Article 14 of the Constitution, the Health Assembly, at each annual session, shall select the country or region in which the next annual session shall be held, the Executive Board subsequently fixing the date and place. 1 should also recall that the Thirty-eighth W orld Health Assembly concluded that it was in the interest of ali Member States to maintain the practice of holding Health Assemblies at the site of the headquarters of the Organization. 1 therefore take it that the Assembly decides that the Fifty-third World Health Assembly will be held in Switzerland. In the absence of any objections, it is therefore so decided.

ANNOUNCEMENT COMMUNICATION

The PRESIDENT: Before adjouming the meeting, 1 would like to mention that a seminar on "Year 2000 computer problem" will be held today at 14:30 in Room A at WHO headquarters. 1 shall now adjoum the meeting for a few minutes. Please remain in your seats. The closing plenary will be held in a few minutes.

The meeting rose at 11:45. La séance est levée à 11h45.

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ELEVENTH PLENARY MEETING Tuesday, 25 May 1999, at 11:45 President: Mrs Maria de Belém ROSEIRA (Portugal)

ONZIEME SEANCE PLENIERE Mardi 25 mai 1999, 11h45 Président: Mme Maria de Belém ROSEIRA (Portugal)

CLOSURE OF THE SESSION CLOTURE DE LA SESSION The PRESIDENT:

1 invite Dr Sulaiman, Chairman ofCommittee A, to come to the rostrum and address the Assembly to give us an overview of the work of Committee A. Dr SULAIMAN (Oman) (Chairman, Committee A):

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The PRESIDENT: Thank you, Dr Sulaiman. 1 should like to congratulate you very warmly for your excellent presentation and also for the outstanding way in which you presided over the Committee. The next speaker will be the Vice-Chairman of Committee B, Mr Eskola, whom 1 invite to the rostrum to report on the work of Committee B. Mr ESKOLA (Finland) (Vice-Chairman ofCommittee B): Madam President, distinguished delegates, Dr Brundtland, ladies and gentlemen, it is a pleasure for me to present you with a report of the work ofCommittee B during this year's Health Assembly. 1 shall try to be brief and concentrate my remarks on the highlights of the Committee's work, as the details cao be found in the reports. As usual, the emphasis in the work of Committee B was on management and financial matters agenda item 15. Many subitems were dealt with under this main agenda item. One of the noteworthy issues discussed was the Appointment of the Externat Auditor. This resulted in the approval of a resolution reappointing South Africa as Externat Auditor of the accounts of the World Health Organization for the financial periods 2000-2001 and 2002-2003. Other subitems included personnel matters. Dr Malolo (Tonga), previously alternate member, WHO Staff Pension Committee, replaced Professor Agboton as member, and Dr Mulwa (Botswana) was appointed as an alternate member. The Committee noted the report on Employment and participation of women in the work of WHO and congratulated in particular the new Director-General, Dr Brundtland, and ber staff on the progress made since she took office. Amendments to the Staff Regulations and Ru les and to the Financial Regulations were approved, as was the Executive Board resolution on the Real Estate Fund. A resolution on health conditions of, and assistance to, the Arab population in the occupied Arab territories, including Palestine, was approved. Discussion of the item on Collaboration within the United Nations system and with other intergovernmental organizations resulted in the following resolutions, namely: Agreement between the World Health Organization and the Universal Postal Union; active ageing; 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. Under the item on reform of the Health Assembly, a resolution was adopted requesting the DirectorGenera, inter alia, to submit proposais for the themes and procedures for the conduct of high-level discussions at the next Health Assembly. The supplementary agenda item on the use of official languages in WHO and in its publications was the last item on Committee B's agenda. The draft resolution was cosponsored by sorne 50 Member States. This agenda item elicited an intense and lively debate; over 40 delegations took the floor. The proposed resolution was not approved, but it was agreed by consensus to put the item on the agenda of the 105th session of the Executive Board, with an accompanying overview of the financial resources necessary to implement such a resolution. Madam President, distinguished delegates, Director-General and staff of WHO, it bas been an honour and a privilege for me to serve as Vice-Chairman ofCommittee B. Vitally important management and financial matters were settled in the spirit of conciliation and consensus. 1 should like to thank warmly ali the delegations who contributed to settling our differences in such a spirit. Deliberations were made possible thanks to the unfailing support and cooperation of the Secretariat of Committee B. Finally, 1 extend my thanks to you, Madam President, and to the Vice-Presidents and the DirectorGeneral for taking such a strong interest in our work. We leave soon for our respèctive homes, and 1 should like to take this opportunity to wish you, Madam, and ali other officers and delegates, your families, and indeed your countries, continued good health during the coming year. The YK2000 problem was briefly alluded to by the Externat Auditor. Let us hope that we ali survive the YK2000 and meet again for the Fifty-third World Health Assembly. Safe journey home - bon voyage, adios y buen viaje! The PRESIDENT: Thank you, Mr Eskola. 1 wish to thank you for your comprehensive report and thank also the . Chairman, Dr Tapia, for conducting so weil the work of Committee B. Dr Brundtland would like to say a few words. Dr Brundtland, you have the floor.

A52/VR/11 page139

The DIRECTOR-GENERAL: Madam President, distinguished delegates, as we are about to finish my first Health Assembly as Director-General, 1 move on with very positive impressions and memories. 1 am grateful that the round tables have so actively and so fully engaged so many ministers. 1 be lieve they will prove to be important for our future work and we will draw on their inspiration and the tessons leamed when preparing for the Assembly next year. We will ali need to further reflect on Professor Sen's presentation a week ago. Health and development are indeed inextricably linked. It is not always a simple relationship, but 1 believe a greater understanding of it will help decision-makers make the right choices. Placing health at the core of the development agenda remains a key priority for me, and we will be working hard to pursue this ambition in the years to come. 1 was greatly encouraged by your support for the changes that are taking place throughout WHO. The year that has passed since 1 identified the projects on Roll Back Malaria and the Tobacco Free Initiative bas helped us move ahead so that we can really make a difference. 1 thank you also for the strong support for the poliomyelitis eradication campaign. We are ali aware of the momentum that we need to give it on the final home stretch. The adoption of the budget by consensus after lengthy negotiations was an important achievement. Now it is our challenge to deliver the programme that you have agreed to finance, working hard to achieve the necessary efficiency. Let us not forget that this programme budget was not only about a specifie amount of money, it was also a choice of strategie direction for WHO. This Health Assembly has truly been a global health conference, with very broad participation in ali of the debates and in the reaching of conclusions. 1 would like to thank you personally, Madam President, for guiding us through so skilfully. The Vice-Presidents and the Chairmen of committees have also played, as we aU know, a critical rote in making this Assembly a success. Let me thank every delegate for contributing so actively to 10 days of very solid work, and 1 thank ali my staffwho have worked so hard to support our important discussions. Thank you ali and have a safe joumey home. The PRESIDENT: Distinguished delegates, Madam Director-General, ladies and gentlemen, what is really important can be said in few words. Throughout the Fifty-second World Health Assembly, four aspects became evident: first, we now have a very clear and well-focused health agenda; secondly, we have experienced a participatory, informative and intellectually stimulating Health Assembly; thirdly, there is a better organized, cohesive and firmly led World Health Organization; and fourthly, there is a strengthened WHO, as reflected in the adoption of the appropriation resolution by consensus. (The President continued in French.) (Le Président poursuit en français.)

Un programme d'action sanitaire mieux ciblé: qui vise des problèmes de santé majeurs, tels qu'une diminution de 50% de la mortalité liée au paludisme en dix ans, mais aussi la tuberculose et d'autres maladies à forte prévalence; qui s'attaque résolument à des risques imputables à l'homme, tels que le tabagisme; qui s'efforce de contribuer à l'instauration de systèmes de santé plus équitables, plus efficaces et plus efficients; qui reconnaît le rôle central de la connaissance. Une meilleure Assemblée mondiale de la Santé. Afm que notre programme d'action sanitaire apporte un réel changement, il doit être débattu, adopté, suivi et révisé. Au cours de l'Assemblée de la Santé des mesures importantes ont été prises dans le bon sens. Nous nous sommes écoutés les uns les a~tres attentivement, avons participé ou assisté à des tables rondes - nouvelle initiative très bien accueillie - et avons pu suivre des séances d'information très bien préparées: fixation des priorités dans le secteur de la santé : les ministres face à une entreprise ardue; investissements dans les hôpitaux : les ministres face à des dilemmes; trouver de l'argent: les ministres face à des dilemmes; VIHISIDA : stratégies propices à une réaction adéquate et durable face à l'épidémie. Une Organisation mondiale de la Santé plus forte. Une seule OMS qui tire pleinement parti de sa structure régionale, en agissant là où il le faut - dans les grandes villes, les petites communautés rurales, les écoles, les lieux de travail, la famille - là où son action est le plus nécessaire. Ceci exige une vision claire. Nous avons cette vision prospective, mais il fallait aussi une véritable direction et nous avons à présent cette direction à l'OMS.

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(l'he President continued in English.) (Le Président poursuit en anglais.) It is time to depart. To return to our countries, to renew in many practical and tangible ways our commitment to health for ali. We will gather again, at the dawn of a new millennium, strengthened by our achievements in improving the health of our nations, touched by an even stronger sense of solidarity towards ali nations. Madam Director-General, we thank you wholeheartedly for everything you have already done in this first year ofyour mandate for our health organization. We wish you an equally successful second year. Rest assured, we are ali frrmly behind you. 1 thank you ali very much for making this experience of mine . as President of the Fifty-second World Health Assembly a very pleasant and rewarding one. 1 appreciated indeed your kind support, and above ali your warm friendship. 1 would also like to thank ali those who have worked behind the scenes and who have facilitated the work of the Assembly, particularly the interpreters who have been very understanding in the use oftheir time to allow us to complete our work on time. 1 wish you a safe journey home and now just allow me only one word in my own language, Portuguese, which is spoken by more than 200 million people throughout the world. 1 could not use it in dealing with the Assembly, as it is not an official language of the Organization, except in the Americas. So, just to thank you ali very warmly: obrigada. And now, already missing your presence, 1 formally declare the Fifty-second World Health Assembly closed.

The session closed at 12:20. La session est close à 12h20.

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COMPOSITION DE L'ASSEMBLÉE DE LA SANTÉ MEMBERSHIP OF THE HEALTH ASSEMBLY LISTE DES DÉLÉGUÉS ET AUTRES PARTICIPANTS LIST OF DELEGATES AND OTHER PARTICIPANTS

DÉLÉGATIONS DES ETATS MEMBRES DELEGATIONS OF MEMBER STATES AFGHANISTAN- AFGHANISTAN Chief delegate - Chef de délégation Dr M. Y. Barakzai Ministre de la Santé publique

Professeur J.-P. Grangaud Directeur de la Prévention, Ministère de la Santé et de la Population Dr A. Guennar Directeur des Services de Santé, Ministère de la Santé et de la Population Professeur D. Larbaoui Président, Comité national de la Lutte contre la Tuberculose Professeur Z. Mentouri Chef de Service, Centre hospitalo-universitaire, Oran M. M. Snoussi Inspecteur général, Inspection générale des Finances M. M. Belkacem Chargé de la Communication, Ministère de la Santé et de la Population M. H. Kheddouci Chef du Protocole, Ministère de la Santé et de la Population M. A. Chaouche Directeur d'Etudes, Ministère de la Santé et de la Population

Delegate(s) - Délégué(s) M. H. Tandar Chargé d'affaires, a.i., Mission permanente, Genève

ALBANIA -ALBANIE Chief delegate - Chef de délégation Dr L. Solis Minister of Health

ANDORRA-ANDORRE Chief delegate - Chef de délégation Mr J.M. Goicoechea Minister of Health and Welfare

Delegate(s) - Délégué(s) Dr E. Hashorva Director of the lnstitute of Public Health and Adviser of the Minister of Health Mr K. Krisafi Ambassador, Permanent Representative, Geneva

Delegate(s) - Délégué(s) Mrs R.M. Mandic6 Director of Health and Welfare

Alternate(s)- Suppléant(s) Mrs M. Gega Second Secretary, Permanent Mission, Geneva

ANGOLA -ANGOLA Chief delegate - Chef de délégation

ALGERIA - ALGERIE Chief delegate - Chef de délégation Professeur Y. Guidoum Ministre de la Santé et de la Population

M. A. Manaças da Silva Neto Ministre de la Santé

Delegate(s)- Délégué(s) M. J. Saweka Directeur, Cabinet des Relations internationales M. C.A. Antonio Directeur pour l'Information

Delegate(s) - Délégué(s) M. M.-S. Dembri Ambassadeur, Représentant permanent, Genève M. A. Kara-Mostepha Inspecteur général, Ministère de la Santé et de la Population

Alternate(s)- Suppléant(s) Mme A. dos S. Fernandes de Carvalho Directrice nationale de la Santé publique M. 1. Chachiolo Délégué provincial de la Santé Mme M.E. Swarte Costa Ferreira Directrice nationale adjoint, Administration et Gestion budgétaire Mme M.J. Navalha Secrétaire

Alternate(s) - Suppléant(s) M. M. Messaoui Ministre conseiller, Mission permanente, Genève M. M.L. Chergui Directeur d'Etudes chargé des Relations internationales, Ministère de la Santé et de la Population

A52/VR

page 142 M. L. da Costa e Silva Chargé d'affaires, Mission permanente, Genève M. R. Neto Conseiller, Mission permanente, Genève Mme S. Pegado Premier Secrétaire, Mission permanente, Genève M. M. de Azevedo Deuxième Secrétaire, Mission permanente, Genève

Deputy chief delegate - Chef adjoint de la délégation Mr K. Nazarian Ambassador, Permanent Representative, Geneva

Adviser(s)- Conseiller(s) Ms A. Gevorgian Third Secretary, Permanent Mission, Geneva

AUSTRALIA -AUSTRALIE ANTIGUA AND BARBU DA -ANTIGUA-ETBARBU DA Chief delegate - Chef de délégation Mr B. Percival Minister of Health and Social lmprovement

Chief delegate - Chef de délégation Professor J. Whitworth Chief Medical Officer, Department of Health and Aged Ca re

Alternate(s) - Suppléant(s) Ms J. Bennett Acting First Assistant Secretary, Population Health Division, Department of Health and Aged Care Ms J. Davidson Assistant Secretary, Policy and International Branch, Department of Health and Aged Care Mr B. Eckhardt Director, International Organisations Section, Department of Health and Aged Care

Delegate(s) - Délégué(s) MrS. Aymer Adviser to the Minister of Health and Social lmprovement

ARGENTINA -ARGENTINE Chief delegate - Chef de délégation Dr. A.J. Mazza Ministro de Salud y Accién Social

Adviser(s)- Conseiller(s) Mr K. Kutch Counsellor (Development), Permanent Mission, Geneva Mr E. Van Der Wal First Secretary, Permanent Mission, Geneva

Deputy chief delegate - Chef adjoint de la délégation Professor A.L. Pico Subsecretario de Politicas de Salud y Relaciones lnternacionales, Ministerio de Salud y Accién Social

Delegate(s) - Délégué(s) Sr. D. G. Gonzalez Embajador, Representante Permanente, Ginebra

AUSTRIA -AUTRICHE Chief delegate - Chef de délégation Dr G. Liebeswar Director-General of Public Health, Federal Ministry of Labour, Health and Social Affairs (Chief delegate from 17 to 20 May) (Chef de délégation du 17 au 20 mai)

Alternate(s) - Suppléant(s) Sr. M. Benitez Representante Permanente Adjunto, Ginebra Dr. O. Gonzalez Carrizo Director de Coordinacién y Relaciones Sanitarias, Ministerio de Salud y Accién Social Sr. E. Varela Consejero, Misién Permanente, Ginebra Sra. M. Gabrieloni Consejero, Misién Permanente, Ginebra Sra. A. Repetti Tercer Secretario, Misién Permanente, Ginebra

Delegate(s)- Délégué(s) Dr H. Kreid Ambassador, Permanent Representative, Geneva Dr E. Fritz Director, Federal Ministry of Labour, Health and Social Affairs, Department of Public Health (Chief delegate from 21 to 25 May) (Chef de délégation du 21 au 25 mai)

Alternate(s) - Suppléant(s) Dr V. Gregorich-Schega Director, Federal Ministry of Labour, Health and Social Affairs, Department of Public Health Dr S. Weinberger Deputy Director, Federal Ministry of Labour, Health and Social Affairs, Department of Public Health Dr C. Parisini Federal Ministry of Foreign Affairs, Department IV/3a MrU. Frank First Secretary, Permanent Mission, Geneva

ARMENIA - ARMENIE Chief delegate - Chef de délégation Dr H. Nikogosian Minister of Health

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AZERBAIJAN - AZERBAIDJAN Chief delegate - Chef de délégation Mrs S. Eivazova Ambassador, Permanent Representative, Geneva

Alternate(s) - Suppléant(s) Miss 1. Jahan Counsellor, Permanent Mission, Geneva

Adviser(s)- Conseiller(s) Mr M.S. Haque Counsellor, Permanent Mission, Geneva Mr K. Rahman Counsellor, Permanent Mission, Geneva Dr A. Begum Professor of Gynaecology, Dhaka Medical College Hospital Professor S.M. Ali Director, Nationallnstitute of Ophthalmology Mr S. Sajedul Karim Deputy Auditor General

Delegate(s)- Délégué(s) Mr E. Aliev Second Secretary, Permanent Mission, Geneva

BAHAMAS-BAHAMAS Chief delegate - Chef de délégation Dr R. Knowles Minister of Health

Deputy chief delegate - Chef adjoint de la délégation Dr M. Dahi-Regis Chief Medical Officer, Ministry of Health

BARBADOS-BARBADE Chief delegate - Chef de délégation

BAHRAIN - BAHREIN Chief delegate - Chef de délégation Dr F .R. AI-Mousawi Minister of Health

Mrs H.E. Thompson Minister of Health

Delegate(s)- Délégué(s) Dr B. Miller Chief Medical Officer Dr E. Ferdinand Senior Medical Officer

Delegate(s) - Délégué(s) Mr A. M. AI-Haddad Ambassador, Permanent Representative, Geneva Mr I.E. Akbari Head, International Relations, Ministry of Health

Alternate(s)- Suppléant(s) Miss S. Rudder Chargé d'affaires, Permanent Mission, Geneva

Alternate(s) - Suppléant(s) Dr A.Y. Hamza Chief, Medical Services, Salmaniya Medical Centre, Ministry of Health Dr NA Haffadh Chief, Programmes of Mother and Child Gare, Ministry of Health Mr RA. Dhaif Director, Office of the Minister of Health

BELARUS - BELARUS Chief delegate - Chef de délégation Mr 1. Zelenkevich Minister of Health

Delegate(s)- Délégué(s) Mr S. Mikhnevich Chargé d'affaires a.i., Permanent Mission, Geneva Mr E. Glazkov Head, Foreign Relations Department, Ministry of Health

BANGLADESH-BANGLADESH Chief delegate - Chef de délégation Mr S.U. Yusuf Minister of Health and Family Welfare

Alternate(s) - Suppléant(s) Ms T. Kharashun Second Secretary, Permanent Mission, Geneva

Delegate(s)- Délégué(s) Dr I.A. Chowdhury Ambassador, Permanent Representative, Geneva Professor A. K. M. Nurul Anwar Director-General of Health Services, Ministry of Health and Family Welfare

BELGIUM - BELGIQUE Chief delegate - Chef de délégation M. M. Colla Ministre de la Santé publique et des Pensions

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page144 Deputy chief delegate - Chef adjoint de la délégation M. J.-M. Noirfalisse Ambassadeur, Représentant permanent, Genève Dr V. Tellier Service de Santé publique et d'Epidémiologie, Université de Liège Dr B. Grijseels Directeur, Institut de Médecine tropicale Prince Léopold, Antwerpen DrThilly Ecole de Santé publique, Université libre, Bruxelles Dr F. Delange Ecole de Santé publique, Université libre, Bruxelles

Delegate(s) - Délégué(s) M. J. Dams Représentant du Ministre de la Communité flamande, Adjoint au Directeur de l'Administration des Soins de Santé

Alternate(s)- Suppléant(s) Mme C. Hoedemakers Chef de Cabinet adjoint du Ministre de la Santé publique et des Pensions M. H. Becquaert Conseiller, Cabinet du Ministre de la Santé publique et des Pensions Mme T. Belhouari Attachée, Cabinet du Ministre chargé de la Santé pour la Région de Bruxelles M. P. Delcartes Conseiller, Chef de Service, Service Santé de la Commission communautaire française de Bruxelles M. A. Berwaerts Conseiller général, Ministère fédéral des Affaires sociales, de la Santé publique et de l'Environnement, Service des Relations internationales Mme P. Megal Conseiller adjoint, Ministère fédéral des Affaires sociales, de la Santé publique et de l'Environnement, Service des Relations internationales DrG. Thiers Directeur, Institut scientifique de la Santé publique Louis Pasteur M. J. Laruelle Chargé du Bureau des Organismes spécialisés pour la Coopération indirecte multilatérale, Administration générale de la Coopération au Développement M. G. Rayee Représentant, Administration générale de la Coopération au Développement, Genève Mme L. Crapanzano Représentante, Direction générale de la Santé de la Communauté française M. T. Lahaye Conseiller adjoint, Commission communautaire française

BELIZE - BELIZE Chief delegate - Chef de délégation Mr S. Baeza Minister of Health

Delegate(s)- Délégué(s) Dr R. Figueroa Permanent Secretary

BENIN - BENIN Chief delegate - Chef de délégation Mme M. d'Aimeida-Massougbodji Ministre de la Santé publique

Delegate(s) - Délégué(s) Mme A. Baba Moussa Yakoubou Directrice adjointe, Cabinet du Ministère de la Santé publique Professeur A. Massougbodji Faculté des Sciences de la Santé, Université nationale du Bénin

Alternate(s) - Suppléant(s) M. P. Dossou-Togbe Secrétaire général, Ministère de la Santé publique Dr J.A. Hassan Directeur national de la Protection sanitaire M. H. Tchibozo Attaché de Cabinet du Ministre de la Santé publique Mme M.-T. Houtoukpe-Capo Secrétaire du Ministre de la Santé publique

BHUTAN- BHOUTAN M. E. Vinck Attaché, Mission permanente, Genève M. C. Bourgoignie Délégué, Communauté française Wallonie-Bruxelles, Genève

Chief delegate - Chef de délégation Mr S. Ngedup Minister of Health and Education

Adviser(s) - Conseiller(s) Professeur F. Barc Directeur, Institut Sainte-Camille, Université catholique, Louvain Professeur R. Lagasse Président, Ecole de Santé publique, Université libre, Bruxelles Dr H. Van Puymbroeck Maitre de Stage, Département de Médecine générale, Université d'Antwerpen

Delegate(s)- Délégué(s) Mr B. Kesang Ambassador, Permanent Representative, Geneva Ms N. Wangmo Nursing and Training Coordinator

A52NR page 145 Adviser(s)- Conseiller(s) Mr K. Singye First Secretary, Permanent Mission, Geneva Mr U. Tshewang Second Secretary, Permanent Mission, Geneva MrS. Tobgay Third Secretary, Permanent Mission, Geneva

BOTSWANA - BOTSWANA Chief delegate - Chef de délégation Mr C.J. Butale Minister of Health

Delegate(s) - Délégué(s) Dr J.K.M. Mulwa Permanent Secretary, Ministry of Health Dr P.N. Mazonde Consultant Paediatrician

BOLIVIA - BOLIVIE Chief delegate - Chef de délégation Dr. G. Cuentas Yaiiez Ministre de Salud y Previsién Social

Alternate(s) - Suppléant(s) Mr B.K. Sentie Deputy Permanent Secretary, Ministry of Local Government,.Lands and Housing

Delegate(s) - Délégué(s) Sra. S. Avila Seifert Embajadora, Representante Permanente, Ginebra Dr. F. Cisneros del Carpio Jefe de Relaciones lnternacionales, Ministerio de Salud y Previsién Social

Adviser(s)- Conseiller(s) Mrs P. Tembo Senior Nursing Sister, Aids at the Work Place, Occupational Health Dr K. Seipone Medical Officer

Alternate(s)- Suppléant(s) Dr. F. Antezana Aranibar Asesor del Oespacho Ministerial Dr. M. Paz Zamora Presidente de la Comisién de Salud de la Honorable Camarade Sen adores Sr. J. Loayza Ministre, Misién Permanente, Ginebra Sra. M. Victoria Montalva Segundo Secretario, Misién Permanente, Ginebra

BRAZIL - BRESIL Chief delegate - Chef de délégation Dr J. Serra Minister of Health

Deputy chief delegate - Chef adjoint de la délégation Mr C.L.N. Amorim Ambassador, Permanent Representative, Geneva

Delegate(s) - Délégué(s)

BOSNIA AND HERZEGOVINA - BOSNIEHERZEGOVINE Chief delegate - Chef de délégation MrT. Dutina Ambassador, Permanent Representative, Geneva

Mr A.G. Bahadian Deputy Permanent Representative, Geneva

Alternate(s) - Supptéant(s) Dr J. Y unes Secretary of Health Policies Dr J. Barbosa da Silva Jr Director, National Center of Epidemiology, National Health Foundation Mr CA Simas Magalhâes Minister Counsellor, Permanent Mission, Geneva Mr E.O. Rubarth Director, Office of International Issues, Ministry of Health Dr V.L. Costa e Silva National Coordinator of Tobacco Control, Nationallnstitute of Cancer Dr O. Coitinho Coordinator of the Technical Area of Nutrition Needs, Secretary of Health Policies Dr O. Capistrano da Costa Filho Sanitarist Physician, Coordinator of the Family Health Project, Secretary of Health of the State of Sâo Paulo Mr J.M.N. Vianna Second Secretary, Ministry of External Relations

Delegate(s) - Délégué(s) Mr B. Ljubic MrZ. Radie

Alternate(s) - Suppléant(s) Mr F. Gavrankapetanovic Deputy Minister, lnstitute for Health Mr Z. Pavie Assistant Minister, Ministry of Health Mr S. Fadzan Counsellor, Permanent Mission, Geneva Ms S. Avdic Second Secretary, Permanent Mission, Geneva Professer A Smajkic General Director, Nationallnstitute of Public Health

A52/VR page 146 Mr L. Coelho de Souza Second Secretary, Permanent Mission, Geneva

Delegate(s)- Délégué(s) Dr B. M. Sombié Conseiller technique du Ministre de la Santé, Coordinateur du Secrétariat technique du Plan national du Développement sanitaire Dr B. Bamouni

BRUNEI DARUSSALAM - BRUNEI DARUSSALAM Chief delegate - Chef de délégation Mr Haji Ahmad Matnor Permanent Secretary, Ministry of Health

BURUNDI - BURUNDI Chief delegate - Chef de délégation Dr J.M. Kariburyo Ministre de la Santé publique

Deputy chief delegate - Chef adjoint de la délégation Mr Pengiran Haji ldriss Ambassador, Permanent Representative, Geneva

Delegate(s)- Délégué(s) Dr L. Mboneko Inspecteur général de la Santé publique Mr S.E.M.A. Nahayo Ambassadeur, Représentant permanent, Genève

Delegate(s)- Délégué(s) Dr A.L.H. Ibrahim Director, Medical and Health Services, Ministry of Health

Alternate(s) - Suppléant(s) Mr Haji G. Osman Minister Counsellor, Chargé d'affaires a.i., Permanent Mission, Ge neva MrY.Amba Senior Biomedical Engineer, Ministry of Health Mrs H.F. Fatmah Jamil Senior Public Relations Officer, Ministry of Health Mr Haji A. Abu Sufian Second Secretary, Permanent Mission, Geneva

Alternate(s) - Suppléant(s) Mme E. Kabushemeye Premier conseiller, Mission permanente, Genève M. J.-B. Mbonyingingo M. B. Habonimana M. G. Magete Ambassadeur, Prétoria

CAMBODIA - CAMBODGE BULGARIA - BULGARIE Chief delegate - Chef de délégation Dr S. Katzarov Deputy Minister of Health

Chief delegate - Chef de délégation Mr Hong Sun Huot Senior Minister and Minister of Health

Delegate(s)- Délégué(s) Dr Youk Sambath Deputy Director for Finance and Budget, Ministry of Health

Deputy chief delegate - Chef adjoint de la délégation MrV. lvanov Director, International Organizations and Human Rights Directorate, Ministry of Foreign Affairs

CAMEROON-CAMEROUN Chief delegate - Chef de délégation Professeur G.L. Monekosso Ministre de la Santé publique

Delegate(s) - Délégué(s) Mr V. Dontchev First Secretary, Permanent Mission, Geneva

Alternate(s) - Suppléant(s) Dr S. Kulaksazov Director, Health Policy, International Cooperation, European Integration Directorate, Ministry of Health

Delegate(s) - Délégué(s) M. F.-X. Ngoubeyou Ambassadeur, Représentant permanent, Genève Dr Y. Boubakari Inspecteur général, Ministère de la Santé publique

BURKINA FASO - BURKINA FASO Chief delegate - Chef de délégation M. A.L. Tou Ministre de la Santé

Alternate(s) - Suppléant(s) Dr C. Bomba-Nkolo Chef, Division de la Coopération, Ministère de la Santé publique Dr B. Kollo Directeur de la Santé communautaire, Ministère de la Santé publique Dr J. R. Ndo Directeur de la Pharmacie et du Médicament, Ministère de la Santé publique

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CANADA-CANADA Chief delegate - Chef de délégation Mrs E. Capian Member of Parliament, Parliamentary Secretary to the Minister of Health

CENTRAL AFRICAN REPUBLIC REPUBLIQUE CENTRAFRICAINE Chief delegate - Chef de délégation Dr P. Thimossat Ministre de la Santé publique et de la Population

Delegate(s)- Délégué(s) MrM. Moher Ambassador, Permanent Representative, Geneva

Delegate(s) - Délégué(s) Dr J. Ndoyo Directeur de la Médecine préventive et de la Lutte contre la Maladie OrO. Yazido Chef de la Région sanitaire n•1

Alternate(s)- Suppléant(s) Ms P. Priddy Minister of Health, Province of British Columbia Mr E. Aiston Director-General, International Affairs Directorate, Health Canada Dr J. Larivière Senior Medical Adviser, International Affairs Directorate, Health Canada Mrs M. Gervais-Vidricaire Deputy Permanent Representative, Geneva Mrs J. Perlin Counsellor, Permanent Mission, Geneva

CHAD-TCHAD Chief delegate - Chef de délégation M. Y.H. Kedella Ministre de la Santé publique

Delegate(s) - Délégué(s) Dr M.E. Mbaiong Directeur général adjoint, Ministère de la Santé publique Dr N.M. Ndeikoundam Chef de la Division des Maladies transmissibles

Adviser(s)- Conseiller(s) Mrs L. Gravel Ministry of Health, Province of Quebec

CHILE - CHILI Mr R. Massé Assistant Deputy Minister for Public Health, Ministry of Health and Social Services, Province of Quebec Dr Y. Bergevin Health and Population Policy Branch, Canadian International Development Agency Mrs L. Bayne Assistant Deputy Minister, Ministry of Health, Province of British Columbia Mrs M. Hilson Associate Executive Director, Canadian Public Health Association Mr P. Priee Senior Policy Analyst, United Nations Specialized Agencies and Economie Issues, Department of Foreign Affairs and International Trade MrA. Rangel United Nations Specialized Agencies and Economie Issues, Department of Foreign Affairs and International Trade

Chief delegate - Chef de délégation Dr. A. Figueroa Ministre de Salud

Delegate(s) - Délégué(s) Sr. P. Seguel Oficina de Cooperaci6n y Asuntos lnternacionales Sr. P. Ortiz Jefe de Gabinete del Ministre de Salud

Alternate(s) - Suppléant(s) Sr. F. Ernst Primer Secretario, Misi6n Permanente, Ginebra

CHINA - CHINE Chief delegate - Chef de délégation Professeur Wang Longde Vice-Minister, Ministry of Health

CAPE VERDE - CAP-VERT Chief delegate - Chef de délégation Dr J.B. Ferreira Medina Ministre de la Santé

Delegate(s) - Délégué(s) Mr Qiao Zonghuai Ambassador, Permanent Representative, Geneva Mr Liu Peilong Director-General, Department of International Cooperation, Ministry of Health

Delegate(s) - Délégué(s) M. 1. de Sousa Carvalho Conseiller du Ministre M. A. Alves Lopes Chargé d'affaires a.i.

A52/VR page 148

Alternate(s) - Suppléant(s) Dr Margaret Chan Director, Department of Health, Hongkong, Special Administrative Region Dr Liu Quanxi Director-General, Henan Provincial Health Department Dr Liu Keling Deputy Director-General, Oepartment of Grassroots, Maternai and Child Health, Ministry of Health Dr Shao Ruilai Deputy Director-General, Oepartment of Disease Control, Ministry of Health Mr Hou Zhenyi · Counsellor, Permanent Mission Ms Wang Yuxun Director; Division of Planning and Priee, Department of Planning and Finance, Ministry of Health Mr Zhao Jian Deputy Director, Department of International Organizations and Conferences, Ministry of Foreign Affairs Mr Li Jianzhong Counsellor, Department of Hong Kong, Macao and Taiwan Affairs, Ministry of Foreign Affairs Mr Xu Nanshan Director, Division International Organizations, External Finance Department, Ministry of Finance Dr Qi Qingdong Deputy Director, Division of Multilateral Relations, Department of International Cooperation, Ministry of Health

Alternate(s) - Suppléant(s) Dr. R.E. Pellaloza Director de Estudios Econémicos e lnversién Pûblica, Ministerio de Salud Dr. J.J. Arbeléez Moreno Director, Programa de Apoyo a la Reforma, Ministerio de Salud

COMOROS - COMORES Chief delegate - Chef de délégation DrMbaeToyb Directeur général de la Santé

CONGO-CONGO Chief delegate - Chef de délégation Mr L.A. Opimbat Ministre de la Santé, de la Solidarité et de l'Action humanitaire

Delegate(s) - Délégué(s) Mr R.J. Menga Ambassadeur, Représentant permanent, Genève Mr O. Bodzongo Directeur général de la Santé

Alternate(s)- Suppléant(s) Mr P.H. Kengouya Conseiller juridique du Ministre Mr A. Botonga Mokakassa Assistant du Ministre Mr J. Biabaroh-lboro Conseiller, Mission permanente, Genève

Adviser(s)- Conseiller(s) Dr Lam Ping Yan Deputy Director, Department of Health, Hongkong, Special Administrative Region Mrs Liu Guangyuan Programme Officer, Division of Multilateral Relations, Department of International Cooperation, Ministry of Health Mr Tong Xianguo First Secretary, Permanent Mission, Geneva Professor Lu Rushan Honorary Director, lnstitute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College

COOK ISLANDS - ILES COOK Chief delegate - Chef de délégation Mr T. Faireka Minister of Health

COSTA RICA - COSTA RICA Chief delegate - Chef de délégation Sr. R. Pardo Evans Ministro de Salud

COLOMBIA - COLOMBIE Chief delegate - Chef de délégation Dr. V. Galvis Ramirez Ministro de Salud

Deputy chief delegate - Chef adjoint de la délégation Sra. N. Ruiz de Angulo Embajadora, Representante Permanente, Ginebra

Delegate(s) - Délégué(s) Sr. C. Reyes Rodriguez Embajador, Representante Permanente, Ginebra Dra. F.E. Benavides Cotes Ministro Consejero, Misién Permanente, Ginebra

Delegate(s) - Délégué(s) Sr. C. Guillermet Consejero, Misién Permanente, Ginebra

A52NR page149 Alternate(s)- Suppléant(s) Sr. J. Guillermo Ortiz Asesor Nacional del EBAIS, Caja Costarricense del Seguro Social Sr. R. Leon-Soto Misi6n Permanente, Ginebra

Deputy chief delegate - Chef adjoint de la délégation Dr. C. Amal Forés Embajador, Representante Permanente, Ginebra

Delegate(s) - Délégué(s) Dr. J. Garate Dominguez Viceministro, Ministerio de Salud Pûblica

COTE D'IVOIRE - COTE D'IVOIRE Chief delegate - Chef de délégation Professeur M. Kakou Guikahue Ministre de la Santé publique

Alternate(s)- Suppléant(s) Sr. E. Comendeiro Hernandez Director de Relaciones lnternacionales, Ministerio de Salud Pûblica Profesor C. Ordonez Carceller Director, Policlinico Decente Plaza de la Revoluci6n Dr. E. Zacca Pena Director Nacional de Estadisticas, Ministerio de Salud Pûblica Dr. A. Gonzalez Fernandez Jefe, Departamento de Organismes lnternacionales, Ministerio de Salud Pûblica Sr. A. Alonso Consejero, Misi6n Permanente, Ginebra Sra. M.E. Fiffe Cabreja Primer Secretario, Misi6n Permanente, Ginebra Sra. A. Hemândez Quesada Segundo Secretario, Misi6n Permanente, Ginebra

Deputy chief delegate - Chef adjoint de la délégation M. C. Bouah-Kamon Ambassadeur, Représentant permanent, Genève

Delegate(s)- Délégué(s) Professeur Diarra Directeur, Institut national de la Santé publique

Alternate(s) - Suppléant(s) DrD.Koffi Directeur, Service de la Santé communautaire M. C.Assi Chef, Service national d'Information, Education et Communication Mme J. Barry Journaliste, Fraternité Matin Mr H.M. Kouassi Premier conseiller, Mission permanente, Genève M. J.K. Weya Conseiller, Mission permanente, Genève

CYPRUS-CHYPRE Chief delegate - Chef de délégation Mr C. Solomis Minister of Health

Delegate(s) - Délégué(s)

CROATIA- CROATIE Chief delegate - Chef de délégation Professer Z. Reiner Minister of Health

Mr A. Patzinakos Permanent Secretary, Ministry of Health Mr P. Eftychiou Ambassador, Permanent Representative, Geneva

Alternate(s)- Suppléant(s) Mrs C. Komodiki Chief Health Officer, Ministry of Health Mrs 1. Atteshli Director of Administration, Ministry of Health Mr P. Kestoras Counsellor, Permanent Mission, Geneva

Deputy chief delegate - Chef adjoint de la délégation Mrs S. Cek Ambassador, Permanent Representative, Geneva

Adviser(s)- Conseiller(s) Ms V. Kos First Secretary, Permanent Mission, Geneva Ms S. Blazevic Third Secretary, Ministry of Foreign Affairs

Adviser(s)- Conseiller(s) Mr A. Vasiliou President, Pancyprian Medical Association Mrs A. Tapakoudi President, Cyprus Nurses Association

CUBA-CUBA Chief delegate - Chef de délégation Dr. C. Dotres Martinez Ministre de Salud Pûblica

A52NR page 150

CZECH REPUBLIC - REPUBLIQUE TCHEQUE Chief delegate - Chef de délégation Dr 1. David Minister of Health

Alternate(s) - Suppléant(s) Dr B. Nyandu Médecin Directeur du PEV-LMTE, Ministère de la Santé publique Mme B.N. Mpundu Présidente, Commission nationale de Mobilisation sociale des Journées nationales de Vaccination

Delegate(s) - Délégué(s) Dr M. Holcat First Vice-Minister of Health MrM. Somol Ambassador, Permanent Representative, Geneva

DENMARK-DANEMARK Chief delegate - Chef de délégation Mr 1. Valsborg Permanent Secretary, Ministry of Health

Alternate(s) - Suppléant(s) Professer F. Kolbel Head of the Internai Clinic of the Second Faculty of Medicine of the Charles University, Motol Faculty Hospital Mr 1. Pintér Counsellor, Permanent Mission, Geneva MrP. Skoda United Nations Department, Ministry of Foreign Affairs

Delegate(s) - Délégué(s) Dr E. Krag Chief Medical Officer, National Board of Health Mr M. Jorgensen Director of International Affairs, Ministry of Health

Alternate(s)- Suppléant(s) Mr H.H. Bruun Ambassador, Permanent Representative, Geneva Mr O. Torpegaard Hansen Counsellor, Permanent Mission, Geneva Ms E. Vinding Deputy Chief Medical Officer, National Board of Health Mr S. Thomsen Head of Section, Ministry of Health Mr J. Nielsen Head of Section, Ministry of Foreign Affairs

DEMOCRATIC PEOPLE'S REPUBLIC OF KOREA REPUBLIQUE POPULAIRE DEMOCRATIQUE DECOREE Chief delegate - Chef de délégation Dr Choi Chang Sik Vice-Minister, Ministry of Public Health

Delegate(s) - Délégué(s) Dr Choi Tae Sop Section Chief, Academy of Traditional Korean Medicine Mr Hong Song 0 Expert, International Organizations Department, Ministry of Foreign Affairs

Adviser(s)- Conseiller(s) Mrs M. Kristensen Senior Adviser, National Board of Health Mr K. Harnisch Assistant Attaché, Permanent Mission, Geneva

Alternate(s) - Suppléant(s) MrSo Chol First Secretary, Permanent Mission, Geneva Mr Kim Ho Bu Official, Department of External Affairs, Ministry of Public Health

DJIBOUTI - DJIBOUTI Chief delegate - Chef de délégation M. A.M. Daoud Ministre de la Santé publique et des Affaires sociales

DEMOCRATIC RE PUBLIC OF THE CONGO REPUBLIQUE DEMOCRATIQUE DU CONGO Chief delegate - Chef de délégation M. M. Mamba Ministre de la Santé

Delegate(s) - Délégué(s) M. A.S. Abdallah Dr R.A. Goumaned

Delegate(s)- Délégué(s) Professeur M. M. Mampunza Directeur de Cabinet adjoint, Ministère de la Santé M. M. Tchelo Secrétaire particulier du Ministre de la Santé

DOMINICA - DOMINIQUE Chief delegate - Chef de délégation Mrs D. Paul Minister of Health and Social Security

A52NR page 151 Delegate(s) - Délégué(s) Dr R. Nasiiro Chief Medical Officer, Ministry of Health and Social Security

Alternate(s) - Suppléant(s) Dr E. Mansour Director-General, General Department of Childhood and Motherhood Care, Ministry of Health and Population Dr A Darwish Executive Director, Vaccinations Unit, Ministry of Health and Population MrT. Adel First Secretary, Permanent Mission, Geneva

DOMINICAN REPUBLIC - REPUBLIQUE DOMINICAINE Chief delegate - Chef de délégation Dr. S. Sarita Valdez Subsecretario de Estado de Salud Pûblica

Delegate(s)- Délégué(s) Dr. F.A. Cuello Embajador, Representante Permanente, Ginebra Sra. V. Nwiez Directora, Programa contra la Tuberculosis, Secretaria de Estado de Salud Publica

ELSALVADOR-ELSALVADOR Chief delegate - Chef de délégation Sr. V.M. Lagos Pizzati Embajador, Representante Permanente, Ginebra

Delegate(s)- Délégué(s) Sr. M. Castro Grande Ministro Consejero, Misi6n Permanente, Ginebra

Alternate(s) - Suppléant(s) Sra. M. Bello de Kemper Consejero, Misi6n Permanente, Ginebra

ECUADOR-EQUATEUR Chief delegate - Chef de délégation Dr. E. Rodas Andrade Ministro de Salud Pûblica

EQUATORIAL GUINEA- GUINEE EQUATORIALE Chief delegate -.Chef de délégation Dr. S. Nguema Owono Ministro de Estado de Sanidad y Bienestar Social

Delegate(s) - Délégué(s) Dra. T. Neira Alvarado Directora de Relaciones lnternacionales, Ministerio de Salud Pûblica Dr. C. Hermida Bustos Subsecretario General de Salud, Ministerio de Salud Pûblica

Delegate(s) - Délégué(s) Sra. C. Ondo Efua Directora General de Farmacia y Medicina Tradicional Dr. M. Nguema Ntutumu

Alternate(s) - Suppléant(s) Sr. L. Gallegos Chiriboga Embajador, Representante Permanente, Ginebra Sr. A Rodas Ministro, Misi6n Permanente, Ginebra Sr. F. Meneses Ministro, Misi6n Permanente, Ginebra

ERITREA - ERYTHREE Chief delegate - Chef de délégation Mr S. Meki Minister of Health

Delegate(s)- Délégué(s) Dr A. Ocbmarian Head of Transmittable Diseases, Ministry of Health Mr B. Woldeyokannes Consul, Geneva

EGYPT - EGYPTE Chief delegate - Chef de délégation Professor 1. Sallam Minister of Health and Population

ESTONIA - ESTONIE Chief delegate - Chef de délégation MrP. Pallum Ambassador, Permanent Representative, Geneva

Delegate(s)- Délégué(s) Mr M. Zahran Ambassador, Permanent Representative, Geneva Dr W.A.R. Anwar Consultant to the Minister of Health and Population, Scientific Research Programmes and Foreign Health Relations

Delegate(s)- Délégué(s) Mrs P. Laur Head, Public Health Department, Ministry of Social Affairs Ms M. Talvet Counsellor, Permanent Mission, Geneva

A52NR page 152

ETHIOPIA - ETHIOPIE Chief delegate - Chef de délégation Dr L. Hayesso Vice-Minister, Ministry of Health

Ms R. Resch Director, Division for United Nations Affairs, Ministry of Foreign Affairs Ms H. Rinkineva-Heikkila Counsellor, Permanent Mission, Geneva

Delegate(s)- Délégué(s) Mr F. Yimer Ambassador, Permanent Representative, Geneva Dr G. Meskel Habte Mariam Head of Planning and Project Department, Ministry of Health Ms A. Amaha Counsellor, Permanent Mission, Geneva

Adviser(s) - Conseiller(&) Ms T. Mikkola Senior Adviser, Division for International Affairs, Ministry of Social Affairs and Health Ms A. Vuorinen Director, Department for International Development Cooperation, Ministry of Foreign Affairs Ms A. Elfvengren Secretary, Department for International Development Cooperation, Ministry of Foreign Affairs Ms K. Komulainen Assistant, Permanent Mission, Geneva

FIJI- FIDJI Chief delegate - Chef de délégation Dr A. Boladuadua Deputy Permanent Secretary, Ministry of Health

FRANCE-FRANCE Chief delegate - Chef de délégation Dr B. Kouchner Secrétaire d'Etat à la Santé et à l'Action sociale

Delegate(s) - Délégué(s) Ms A. Vakacegu Ministry of Health

FINLAND - FINLANDE Chief delegate - Chef de délégation Ms E. Biaudet Minister of Social Affairs and Health (Chief delegate from 17 to 19 May) (Chef de délégation du 17 au 19 mai)

Delegate(s)- Délégué(s) Professeur J.-F. Girard Conseiller d'Etat M. P. Petit Ambassadeur, Représentant permanent, Genève

Alternate(s) - Suppléant(s) M. F. Saint-Paul Représentant permanent adjoint, Genève Dr F. Varet Direction générale de la Coopération internationale et du Développement, Division du Développement sanitaire et social Mme M. Boccoz Conseiller, Mission permanente, Genève M. F. Poinsot Directeur des Nations Unies et des Organisations internationales, Ministère de l'Emploi et de la Solidarité, Secrétariat d'Etat à la Santé et à l'Action sociale Dr E. Chevallier Conseiller technique, Cabinet du Secrétaire d'Etat à la Santé et à l'Action sociale Mme A. Lapidus Conseiller technique, Cabinet du Secrétaire d'Etat à la Santé et à l'Action sociale Dr M. Jeanfrançois Délégué pour les Affaires européennes et internationales Dr R. Lefait-Robin Délégué pour les Affaires européennes et internationales Mme J. Harari Direction générale de la Santé Dr P. Chevit Directeur, Ecole nationale de Santé publique

Deputy chief delegate - Chef adjoint de la délégation Mr P. Huhtaniemi Ambassador, Permanent Representative, Geneva

Delegate(s)- Délégué(s) Mr J. Eskola Director-General, Department of Promotion and Prevention, Ministry of Social Affairs and Health (Chief delegate from 20 to 25 May) (Chef de délégation du 20 au 25 mai)

Alternate(s) - Suppléant(s) Dr K. Leppo Director-General, Department of Social and Health Services, Ministry of Social Affairs and Health Ms M. Blanco-Sequeiros Deputy Director-General, Department of Social Affairs and Health Ministry of Social Affairs and Health ' Ms L. Ollila Head of Section for United Nations and Multilateral Cooperation, Ministry of Social Affairs and Health Dr M. Saarinen Senior Medical Officer, Department of Social and Health Services ' Ministry of Social Affairs and Health Mr P. Puska Research Professer, National Public Health lnstitute

A52NR page 153 Dr M. Danzon Mutualité française

Alternate(s) - Suppléant(s) Mrs M. Gudushauri Deputy Minister of Health

Adviser(s) - Conseiller(s) M. M.A. Lacroix

GERMANY-ALLEMAGNE GABON-GABON Chief delegate - Chef de délégation M. F. Boukoubi Ministre de la Santé publique et de la Population

Chief delegate - Chef de délégation Mrs A. Fischer Federal Minister of Health (Chief delegate from 17 to 19 May) (Chef de délégation du 17 au 19 mai)

Delegate(s) - Délégué(s) Mme Y. Bike Ambassadeur, Représentant permanent, Genève Dr Epighat Apinda Conseiller spécial du Président de la République auprès du Ministre de la Santé publique et de la Population

Delegate(s) - Délégué(s) Dr M. Lewalter Ambassador, Permanent Representative, Geneva Mr H. Voigtlander Ministerialdirigent, Federal Ministry of Health (Chief delegate from 20 to 25 May) (Chef de délégation du 20 au 25 mai)

Alternate(s) - Suppléant(s) Mme P. Mounguengui Conseiller du Ministre de la Santé publique et de la Population Dr M. Toung-Mve Directeur général de la Santé Mme Angone Abena Conseiller, Mission permanente, Genève M. H. Djambo Attaché de Cabinet

Alternate(s) - Suppléant(s) Mr H. Eberle Deputy Permanent Representative, Geneva Dr M. Schafer Permanent Mission, Geneva Mr M. Debrus Head of Division Z 23, Multilateral Cooperation in the Field of Health, Federal Ministry of Health Dr C. Luetkens Head of Division, Hessian Ministry for Energy, Environment, Youth, Family Affairs and Health, Wiesbaden DrE.Pott Director of the Federal Centre for Heatth Education (BZgA), Cologne Dr R. Korte German Agency for Technical Cooperation (GTZ), Eschborn Dr E. Aderhold First Secretary, Permanent Mission, Geneva Mr U. Kalbitzer Counsellor, 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 of Health

GAMBIA - GAMBIE Chief delegate - Chef de délégation Mrs 1. Njie-Saidy Vice-President and Secretary of State for Health, Social Welfare and Women's Affairs

Delegate(s)- Délégué(s) Mrs S. Bojang Deputy Permanent Secretary, Department of State for Health, Social Welfare and Women's Affairs Dr Y. Gassama Director of Health Services

Alternate(s) - Suppléant(s) Mr N. Saer Bah Ambassador, Permanent Mission, Geneva

Adviser(s) - Conseiller(s)

GEORGIA - GEORGIE Chief delegate - Chef de délégation Mr A. Gamkrelidze First Deputy Minister of Health

Ms O. Schmidt Permanent Mission, Geneva Ms G. Theurer Permanent Mission, Geneva Mr D. Rentzsch Permanent Mission, Geneva Professer 1. Kickbusch Yale University, New Haven Dr Behles Federal Ministry of Health

Delegate(s) - Délégué(s) Mr A. Kavadze Ambassador, Permanent Representative, Geneva Mr T. Bakradze Minister Plenipotentiary, Permanent Mission, Geneva

A52/VR page 154 Mr H. Lehmann Deputy Director of the Federal Centre for Health Education (FCHE)

GRENADA - GRENADE Chief delegate - Chef de délégation

GHANA - GHANA Chief delegate - Chef de délégation Mr S. Nuamah Donkor Minister of Health

Dr C. Modeste Curwen Minister for Health and the Environment

Delegate(s) - Délégué(s) Ms L. Mc Phail Permanent Secretary, Ministry of Health and the Environment

Deputy chief delegate - Chef adjoint de la délégation Mrs A. Y. Aggrey-Orleans Ambassador, Permanent Representative, Geneva

GUATEMALA-GUATEMALA Chief delegate - Chef de délégation Sr. M.T. Sosa Ramfrez Ministre de Salud Publica y Asistencia Social (Chief delegate from 17 to 23 May) (Chef de délégation du 17 au 24 mai)

Delegate(s)- Délégué(s) MrY.Adjei Deputy Permanent Representative, Geneva

Alternate(s) - Suppléant(s) Dr A. lssaka-Tinorgah Acting Director of Medical Services, Ministry of Health Dr M. B. Ibrahim Regional Director, Western Region Mr K. Asante Minister Counsellor, Permanent Mission, Geneva Mrs A. Twum-Amoah First Secretary, Permanent Mission, Geneva

Deputy chief delegate - Chef adjoint de la délégation Dr. C. Andrade Lara Viceministro de Salud Pûblica y Asistencia Social (Chief delegate from 24 to 25 May) (Chef de délégation du 24 au 25 mai)

Oelegate(s) - Délégué(s) Sr. L.A. Padilla Menéndez Embajador, Representante Permanente, Ginebra

Alternate(s) - Suppléant(s)

GREECE - GRECE Chief delegate - Chef de délégation Mr N. Farmakis Deputy Minister of Health

Srta. S. Solfs-Castaiieda Ministre Consejero Srta. B. Méndez de la Hoz Tercer Secreta rio, Misi6n Permanente, Ginebra

Delegate(s)- Délégué(s) Professer A. Sissouras Chief Adviser, Ministry of Health and Welfare Mrs A. Moraitaki Adviser, Ministry of Health and Welfare

GUINEA -GUINEE Chief delegate - Chef de délégation Dr K. Dramé Ministre de la Santé

Alternate(s) - Suppléant(s) Professer M. Violaki-Paraskeva Honorary Director-General, Ministry of Health and Welfare Mr D. Coundoureas First Counsellor, Permanent Mission, Geneva Mr A. Filalithis Professer, School of Medicine, University of Crete Mr A. Ypsilantis First Secretary, Permanent Mission, Geneva

Delegate(s) - Délégué(s) Dr C. Loua Conseiller chargé de la Coopération, Ministère de la Santé Dr J. Austin Directrice nationale de la Santé publique, Ministère de la Santé

Alternate(s) - Suppléant(s) M. S. Camara Chargé d'affaires a.i., Mission permanente, Genève

GUINEA-BISSAU - GUINEE-BISSAU Chief delegate - Chef de délégation Dr J. Amadu Fadia Ministre de la Santé et des Affaires sociales

A52/VR page 155 Delegate(s) - Délégué(s) M. A. Paulo Gomes Chef de Cabinet, Ministère de la Santé et des Affaires sociales

HUNGARY - HONGRIE Chief delegate - Chef de délégation Dr A. G6gl Minister of Health

GUYANA- GUYANA Chief delegate - Chef de délégation Dr H. Jeffrey Minister of Health and Labour

Deputy chief delegate - Chef adjoint de la délégation Dr P. Nâray Ambassador, Permanent Representative, Geneva

Delegate(s) - Délégué(s) Dr R. Cummings Acting Chief Medical Officer

Delegate(s) - Délégué(s) Dr Z. Varga Deputy State Secretary, Ministry of Health

Alternate(s) - Suppléant(s)

HAITI - HAITI Chief delegate - Chef de délégation Dr M. Amédée-Gédéon Ministre de la Santé

Mr F. Bosenbacher Deputy Permanent Representative, Geneva Mrs K. Novâk Director of Department, Ministry of Health Dr É. Kereszty Director of Departmeht, Ministry of Health Mr G. Szab6 Counsellor, Permanent Mission, Geneva Mr G. Kovâcs Deputy Head of Department, Ministry of Health

Delegate(s)- Délégué(s) M. J.P. Antonio Ambassadeur, Représentant permanent, Genève Dr H.-C. Voltaire Directeur général, Ministère de la Santé

Alternate(s) - Suppléant(s) Dr M. Laroche Directeur, Direction des Organisations des Services de Santé Dr G. Jean-Pierre Directeur, Cabinet particulier du Ministre de la Santé Dr M. Julien Directeur, Département sanitaire du Nord M.F. Gaspard Conseiller, Mission permanente, Genève Mme K. Fouron Mission permanente, Genève Mme M.T. Bruno Secrétaire, Bureau du Ministre de la Santé

ICELAND - ISLANDE Chief delegate - Chef de délégation Mrs 1. Pâlmad6ttir Minister of Health and Social Security

Deputy chief delegate - Chef adjoint de la délégation Mr D.A. Gunnarsson Permanent Secretary, Ministry of Health and Social Security

Delegate(s)- Délégué(s) Mr B. J6nsson Ambassador, Permanent Representative, Geneva

Alternate(s) - Suppléant(s)

HONDURAS-HONDURAS Chief delegate - Chef de délégation Dr. P. Castellanos Secretario de Estado en los Despaèhos de Salud Publica

Ms R. Haraldsd6ttir Deputy Permanent Secretary, Ministry of Health and Social Security Mr S. Gudmundsson Director-General of Public Health Mr 1. Einarsson Head of Department, Ministry of Health and Social Security Mr H. 61afsson Minister Counsellor, Permanent Mission, Geneva Mrs V. lng61fsd6ttir Chief Nurse, Directorate of Public Health

Delegate(s) - Délégué(s) Sra. G. Bu Figueroa Consejero, Encargada de Negocias, a.i., Misi6n Permanente, Ginebra '

A521VR page 156 Alternate(s) - Suppléant(s) Mr S. Sutoyo Deputy Permanent Representative, Geneva Dr B. Wasisto Head, Center for Information and Health Crisis Response, Department of Health Dr D.S. Argadiredja Head, Bureau of Planning, Department of Health

INDIA -INDE Chief delegate - Chef de délégation Mr D. Ezhilmalai Union Minister of Health and Family Welfare

Delegate(s) - Délégué(s) Mr Y.N. Chaturvedi Secretary, Ministry of Health and Family Welfare Ms S. Kunadi Ambassador, Permanent Representative, Geneva

Adviser(s) - Conseiller(s) Ms L.H. Rustam Counsellor, Permanent Mission, Geneva Mr M.P. Hendrasmoro First Secretary, Permanent Mission, Geneva

Alternate(s) - Suppléant(s) Dr S. P. Agarwal Director-General of Health Services, Ministry of Health and Family Welfare Mr H.K. Singh Deputy Permanent Representative, Permanent Mission, Geneva Ms S. Rao Joint Secretary (IH), Ministry of Health and Family Welfare Ms S. Koshy Director (IH), Ministry of Health and Family Welfare Mr R. Shahare First Secretary, Permanent Mission, Geneva Mr R. Albert Ministry of Health and Family Welfare Mr I.P. Singh Deputy Controller and Auditor General of lndia Mr A.N. Chatterji Principal Director, Research and International Relations Division, Controller and Auditor General of lndia Mr K. K. Baksi Secretary (Health) Mr S.K.F. Kujur Minister, lndian Mission, London Mr S. Kurbet Permanent Mission, Geneva

IRAN (ISLAMIC REPUBLIC OF) IRAN (REPUBLIQUE ISLAMIQUE D') Chief delegate - Chef de délégation Dr M. Farhadi Minister of Health and Medical Education

Delegate(s) - Délégué(s) Mr A. Khorram Ambassador, Permanent Representative, Geneva Dr S.A. Paknejad Member of Parliament

Alternate(s) - Suppléant(s) Mr H. Soleymanpour Deputy Permanent Representative, Geneva Dr M. H. Niknam Director-General, Office of Public Relations and International Affairs, Ministry of Health and Medical Education

Adviser(s) - Conseiller(s) Dr M.T. Cheraghchi Technical Adviser to the Deputy, Ministry of Health Dr A.-A. Cheraghali Director, Iran Drug Selection Committee, Ministry of Health Mr M. Baharvand Second Secretary, Permanent Mission, Geneva Mr A. Fathollahi Ministry of Health Mr N. Haj Abedini Head Division of International Organizations, Ministry of Health and Medical Education

INDONESIA - INDONESIE Chief delegate - Chef de délégation Professer F.A. Moeloek Minister of Health

Deputy chief delegate - Chef adjoint de la délégation Dr N.H. Wirajuda Ambassador, Permanent Representative, Geneva

IRAQ-IRAQ Chief delegate - Chef de délégation M. O.M. Mubarak Ministre de la Santé

Delegate(s) - Délégué(s) Professer A. Azwar Director-General of Community Health, Department of Health

A52/VR page157 Delegate(s)- Délégué(s) M. M. AI-Douri Ambassadeur, Représentant permanent, Genève Dr N.H. Ali Directeur de la Plannification et de l'Enseignement sanitaire, Ministère de la Santé

Alternate(s) - Suppléant(s) Professer B. Rager Chief Scientist, Ministry of Health Dr Y. Sever Director, General Medicine Division, Ministry of Health Dr A. Leventhal Head, Public Health Services, Ministry of Health Ms Y. Rubinstein Minister Counsellor, International Organisations Division, Ministry of Foreign Affairs Mr G. Koren Counsellor, Permanent Mission, Geneva

Alternate(s) - Suppléant(s) Dr A. S. Mehdy Bureau de la Santé internationale Dr T.T. Salman Ministère de la Santé Dr S.A. Hassan Ministère de la Santé M. G.F. Askar Deuxième Secrétaire, Mission permanente, Genève

Adviser(s)- Conseiller(s) Ms T. Guluma Permanent Mission, Geneva

IRELAND - IRLANDE Chief delegate - Chef de délégation Dr A. Anderson Ambassador, Permanent Representative, Geneva

ITALY -ITALIE Chief delegate - Chef de délégation Mme M. Bettoni Brandani Sous-Secrétaire d'Etat à la Santé

Deputy chief delegate - Chef adjoint de la délégation Dr J. Kiely Chief Medical Officer, Department of Health and Children

Delegate(s)- Délégué(s) M. V. Silane Directeur général, Bureau des Rapports internationaux Mme M. Di Gennaro Secrétaire général, Conseil supérieur de Santé

Delegate(s) - Délégué(s) Ms B. O'Keefe Department of Health and Children

Alternate(s) - Suppléant(s) M. S. Proia Conseiller, Ministère de la Santé M. F. Cicogna Bureau des Rapports internationaux, Ministère de la Santé M. G. Majori Directeur, Laboratoire de Parasitologie, Institut supérieur de Santé M. E. Missoni Expert, Département pour la Coopération, Ministère des Affaires étrangères M. A. Negrotto Cambiaso Ambassadeur, Représentant permanent, Genève M. G. Schiavoni Premier conseiller, Mission permanente, Genève

Alternate(s) - Suppléant(s) Mr J. Cregan Department of Health and Children Ms S. Kelly Department of Health and Children Mr B. Brogan Department of Health and Children Mr N. Burgess Permanent Mission, Geneva Mr B. Ardiff Permanent Mission, Geneva Ms 1. Daveney Permanent Mission, Geneva

Adviser(s)- Conseiller(s) Mme L. Corneli Mission permanente, Genève Mme R. Whiting Mission permanente, Genève

ISRAEL - ISRAEL Chief delegate - Chef de délégation Professer J. Shemer Director-General, Ministry of Health

Delegate(s) - Délégué(s) Mr D. Peleg Ambassador, Permanent Representative, Geneva Mr P. Hubert Adviser to the Minister, Ministry of Health

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JAMAICA - JAMAIQUE Chief delegate - Chef de délégation Mr J. Junor Minister of Health

Dr T. Shobayashi Special Health Insu rance lnspector, Office of Medical Guidance and Inspection, Medical Economies Division, Health lnsurance Bureau, Ministry of Health and Welfare Mr R. Matsuoka Deputy Director, International Affairs Division, Minister's Secretariat, Ministry of Health and Welfare Mr A. Yokomaku First Secretary, Permanent Mission, Geneva Mr Y. Torii Deputy Director, Personnel Affairs Division, Minister's Secretariat, Ministry of Health and Welfare DrY. Saito Deputy Director, Office of International Cooperation, International Affairs Division, Minister's Secretariat, Ministry of Health and Welfare Dr T. Miyamura Director, Department of Virology Il, National lnstitute of lnfectious Diseases Dr E. Nakamura Technical Adviser for International Cooperation, International Affairs Division, Minister's Secretariat, Ministry of Health and Welfare Dr T. Fukuhara Managing Director, Medical Cooperation Department, Japan International Cooperation Agency

Delegate(s)- Délégué(s) Mr K.G.A. Hill Ambassador, Permanent Representative, Geneva Mr G.A. Briggs Permanent Secretary, Ministry of Health

Alternate(s) - Suppléant(s) Dr P. Figueroa Chief Medical Officer, Ministry of Health Dr B. Wint Health Adviser, CARICOM Secretariat Mrs C. Maryns Minister Counsellor, Permanent Mission, Geneva Mr F. Hall Counsellor, Permanent Mission, Geneva

JAPAN -JAPON Chief delegate - Chef de délégation MrT. Nemoto State Secretary for Health and Welfare

JORDAN -JORDANIE Chief delegate - Chef de délégation Dr 1. Marqa Minister of Health

Delegate(s)- Délégué(s) MrN.Akao Ambassador, Permanent Representative, Geneva

Alternate(s)- Suppléant(s) Dr H. Shinozaki Counsellor for Science and Technology, Minister's Secretariat, Ministry of Health and Welfare Mr S. Kaneko Director, International Affairs Division, Minister's Secretariat, Ministry of Health and Welfare MrS. Sumi Counsellor, Permanent Mission, Geneva Dr M. Mugitani Director, Office of International Cooperation, International Affairs Division, Minister's Secretariat, Ministry of Health and Welfare Mr M. Takezawa Counsellor, Permanent Mission, Geneva

Delegate(s)- Délégué(s) Mr A. Madadha Ambassador, Permanent Representative, Geneva Dr J. Huneiti Director-General of Health, Governorate of Madaba

Alternate(s) - Suppléant(s) Dr A. Belbeisi Assistant Director, Disease Control, Ministry of Health MrM. Qassem Chief of International Health, Ministry of Health Mr K. Masri Second Secretary, Permanent Mission, Geneva

Adviser(s)- Conseiller(s) Mr A. Chiba First Secretary, Permanent Mission, Geneva MrT. Uehara First Secretary, Permanent Mission, Geneva Mr S. Tsuda Deputy Director, International Affairs Division, Minister's Secretariat, Ministry of Health and Welfare Dr O. Utsunomiya Deputy Director, International Affairs Division, Minister's Secretariat, Ministry of Health and Welfare

KAZAKHSTAN-KAZAKHSTAN Deputy chief delegate - Chef adjoint de la délégation Professor A. Akanov Director-General, National Center for the Development of Healthy Lifestyles, Ministry of Foreign Affairs, Education and Sport

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Delegate(s)- Délégué(s) Mr Z. Abishev First Secretary, Permanent Mission, Geneva Mr A. Zhumadilov Second Secretary, Permanent Mission, Geneva

Alternate(s) - Suppléant(s) Dr RH. AI-Rashoud Assistant Under-Secretary for Standards and Quality Dr M. S. AI-Ayyad Director, Hawalli Health Region Dr K.A. AI-Saqabi Director, Department of Planning Mr W. AI-Wuqayyan Director, Minister of Health Department Dr D.F. Aburamia Director, Al Jahra Hospital Mr J. Jaralla Assistant Director, AI-Jahra Hospital Mr A.H.H.H. AI-Jassam Third Secretary, Permanent Mission, Geneva Mr A. AI-Askar Second Secretary, Permanent Mission, Geneva

Alternate(s) - Suppléant(s) Mr E. Zhussupov Second Secretary, Permanent Mission, Geneva

KENYA- KENYA Chief delegate - Chef de délégation Mr J.l. Kalweo Minister of Health

Deputy chief delegate - Chef adjoint de la délégation Mr P. Mwaisaka Permanent Secretary, Ministry of Health

Delegate(s) - Délégué(s) Dr K.A.A. Rana Ambassador, Permanent Representative, Geneva

KYRGYZSTAN - KIRGHIZISTAN Chief delegate - Chef de délégation Mr N. Kasiev Minister of Health

Alternate(s) - Suppléant(s) Professer J. Meme Director of Medical Services Dr A. Muita Director, Kenyatta National Hospital Dr R. Muga Provincial Medical Officer, Kisumu Mrs M.W. Ngure Chief Nursing Officer Mr J.N. Busiega First Secretary, Permanent Mission, Geneva

Delegate(s) - Délégué(s) Mr B. Dimitrov Head, Department of External Relations, Ministry of Health

LAO PEOPLE'S DEMOCRATIC REPUBLIC REPUBLIQUE DEMOCRATIQUE POPULAIRE LAO Chief delegate - Chef de délégation Dr Ponmek Dalaloy Ministre de la Santé publique

KIRIBATI- KIRIBATI Chief delegate - Chef de délégation Mr B. Mooa Minister of Health

Delegate(s)- Délégué(s) M. K. Heuangvongsy Directeur général d!J Département de l'Organisation et de formation du Personnel, Ministère de la Santé publique Dr N. Boutta Directeur adjoint du Cabinet, Ministère de la Santé publique

Delegate(s)- Délégué(s) Dr T. Kienene Permanent Secretary for Health

LATVIA- LETTONIE KUWAIT - KOWEIT Chief delegate - Chef de délégation Dr A. K. AI-Sabeeh Minister of Health

Chief delegate - Chef de délégation Mr V. Jaksons Under-Secretary of State, Ministry ofWelfare

Delegate(s) - Délégué(s) Ms 1. Aizsilniece President of Riga Division, Latvian Medical Society Mr R. Baumanis Ambassador, Permanent Representative, Geneva

Delegate(s) - Délégué(s) Mr DAR. Razzooqi Ambassador, Permanent Representative, Geneva Dr A.Y. AI-Saif Assistant Under-Secretary for Community Health and Environment

A521VR page 160

Alternate(s) - Suppléant(s) Mr M. Pavelsons Third Secretary, Permanent Mission, Geneva

Alternate(s)- Suppléant(s) DrT.Shaffah Consultant, General People's Committee for Health and Social Welfare Mr A.M. Allafi General People's Committee for Health and Social Welfare Dr A. Rahil Counsellor for Health Affairs, Permanent Mission, Geneva Mr F. Ashour General People's Committee for Health and Social Welfare

LEBANON - LIBAN Chief delegate - Chef de délégation Dr K. Karam Ministre de la Santé

Delegate(s) - Délégué(s) DrW.Ammar Directeur général, Ministère de la Santé

LITHUANIA - LITUANIE Chief delegate- Chef de délégation Mr M.L. Stankevicius Acting Minister of Health

LESOTHO - LESOTHO Chief delegate - Chef de délégation MrV. Bulane Minister of Health

Delegate(s) - Délégué(s) Professer V. Grabauskas Rector, Kaunas University of Medicine Mr A. Navikas Chargé d'affaires a.i., Permanent Mission, Geneva

Delegate(s) - Délégué(s) Mrs J.M. Rasethuntsa Deputy Principal Secretary, Ministry of Health and Social Welfare Dr T. Ramatlapeng Director-General of Health Services

Alternate(s)- Suppléant(s) Mr A. Gailiunas First Secretary, Permanent Mission, Geneva

LIBERIA - LIBERIA LUXEMBOURG-LUXEMBOURG Chief delegate - Chef de délégation Dr P. Coleman Minister of Health and Social Welfare

Chief delegate - Chef de délégation Dr D. Hansen-Koenig Directeur de la Santé; Ministère de la Santé

Delegate(s)- Délégué(s) Dr N.S. Bartee Deputy Minister, Chief Medical Officer Mr H.D. Williamson Ambassador, Permanent Representative, Geneva

Deputy chief delegate - Chef adjoint de la délégation Mme A. Schleder-Leuck Conseiller de Direction, Ministère de la Santé

Alternate(s) - Suppléant(s) Mr E. Clarke Permanent Mission, Geneva Mrs N. Damachi Permanent Mission, Geneva

Delegate(s) - Délégué(s) Mme M. Pranchère-Tomassini Ambassadeur, Représentant permanent, Genève

Alternate(s) - Suppléant(s) M. A. Weber Premier Secrétaire, Mission permanente, Genève

LIBYAN ARAB JAMAHIRIYA- JAMAHIRIYA ARABE LIBYENNE Chief delegate - Chef de délégation Dr E.F. Ehtuish Secretary of General People's Committee for Health and Social Welfare

MADAGASCAR-MADAGASCAR Chief delegate - Chef de délégation Professeur H. Ratsimbazafimahefa Ministre de la Santé

Delegate(s) - Délégué(s) M. M. Zafera Ambassadeur, Représentant permanent, Genève Dr Razafimanantoanina Directeur des Pharmacies et Laboratoires, Ministère de la Santé

Delegate(s)- Délégué(s) Mrs N. AI-Hajjaji Chargé d'affaires, Permanent Mission, Geneva Dr A. Abudajaja Consultant, General People's Committee for Health and Social Welfare

A52NR page 161 Alternate(s) - Suppléant(s) Mme F. Rakotoniaina Représentant permanent adjoint, Genève M. K. Allaouidine Secrétaire d'Ambassade, Mission permanente, Genève

MALI- MALI Chief delegate - Chef de délégation Mme D.F. N'Diaye Ministre de la Santé, des Personnes âgées et de la Solidarité

Delegate(s)- Délégué(s)

MALAWI - MALAWI Chief delegate - Chef de délégation Dr W.O.O. Sangala Secretary for Health and Population

Dr L. Konate Conseiller technique Dr M.A. Kane Directeur national de la Santé publique

Alternate(s) - Suppléant(s) M. M.B. Ballo Directeur, Cellule de Planification et de Statistiques

Deputy chief delegate - Chef adjoint de la délégation Dr R. Pendame Controller of Clinical Services

MALTA- MALTE Delegate(s)- Délégué(s) Mrs D. Machinjiri Principal Nursing Officer

Chief delegate - Chef de délégation Dr L. Deguara Minister of Health

MALAYSIA - MALAISIE Chief delegate - Chef de délégation Mr M. Ali Mohamed Rustam Deputy Minister of Health

Deputy chief delegate - Chef adjoint de la délégation Mr M. Bartolo Ambassador, Permanent Representative, Geneva

Delegate(s) - Délégué(s) Dr R. Busuttil Director-General (Health)

Delegate(s)- Délégué(s) Mr Hamidon Ali Ambassador, Permanent Representative, Geneva Dr M. Taha bin Arif Director of Disease Control, Ministry of Health

Alternate(s)- Suppléant(s) Dr N. Azzopardi Medical Officer, Office of the Director-General (Health) Dr A. Amato-Gauci Consultant in Public Health Dr J. Aquilina First Secretary, Permanent Mission, Geneva Mr S. Sciberras Persona! Assistant to the Minister of Health

Alternate(s)- Suppléant(s) Dr Lee Cheow Pheng State Director of Health, Selangor Health Department Mr Raja Nushirwan Zainal Abidin Second Secretary, Permanent Mission, Geneva

MALDIVES - MALDIVES Chief delegate - Chef de délégation Mr A. Abdullah Minister of Health

MARSHALL ISLANDS - ILES MARSHALL Chief delegate - Chef de délégation Mr T.D. Kijiner Minister of Health and Environment

Deputy chief delegate - Chef adjoint de la délégation DrA. Waheed Director-General of Health Services

MAURITANIA- MAURITANIE Chief delegate - Chef de délégation Mme D. Ba Ministre de la Santé et des Affaires sociales

Delegate(s)- Délégué(s) Mr A. Salih Deputy Director, Ministry of Health

Delegate(s)- Délégué(s) M. M.S.O.M. Lemine Ambassadeur, Représentant permanent, Genève

A52/VR page 162 M. A.O.M. Lehbib Directeur de la Plannification, de la Coopération et de la Statistique, Ministère de la Santé et des Affaires sociales

MONACO - MONACO Chief delegate - Chef de délégation Dr A. Negre Direction de l'Action sanitaire et sociale

Alternate(s) - Suppléant(s) M. M.O. Mennou Directeur de la Protection sanitaire, Ministère de la Santé et des Affaires sociales

MONGOLIA-MONGOLIE MAURITIUS - MAURICE Chief delegate - Chef de délégation Mr N. Deerpalsingh Minister of Health and Quality of Life

Chief delegate - Chef de délégation Dr S. Sonin Minister of Health and Social Welfare

Deputy chief delegate - Chef adjoint de la délégation Mr S.-O. Bold Ambassador, Permanent Representative, Geneva

Deputy chief delegate - Chef adjoint de la délégation Mr K.R. Mudhoo Permanent Secretary, Ministry of Health and Quality of Life

Delegate(s) - Délégué(s) Mr D. Bayarsaikhan Director, Administration Department, Ministry of Health and Social Welfare

Delegate(s)- Délégué(s) Mrs U.C.D. Canabady Counsellor, Permanent Mission, Geneva

Alternate(s) - Suppléant(s) Mr 8.-0. Erdenebulgan Attaché, Permanent Mission, Geneva

Alternate(s) - Suppléant(s) Mr R. Sawmy Second Secretary, Permanent Mission, Geneva Mr A. Koodoruth Second Secretary, Permanent Mission, Geneva Mr H.K. Bhunjoo Attaché, Permanent Mission, Geneva

MOROCCO-MAROC Chief delegate - Chef de délégation Dr A. El Fassi Ministre de la Santé

MEXICO - MEXIQUE Chief delegate - Chef de délégation Dr R. Tapia Subsecretario, Prevenci6n y Control de Enfermedades, Secretaria de Salud

Delegate(s) - Délégué(s) M. M.N. Benjelloun Touimi Ambassadeur, Représentant permanent, Genève Dr F. Hamadi Secrétaire général, Ministère de la Santé

Delegate(s) - Délégué(s) Sr. E. Jaramillo Navarrete Director General, Asuntos lnternacionales, Secreta ria de Salud Profesor J. Urbi na Soria Director General, Promoci6n de la Salud, Secreta ria de Salud

Alternate(s) - Suppléant(s) Dr M. M. Ellsmaïli Lalaoui Inspecteur général, Ministère de la Santé Dr J. Mahjour Directeur de I'Epidémiologie et de la Lutte contre les Maladies, Ministère de la Santé Mme S. Choujaa Jrondi Directeur des Hôpitaux et des Soins ambulatoires, Ministère de la Santé M. M. Benabla Chef de la Division de la Coopération, Ministère de la Santé M. A. Allauch Premier Secrétaire, Mission permanente, Genève

Alternate(s) - Suppléant(s) Sra. M.F. Merino Juarez Directora de Cooperaci6n con Organismes Multilaterales, Secretaria de Salud Sr. J.C. Nolte Santillan Director de Concentraci6n lntersectorial y Programas Especiales, Secretaria de Salud Dra. L. Rodriguez Cabrera Directora de Salud Familiar y Escolar, Secretaria de Salud Sra. L. Sosa Marquez Segunda Secretaria, Misi6n Permanente, Ginebra

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MOZAMBIQUE - MOZAMBIQUE Chief delegate - Chef de délégation Mr A.A. Zilhao Minister of Health

NAMIBIA - NAMIBIE Chief delegate - Chef de délégation Dr L. Amathila Minister of Health and Social Services

Delegate(s)- Délégué(s) Mr A.L.J. Manguel National Director of Health Mr H.A.P. Cossa National Director for Planning and Cooperation

Deputy chief delegate - Chef adjoint de la délégation Dr K. Shangula Permanent Secretary, Ministry of Health and Social Services

Delegate(s)- Délégué(s) Dr N. Hamata Regional Director

Alternate(s) - Suppléant(s) Mrs G.P. Langa Ministry of Health

Alternate(s)- Suppléant(s) Ms M. Nghatanga Director, Primary Health Care and Nursing Services

MYANMAR-MYANMAR Chief delegate - Chef de délégation Mr Ket Sein Minister of Health

NEPAL-NEPAL Chief delegate - Chef de délégation Dr D.P. Manandhar Officiating Secretary, Ministry of Health

Deputy chief delegate - Chef adjoint de la délégation MrAye Ambassdor, Permanent Representative, Geneva

Delegate(s) - Délégué(s) Dr S.P. Bhattarai Chief of Planning Division, Ministry of Health Mr N.B. Shrestha Minister Counsellor, Permanent Mission, Geneva

Delegate(s) - Délégué(s) Mr Phone Myint Ambassador, Embassy of the Union of Myanmar, Rome

Alternate(s) - Suppléant(s) Mr Linn Myaing Deputy Permanent Representative, Geneva Mr Denzil Abel Deputy Permanent Representative, Geneva Dr Kyaw Myint Director-General, Department of Medical Sciences Dr Kyi Soe Director-General, Department of Health Planning Dr Myo Myint Rector, lnstitute of Medicine Mr Khin Tun Director, Department of Health Mr Aung Ba Kyu First Secretary, Permanent Mission, Geneva Mr Kyaw Swe Tint First Secretary, Permanent Mission, Geneva Ms Ei EiTin Second Secretary, Permanent Mission, Geneva DrOhn Kyaw Chief of International Health Division, Ministry of Health

Alternate(s) - Suppléant(s) Mr G.R. Gyanwali Section Officer, Ministry of Health

NETHERLANDS- PAYS-BAS Chief delegate - Chef de délégation Dr E. Borst-Eilers Minister of Health, Welfare and Sport

Delegate(s)- Délégué(s) Dr H.J. Schneider Director-General for Health, Ministry of Health, Welfare and Sport Mr H.J. Heinemann Ambassador, Permanent Representative, Geneva

Alternate(s)- Suppléant(s) Mr G.M. van Etten Head, International Affairs, Ministry of Health, Welfare and Sport Mr B.C.A.F. van der Heijden Deputy Permanent Representative, Geneva Ms M.A.C.M. Middelhoff Senior Adviser, International Affairs, Ministry of Health, Welfare and Sport Mr J. Waslander First Secretary, Permanent Mission, Geneva

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page 164 Mr J.P.G. Mout Policy Officer, United Nations Department, Ministry of Foreign Affairs Ms M. Wijnroks Health Adviser, Directorate of Social and lnstitutional Development, Ministry of Foreign Affairs Ms Y. Henriquez-de Waal Pohcy Officer, Medical Ethics, Ministry of Health, Welfare and Sport

NIGER - NIGER Chief delegate - Chef de délégation M. M.S.M. Maman Ministre de la Santé publique

Delegate(s) - Délégué(s) Dr H. Maoudé Secrétaire général, Ministère de la Santé publique DrG. Magagi Directeur de la Promotion, Ministère de la Santé publique

Adviser(s)- Conseiller(s) Ms M.A.C. Galesloot Director-General, Prevention, Youth and Sanctions, Ministry of Justice Ms I.E. van Geest-Jacobs Director, Information and Communication, Ministry of Health, Welfare and Sport

Altemate(s) - Suppléant(s) Dr F.I.H. Djermakoye Coordonnatrice du Programme national de la Lutte contre le Paludisme

NEW ZEALAND - NOUVELLE-ZELANDE Chief delegate - Chef de délégation DrG. Durham Deputy Director-General, Safety and Regulation Branch, Ministry of Health

NIGERIA - NIGERIA Chief delegate - Chef de délégation Professer D. Adeyemi Minister of Health

Delegate(s) - Délégué(s) Delegate(s)- Délégué(s) Mr T. Krieble Director, Development, Ministry of Health MrM. Gubb Permanent Mission, Geneva MrA. T. Mani Permanent Secretary

Alternate(s)- Suppléant(s) MrC.A. Osah Chargé d'affaires a.i., Permanent Mission, Geneva

Adviser(s)- Conseiller(s) Professer R. Beaglehole Auckland School of Medicine, University of Auckland Ms D. Geels Permanent Mission, Geneva

Adviser(s)- Conseiller(s) DrT. Fakeye Director, Special Project Dr Suleiman Sani Director, Health Services Dr S. Suie Director, Ministry of Health Dr E. Abebe Director, PHC/DC Dr 0.0. Dokunmu Executive Director, NPHCDA Dr A. Nuhu Commissioner of Health, Kano State Dr R.O. Barrow Director, Medical and Pharmaceutical Services Dr J.N. Ugwuegede Commissioner of Health, Enugu State Dr M.O. Ogungbesan Commissioner of Health, Lagos State Dr O.E. Udoidoik Permanent Secretary of Health, Akwa lbom State Mr A. Hassan Senior Counsellor, Permanent Mission, Geneva

NICARAGUA - NICARAGUA Chief delegate - Chef de délégation Sra. M. McCoy Sanchez Ministra de Salud

Delegate(s)- Délégué(s) Sr. A. Montenegro Mallona Embajador, Representante Permanente, Ginebra Dr. F. Prado Rocha Secretario General, Ministerio de Salud

Alternate(s) - Suppléant(s) Dr. M. L6pez Baldizon Director General de Planificaci6n, Ministerio de Salud Sra. C. Sanchez Reyes Ministre Consejero, Misi6n Permanente, Ginebra

A52NR page 165 Delegate(s) - Délégué(s) Mr M.O.A. Aideed Ambassador, Permanent Representative, Geneva Dr A.J.M. Sulaiman Director-General of Health Affairs, Ministry of Health

NIUE- NIQUE Chief delegate - Chef de délégation Mr R.R. Rex Minister of Health

Delegate(s)- Délégué(s) Dr L. Woonton Director of Health

Alternate(s) - Suppléant(s) Mrs F.A. Al-Ghazali Health Attaché, London Mr A.A. AI-Khanji Director-General of Health Services of Muscat Province, Ministry of Health Mr A.A. AI-Balushi First Secretary, Permanent Mission, Geneva Mr E. AI-Khanjari First Secretary, Permanent Mission, Geneva

NORWAY - NORVEGE Chief delegate - Chef de délégation Mr D. Hèiybrâten Minister of Health and Social Affairs (Chief delegate from 18 to 19 May) (Chef de délégation du 18 au 19 mai)

Delegate(s) - Délégué(s) DrA. Alvik Director-General, Norwegian Board of Health (Chief delegate on 17 and from 20 to 25 May) (Chef de délégation le 17 et du 20 au 25 mai) Mr B. Skogmo Ambassador, Permanent Representative, Geneva

PAKISTAN- PAKISTAN Chief delegate - Chef de délégation Mr M.M.J. Hashmi Minister of Health

Delegate(s)- Délégué(s) MrM. Akram Ambassador, Permanent Representative, Geneva Mr A. S. Chaudhry Health Educational Adviser, Ministry of Health

Alternate(s) - Suppléant(s) Ms A.-S. Trosdahl Oraug Deputy Director-General, Ministry of Health and Social Affairs DrT. Hetland Adviser, Ministry of Health and Social Affairs MrT.C. Hildan Minister Counsellor, Permanent Mission, Geneva Dr O.T. Christiansen Counsellor, Permanent Mission, Geneva Dr P. Wium Senior Adviser, Norwegian Board of Health Ms G.A. Endresen Adviser, Ministry of Foreign Affairs

Alternate(s) - Suppléant(s) Mrs T. Janjua Counsellor, Permanent Mission, Geneva MrM.S. Qazi Second Secretary, Permanent Mission, Geneva Mr F.l. Khan Third Secretary, Permanent Mission, Geneva Mr S. Raza Permanent Mission, Geneva

Adviser(s) - Conseiller(s) Dr B. Austveg Senior Adviser, Norwegian Board of Health Dr A.B. Knapskog County Medical Officer Ms B. Slaatten President, Norwegian Association of Health and Social Gare Personnel

PALAU- PALAOS Chief delegate - Chef de délégation Dr C.T.O. Otto Director, Bureau of Public Health, Ministry of Health

Delegate(s) - Délégué(s) Ms J.M. Polloi Chief, Health Hu man Resources Development, Ministry of Health

OMAN-OMAN Chief delegate - Chef de délégation Dr A. M. Moosa Minister of Health

PANAMA-PANAMA Chief delegate - Chef de délégation Dra. A.L. Moreno de Rivera Ministra de Salud

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Delegate(s)- Délégué(s) Sr. L. Kam Embajador, Representante Permanente, Ginebra Sr. J. Bonagas Representante Permanente Alterne, Ginebra

PERU- PEROU Chief delegate - Chef de délégation Dr. A. Aguinaga Ministre de Salud

Alternate(s) - Suppléant(s) Sra. M. Garrido Consejera, Misién Permanente, Ginebra

Delegate(s) - Délégué(s) Sr. J. Voto-Bernales Embajador, Representante Permanente, Ginebra Dr. A. Mesarina Asesor del Despacho Ministerial del Sector Salud

PAPUA NEW GUINEA - PAPOUASIENOUVELLE-GUINEE Chief delegate - Chef de délégation Mr L. Mond Minister of Health

Alternate(s) - Suppléant(s) Dr. A. Meloni Director General, Oficina de Financiamiento, lnversiones y de Cooperacién Externa, Ministerio de Salud Sr. M. Rodriguez Representante Permanente Alterne, Ginebra Sr. G. Guillen Primer Secretario, Misién Permanente, Ginebra

Delegate(s)- Délégué(s) Mr R. Drew First Secretary, Ministry of Health Mr L. Piliwas Director, Promotive and Preventive Health Division, Department of Health

PHILIPPINES - PHILIPPINES Chief delegate - Chef de délégation Mr A.G. Romualdez Secretary, Department of Health

Alternate(s) - Suppléant(s) Mrs R. Mond Secretary

PARAGUAY-PARAGUAY Chief delegate - Chef de délégation Dr. M. A. Chiola Ministre de Salud Publica y Bienestar Social

Deputy chief delegate -Chef adjoint de la délégation Mrs L.R. Bautista Ambassador, Permanent Representative, Geneva

Delegate(s) - Délégué(s) Ms R.V. Pauline Director Ill, Foreign Assistance Coordination Service, Department of Health

Delegate(s) - Délégué(s) Dr. V. Duarte Pistilli Asesor Médico del Gabinete del Ministerio de Salud Publica y Bienestar Social Sr. R. Recaldo Consejero, Encargado de Negocies a.i., Misién Permanente, Ginebra

Adviser(s)- Conseiller(s) Ms M.E.G. Callangan Second Secretary, Permanent Mission, Geneva Dr A.N. Acosta Consultant, Department of Health

Alternate(s) - Suppléant(s) Dr. R. Dullak Vice Director de la Unidad de Planificacién y Evaluacién del Ministerio de Salud Publica y Bienestar Social Dr. F. Centurién Mayor Superintendente de Salud del Ministerio de Salud Publica y Bienestar Social Sr. R. Ugarriza Primer Secretario, Misién Permanente, Ginebra Sra. L. Casati Segunda Secretaria, Misién Permanente, Ginebra

POLAND-POLOGNE Chief delegate - Chef de délégation Dr J.A. Piatkiewicz Vice-Minister of Health and Social Welfare

Delegate(s) - Délégué(s) Mr K. Jakubowski Ambassador, Permanent Representative, Geneva Professer J. Leowski Director, School of Public Health and Social Medecine, Medical Centre for Postgraduate Education

A52JVR page 167 Alternate(s) - Suppléant(s) Mrs B. Bitner Director, Bureau of European Integration and Foreign Cooperation, Ministry of Health and Social Welfare Mr K. Rozek Counsellor, Permanent Mission, Geneva

REPUBLIC OF KOREA - REPUBLIQUE DE COREE Chief delegate - Chef de délégation Dr M.-1. Kim Minister of Health and Welfare

PORTUGAL-PORTUGAL Chief delegate - Chef de délégation Mme M. de Belém Roseira Ministre de la Santé

Deputy chief delegate - Chef adjoint de la délégation Mr M.-S. Chang Ambassador, Permanent Representative, Geneva

Delegate(s) - Délégué(s) Mr Y.-H. Yang Counsellor, Permanent Mission, Geneva

Deputy chief delegate - Chef adjoint de la délégation M. G. de Santa Clara Gomes Ambassadeur, Représentant permanent, Genève

Alternate(s) - Suppléant(s) Mr D.-K. Oh Director-General, Health Promotion Bureau, Ministry of Health and Welfare Mr H.-Y. Ann Counsellor, Permanent Mission, Geneva Mr C.-H. Park Director, International Cooperation Division, Ministry of Health and Welfare Mr J.-H. Lim Second Secretary, Permanent Mission, Geneva MrC. Lee Deputy Director, Human Rights and Social Affairs Division, Ministry of Foreign Affairs and Trade Mr D.-Y. Ko Deputy Director, International Cooperation Division, Ministry of Health and Welfare Mr Y.-J. Hur Deputy Director, Communicable Disease Control Division, Ministry of Health and Welfare Mr M.-S. Yeom Deputy Director, Ministry of Health and Welfare Mr E.-S. Kim Professer/Consultant, Yonsei University

Delegate(s)- Délégué(s) Professeur C. Sakellarides Directeur général de la Santé

Alternate(s) - Suppléant(s) M. J.J. Pereira Gomes Conseiller, Mission permanente, Genève Mme 1. Marquez Première Secrétaire, Mission permanente, Genève Mme P. Pinto de Fonseca Conseiller de Presse du Ministre de la Santé Professeur J. Lapes Martins Coordonnateur de la Coopération bilatérale, Direction générale de la Santé Mme D. Rogeiro Cruz .Chef des Services administratifs de la Coopération internationale, Direction générale de la Santé

QATAR- QATAR Chief delegate - Chef de délégation Or H.A.H. AI-Binali Minister of Public Health

Delegate(s) - Délégué(s) Mr F.A. AI-Thani Ambassador, Permanent Representative, Geneva Dr K.A. AI-Jaber Assistant Under-Secretary for Technical Affairs, Ministry of Public Health

REPUBLIC OF MOLDOVA- REPUBLIQUE DE MOLDOVA Chief delegate - Chef de délégation Mr E. Gladun Minister of Health

Delegate(s)- Délégué(s) Alternate(s) - Suppléant(s) Mr H.M. AI-Hatmi Director, Office of the Minister, Ministry of Public Health Mr A.H. Al-Abd alla Head of Public and International Relations, Ministry of Public Health Mr A. Cheptine Ambassador, Permanent Representative, Geneva MrA. Calmac Deputy Permanent Representative, Geneva

A52NR page 168 Alternate(s) - Suppléant(s) Ms L. Negru First Secretary, Permanent Misison, Geneva

Adviser(s) - Conseiller(s) Dr V.K. Riazantsev Chief Specialist, International Relations Department, Ministry of Health Mr R.J. Alyautdinov Counsellor, Permanent Mission, Geneva Dr A. V. Pavlov Counsellor, Permanent Mission, Geneva Mr A.V. Kovalenko Second Secretary, Permanent Mission, Geneva Dr R.V. Grishchenko Attaché, Permanent Mission, Geneva

ROMANIA - ROUMANIE Chief delegate - Chef de délégation Professor A. Ciocalteu Secretary of State, Ministry of Health (Chief delegate from 17 to 20 May) (Chef de délégation du 17 au 20 mai)

Deputy chief delegate - Chef adjoint de la délégation MrM. Popa Director-General, General Department of Public Health, Ministry of Health

RWANDA - RWANDA Chief delegate - Chef de délégation Dr E. Rwabuhihi Ministre de la Santé

Delegate(s)- Délégué(s) Mr 1. Maxim Ambassador, Permanent Representative, Geneva (Chief delegate from 21 to 25 May) (Chef de délégation du 21 au 25 mai)

Delegate(s) - Délégué(s) Dr T. Nizemyimana Directeur de la Région sanitaire de Buta re Dr M. Mugabo Chef de la Division de la Santé maternelle et infantile

Alternate(s) - Suppléant(s) Mr T. Negru Director-General, General Division of Budget, Ministry of Health Ms L. Popescu Director, Department of International Relations, Ministry of Health Ms C. Heredea Expert, Ministry of Health Ms G. Dumitriu Second Secretary, Ministry of Foreign Affairs Mr A. Pacuretu Third Secretary, Permanent Mission Geneva

Alternate(s) - Suppléant(s) Dr C. Kananura Chargé d'affaires a.i., Mission permanente, Genève

SAINT KITTS AND NEVIS - SAINT -KITTS-ETNEVIS Chief delegate - Chef de délégation Mr E. Newton Health Planner, Ministry of Health and Women's Affairs

RUSSIAN FEDERATION - FEDERATION DE RUSSIE Chief delegate - Chef de délégation Professor V.l. Starodubov Minister of Health

SAINT LUCIA - SAINTE-LUCIE Chief delegate- Chef de délégation Mrs S.L. Flood Minister of Health, Family Affairs, Human Services and Gender Relations

Deputy chief delegate - Chef adjoint de la délégation Mr V.S. Sidorov Ambassador, Permanent Representative, Geneva

Delegate(s)- Délégué(s) Mr C. Beaubrun Ministry of Health

Delegate(s) - Délégué(s) Dr N.N. Fetisov Director, International Relations Department, Ministry of Health

Alternate(s) - Suppléant(s) Professor Y.F. lssakov Vice-President, Russian Academy of Medical Sciences Mr R.A. Kolodkin Deputy Permanent Representative, Geneva Dr A.A. Monissov Director, Department of the State Sanitary and Epidemiological Surveillance, Ministry of Health

SAINT VINCENT AND THE GRENADINES SAINT -VINCENT -ET -GRENADINES Chief delegate - Chef de délégation MrC. Thomas Minister of Health and the Environment

A52/VR page 169

Delegate(s)- Délégué(s) Ms N. Dabinovic Honorary Consul, Geneva

SAUDI ARABIA -ARABIE SAOUDITE Chief delegate - Chef de délégation Professer O.A.M. Shobokshi Minister of Health

SAMOA-SAMOA Chief delegate - Chef de délégation Mr M. Telefoni Retzlaff Minister of Health

Delegate(s)- Délégué(s) Dr R.M. Khalil Adviser to the Minister, Ministry of Health Dr Y.Y. AI-Mazrou Assistant Deputy Minister, Prevention Department, Ministry of Health

Delegate(s)- Délégué(s) Dr T.E. Enosa Director-General of Health, Department of Health

Alternate(s) - Suppléant(s) Dr A.-R.M. Aqeel General Director of the Region of Jazan Dr A.-W.M. Makki Dr I.M. AI-Shuwaer Adviser to the Minister, Ministry of Health Mr H.M. AI-Fakheri Director, Planning Department, Ministry of Health Mr A. O. AI-Khattabi General Director, International Health Department, Ministry of Health Dr A.A.-H. Mashkhas Director, Communicable Diseases Department, Ministry of Health Mr G.M. AI-Ragragi Secretary, Ministry of Health Mr M. AI-Suraihi Permanent Mission, Geneva

Alternate(s) - Suppléant(s) Dr L.J. Ainuu Director of Clinical Services, Department of Health Mrs P. Stowers Director of Nursing, Department of Health

SAN MARINO - SAINT -MARIN Chief delegate - Chef de délégation M. L. Ciavatta Ministre de la Santé et de la Sécurité sociale

Delegate(s) - Délégué(s) MmeF. Bigi Représentant permanent adjoint, Genève Mme H. Zeiler-Werbrouck Conseiller, Mission permanente, Genève

Alternate(s) - Suppléant(s) M. M. Chiaruzzi Coordonnateur du Département Santé et Sécurité sociale Mme A. Cervellini Secrétaire du Ministre de la Santé et de la Sécurité sociale Mme A. Bernardi Département Santé et Sécurité sociale

SENEGAL-SENEGAL Chief delegate - Chef de délégation M. A. Diop Ministre de la Santé

Delegate(s) - Délégué(s) Mme A. C. Di allo Ambassadeur, Représentant permanent, Genève

SAO TOME AND PRINCIPE - SAO TOME-ETPRINCIPE Chief delegate - Chef de délégation Dr A. S. Marques de Lima Ministre de la Santé

M.l. Ndiaye Ministre conseiller, Mission permanente, Genève

Alternate(s)- Suppléant(s) Dr M. Niang Directeur de la Santé Dr A. Ndiaye Conseiller technique, Cabinet du Ministre de la Santé Mr E.H.S. Niang Premier Secrétaire, Mission permanente, Genève Mr M. Gueye Conseiller, Mission permanente, Genève

Delegate(s) - Délégué(s) Dr C. Augusto da Cruz Directrice, Centre hospitalier de Sao Tomé

A52/VR

page 170

SEYCHELLES - SEYCHELLES Chief delegate - Chef de délégation Mr J. Dugasse Minister of Health

Alternate(s) - Suppléant(s) Mrs M. Kollàrovà Director, Department of International Relations, Ministry of Health Mr F. Rosocha Second Secretary, Permanent Mission, Geneva Mrs Z. Cervenà Department of International Relations, Ministry of Health

Delegate(s)- Délégué(s) Mrs M.-A. Houareau Principal Secretary, Ministry of Health Dr C. Shamlaye Special Adviser to the Minister of Health

SLOVENIA - SLOVENIE Chief delegate - Chef de délégation

SIERRA LEONE -SIERRA LEONE Chief delegate - Chef de délégation Mr E.E. Luy Consul, Geneva

Dr D.P. Kosmac State Secretary, Ministry of Health

Delegate(s) - Délégué(s) Mr G. Zore Ambassador, Permanent Representative, Geneva MrF. Miksa Deputy Permanent Representative, Geneva

SINGAPORE - SINGAPOUR Chief delegate - Chef de délégation Mr M. Lee Kim Poo Second Permanent Secretary (Health), Ministry of Health

SOLOMON ISLANDS - ILE~ SALOMON Chief delegate - Chef de délégation Mr D. lniakwala Under-Secretary, Health lmprovement, Ministry of Health and Medical Services

Delegate(s)- Délégué(s) Dr Tan Cher Hiang Director (Human Resources), Ministry of Health Mr Lee Tong Yang Deputy Director (Financial Policy

Delegate(s)- Délégué(s) an~

Planning), Ministry of Health

Adviser(s)- Conseiller(s) Mr See Chak Mun Ambassador, Permanent Representative, Geneva Ms M. Liang Deputy Permanent Representative, Geneva Mr Ann Hee Kyet First Secretary, Permanent Mission, Geneva Ms Ong Yen Cheng Second Secretary, Permanent Mission, Geneva Mr V. Ramakrishnan Third Secretary, Permanent Mission, Geneva

Mr A. Punufimana Director, Nursing Services, Ministry of Health and Medical Services

SOUTH AFRICA -AFRIQUE DU SUD Miss B. Qwabe First Secretary, Permanent Mission, Geneva Mr D. Johns Health Attaché, Permanent Mission, Ge neva

Chief delegate - Chef de délégation Dr N.C. Dlamini-Zuma Minister of Health

Delegate(s) - Délégué(s)

SLOVAKIA- SLOVAQUIE Chief delegate - Chef de délégation Mr 1. Rovny Director-General for the Protection of Health of lnhabitants, Ministry of Health

MrG.S. Nene Ambassador, Permanent Representative, Geneva Mr A. Ntsaluba Director-General, Department of Health

Alternate(s) - Suppléant(s) Mr R.V. Mabope Chief Director, National Health Systems

Delegate(s) - Délégué(s) Mr K. Petécz Ambassador, Permanent Representative, Geneva Mrs D. Rozgonovà Director, Department of the United Nations and Specialized Agencies, Ministry of Foreign Affairs

Adviser(s)- Conseiller(s) Mr 1. Roberts Special Adviser to the Minister of Health Mr G.J. Sekobe Chief Director, Environmental and Occupational Health, Department of Health

A52/VR page 171 Ms N.C. Dladla Director, Nutrition, Department of Health Ms E.F. Kola Assistant Director, International Health Liaison, Department of Health Mr K.V. Hlongwane Persona! Assistant to the Minister of Health

SRI LANKA - SRI LANKA Chief delegate - Chef de délégation Mr N.S. de Silva Minister of Health and lndigenous Medicine

Delegate(s) - Délégué(s) Mr H.M.G.S. Palihakkara Ambassador, Permanent Representative, Geneva

SPAIN -ESPAGNE Chief delegate - Chef de délégation Sr. J.M. Romay Beccaria Ministro de Sanidad y Consumo

Alternate(s)- Suppléant{s) Dr Y.D.N. Jayathilaka Secretary, Medical Services, Ministry of Health and lndigenous Medicine Dr V. Jeganathan Director-General of Health Services Professor N. Mendis Professor of Psychiatry, Faculty of Medicine, University of Colombo

Deputy chief delegate - Chef adjoint de la délégation Sr. R. Pérez-Hernândez y Torra Embajador, Representante Permanente, Ginebra

Adviser(s) - Conseiller(s) Mr S.S. Ganegama Arachchi First Secretary, Permanent Mission, Geneva Mr A.S.U. Mendis Second Secretary, Permanent Mission, Geneva • Mrs C.l. de Silva Private Secretary to the Minister of Health and lndigenous Medicine

Delegate(s)- Délégué(s) Dr. J.M. Martin Moreno Director, Escuela Nacional de Sanidad, Ministerio de Sanidad y Consumo

Alternate(s) - Suppléant(s) Sra. 1. de la Mata Barranco Vocal Asesora del Subsecretario de Farmacia y Productos Sanitarios, Ministerio de Sanidad y Consumo

Adviser(s)- Conseiller(s) Dra. C. Garcia Alvarez Directora del Gabinete del Ministro de Sanidad y Consumo Sra. M. Saenz de Heredia Subdirectora General de Organismos lnternacionales Técnicos, Ministerio de Asuntos Exteriores Dr. P. A Garcia Gonzâlez Subdirector General de Relaciones lnternacionales, Ministerio de Sanidad y Consumo Sr. J. L. Consarnau Consejero, Misi6n Permanente, Ginebra Dr. A Rodriguez Alvarez Consejo Técnico, Direcci6n General de Farmacia y Productos Sanitarios, Ministerio de Sanidad y Consumo Sra. C. Pérez Jefe de Area de Organismos lnternacionales Técnicos, Ministerio de Asuntos Exteriores Dra. M.T. Pagés Jiménez Jefe de Division, Agencia Espaiiola del Medicamento, Ministerio de Sanidad y Consumo Sra. E. Rodriguez Machado Jefe de Servicio de Asuntos lnternacionales, Subdirecci6n General de Relaciones lnternacionales, Ministerio de San id ad y Consumo Dra. M.L. Garcia Tuii6n de Lara Jefe de Servicio, Subdirecci6n General de Relaciones lnternacionales, Ministerio de Sanidad y Consumo Sra. P. Garcia Santesmases Jefe de Servicio, lnstituto de Salud Carlos Ill

SUDAN-SOUDAN Chief delegate - Chef de délégation Mr M. B. Nimir Minister of Federal Health

Delegate(s) - Délégué(s) Dr I.M. Ibrahim Ambassador, Permanent Representative, Geneva Dr B.I.M. Elbeshir Ministry of Federal Health

Alternate(s) - Suppléant(s) Dr Z.A. Zeidan Ministry of Federal Health Mr A. Nour-EI-Deen Permanent Mission, Geneva

SWAZILAND - SWAZILAND Chief delegate - Chef de délégation Dr P.K. Dlamini Minister of Health and Social Welfare

Delegate(s) - Délégué(s) Mr M.E. Vilakazi Principal Secretary, Ministry of Health and Social Welfare Dr S. Shongwe Deputy Director of Health Services

A52/VR page172 Alternate(s)- Suppléant(s) Mrs E.S. Dlamini Deputy Chief Nursing Officer, Ministry of Health and Social Welfare

Delegate(s)- Délégué(s) M. W.B. Gyger Ambassadeur, Représentant permanent, Genève Dr M. Berger Service des Ressources humaines, Direction du Développement et de la Coopération, Département fédéral des Affaires étrangères

SWEDEN - SUEDE Chief delegate - Chef de délégation Mr L. Engqvist Minister of Health and Social Affairs

Alternate(s) - Suppléant(s) Dr S. Zobrist Chef, Section des Affaires internationales, Office fédéral de la Santé publique, Départment fédéral de l'Intérieur Mme D. Petter Conseiller, Mission permanente, Genève M. J. Burri Section des Nations Unies, Direction politique, Département fédéral des Affaires étrangères Mme S. Ulmann Section des Affaires multilatérales, Direction du Développement et de la Coopération, Département fédéral des Affaires étrangères M. F.A. Gruber Conseiller, Mission permanente, Genève Mme F. Gaillat Engeli Chef suppléante, Section des Affaires internationales, Office fédéral de la Santé publique, Département fédéral de l'Intérieur

Deputy chief delegate - Chef adjoint de la délégation Mr M. Sjôberg State Secretary, Ministry of Health and Social Affairs

Delegate(s)- Délégué(s) Mrs K. Wigzell Director-General, National Board of Health and Welfare

Alternate(s) - Suppléant(s) Mr J. Molander Ambassador, Permanent Representative, Geneva Mr T. Zetterberg Counsellor, Ministry for Foreign Affairs Mrs C. Bjôrner Counsellor, Permanent Mission, Geneva Ms A.-C. Filipsson Deputy Director, Ministry of Health and Social Affairs Ms U. Lindblom Head of Section, Ministry of Health and Social Affairs DrA. Molin Senior Programme Officer, Swedish International Development Authority (Sida) Ms B. Schmidt Administrative Director, National Board of Health and Welfare Professer E. Nordenfelt Director-General, Swedish lnstitute for lnfectious Disease Control Mr B. Pettersson Senior Adviser for Health Promotion, Nationallnstitute of Public Health

Adviser(s)- Conseiller(s) Mme A. Scherrer-Baumann Conseillère d'Etat, Chef de la Direction de la Santé du Canton d'Appenzell (Rh.-Ext.), Herisau Mme T.-L. Tran Wasescha Chef, Section des Affaires internationales, Institut fédéral de la Propriété intellectuelle, Département fédéral de Justice et Police Dr D. Brenner Chef, Section Alcool et Tabac, Office fédéral de la Santé publique, Département fédéral de l'Intérieur Mme U. Wyssmann Section des Affaires internationales, Office fédéral de la Santé publique, Département fédéral de l'Intérieur M. M. Schlagenhof Collaborateur, Entraves techniques au Commerce, Office fédéral des Affaires économiques extérieures, Département fédéral de l'Economie

Adviser(s)- Conseiller(s) DrA. Milton Secretary-General, Swedish Medical Association Ms S. Calltorp Permanent Mission, Geneva

SYRIAN ARAB REPUBLIC - REPUBLIQUE ARABE SYRIENNE Chief delegate - Chef de délégation Dr M.l. AI-Chatti Minister of Health

SWITZERLAND - SUISSE Chief delegate - Chef de délégation Professeur T. Zeltner Secrétaire d'Etat, Directeur de l'Office fédéral de la Santé publique, Département fédéral de l'Intérieur

TAJIKISTAN- TADJIKISTAN Chief delegate - Chef de délégation Dr A. Latipov Deputy Minister of Health

A52NR page 173

THAILAND - THAILANDE Chief delegate - Chef de délégation Dr O. Sukaromana Deputy Minister of Public Health

Delegate(s)- Délégué(s) Mr T. Markovski Under-Secretary, Ministry of Health

Alternate(s) - Suppléant(s) Mrs B. Stefanovska-Sekovska First Secretary, Permanent Mission, Geneva

Deputy chief delegate - Chef adjoint de la délégation Mr Krit Garnjana-Goonchorn Ambassador, Permanent Representative, Geneva

TOGO-TOGO Chief delegate - Chef de délégation Dr E. Batchassi Directeur général de la Santé

Delegate(s)- Délégué(s) Dr Sucharit Sriprapandh Acting Permanent Secretary, Ministry of Public Health

Alternate(s) - Suppléant(s) Mrs A. Dvitiyananda Deputy Permanent Representative, Geneva Professer Pakdee Pothisiri Deputy Permanent Secretary, Ministry of Public Health Professer Chitr Sitthi-Amorn Dean, Collage of Public Health, Chulalongkorn University Dr Suwit Wibulpolprasert Assistant Permanent Secretary, Ministry of Public Health Dr Viroj Tangcharoensathien Senior Policy and Plan Analyst, Health Systems Research lnstitute, Ministry of Public Health Mrs Nantika Sungoonshorn Foreign Relations Officer, International Health Division, Ministry of Public Health Dr Chatree Charoensiri Director of Renunakorn Hospital, Ministry of Public Health Dr Orasa Kovindha Policy and Plan Analyst, Bureau of Health Policy and Planning, Ministry of Public Health Dr Sopida Chavanichkul International Cooperation Manager, Foreign Relations Office, Department of Medical Services, Ministry of Public Health Ms Pornpis Silkavuth Head of Chemical Safety Section, Food and Drug Administration, Ministry of Public Health Ms Q. Sasivanij Second Secretary, Permanent Mission, Geneva

Delegate(s) - Délégué(s) Dr E. Agbobly-Apetsianyi Chef de la Division de la Santé familiale

TONGA-TONGA Chief delegate - Chef de délégation Dr V. Tangi Minister of Health

Delegate(s)- Délégué(s) Dr L. Malolo Director of Health

TRINIDAD AND TOBAGO -TRINITE-ETTOBAGO Chief delegate - Chef de délégation Dr R. Paul Manager, Health Policy and Planning, Ministry of Health

Delegate(s)- Délégué(s) Ms D. Jones Acting Permanent Secretary, Ministry of Health Miss M.-A. Richards Chargé d'affaires a.i., Permanent Mission, Geneva

TUNISIA -TUNISIE Chief delegate - Chef de délégation

THE FORMER YUGOSLAV REPUBLIC OF MACEDONIA EX-REPUBLIQUE YOUGOSLAVE DE MACEDOINE Chief delegate - Chef de délégation Mr M. Nedzipi Deputy Minister of Health

M. K. Morjane Ambassadeur, Représentant permanent, Genève

Delegate(s) - Délégué(s) Dr H. Abdesselem Directeur général de l'Unité de la Coopération technique Dr M. Sidhom Directeur des Soins de Santé de base

Deputy chief delegate - Chef adjoint de la délégation Mr G. Petreski Ambassador, Permanent Representative, Geneva

Alternate(s) - Suppléant(s) M. K. Baccar Conseiller des Affaires étrangères, Mission permanente, Genève Mme R. M'Rabet Secrétaire des Affaires étrangères, Mission permanente, Genève

A52/VR page 174

TURKEY -TURQUIE Chief delegate - Chef de délégation Dr M.G. Karahan Minister of Health

TUVALU-TUVALU Chief delegate - Chef de délégation MrT. Esekia Minister of Health, Women and Community Affairs and Minister of Education and Culture

Deputy chief delegate - Chef adjoint de la délégation Mr M. Sungar Ambassador, Permanent Representative, Geneva

Delegate(s) - Délégué(s) Ms L. Petaia Secretary for Health, Women and Community Affairs, Ministry of Health, Women and Community Affairs DrT. Pulusi Director for Health, Ministry of Health, Women and Community Affairs

Delegate(s) - Délégué(s) Dr R. Zeydan Deputy Under-Secretary, Ministry of Health

Alternate(s) - Suppléant(s) Dr C. Ozcan Director-General of Health Care, Ministry of Health MrM. Bal Head of the Council of Research, Planning and Coordination, Ministry of Health Mr G. Sahin Director-General of the Persona! Department, Ministry of Health DrN. Çakmak Deputy Director-General, Primary Health Care, Ministry of Health Dr M.R. Kose Director-General of Maternel and Child Care and Family Planning, Ministry of Health Mr B. Metin Head of Foreign Relations Department, Ministry of Health Dr S. Metiner Acting General Coordinator of the Health Project, Ministry of Health Professer A. Akin Department of Public Health, Faculty of Medecine, University of Hacettepe Dr O. Afsar Deputy Head, Department of the Contagious Diseases, Ministry of Health Mrs S. Kizildeli First Counsellor, Permanent Mission, Geneva Mr z. Gazioglu Counsellor of Special Political Affairs, Permanent Mission, Geneva Mr V.T. Vu rai First Secretary, Permanent Mission, Geneva Miss A. Degirmencioglu Second Secretary, Permanent Mission, Geneva MrVarlik Expert, Under-Secretariat of State Planning DrT. Akalin Ministry of Health

Alternate(s) - Suppléant(s) Mr A. Sandy Persona! Assistant, Ministry of Health, Women and Community Affairs

UGANDA-OUGANDA Chief delegate - Chef de délégation Dr C.W.C.B. Kiyonga Minister of Health

Delegate(s)- Délégué(s) Mr J.W. Wagonda Muguli Permanent Secretary Mr N. lrumba Chargé d'affaires, Permanent Mission, Geneva

Alternate(s)- Suppléant(s) Dr F.G. Omaswa Director-General, Health Services Dr J.H. Kyabaggu Director Health Services, Planning and Development Dr G. Magumba Deputy District Director, Health Services-Mukuno Dr P. Tumusime Acting Commissioner, Health Services Planning Dr V. Ojoome Assistant Commissioner, Health Services-Human Resource Dr G. Mulindwa Principal Health Planner MrJ. Anyali Principal Finance Officer Mr S.W. Kisembo Chief of Division Financial Management, Decentralisation Secretariat Mr 1. Magona Assistant Commissioner, Ministry of Finance MsG. Kinimi Commissioner, Nursing Mr K. Kunsa Commissioner

A52/VR page 175 Mr G. Warrington First Secretary, Permanent Mission, Geneva

UKRAINE - UKRAINE Chief delegate - Chef de délégation Mr M. Maimeskoul Ambassador, Permanent Representative, Geneva

Adviser(s) - Conseiller(s) Professer K. Calman Vice-Chancellor and Warden, University of Durham, Durham Professer A. Maslin Nursing Officer, Department of Health Dr W. Thorne Senior Medical Officer, Department of Health Mr R. Dickman International Branch, Department of Health Ms H. Rogers Private Secretary, Department of Health Ms J. Cleves Acting Chief Health and Population Adviser, Department for International Development Mr P. Mason Head, Health and Population Division, Department for International Development Mr J. Gordon Health and Population Division, Department for International Development Mr D. Maher Public Health Specialist, Department for International Development MrT. Sims First Secretary, Permanent Mission, Geneva Mr J. Bradley Second Secretary, Permanent Mission, Geneva Mr D. Walton Legal Adviser, Permanent Misison, Geneva Mr R. Thompson Press Officer, Permanent Mission, Geneva Mr M. Proctor Attaché, Permanent Mission, Geneva Mr D. McCormick .Public Health Specialist, Department for International Development Ms A. Handicott Assistant Private Secretary, Department of Health

Delegate(s)- Délégué(s) Mr V. Grynyshyn Second Secretary, Permanent Mission, Geneva

UNITED ARAB EMIRATES - EMIRATS ARABES UNIS Chief delegate - Chef de délégation Mr H.A.R. AI-Madfa Minister of Health

Delegate(s)- Délégué(s) Dr A. R. Jaffar Under-Secretary, Ministry of Health Dr F. Bin Khalid Al Qassimi Assistant Under-Secretary, Ministry of Health

Alternate(s) - Suppléant(s) Dr M. Fikri Assistant Under-Secretary for Preventive Medicine, Ministry of Health Mr N.K. AI-Budour Director, Office of the Minister of Health and Director of External Relations and International Health Affairs Dr M. Kaladari Director of Pharmacy and Drugs Control Department Mr A.H.S. Al Hamoud Head of External Affairs Department

UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND ROYAUME-UNI DE GRANDE-BRETAGNE ET D'IRLANDE DU NORD Chief delegate - Chef de délégation Mr F. Dobson Secretary of State for Health

Delegate(s)- Délégué(s) Professer L. Donaldson Chief Medical Officer, Department of Health Dr J. Metters Deputy Chief Medical Officer, Department of Health

UNITED REPUBLIC OF TANZANIA REPUBLIQUE-UNIE DE TANZANIE Chief delegate - Chef de délégation Dr A.D. Chiduo Minister of Health

Alternate(s) - Suppléant(s) Mr R. Lyne Ambassador, Permanent Representative, Geneva Mrs Y. Moeres Chief Nursing Officer, Department of Health Mr A. King ham International Branch, Department of Health

Deputy chief delegate - Chef adjoint de la délégation Dr A. M. Shein Deputy Minister of Health

A52NR

page176 Delegate(s) - Délégué(s) Dr G.L. Upunda Chief Medical Officer, Ministry of Health

Adviser(s)- Conseiller(s) Dr S.B. Blount Assistant Director, Global Affairs, Centers for Disease Control and Prevention, Department of Health and Human Services MrT.Burns Commercial Attaché, Office of the United States Trade Representative, Executive Office of the President, Geneva Dr M. Ericksen Director, Office on Smoking and Health, Centers for Disease Control and Prevention, Department of Health and Human Services Mrs K. Johnson International Resource Management, Permanent Mission, Geneva DrG. Keusch Director, Fogarty International Center, National Institutes of Health, Department of Health and Human Services Dr S. Nightingale Associate Commissioner for Health Affairs, Food and Drug Administration, Department of Health and Human Services DrG. Pappas Acting Director, Office International and Refugee Health, Office of Public Health and Science, Department of Health and Human Services Mr J. Riggs-Perla Director, Bureau for Global Programs, Field Support and Research, United States Agency for International Development Ms M.L. Valdez International Health Program Officer, Office of International and Refugee Health, Office of Public Health and Science, Department ofHealth and Human Services Mrs L. Vogel International Health Attaché, Permanent Mission, Geneva Dr M. Akhter Executive Director, American Public Health Association Dr N. Daulaire President and Chief Executive Officer, Global Health Council Dr B. L. Malone President, American Nurses Association Dr R. Smoak Chair, Board of Trustees, American Medical Association

Alternate(s) - Suppléant(s) Dr U.M. Kisumku Deputy Permanent Secretary, Ministry of Health Dr A.A. Mzige Regional Medical Officer, Coast Region ProfessorW.L. KHama President, World Federation of Public Health Association MrA: Mchumo ·Ambassador, Permanent Representative, Geneva Mr F. Malambugi Minister Counsellor, Permanent Mission, Geneva

UNITED STATES OF AMERICA - ETATS-UNIS D'AMERIQUE Chief delegate - Chef de délégation Dr D.E. Shalala Secretary of Health and Human Services

Deputy chief delegate - Chef adjoint de la délégation Dr D. Satcher Assistant Secretary of Health and Surgeon General, Office of Public Health and Science, Department of Health and Human Services

Delegate(s)- Délégué(s) Mr G.E. Moose Ambassador, Permanent Representative, Geneva

Alternate(s)- Suppléant(s) Dr J.l. Boufford Special Adviser to the Assistant Secretary for Health/Surgeon General, Office of Public Health and Science, Department of Health and Human Services Mr N.A. Boyer Director for Health and Transportation Programs, Bureau of International and Organization Affairs, Department of State Mr E. Cummings Counsellor for Legal Affairs, Permanent Mission, Geneva Dr J. Eisenberg Administrator, Agency for Health Care Policy and Research, Department of Health and Hu man Services Dr J. Koplan Director, Centers for Disease Control and Prevention, Department of Health and Human Services Mr R.G. Loftis Counsellor for Pofitical and Specialized Agency Affairs, Permanent Mission, Geneva Dr N. Lurie Principal Deputy Assistant Secretary for Health, Office of Public Health and Science, Department of Health and Human Services

URUGUAY-URUGUAY Chief delegate- Chef de délégation Dr. R. Bustos Alonso Ministre de Salud Publica

Deputy chief delegate - Chef adjoint de la délégation Sr. C. Pérez del Castille Embajador, Representante Permanente, Ginebra

Delegate(s) - Délégué(s) Dr. A. Chiesa Director General de la Salud

A52/VR page 177

Alternate(s) - Suppléant(s) Dra. B. Rivas Barres Directora de la Cooperaci6n lnternacional, Ministerio de Salud Pûblica Sr. C. Sgarbi Ministre Consejero, Misi6n Permanente, Ginebra Sra. P. Vivas Consejero, Misi6n Permanente, Ginebra

Alternate(s) - Suppléant(s) Dr Nguyen Duy Khe Vice-Director, Administrative Office, Ministry of Health Services Dr Phung Dang Khoa Expert, Department of International Cooperation, Ministry of Health Services Mrs Tran Cam Hung First Secretary, Permanent Mission, Geneva

VANUATU-VANUATU Chief delegate - Chef de délégation Mr K. Song Minister of Health

YEMEN-YEMEN Chief delegate - Chef de délégation Dr A.A.W. Nasher Minister of Public Health

Deputy chief delegate - Chef adjoint de la délégation Ms M. Abel Director of Public Health

Deputy chief delegate - Chef adjoint de la délégation Mr M.S. AI-Attar Ambassador, Permanent Representative, Geneva

Delegate(s)- Délégué(s) Mr B. Kuao Second Political Adviser

Delegate(s)- Délégué(s) Dr A. O. AI-Sallami Under-Secretary for Pharmacy, Supplies and Equipment, Ministry of Public Health

VENEZUELA-VENEZUELA Chief delegate - Chef de délégation Dr. G. Rodrfguez Ochoa Ministre de Sanidad y Asistencia Social

Alternate(s) - Suppléant(s) Mr K. AI-Sakkaf Adviser, Secretariat of the Minister of Public Health Mr A.T .A. Moghni Director-General, Finances, Secretariat of the Ministry of Public Health Mr M.M. Hajar Director-General, Health Affairs Bureau, Secretariat of the Ministry of Public Health Mr F. Alobthani First Secretary, Permanent Mission, Geneva

Delegate(s) - Délégué(s) Sr. W. Corrales Leal Embajador, Representante Permanente, Ginebra Sr. V. Rodriguez Cedeno Representante Permanente Alterne, Ginebra

Alternate(s) - Suppléant(s) Dr. J. Mendoza Jefe de Endemias Rurales, Direcci6n General Sectorial de Malariologia y Saneamiento Ambiental, Ministerio de Sanidad y Asistencia Social Sr. L. Ricardo Salas Segundo Secretario, Misi6n Permanente, Ginebra

ZAMBIA -ZAMBIE Chief delegate - Chef de délégation Professer N. Luo Minister of Health

VIET NAM - VIET NAM Chief delegate - Chef de délégation Professer Do Nguyen Phuong Minister of Health Services

Deputy chief delegate - Chef adjoint de la délégation Mr N.L. Magolo Acting Permanent Secretary, Ministry of Health

Delegate(s) - Délégué(s) Mr P.N. Sinyinza Ambassador, Permanent Representative, Geneva

Delegate(s) - Délégué(s) Mr Nguyen Qui Binh Ambassador, Permanent Representative, Geneva Dr Trinh Bang Hop Director, Department of International Cooperation, Ministry of Health Services

Alternate(s) - Suppléant(s) Dr G. Silwamba Director-General, Central Board of Health DrA. Sitali Acting Regional Director - South East Region Miss M.B. Mapanza Registered Nurse, Lewanika General Hospital, Mongu

A52/VR page 178 Mrs D.E. Choongo Principal Nursing Officer, Central Board of Health Ms I.B. Fundafunda Counsellor, Permanent Mission, Geneva Ms A. Kazhingu Second Secretary, Permanent Mission, Geneva

OBSERVERS FOR A NON-MEMBER STATE OBSERVATEURS D'UN ETAT NON MEMBRE

ZIMBABWE -ZIMBABWE Chief delegate - Chef de délégation Dr T.J. Stamps Minister of Health and Child Welfare

HOLY SEE - SAINT -SIEGE Mgr J. Lozano Barragan Président du Conseil Pontifical pour la Pastorale des Services de la Santé Mgr G. Bertello Nonce Apostolique, Observateur permanent, Genève Mgr P. Magee Conseiller, Mission permanente, Genève Mgr J.-M.M. Mpendawatu Expert Dr M. Ferra rio Expert Mlle A.-M. Cola nd rea Expert

Deputy chief delegate - Chef adjoint de la délégation Dr T.J.B. Jokonya Ambassador, Permanent Representative, Geneva

Dele~ate(s)

- Délégué(s)

Dr P.L.N. Sikhosana Secretary for Health and Child Welfare

Alternate(s) - Suppléant(s) Mr T. Zigora Deputy Secretary, Ministry of Health and Child Welfare Dr R. Labode Provincial Medical Director Mr T.T. Chifamba Minister Counsellor, Permanent Mission, Geneva Dr M. Wellington Medical Officer Ms G. Mahlangu Medicines Control Authority, Ministry of Health and Child Welfare Mr N. Kanyowa . Counsellor, Permanent Mission, Geneva

OBSERVERS OBSERVATEURS

Adviser(s) - Conseiller(s) Mr C. Zavazava Minister Counsellor, Permanent Mission, Geneva

OROER OF MALTA - ORDRE DE MALTE M. E. Decazes Ambassadeur, Délégué permanent, Genève M. C. Fedele Ambassadeur, Délégué permanent adjoint, Genève Mme M.-T. Pictet-Aithann Premier Conseiller, Mission permanente, Genève M. A. Nguyen van Chau Conseiller, Mission permanente, Genève M. B. Mauduit Conseiller technique, Mission permanente, Genève

A52/VR page 179

INTERNATIONAL COMMITTEE OF THE RED CROSS COMITE INTERNATIONAL DE LA CROIXROUGE Dr B. Eshaya-Chauvin Chef, Division Santé et Secours M.J. Lagoutte Chef d'Unité, Services de Santé M. M. Studer Chef de Secteur, Division des Organisations internationales Mme C. Rottensteiner Attachée, Division des Organisations internationales M. A. Luethold Chef adjoint, Division des Organisations internationales

OBSERVERS INVITED IN ACCORDANCE WITH RESOLUTION WHA27.37 OBSERVATEURS INVITES CONFORMEMENT A LA RESOLUTION WHA27 .37

PALESTINE - PALESTINE Dr F. Arafat President of the Palestine Council of Health

INTERNATIONAL FEDERATION OF RED CROSS AND RED CRESCENT SOCIETIES FEDERATION INTERNATIONALE DES SOCIETES DE LA CROIX-ROUGE ET DU CROISSANT -ROUGE Mrs R. Ahluwalia Director, External Relations Department Dr E. Strijak Special Adviser to the Secretary-General Dr A. Mahallati Director, Community Health and Social Welfare Department Dr H. Sandbladh Head, Relief Health Department Dr J.-P. Revel Senior Officer, Relief Health Department Dr E. Bernes Senior Officer, Community Health and Social Welfare Department Mr T. Svenning Senior Officer, External Relations Department Ms M. Babé Senior Officer, Community Health and Social Welfare Department Ms B. Luntan Head, Women and Development Mr R. Thomson Senior Officer Refugees, Disaster Response and Operations Coordination Dr 1. Young Director, Blood Department

Mr M.W.A. Alshareef Deputy Minister Mr N. Ramlawi Ambassador, Permanent Observer, Geneva Dr 1. Tarawiyeh Director-General of the Ministry of Health Dr R. Khouri Counsellor of the President of the Health Council for Public Relations Mr T. Al-Adj ou ri

REPRESENTATIVES OF THE UNITED NATIONS AND RELATED ORGANIZATIONS REPRESENTANTS DE L'ORGANISATION DES NATIONS UNIES ET DES INSTITUTIONS APPARENTEES

UNITED NATIONS - ORGANISATION DES NATIONS UNIES Mr S. Khmelnitski External Relations and lnter-Agency Affairs Officer, Geneva Mr R. Mountain Assistant Emergency Relief Coordinator and Director, Office for the Coordination of Humanitarian Affairs, Geneva Mr G. Putman-Cramer Deputy Director, Office for the Coordination of Humanitarian Affairs, Geneva, Chief Disaster Response Branch

A52JVR page 180 Dr P. Calvi-Parisetti Chief, lnter-Agency Standing Committee, Liaison Unit, Geneva Mr A. Abraszewski Inspecter, Joint Inspection Unit, Geneva Mr K.l. Othman Inspecter, Joint Inspection Unit, Geneva Mr E. Kudryavtsev Inspecter, Joint Inspection Unit, Geneva MrW. Munch Inspecter, Joint Inspection Unit, Geneva

UNITED NATIONS POPULATION FUND FONDS DES NATIONS UNIES POUR LA POPULATION Mr A. MacDonald Director, UNFPA European Liaison Office, Geneva Mr S. Bavelaar Senior External Relations Officer, UNFPA European Liaison Office, Ge neva Ms N. Confalone Junior Professional Officer, UNFPA European Liaison Office, Ge neva Dr D. Pierotti Principal Officer for Crisis Relief, Emergency Relief Operations, UNFPA European Liaison Office, Geneva Ms C. Morale Junior Professional Officer, Emergency Relief Operations, UNFPA European Liaison Office, Geneva Mr H. De Knocke Technical Officer, UNAIDS

UNITED NATIONS CHILDREN'S FUND FONDS DES NATIONS UNIES POUR L'ENFANCE Mr D. Alnwick Chief, Health Section, Focal Point for Health Mr K. Mukelabai Health Programme Division Ms Z. Bendow Senior Adviser, Focal Point for lnter-Agency Collaboration and Coordination, UNICEF Office, Geneva Ms B.O. Bassani Deputy Regional Director, UNICEF Office, Geneva

UNITED NATIONS CONFERENCE ON TRACE AND DEVELOPMENT CONFERENCE DES NATIONS UNIES SUR LE COMMERCE ET LE DEVELOPPEMENT Mr R. Uranga United Nations Focal Point for Tobacco or Health

UNITED NATIONS RELIEF AND WORKS AGENCY FOR PALESTINE REFUGEES IN THE NEAR EAST OFFICE DE SECOURS ET DE TRAVAUX DES NATIONS UNIES POUR LES REFUGIES DE PALESTINE DANS LE PROCHE-ORIENT Dr F. Moussa Director of Health

UNAIDS - UNAIDS Dr P. Piot Executive Director

UNITED NATIONS DEVELOPMENT PROGRAMME PROGRAMME DES NATIONS UNIES POUR LE DEVELOPPEMENT Mr E. Bonev Senior Adviser, UNDP European Office, Geneva Ms S. Pedersen Programme Officer, UNDP European Office, Geneva

Ms P. Mane Dr A. M. Coii-Seck Ms S. Cowal MrO. Elo Mr R. Chahii-Graf MrM. Moeti Mr O. Miller

UNITED NATIONS ENVIRONMENT PROGRAMME PROGRAMME DES NATIONS UNIES POUR L'ENVIRONNEMENT Mr J.B. Willis Director, UNEP Chemicals, Geneva Mr S. Milad UNEP Chemicals, Geneva

Ms F. MacCaul Dr J. Saba Mr B. Schwartlander Mr J. Sherry

A52NR page 181

SPECIALIZED AGENCIES INSTITUTIONS SPECIALISEES

WORLD INTELLECTUAL PROPERTY ORGANIZATION ORGANISATION MONDIALE DE LA PROPRIETE INTELLECTUELLE M. N. Khlestov Conseiller principal, Bureau de la Planification stratégique et du Développement des Politiques Dr J.-P. Naïm Chef de l'Unité médicale

INTERNATIONAL LABOUR ORGANISATION ORGANISATION INTERNATIONALE DU TRAVAIL M. E. Davydov Relations avec les Organisations internationales Mme M.-W. Kang Relations avec les Organisations internationales

INTERNATIONAL ATOMIC ENERGY AGENCY AGENCE INTERNATIONALE DE L'ENERGIE ATOMIQUE Ms M.S. Opelz Head, IAEA Office, Geneva Ms A. B. Webster IAEA Office, Geneva

FOOD AND AGRICULTURE ORGANIZATION OF THE UNITED NATIONS ORGANISATION DES NATIONS UNIES POUR L'ALIMENTATION ET L'AGRICULTURE Mr T.N. Masuku Director, FAO Liaison Office with the United Nations, Geneva Mr P. Konandreas Senior Liaison Officer, FAO Liaison Office with the United Nations, Ge neva Ms N. Brandstrup Liaison Officer, FAO Liaison Office with the United Nations, Geneva

WORLD TRADE ORGANIZATION ORGANISATION MONDIALE DU COMMERCE M. M. Kennedy Conseiller, Division de la Popriété intellectuelle

UNITED NATIONS EDUCATIONAL, SCIENTIFIC AND CULTURAL ORGANIZATION ORGANISATION DES NATIONS UNIES POUR L'EDUCATION, LA SCIENCE ET LA CULTURE Mme A. Cassam Directeur, Bureau de Liaison, Genève

REPRESENTATIVES OF OTHER INTERGOVERNMENTAL ORGANIZA Tl ONS REPRESENTANTS D'AUTRES ORGANISATIONS INTERGOUVERNEMENTALES

WORLD BANK - BANQUE MONDIALE Mr J.C. Lovelace Director, Health, Nutrition and Population

LEAGUE OF ARAB STATES- LIGUE DES ETATS ARABES M. D.A. Sweedan Secrétaire général adjoint

INTERNATIONAL MONETARY FUND FONDS MONETAIRE INTERNATIONAL Mr G.B. Taplin Acting Director, IMF Office, Geneva Mr A. AI-Yousuf Economist, IMF Office, Geneva Mr N. Scott Consultant, IMF Office, Geneva

M. S. Alfarargi Ambassadeur, Observateur permanent, Genève Dr. H.A. Hammouda Directeur, Département de la Santé et de l'Environnement M. S. Seif Alyazal Troisième Secrétaire, Délégation permanente, Genève Dr O. El Hajje Délégation permanente, Genève M. S. Aeid Délégation permanente, Genève

A52JVR page 182

ORGANIZATION OF AFRICAN UNITY ORGANISATION DE L'UNITE AFRICAINE Mr A. Bensid Permanent Observer, Geneva Mr V. Wege Nzomwita Deputy Permanent Observer, Geneva Mr 1.0. Mensa-Bonsu Minister Counsellor, Geneva

INTERNATIONAL ORGANIZATION FOR MIGRATION ORGANISATION INTERNATIONALE POUR LES MIGRATl ONS Dr B. Gushulak Director, Medical Services Mr P. Schatzer Director, External Relations and Information

EUROPEAN COMMISSION - COMMISSION EUROPEENNE Mr A. Berlin Counsellor, Di recto rate General for Employment and Social Affairs, European Commission, Brussels Mr G. Gouvras Head of Unit, Public Health, Directorate General for Employment and Social Affairs, European Commission, Brussels Mr B. Merkel Principal Administrator, Directorate General for Employment and Social Affairs, European Commission, Brussels MrM. Hübel Administrator, Directorate General for Employrnent and Social Affairs, European Commission, Brussels Mr C. Dufour Permanent Delegation, Geneva

ORGANIZATION OF THE ISLAMIC CONFERENCE ORGANISATION DE LA CONFERENCE ISLAMIQUE Mr N.S. Tarzi Ambassador, Permanent Observer, Permanent Delegation, Geneva Mr J. Olia Deputy Permanent Observer, Permanent Delegation, Geneva

COMMONWEALTH SECRETARIATSECRETARIAT DU COMMONWEALTH Dr Q.Q. Dlamini Special Adviser, Head of Health Department Dr W. Mpanju-Shumbusho Regional Secretary, Commonwealth Regional Health Community Secretariat for East, Central and Southern Africa Dr K.T. Joiner Executive Director, West African Health Community Secretariat Dr B. Win! Programme Manager, Health Sector Development Caribbean Community Secretariat Professer K. Stuart Essential National Health Research Dr G. Bodeker Global Initiatives for Traditional Systems of Health Dr S.P.A. Obe

HEALTH MINISTERS' COUNCIL FOR GULF COOPERATION COUNCIL STATES CONSEIL DES MINISTRES DE LA SANTE, CONSEIL DE COOPERATION DES ETATS ARABES DU GOLFE Dr AR. AI-Swailem Executive Director Mr R.l. AI-Mousa Dr H.A. Gadalla

INTERNATIONAL CIVIL DEFENCE ORGANIZATION ORGANISATION INTERNATIONALE DE PROTECTION CIVILE Mr S. Znaidi Secretary-General Mr V. Kakusha Assistant to the Secretary-General

A52/VR page 183

REPRESENTATIVES OF NONGOVERNMENTAL ORGANIZATl ONS IN OFFICIAL RELA Tl ONS WITH WHO REPRESENTANTS DES ORGANISATIONS NON GOUVERNEMENTALES EN RELATIONS OFFICIELLES AVEC L'OMS

Council for International Organizations of Medical Sciences Conseil des Organisations internationales des Sciences médicales Dr Z. Bankowski Professer M. Abdussalam Mr S.S. Fluss Dr J. Gallagher Professer J.C. Siim

Council on Health Research for Development Conseil de la Recherche en Santé pour le Développement Dr C. Suwanwela Dr M. Kerker

CMC - Churches' Action for Health CMC - L'Action des Eglises pour la Santé Dr M. Kurian Dr E. Ombaka Dr P. Nickson Dr M. Risk Dr J. Pehle

DrY. Nuyens Dr M. Jegathesan Ms S. de Haan

Commonwealth Association for Mental Handicap and Developmental Disabilities Association du Commonwealth pour les Handicaps mentaux et les Incapacités liées au développement Dr V.R. Pandurangi Dr G. Supramaniam Miss M.A. Brayton Ms B. Harlev Lam Dr R.M. Varma

Federation for International Cooperation of Health Services and Systems Research Centers Fédération internationale de Coopération des Centres de Recherche sur les Systèmes et Services de Santé Professer A. Taket

German Pharma Health Fund e.V. German Pharma Health Fund e.V. Dr G. Küsters Dr C. Fink-Anthe

Commonwealth Medical Association Association médicale du Commonwealth Ms M. Haslegrave Dr J. Havard

Global Health Council - Conseil global de la Santé Ms S. Newsome Dr W.W. Kamel Dr M.D. Gutekunst Dr M. Clark Dr M. Katz Mr H. McConnell Dr D. Smith

A52/VR page 184 Mr J. Kra us MrC. Cole Ms H. Kuiper Dr M.H. Proctor Mr S. Williams Ms N. Williams Dr M. Alattar Mr G. Auerbach Dr S. Sautre Dr M. Brickman Mr E. Sawyer Dr W. Jansen Dr N. Daulaire Ms P. Giles Ms G. Haupter Ms M. Pal Ms E. Bopp Ms H. Sackstein

lnter-Parliamentary Union - Union interparlementaire Mr A. B. Johnsson Mr S. Tchelnokov

International Alliance of Women Alliance internationale des Femmes

Inclusion International - Inclusion International Ms N. Breitenbach Ms U. Michel

International Association for Maternai and Neonatal Health Association internationale pour la Santé de la Mère et du Nouveau-Né Dr S. Nazeer Mr H. Wagener

lndustry Council for Development Conseil de l'Industrie pour Je Développement Dr D. Jonas Dr S. Jongeneel

International Association of Lions Clubs (Lions Club International) Association internationale des Lions Clubs (Lions Club International) Dr M. Fabio

lnter-African Committee on Traditional Practices affecting the Health of Women and Children Comité inter-africain sur les Pratiques traditionnelles ayant effet sur la Santé des Femmes et des Enfants Mrs B. Ras-Work Mrs R. Sonner

International Association of Logopedics and Phoniatries Association internationale de Logopédie et Phoniatrie Dr A. Muller

International College of Surgeons Collège international des Chirurgiens Professer P.S. Hahnloser

lnter-American Association of Sanitary and Environmental Engineering Association interaméricaine de Génie sanitaire et de l'Environnement Mr O. Sperandio

A52NR page 185

International Consultation on Urological Diseases Consultation internationale sur les Maladies urologiques Professer S. Khoury

International Council of Women Conseil international des Femmes Mrs P. Herzog

International Council for Control of lodine Deficiency Disorders Conseil international pour la Lutte contre les Troubles dus à une Carence en Iode Professer F. Delange Mr Singh

International Council on Alcohol and Addictions Conseil international sur les Problèmes de l'Alcoolisme et des Toxicomanies Dr E. Tongue Dr L. Ramstrom

International Council on Social Welfare Conseil international de l'Action sociale International Council for Standardization in Haematology Conseil international pour la Standardisation en Hématologie Dr G. Stott Ms J. Koch Ms H. Etemadi

International Council of Nurses Conseil international des Infirmières Dr J.A. Oulton Dr M. Kingma Dr T. Ghebrehiwet Miss F.A. Affara Mrs L. Carrier-Walker

International Cystic Fibrosis (Mucoviscidosis) Association Association internationale de Lutte contre la Mucoviscidose Mr E. Silver Ms L. Heidet

International Epidemiological Association Association internationale d'Epidémiologie Dr R. Saracci

Mrs M. Bertholet Pradervand Ms C. Hyde-Pride Mrs L. Arietti Ms M. Fisher Mrs C. Bosson Ms G. Gonzenbach

International Federation of Business and Professional Women Fédération internationale des Femmes de Carrières libérales et commerciales

International Council of Scientific Unions Conseil international des Unions scientifiques Professer Y. Verhasselt

Ms M. Gerber

International Federation of Gynecology and Obstetrics Fédération internationale de Gynécologie et d'Obstétrique Dr S. Nazeer

A521VR page 186

International Federation of Health Records Organizations Fédération internationale des Associations du Dossier de Santé Mrs V. Tichbourne

Mr B. Mesuré Mr N. Warma Mr B. Lemoine Dr L. Teulières Mr C. Yoshida

International Federation of Medical Students Associations Fédération internationale des Associations d'Etudiants en Médecine Mr M. El Batta

Mr T. Bombe lies Dr C. Fink-Anthe Dr M. Philippe Mr P. Hedger Mr J. Pender

Mr A. Bodiroza Mr D. Bauer Mr C. Schaars Dr L. Mancuso Ms B. Smrzova Mr W. B. Walsh Mr S. Sapkota Mr R. McDonough Mr M. Sundberg Ms M. Sfika MrT. Monaco Mr B. Bagnall Ms S. Koso DrT. Empkie Ms F. Porta Mr M. Dickinson Mr A. Soto Ms L. Kroukamp Ms S. De Ribaupierre Mr P. Barrett Ms J. Treon Mr M. Murray Mr M. Nitschke Mr C. Hardwick Mr RD. Nielsen Mr M. Yazhari Mr G. Georgakis Mrs S. Crawley Mr A. Kaintatzis

International Federation of Pharmaceutical Manufacturers Associations Fédération internationale de l'Industrie du Médicament Dr H.E. Baie Mr J.-F. Gaulis Dr O. Morin Carpentier Mrs F. Buhl Mr W. Vandersmissen Mr A. Aumonier Dr P. Carlevaro Mrs E. Grut Ms E. Tyson

International Federation of Surgical Colleges Fédération internationale des Collèges de Chirurgie Professer S.W. Gunn

International Hospital Federation Fédération internationale des Hôpitaux Professer P.-G. Svensson

A52/VR page 187 Ms E. Hayes

International Lactation Consultant Association Association internationale de Conseil en Allaitement Ms M. Lehmann-Suri Ms E. Horman

Mr M. Raijmakers Dr B. Pecoul Mr D. Behrman Ms K. Sagoo Dr Z. Mirza Dr Z. Chowdhury

International Leprosy Union Union internationale contre la Lèpre Dr N. Pandit

Mr J.C. Arbi Akerekoro Mr J. Love Mr B. Marchand

International Life Sciences lnstitute Institut international des Sciences de la Vie Dr A. Malaspina

Ms A. Linnecar Ms N.J. Peck Ms M.B. Morsink Ms D. Vicencio

International Medical lnformatics Association Association internationale d'Informatique médicale Dr V. Griesser

Mr A. Kiani Ms A. Allain Mr Yeong Joo Kean

International Medical Parliamentarians Organization Organisation internationale des Parlementaires Médecins Professor C. Sitthi-Amorn

International Pharmaceutical Federation Fédération internationale pharmaceutique Mr P. Kielgast MrT. Hoek Mr K. Moody Mr M. Kos

International Occupational Hygiene Association Association internationale d'Hygiène du Travail Dr A. Steinegger

International Physicians for the Prevention of NuclearWar Association internationale des Médecins pour la Prévention de la Guerre nucléaire Dr K. Trouton Dr L. Moore

International Organization for Standardization Organisation internationale de Normalisation Mr T.J. Hancox

International Organization of Consumers Unions (Consumers International) Organisation internationale des Unions de Consommateurs (Organisation internationale des Consommateurs) Dr 1. Aizsilniece Ms E. 't Hoen Mr B. van der Heide

International Society for Preventive Oncology Association internationale pour la Prévention et le Dépistage du Cancer Dr H.E. Nieburgs Dr L. Santi

A52/VR page 188

International Society of Chemotherapy Société internationale de Chimiothérapie Professer J.-C. Pechere Professer T. Bergan

Mr Konno Mr O. Spiegel Mr L. Bick

International Society of Hematology Société internationale d'Hématologie OrS. Miwa

International Union for Conservation of Nature and Natural Resources - The World Conservation Union Union internationale pour la Conservation de la Nature et de ses Ressources - L'Union mondiale pour la Nature Mr G. Sheppard Mr C. Boljkovac Mr C. Curtis

International Society of Nurses in Cancer Ca re Société internationale des Infirmiers en Cancérologie Ms S.A. Bialous

International Society of Surgery Société internationale de Chirurgie Professer S. W. Gunn

International Union for Health Promotion and Education Union internationale de Promotion de la Santé et d'Education pour la Santé Mr P. Trowell

International Sociological Association Association internationale de Sociologie Dr E.B. Gallagher

ltalian Association of Friends of Raoul Folle reau Association italienne Amis de Raoul Follereau Dr E. Zecchini

International Special Dietary Foods Industries Fédération internationale des Industries des Aliments diététiques Dr A. Branner Dr P. Borasio

Dr S. Deepak

Medical Women's International Association Association internationale des Femmes Médecins Dr C. Bretscher-Dutoit

Mr M. de Skowronski Dr O. Ward Mr K. de Jang Dr W. Diekhaus Ms J. Keith Mr O. Segal Ms O. Loiselle Ms L. Pakalski Mr G. Fookes Dr S. Rypkema Mr N. Christiansen Ms F. Wijckmans Dr B. de Buzonnière Mr O. lilian Mr A. Raemaekers Mr S. Tasher Professer H. Van Balen Dr G. Andreis Mr M.A. Argal

Medicus Mundi lnternationalis (International Organization for Cooperation in Health Care) Medicus Mundi lnternationalis (Organisation internationale de Coopération pour la Santé)

A521VR page 189 Dr N. Lorenz Dr E. Widmer Dr J. Eidenbenz Dr F. Küchler Dr E. Burnier Mr T. Schwarz Mr A. Weymann Mr J. Goldhahn Ms B. Schüpp Ms C. Büsser Ms T. Zangger Ms C. Chattophadyay Mr G. Eskens DrT. Puis Ms M. Verhallen Ms C. Schmolinski Mr B. Pastors DrU. Küpper Dr A. Foracchia Dr G. Polak Mr M.O. Yorou Dr F. De Paepe Br D. Forkan Dr N. Rehlis Professer Z. Pawlowski Dr S. Flache Ms I.S. Nordback

Save the Children Fund (UK) Save the Children Fund (Royaume-Uni) Dr P. Poore

Soroptimist International - Soroptimist International

World Association for Psychosocial Rehabilitation Association mondiale pour la Réadaptation psychosociale

World Association of Girl Guides and Girl Scouts Association mondiale des Guides et des Eclaireuses Ms L. Schürch Ms S. Fluckiger

World Federation for Medical Education Fédération mondiale pour l'Enseignement de la Médecine Dr H. Karle

World Federation for Mental Health Fédération mondiale pour la Santé mentale Dr S. Flache

Network of Community-oriented Educational Institutions for Health Sciences Réseau des Etablissements de Formation en Sciences de la Santé orientés vers les Besoins de la Communauté Dr P. Kekki

World Federation of Associations of Poison Centers and Clinicat Toxicology Centers Fédération mondiale des Associations de Centres antipoisons et de Toxicologie clinique Dr Jou-Fang Deng

Rotary International - Rotary International Mr R. Barth Mr B. Huntley Mr G. Hermann

A521VR page 190

World Federation of Chiropractie Fédération mondiale de Chiropratique DrC. Diem Dr C. Rodnick

Dr S.N. Banoob Mr G. Ashton Professer T. Abel in Dr S. Gurieci

World Federation of Neurology Fédération mondiale de Neurologie Dr J.F. Toole Dr J. Bogousslavsky

World Federation of United Nations Associations Fédération mondiale des Associations pour les Nations Unies Dr R. Masironi Mrs L. Ciaffei

World Federation of Public Health Associations Fédération mondiale des Associations de la Santé publique Dr M.N. Akhter Dr J. Glasser Dr P. Orris Mr Lu Rushan Mr Zhang Jiaxi Mr Niu Shi ru Mr Xu Nanshan Dr K. Fujisaki Professer C. Korczack Professer W. Ki lama Ms M. Hilson Dr A. Leventhal DrN.M. Khan Mr T. Mahmood Ms S. Khan Dr R. Beaglehole Dr A. Jones Ms J. Gunby Dr D.Z. Paget Dr G. Rayner Dr M. Spasovski Mr J. Goldring Mr R. Usuguen Mr H. Tietke Ms E. Chacin

Mr H. Perera Mr M. Weydert Dr M. Violaki Paraskeva Dr J.W. Stein bart

World Hypertension League - Ligue mondiale contre l'Hypertension Dr T. Strasser

World Medical Association - Association médicale mondiale Professer J. Blahos Dr D. Human

World Self-Medication lndustry Industrie mondiale de l'Automédication responsable Dr J.A. Reinstein Dr H. Cranz Ms S. Kelly Mr A. Jamison Mr E.J. Gezzi Mr D. Graham

A52NR page 191 Dr E. Bowen DrA. Haines Dr B. Zurita Dr K. Salma

World Veterans Federation - Fédération mondiale des Anciens Combattants Mr C. Provoost

World Veterinary Association Association mondiale vétérinaire Dr A.T. Rantsios

Ms A. Allain Ms B.E. Bennett Ms A. Naik Dr S.E. Williams

World Vision International Vision mondiale internationale Dr E. Ram Ms K. Mulvey Ms M. Assunta Mr Y. Salooji Dr T. Narayan

Ms L. Wykle-Rosenberg Ms G. Chervaz Ms S. O'Byrne Mrs R. Bloem Dr L. Moore Dr K. Trouton

REPRESENTATIVES OF THE EXECUTIVE BOARD Dr K. A Al-Jaber DrK. Calman Mr Liu Peilong Dr A Sanou Ira

REPRESENTANTS DU CONSEIL EXECUTIF Dr K. A Al-Jaber Dr K. Calman M. Liu Peilong Dr A Sanou Ira

A52NR page 193

INDEX OF NAMES This index contains the nam es of speakers reported in the present volume.

INDEX DES NOMS DES ORATEURS Cet index contient les noms des orateurs dont les interventions figurent dans le présent volume.

ABDULLAH, A. (Maldives), 72 ABUDAJAJA, A. (Libyan Arab Jamahiriya/ Jamahiriya arabe libyenne), 130 AGUINAGA, A. (Peru/Pérou), 48 AHLUW ALlA, R. (International Federation of Red Cross and Red Crescent Societies/ Fédération internationale des Sociétés de la Croix-Rouge et du Croissant-Rouge), 107 ALI MOHAMED RUSTAM, M. (Malaysia/ Malaisie), 84 AMAHA, S. (Ethiopia/Ethiopie), 100 ARAFAT, F. (Palestine), 83 AYE (Myanmar), 16

BARAKZAI, M.Y. (Afghanistan), 99 BARBOSA DA SILVA, J. (Brazilian National Centre for Epidemiology/Centre national brésilien d'Epidémiologie), Ill BERTAN, M. (Ihsan Dogramaci Family Health Foundation Prize/Prix de la Fondation Ihsan Dogramaci pour la Santé de la Famille), 115 BETTON! BRANDAN!, M. (Italy/ltalie),62 BOYER, N.A. (United States of America/ Etats-Unis d'Amérique), 124 BUSTOS ALONSO, R. (Uruguay), 92

CHATTI, M.I. AL- (Syrian Arab Republic/ République arabe syrienne), 53 CHIDUO, A.D. (United Repub1ic ofTanzania/ République-Unie de Tanzanie), 34 CHIOLA, M.A. (Paraguay), 83 CHOI CHANG SIK (Democratie People's Republic ofKorea/République populaire démocratique de Corée), 82 CHOONGO, D.E. (Léon Bernard Foundation · Prize/Prix de la Fondation Léon Bernard), 112 CHRYSOSTOMOS OF KITION (United Arab Emirates Health Foundation Prize/Prix de la Fondation des Emirats arabes unis pour la Santé), 122 CIA V A TTA, L. (San Marino/Saint-Marin), 70 CIOCALTEU, A. (Romania/Roumanie), 90 COLLA, M. (Belgium/Belgique), 102

CALMAN, K. (Chairman of the Executive Board/Président du Conseil exécutif), 20 CAPLAN, E. (Canada), 41

DECAZES, E. (Order of Malta/Ordre de Malte), 101 DEGUARA, L. (Malta/Malte), 75 DE SILVA, N.S. (Sri Lanka), 64 DIRECTOR-GENERAL/DIRECTEUR GENERAL, 23, 108, 139 DOGRAMACI, 1. (Ihsan Dogramaci Family Health Foundation/Fondation Ihsan Dogramaci pour le Santé de la Famille), 114 DOTRES MARTÎNEZ, C. (Cuba), 65 DURHAM, G. (New Zealand/ Nouvelle-Zélande), l 05

A52/VR page 194

EHTUISH, E.F. (Libyan Arab Jamahiriya/ Jamahiriya arabe libyenne), Vice-President of the Fifty-second World Health AssemblyNice-Président de la Cinquante-Deuxième Assemblée mondiale de la Santé, 57 EL FASSI, A. (Morocco/Maroc), 51 ESKOLA, J. (Finland/Finlande), Vice-Chairman of Committee B/ Vice-Président de la Commission B, 138 EZHILMALAI, D. (lndiallnde), 49

MARQA, 1. (Jordan/Jordanie), 87 MARQUES DE LIMA, A.S. (Sao Tome and Principe/Sao Tomé-et-Principe), 93 MAZZA, A.J. (Argentina/Argentine), 51 McCOY SANCHEZ, M. (Nicaragua), 14, 77 MOELOEK, F.A. (lndonesiallndonésie), 60 MOND, L. (Papua New Guinea/ Papouasie-Nouvelle-Guinée), 9~ MOUSAWI, F.R. AL- (Bahrain/Bahreïn), President of the Fifty-first World Health Assembly/Président de la Cinquante et Unième Assemblée mondiale de la Santé, 1, 5 MUBARAK, O.M. (Iraq), 86

F ARHADI, M. (lslamic Republic oflran/ République islamique d'Iran), 74 FARMAKIS, N. (Greece/Grèce), 59 FISCHER, A. (Germany/Allemagne), 43 FLOOD, S.L. (Saint Lucia/Sainte-Lucie), 45

GUIDOUM, Y. (Algeria/Algérie), 60 GUNNARSSON, D.A. (lceland/lslande), 105

NASHER, A.A.W. (Yemen/Yémen), 80 NEMOTO, T. (Japan/Japon), 37 NGEDUP, S. (Bhutan/Bhoutan), 79 NTSALUBA, A. (lnstitute of Urban Primary Health Care) (Sasakawa Health Prize/Prix Sasakawa pour la Santé), 118 NUAMAH DONKOR, S. (Ghana), 95

HASHMI, M.M.J. (Pakistan), 77 HOLCAT, M. (Czech Republic/République tchèque), 71

ORTIZ GUIER J.G. (Sasakawa Health Prize/ Prix Sasakawa pour la Santé), 11 7

KALWEO, J.I. (Kenya), 47 KA TZAROV, S. (Bulgaria!Bulgarie), 104 KET SEIN (Myanmar), 81 KHOURI, R. (Palestine), 125 KIIKUNI, K. (Nippon Foundation), 116 KIM, M.-1. (Republic ofKorea/République de Corée), 67 KIYONGA, C.W.C.B. (Uganda/Ouganda), 99 KONLAAN, B.B. (Jacques Parisot Foundation Medal!Médaille de la Fondation Jacques Parisot), 113 KRAG, E. (Denmark/Danemark), 85

PARDO EV ANS, R. (Costa Rica), 98 PAUL, D. (Dominica/Dominique), 15 PELEG, D. (Israel/Israël), 125 PETROVSKY, V. (Director-General of the United Nations Office at Geneva/ Directeur général de l'Office des Nations Unies à Genève), 2 PIATKIEWICZ, J.A. (Poland!Pologne), 86 PONMEK DALALOY (Lao People's Democratie R.epublic/République démocratique populaire lao), 106

QAZI, M.S. (Pakistan), 55 LOZANO BARRAGÀN, J. (Holy See/ Saint-Siège), 101

MADF A, H.A.R. AL- (United Arab Emirates/ Emirats arabes unis), 40, 120 MANANDHAR, D.P. (Nepal/Népal), 94

RA TSIMBAZAFIMAHEF A, H. (Madagascar), 88 REINER, Z. (Croatia/Croatie), 44 RODRÎGUEZ OCHOA, G. (Venezuela), 76 ROMA Y BECCARiA, J.M. (Spain/Espagne), 66

A52/VR page 195

ROSEIRA, M. DE BELEM (Portugal), President of the Fifty-second World Health Assembly/Présidente de la Cinquante-Deuxième Assemblée mondiale de la Santé, Il, 139 RW ABUHIHI, E. (Rwanda), 92

STARODUBOV, V.l. (Russian Federation/ Fédération de Russie), 38 SUKAROMANA, D. (Thailand/Thaïlande), 69 SULAIMAN, A.J.M. (Oman), Chairman of Committee A/Président de la Commission A, 136 SUNGAR, M. (Turkey/Turquie), 58

SALLAM, I.A. (United Arab Emirates Health Foundation Prize/Prix de la Fondation des Emirats arabes unis pour la Santé), 121 SALLAM, 1. (Egypt!Egypte), 3 7 SEGOND, G.-0. (Representative of the Conseil d'Etat of the Republic and Canton of Geneva/Représentant du Conseil d'Etat de la République et Canton de Genève), 3 SEN, A. (Nobel Laureate in Economies), 28 SERRA, J. (Brazil/Brésil), 67 SHALALA, D.E. (United States of America/ Etats-Unis d'Amérique), 36 SHARMA, V.P. (Darling Foundation Prize!Prix de la Fondation Darling), 111 SHEMER, J. (Israel/Israël), 62 SJOBERG, M. (Sweden/Suède), 47 SONIN, S. (Mongolia!Mongolie), 89 STAMPS, T.J. (Zimbabwe), Vice-President of the Fifty-second World Health AssemblyNice-Président de la Cinquante-Deuxième Assemblée mondiale de la Santé, 131

TAPIA, R. (Mexico/Mexique), Chairman of Committee B/Président de la Commission B, 71 TELEFONI RETZLAFF, M. (Samoa), Vice-President of the Fifty-second World Health AssemblyNice-Président de la Cinquante-Deuxième Assemblée mondiale de la Santé, 128

WANG Longde (China/Chine), 14, 42 WHITWORTH, J. (Australia/Australie), 73

YUSUF, S.U. (Bangladesh), Vice-President of the Fifty-second World Health AssemblyNice-Président de la Cinquante-Deuxième Assemblée mondiale de la Santé, 34, 132

A52/VR

page 197

INDEX OF COUNTRIES AND ORGANIZATIONS This index lists the countries, organizations and bodies represented by the speakers whose names appear in the index on the preceding pages.

AFGHANISTAN, 99 ALGERIA,60 ARGENTINA, 51 AUSTRALIA, 73

FINLAND, 138

GERMANY,43 GHANA,95 GREECE, 59

BAHRAIN, 1, 5 BANGLADESH, 34, 132 BELGIUM, 102 BHUTAN, 79 BRAZIL, 67 BRAZILIAN NATIONAL CENTRE FOR EPIDEMIOLOGY, Ill BULGARIA, 104

HOLY SEE, 101

CANADA,41 CARICOM,45 CENTRAL AMERICA AND DOMINICAN REPUBLIC, 77 CHINA, 14, 42 CONSEIL D'ETAT OF THE REPUBLIC AND CANTON OF GENEY A, 3 COSTA RICA, 98 CROATIA, 44 CUBA, 65 CZECH REPUBLIC, 71

ICELAND, 105 IHSAN DOGRAMACI FAMILY HEALTH FOUNDATION, 114 INDIA, 49 INDONESIA, 60 INSTITUTE OF URBAN PRIMARY HEAL TH CARE, 118 INTERNATION AL FEDERATION OF RED CROSS AND RED CRESCENT SOCIETIES, 107 IRAN (ISLAMIC REPUBLIC OF), 74 IRAQ, 86 ISRAEL, 62, 125 ITALY, 62

JAPAN, 37 JORDAN, 87 DEMOCRATIC PEOPLE'S REPUBLIC OF KOREA, 82 DENMARK,85 DOMINICA, 15

KENYA,47

EGYPT, 37 ETHIOPIA,IOO EUROPEAN UNION, 43

LAO PEOPLE'S DEMOCRATIC REPUBLIC, 106 LIBY AN ARAB JAMAHIRIY A, 57, 130

A52/VR page 198

MADAGASCAR, 88 MALAYSIA, 84 MALDIVES, 72 MALTA, 75 MEXICO, 71 MONGOLIA, 89 MOROCC0,51 MYANMAR, 16, 81

SAINT LUCIA, 45 SAMOA, 128 SAN MARINO, 70 SAO TOME AND PRINCIPE, 93 SOUTHERN AFRICAN DEVELOPMENT COMMUNITY, 34 SPAIN, 66 SRI LANKA, 64 SWEDEN,47 SYRIAN ARAB REPUBLIC, 53

NEPAL, 94 NEW ZEALAND, 105 NICARAGUA, 14,77 NIPPON FOUNDATION, 116

THAILAND, 69 TURKEY,58

OMAN,l36 ORDER OF MALTA, 101

PACIFIC ISLANDS, 97 PAKISTAN, 55,77 PALESTINE, 83, 125 PAPUA NEW GUINEA, 97 PARAGUAY, 83 PERU,48 POLAND, 86 PORTUGAL, 11

UGANDA,99 UNITED ARAB EMIRATES, 40, 120 UNITED NATIONS OFFICE AT GENEY A, 2 UNITED REPUBLIC OF TANZANIA, 34 UNITED STATES OF AMERICA, 36, 124 URUGUAY,92

VENEZUELA, 76

WEST AFRICAN HEALTH COMMUNITY, 95

REPUBLIC OF KOREA, 67 ROMANIA,90 RUSSIAN FEDERATION, 38 RWANDA,92

YEMEN,80

ZIMBABWE, 131

A52/VR page 199

INDEX DES PAYS ET ORGANISATIONS Cet index contient les noms des pays, organisations et organismes divers représentés par les orateurs dont les noms figurent dans l'index précédent.

AFGHANISTAN, 99 ALGERIE, 60 ALLEMAGNE, 43 AMERIQUE CENTRALE ET REPUBLIQUE DOMINICAINE, 77 ARGENTINE, 51 AUSTRALIE, 73

ETATS-UNIS D'AMERIQUE, 36, 124 ETHIOPIE, 100

BAHREIN, 1, 5 BANGLADESH, 34, 132 BELGIQUE, 102 BHOUTAN, 79 BRESIL, 67 BULGARIE, 104

FEDERATION DE RUSSIE, 38 FEDERATlON INTERNATIONALE DES SOCIETES DE LA CROIX-ROUGE ET DU CROISSANT-ROUGE, 107 FINLANDE, 138 FONDATION IHSAN DOGRAMACI POUR LA SANTE DE LA FAMILLE, 114

GHANA,95 GRECE, 59

CANADA,41 CARICOM,45 CENTRE NATIONAL BRESILIEN D'EPIDEMIOLOGIE, 111 CHINE, 14, 42 COMMUNAUTE DE DEVELOPPEMENT DE L'AFRIQUE AUSTRALE, 34 COMMUNAUTE OUEST AFRICAINE POUR LA SANTE, 95 CONSEIL D'ETAT DE LA REPUBLIQUE ET CANTON DE GENEVE, 3 COSTA RICA, 98 CROATIE,44 CUBA, 65

ILES DU PACIFIQUE, 97 INDE,49 INDONESIE, 60 INSTITUT DES SOINS DE SANTE PRIMAIRES EN MILIEU URBAIN, 118 IRAN (REPUBLIQUE ISLAMIQUE D'), 74 IRAQ, 86 ISLANDE, 105 ISRAEL, 62, 125 ITALIE, 62

JAMAHIRIY A ARABE LIBYENNE, 57, 130 JAPON, 37 JORDANIE, 87

DANEMARK, 85 DOMINIQUE, 15

KENYA, 47

EGYPTE, 37 EMIRATS ARABES UNIS, 40, 120 ESPAGNE, 66

MADAGASCAR, 88 MALAISIE, 84 MALDIVES, 72

A521VR pagEl200

MALTE, 75 MAROC, 51 MEXIQUE, 71 MONGOLIE, 89 MY ANMAR, 16, 81

REPUBLIQUE POPULAIRE DEMOCRATIQUE DECOREE, 82 REPUBLIQUE TCHEQUE, 71 REPUBLIQUE-UNIE DE TANZANIE, 34 ROUMANIE, 90 RWANDA, 92

NEPAL, 94 NICARAGUA, 14, 77 NIPPON FOUNDATION, 116 NOUVELLE-ZELANDE, 105

OFFICE DES NA TIONS UNIES A GENEVE, 2 OMAN, 136 ORDRE DE MALTE, 101 OUGANDA,99

SAINTE-LUCIE, 45 SAINT-MARIN, 70 SAINT-SIEGE, 101 SAMOA, 128 SAO TOME-ET-PRINCIPE, 93 SRI LANKA, 64 SUEDE, 47

THAILANDE, 69 TURQUIE, 58 PAKISTAN, 55,77 PALESTINE, 83, 125 PAPOUASIE-NOUVELLE-GUINEE, 97 PARAGUAY, 83 PEROU,48 POLOGNE, 86 PORTUGAL, 11

UNION EUROPEENNE, 43 URUGUAY,92

VENEZUELA, 76

REPUBLIQUE ARABE SYRIENNE, 53 REPUBLIQUE DE COREE, 67 REPUBLIQUE DEMOCRATIQUE POPULAIRE LAO, 106

YEMEN, 80

ZIMBABWE, 131

Key facts

Organisation World Health Organization (WHO)

Document type Governing Bodies documents

Adoption date December 31, 1999

Source World Health Organization