(WPRlRC47/SR/3)
SUMMARY RECORD OF THE THIRD MEETING Grand Ballroom Westin Chosun Hotel. Seoul Tuesday. 10 September 1996 at 2 p.m CHAIRMAN: Mr Ki-ho LEE (Republic of Korea)
CONTENTS
1.
Programme budget ............................................................................................... ..
114 114 117
1.1 1.2
Programme budget 1994-1995: Budget performance (final report) ...... .. Proposed programme budget 1998-1999 ................................................ ..
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1.
PROGRAMME BUDGET: Item 8 of the Agenda
1.1
Programme budget 1994-1995: Budget performance (final report): Item 8.1 of the Agenda (Document WPRlRC47/3) THE REGIONAL DIRECTOR introduced the report noting that it provided an account of the
financial implementation of the regular budget as at 31 December 1995, including a report on the expenditure of extrabudgetary funds. The document showed the changes to the budget since it was presented to the Regional Committee at its forty-third session in 1992. As in the past, explanations for significant variations in the rates of implementation had also been provided. The report started with a description of important developments that had affected the level of the budget and delivery of the activities during the implementation period. Most of the information had been provided to the Regional Committee at its forty-sixth session in 1995, including the basis for the operating budget reflected in column 8 of Annex 2 and in Annex 3. In 1993, the amo,lIlt of accumulated underbudgeting had come to US$ 9.4 million. There had been no significant change with regard to those contributors who had not met their commitments for the current biennium. The Director-General had therefore decided to withhold 4.2% of all
regional allocations to compensate for unpaid contributions. For the Western Pacific Region, that had meant a budget reduction of US$ 3 045000, bringing the shortfall to US$ 12.4 million. A
prioritization exercise had then been carried out in order to match activities with available funds, resulting in a reduction of US$ 7 020 800 at the country level, and US$ 5 424 200 at the Regional Office, WHO Representatives' offices and intercountry levels. The Regional Director' s concern throughout the process had been to make sure that countries were as little affected as possible by the changes. A total of US$ I 592 000 or 2.2% had later been given back to the Region by the Director-General. The amount was US$ I 453 000 less than had been withheld, neverthebs the full amount had been restored to countries by the Regional Director. All the adjustments, along with reprogrammings initiated at country level, were incorporated into the operating budget, against which comparisons had been made in the document regarding the actual implementation. An additional significant change had been the transfer of Mongolia to the Region, together with its country planning figure. That had meant a change in the total of US$ 71.2 million reported
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In
1995 when the interim report was reviewed. to US$ 74 million reported in 1996 (see page 5.
Annex I of the document). Annex 2, on pages 7-12. showed the details of those changes, by major programme and by programme. The presentation followed the same format as the interim report in 1995. Column 7 "Programme changes during implementation" had been subdivided into three headings: "Budget
recosting and cost variances", "Priority X adjustments" and "Reprogrammings". It was hoped that the revised presentation further clarified how the operating budget had been derived. Annex 3, on pages 13-18. compared the operating budget with actual expenditures and obligations, and provided explanations for the most significant variations. Annex 4 on page 19 gave financial information on the implementation of the Regional Director's Development Programme for 1994-1995. Funding for those activities had been
reallocated to the programmes under which they took place. The information provided in the report on page 12 of Annex 2 and page 18 of Annex 3 showed that, as at 31 December 1995. the rate of implementation of the regular programme budget was I 00% in financial terms. However, the I 00% implementation rate in financial terms did not mean that the planned programmes for the 1994-1995 biennium had been delivered in their entirety. The Regional Director apologized to Member States for the disruption caused by changes during implementation, but hoped that they would appreciate that they were beyond the Region's control. Inconvenience at country level had been minimized. He encouraged the representatives to give their views on the manner in which the Regional Office had tackled and overcome the various obstacles described. He thanked Member States for the support that had allowed the Member States and WHO together to react to whatever circumstances were presented, and to achieve the best in difficult circumstances. The REGIONAL DIRECTOR mentioned that while the primary purpose of this report was to show the implementation status of the regular budget, the valuable contribution to WHO's programmes in respect of funding from other sources should not be forgotten. In conformity with previous practice, the amount of extrabudgetary funds implemented were shown in column 11 of Annex 2. Dr Han was most grateful for those additional funds which had increased WHO's
budgetary capacity from US$ 74.0 million to almost US$ 112 million for the biennium.
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Dr FUJII (Japan) commended the prioritization of programmes and cutting of costs.
He
proposed that a new column 13 be added to the table in annex 2 indicating the final implementation percentages, so that the difference in priorities between the allocations of the regular budget and extrabudgetary resources could be clearly seen. He noted that the proportion of extrabudgetary
funding was proportionately much greater to programmes such as organization of health systems based on primary health care, maternal and child health including family planning, prevention and control of alcohol and drug abuse, and measures to control AIDS and other communicable diseases. He asked for the secretariat's views and reply on how such conditions were incorporated in the budget for 1998 and 1999. Dr DURHAM (New Zealand) asked when WHO would produce financial statements that adopted the United Nations Accounting Standards. She asked for the current market valuation of land and buildings owned by WHO in the Western Pacific Region to be made available, if not during the present session, then for the next meeting of the Regional Committee. She wondered also when it was intended to produce a consolidated register of assets, showing their depreciation, and recording it on the Balance Sheet. Ms BLACKWOOD (United States of America) praised the management of a constantly changing budget, and noted that support services, for the first time, had not significantly exceeded the budgeted amount. She welcomed the addition of a column showing extrabudgetary resources, noting that, in programme I S, an additional 34% had been used from extrabudgetary funds. Dr TAPA (Tonga) congratulated the Regional Director on 100% utilization of the operational budget, expressed satisfaction over the expenditure in Annex 4 in respect of the Regional Director's Development Programme and thanked the partners who had contributed some US$ 38 million of extrabudgetary funds, which were of special benefit to small countries. He hoped that their sources would be set out in future reports. Dr NUKURO (Solomon Islands) asked that an annex detailing sources of extrabudgetary funding be provided. The REGIONAL DIRECTOR thanked representatives for their comments and suggestions. In reply to the question from the representative of Japan, he said that a thirteenth column could be added in the next report to show the combined percentage implementation rate of regular and extrabudgetary resources.
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To the questions from the representative of New Zealand, he said that WHO followed the accounting system chosen by WHO headquarters and also any changes suggested by headquarters. Assets, values and depreciation were presently not reported to the global governing bodies. The Regional Director regretted not being able to satisfy the representative's request, and could only suggest that the Delegation of New Zealand address that request to the Governing Bodies. Replying to the question from the representative of the Solomon Islands, the Regional Director said that the matter of showing sources of funding would be studied for future presentations. In the proposed budget for 1998-1999, the level of extrabudgetary resources shown was much lower than in the previous budget, simply because only firm commitments from partners were included, many of whom operated on different budgetary cycles from WHO, and had not yet committed funds. The Regional Director would, however, try to accommodate the suggestions of representatives and said that the secretariat would try to implement them, without, however, going back to arrangements that had already been superseded. The CHAIRMAN noted the satisfaction of the Regional Committee at the complete implementation of the programme budget in financial terms, and the Committee's agreement to support the Regional Director and the secretariat in seeking to maintain a reasonable level of programme implementation in spite of declining available resources and rising costs. It was so decided (see decision WPRlRC47( I
».
1.2
Proposed
pro~ramme hld~et
1998-1999: Item 8.2 of the Agenda (Document WPRlRC47/4)
The REGIONAL DIRI.CTOR presented the proposed programme budget to the Committee, noting that it was the second to be prepared under the Ninth General Programme of Work. The document had beell prepared according to the Procedural Guidance for the Preparation of the Proposed Programme Bud:!et for 1998-1999 (Document PPE/9S.2) which had been used in the development process both by ti,e countries and the programme managers in the Regional Office. The proposed program ne budget had been formulated on the basis of national and regional priorities, as well as the glob. II policy frameworK and five programme priorities stressed by the Director-General. The REGIONAL DIRECTOR affirmed that most of the proposals continued to reflect the priority programmes at all levels, especially country priorities.
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In preparing the proposed programme budget, the strategic (formerly called the broad) programme budget and the plans of action (formerly called the detailed programme budgets) had been prepared together, in order to simplify the process. That was in accordance with the provisions of resolution WPRlRC40.R4 on the streamlining of programme implementation. The proposed programme budget was presented at three levels: country, intercountry and regional. For the 1998-1999 biennium some new concepts and terminology had been introduced. The focus of collaboration had been based on the planned products and an evaluation of activities over the past biennium. The proposed budget also used a new classification of programmes,
introduced by WHO headquarters. In 1995, the Regional Committee, in resolution WPRlRC46.R2, had urged Member States to allocate resources to programmes and activities that reflected the approaches of New horizons in health. The REGIONAL DIRECTOR reported that that directive had been followed in the
preparation of the proposed programme budget. Countries had started to organize activities around the three themes described in the document, namely: preparation for life; protection of life; and quality of life in later years. It had been possible to consolidate those activities into fewer programme areas: often those for national health systems and policies, or for health promotion. Many programmes were adopting a horizontal approach to programme delivery, to ensure better linkages with people outside the health field and with the community itself. The proposed regional programme budget for 1998-1999 amounted to US$ 76 709 000. That was the same level as the approved budget for 1996-1997. Of the total regional budget,
US$ 42729400 or 55.7%, had been allocated for country activities; US$ 21 034000 or 27.4%, for intercountry activities and US$ 12945600 or 16.9% for regional activities. Cost increases might be later added to that amount after the World Health Assembly's approval in 1997 of the budget, the level of cost increase and exchange rates for the biennium. The present non-application of cost increases was intended to focus attention on budget changes in real terms. However, as experienced in the 1996-1997 biennium, the Region was subject to the decisions of the World Health Assembly and might not receive the full cost increase required. Final
implementation of the budget would, therefore, be heavily influenced by the level of cost increase received.
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Looking at the regional priorities, just under three-quarters of the proposed programme budget (US$ 76 709000) for 1998-1999 had been allocated in support of regional priority activities. The detailed breakdown (which included double counting in some areas) was as follows: strengthening management 35.48%, (US$ 27 217 700); human resources for health, including
fellowships 20.83%, (US$ 15 975 200); health promotion 14.46%, (US$ II 090 300); eradication and control of selected diseases (including poliomyelitis eradication) 9.54%, (US$ 7 314 800); environmental health 7.68%, (US$ 5 887 500); and exchange of information and experience 5.58%, (US$ 4 280 600). Technical activities continued to rellect the regional priorities strongly. The control and
eradication of communicable diseases would be a major focus of activity in 1998-1999. That would include not only combating poliomyelitis, leprosy, tuberculosis and malaria, but also facing the threat from new, emerging and re-emerging diseases such as diphtheria, cholera and dengue fever. For that reason, the REGIONAL DIRECTOR had proposed the expansion of the six regional priorities to seven. A great deal of the funding for the activities in the area of communicable disease control came from extrabudgetary sources. He expressed deep gratitude to all partners in those important efforts. With respect to the priorities identified by the Executive Board, the percentage for 1998-1999, if the proposal was approved as presented, would be 77.76%. That rellected a small decrease from the 80.59% allocated in 1996-1997. It was understood that the changes in programme classification since 1996-1997 might make it extremely difficult to analyse the data presented under 1998-1999 headings. However, in the Region WHO had acted upon the Regional Committee's
request to present the budget at a level of detail such that the distinguished representatives might clearly see the allocations to technical programmes. That meant four programmes of special regional significance had been presented at programme component (four-digit) level, while the remaining 46 programmes where the Western Pacific Region had activities were presented at specific programme (three-digit) level. The representatives would no doubt remember that WHO headquarters would only present the proposed programme budget in strategic terms (at two-digit level) from which allocations to programmes such as malaria, tuberculosis and sexually transmitted diseases and AIDS could not be seen. The REGIONAL DIRECTOR believed that the Western Pacific Region was still among the most responsive to the requests made by the Executive Board. He reminded representatives that
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when asked to shift 5% of the allocation for) 996-) 997 to programmes identified by the Executive Board, the Region had exceeded that target, and in dollar terms shifted US$ 3 ) 90 900 to priority areas. Over the biennium, health protection and promotion would assume a greater importance, covering a wider range of issues. The main purpose of such activities remained the encouragement of the individual and the community to take increasing responsibility for their health, and the resources needed to improve their lifestyles and living conditions. Health policy development and reform were issues of concern to many Member States. The emphasis would be on issues related to resource distribution and the balance benveen curative and public health services, and the private and public sectors. Development of appropriate health care systems and services would be encouraged. At peripheral levels, the eight elements of primary
health care would continue to be emphasized. At national level. health workforce planning would focus on appropriate training and numbers of health personnel. The intercountry programme had been an effective and economical means of providing technical cooperation, especially for small islands and least developed countries and areas. For 19981999, provisions for the continued presence of intercountry staff at various duty stations had been made. notably in the South Pacific and other strategic locations, including three technical staff to countries in shared, country-based positions. In addition, some countries with low country planning figures had received an increase. When the ) 994-1995 and 1996-1997 programme budgets had been presented in 1992 and 1994. respectively, the difficulties faced had been due to underbudgeting and inadequate cost increases. The Regional Director had kept Member States fully informed of the steps taken to
overcome the problems, especially where they affected the country and intercountry programmes. He recognized that the adjustments caused inconvenience and disruption to programme delivery. However, the most severe budgetary reductions had been made at the regional level. Many sacrifices had been made, to cope \\ith the workload yet continue to deliver high quality, relevant programmes. As part of the efforts to face those office problems head on, an interim restructuring exercise had been carried out in the Regional Office. The resulting structure would be assessed by the end of 1996, and a decision made on a permanent arrangement in early 1997. The interim arrangement had resulted in three technical divisions instead of four, with one post of director kept frozen.
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The process of restructuring had also affected the area of environmental health. Since 1979, the Western Pacific Regional Environmental Health Centre (formerly known as PEPAS), which was based in the University of Agriculture in Serdang, Malaysia, had encouraged Member States in the Region to broaden their health-related activities to take account of environmental issues affecting health. The Centre had served a very useful purpose, but with the increasing operational costs and changing regional focus, the Regional Director proposed to redeploy some of the staff, and close the Centre at the end of 1997 subject to the concurrence of the Government of Malaysia. The agreement of the Regional Committee was sought on that matter. The Region had been well served by the staff of the Centre for 17 years. The REGIONAL DIRECTOR thanked the past and present staff, and the Government of Malaysia, for the support provided to the operations of the Centre. The hope was expressed that the national environmental health research centre opened by the Government of Malaysia would provide an additional arm for future collaboration in the field of environmental health. The REGIONAL DIRECTOR noted that streamlining and downsizing would be seen in many operations over the coming months. The proposed programme budget required that many staff assume, on a voluntary basis, additional tasks and responsibilities. Every effort would be made to maintain the same high quality of programme delivery, although one in seven posts would be either frozen or deleted in 1998-1999. All means of maintaining staff levels and securing extrabudgetary funding to maintain the level of expertise would be explored. The REGIONAL DIRECTOR said that it had always been his goal to allocate the maximum funds possible to technical activities at the country level. He had always been sensitive to the fact that administrative and staffing costs must be kept as low as possible without sacrificing the supportive role of such services. Although there had been some increase in staffing costs, he had ensured that the proportion of funds allocated to programme 6, Administrative Services, was below 10%. In fact it was 9% of the total regular budget. The proposed programme budget for 1998-1999 also included, as in previous years, all activities for which financing might reasonably be expected from extrabudgetary sources. That
amount was a conservative estimate, as some external support agencies did not allocate funds so far in advance. The current estimates for 1998-1999 showed a decrease from the latest available
estimates for 1996-1997. Further extra budgetary funds were, however, expected to become available closer to and during the 1998-1999 biennium. At the same time, even if the level of funds channelled
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directly to WHO fell, coordination with extrabudgetary partners would be strengthened with a view to soliciting funds for countries even on a bilateral basis without involving WHO. In that way, the funds required could be routed directly from donors to countries in need. As requested by the Regional Committee last year, the programme budget had been presented under 50 headings, to provide details on programmes of regional importance. That
presentation would be later consolidated by headquarters into 19 programmes. The overall global budget would then be submitted to the Executive Board and the World Health Assembly. During the review of the programme budget, the Secretariat would be happy to reply to any query or request for clarification. Dr ADAMS (Australia) commended the Regional Director on the clear presentation of a budget which managed to achieve no increase on the current biennium. This was consistent with efforts throughout the United Nations to contain costs and allocate funds to priority programmes, and it showed a recognition of the budgetary realities faced by Member States and WHO. There was, however, no mention of provision of financial plans for 1996-1997, as had been requested in Resolution WHA 49.2, and he asked when such a plan would be available. He commended the increased allocations to control of communicable diseases, including HIV / AIDS and tuberculosis, and urged the Regional Office to work closely with UNAIDS. The increased allocation towards elimination of leprosy was also appreciated, as was the determination to achieve the total eradication of poliomyelitis. Further information was sought from the Regional
Director on four issues: the 25% increase to regional committees; the 30% increase in personnel, general administration, and budget and finance; the 95% increase in the development programmes of the Director-General and the Regional Director; and the 30% increase in publishing, language and library services. The Australian delegation had concerns about the budget explanation "to allow for staff at current costs" as a justification for programme increases ranging from 20% to 57%. The increase in cost of the Regional Committee was particularly disturbing and the costs of meetings had to be tightly managed. The 30% increase in the budget and finance part of the proposals was due to staff being budgeted at current costs, and details were sought on that. The third point concerned an
increase in the Director-General's and Regional Directors' development funds which was felt to be
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unwarranted, and fourth was that as a cost-saving measure under the programme on publishing, language and library services, it might be possible to outsource some activities. He congratulated the Regional Director on his New horizons in health strategy, which was in keeping with cross-sectoral approaches to health, and which needed to be translated into a clear strategy in the budget process. Essential to the broader approach to health issues was development of strategic directions within countries on the basis of WHO's participation in the broader development policy dialogue. That would form the basis of strategic resource allocation, and stop duplication of efforts with other partners in health. He agreed, with regret, that WHO should seek the agreement of the Government of Malaysia to the closure of the Environmental Health Centre, hoping that environmental health would not lose its emphasis. He hoped that WHO would build on the
collaborating centres in that field, one of which had recently been inaugurated in Australia by the Regional Director. Mr FUJII (Japan) commended the efforts of the Regional Office to cut administrative costs, like overtime and communications, in 1995 and 1996 and hoped that the proposed budget for 19981999 would reflect the continuation of those measures. He noted its user-friendly format with a zerogrowth ceiling and its emphasis on priority programmes such as the control of emerging and reemerging infectious diseases. Referring to table I, page II, he suggested it was overly conservativc to cxpect a 77% decrease in the "Voluntary Fund for Health Promotion" for the 1998-1999 biennium as compared to the last budget. Table 2, page 12 indicated that the budget allocation for 1.1.3 (Regional committees) had increased by 25% and he asked if the Committee meetings could be shortened and simplified considering the difficult financial situation and the priorities set by the Executive Board. He asked for an explanation of the increase in budget allocation for 2.1.4 (Director-
General's and Regional Directors' development programmes). Was the increase by US$ 510 000 a safeguard against uncertainty, such as an outbreak of infectious diseases? He said that transferring five support staff from 2.1.3 (Management and support to information systems) to 2.4.2 (Publishing, language and library services) could not be the sole cause of the increase in that programme by US$ 374 000, and asked for an explanation.
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He was pleased to note that 4.2.2 (Substance abuse including alcohol and tobacco) and 4.2.2.4 (Specific tobacco or health control activities) were further strengthened and more emphasis was placed on tobacco control. Priorities should be placed upon measures to ensure that adolescents did not begin smoking and on legal measures such as regulation of tobacco advertisements. Given the extremely harsh financial conditions, there was no other recourse except to close the Environmental Health Centre in Malaysia. However, he hoped that 4.4.3 (Assessments of
environmental health hazards) would still continue under the present restructuring of the Organization. He queried whether the increase by US$ 229 000 for 6.3.1 (Budget and finance) was wellbalanced with other budget items. He stressed that discllssion of the proposed programme budget should centre on the relevance of considerable changes in some budget items as compared to the last biennium and the underlying principles governing allocation of resources to countries. especially to those in greatest need. It was
difficult to relate the shifts in programmes to significant changes in funds for country activities since there was no mention of the countries which had shifted national priorities. He also cited instances when funds for an affluent country would increase whereas resources for a country in greatest need would show a significant decrease. He would appreciate some more information on the
appropriateness of resource allocation in the proposed programme budget. Professor Ll (China) commended the Regional Director and the Secretariat on the clear presentation of the proposed programme budget for 1998-1999. The budget allocations reflected not only major issues and actual needs of the Region but also the defined priorities at national, regional and global levels. The three themes of the document Nell' horizons in health were integrated into the programme activities. The budget reflected the present restructuring of the Regional Office for
maximum cost effectiveness of limited resources. The reduction in the number of staff posts and the closure of the Environmental Health Centre were reflections of WHO's strong commitment to institute reforms within the Organization. He hoped that some measures could be taken to lessen the impact of staff reduction. His delegation was pleased to endorse the proposed programme budget. He expressed appreciation for the support of the Regional Office and the WHO Representative in China during the formulation of the country programme budget despite the lack of
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human resources in both offices. He suggested that in the future, more time should be given so that high quality of country budgets was ensured. Ms BLACKWOOD (United States of America) thanked the Regional Director for the clear, transparent and concise presentation of the proposed programme budget for 1998-1999. She
welcomed the breakdown into 50 programme headings and additional information at regional level. She noted with disappointment that the global proposed programme budget for 1998-1999 would be consolidated into 19 major programmes for submission to the governing bodies. Such a 19-1ine
presentation was not transparent and did not give sufficient information to the Member States. For the past several years, the United States of America had taken the position that budget levels should be tied to reasonable expectations of income; that position would be maintained in the next budget cycle. There was a major effort in the United States to achieve a balanced federal budget by 2002. Under even the most optimistic scenario, that was likely to entail a reduction in nominal terms, and an even greater reduction in real terms. in the funds available for the United States' assessed contribution to international organizations over the next few years. It was likely that the United States would be unable to pay its full assessment to WHO and other international organizations in the coming years if they remained at current levels. Every effort would be made to secure the resources to meet obligations fully. but that could not be taken for granted. WHO had therefore ensured that the 1998-1999 budget was no higher than the levd of the 1996-1997 budget, for which it should be commended. However, the United States would not support cost-increase requirements for inflation and exchange rate fluctuations when considered at a later stage before the start of the biennium. The United States' specific goal for the 1998-1999 budget level would be worked out for the ninety-ninth session of the Executive Board in 1997, and was intended as a lever for change. WHO must be helped to respond positively by rethinking functions and programmes in order to adapt to the situation regarding resources. The Regional Office for the Western Pacific was already making commendable efforts to organize, restructure and streamline functions and processes to improve programme delivery. In the proposed programme budget, as in the previous one, 5% of the budget had been shifted to priority programmes determined by the Executive Board. She requested details on how the Region had allocated its resources according to those priorities. She was pleased to note that prevention and control of communicable diseases would remain a main feature of WHO collaboration. From the
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budget tables, it would appear that only 3% of resources were allocated to eradication of poliomyelitis and leprosy. Was that sufficient for the Region to achieve its goals? She noted that more than 20% of the Region's resources would be devoted to 3.2.1 (Human resources for health), in particular for fellowships and training, and asked whether such a high proportion of funding should be devoted to human resources development in the light of other competing interests. She also noted some remarkable shifts in funding within specific programmes. For example, there had been a 25% increase in the allocation to 1.1.3 (Regional committees), as mentioned by other representatives. The intention had been to direct money to high priority
programes and away from procedural and administrative activities, and she requested an explanation. Nonetheless, she supported the measures taken to streamline the work of the Committee and to make it more cost effective. Similarly, the allocation to 2.1.1 (Executive management) had risen by 19%, and to 6.3.1 (Budget and finance) by almost 30%. The Region had to absorb cost increases and not selectively apply current costs, especially in administrative areas. She requested a clarification of the abolition of 2.3.2 (Collaboration with countries and peoples in greatest need) as support to those countries should be a central component of the Region's programme. Although 4.4.1 (Water supply and sanitation in human settlements) and 5.2.6 (Control of tropical diseases) were both established global and regional priorities, allocations had been substantially reduced, and she requested clarification. She was also concerned that 5.2.7 (Special programme for research and training for tropical disease) was being phased out. She was pleased to note that the allocation for 5.2.4 (Emerging diseases including cholera and other epidemic diarrhoeas. zoonoses and antimicrobial resistance) had been increased by 136%, although that was still less than I % of the regional budget. As those activities were proposed as a new regional priority, the amount being allocated to them might be insufficient. Dr ARIF (Malaysia) expressed h;s appreciation for the efforts made to eradicate poliomyelitis and eliminate leprosy, and particularly those to tackle problems of malaria, tuberculosis and dengue. He noted with pleasure that extrabudgetary funds were available to carry out activities at regional and country levels. He supported the proposal to include new emerging and re-emerging diseases as a seventh priority for WHO collaboration in the Region.
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He noted that WHO intended to close down the Environmental Health Centre in Malaysia, which had been an important resource centre, making a useful contribution to the Region. Although disappointed at the decision, his Government understood the circumstances in which it had been taken and made no objection to the proposed closure. It intended to speed up establishment of an environmental health research centre at the Institute for Medical Research, and hoped that WHO would collaborate in that process. Dr HOWELL (France), noted that the total proposed funding for regional health programmes had fallen from US$ 113.6 million in 1996-1997 to US$ 91.4 million in 1998-1999, while the regular budget had remained stable at US$ 76.7 million. Did the decline in extra budgetary funds from
US$ 36.9 million to US$ 14.7 million account for that drop? He requested an explanation of the considerable variations In
the funding of several
programmes. For example, had 2.3.2 (Collaboration with countries and peoples in greatest need) simply been abolished, while funding for 3.3.1 (Action programme on essential drugs) had risen by 57%, for 5.1.1.2 (Leprosy), by 522%, and for 4.4.2 (Environmental health in urban development), by over 617%? He supported the comments made by the representative of the United States of America. Dr TAPA (Tonga) agreed with the overview by the Regional Director contained in the proposed programme budget document. He noted that the amount of the regular budget remained unchanged as no cost increases had been included. In some cases, the country budget was lower than in the 1996-1997 programme budget, as a result of the 3% of the budget which had been originally withheld by the Director-General for priority programmes, part of which was subsequently reallocated. That situation would not reoccur. Provided that adequate clarification was given on the points raised by other representatives, he was happy for the Regional Director to transmit the programme budget proposals to the Director-General for inclusion in the consolidated proposed programme budget for 1998-1999. Dr ENOSA (Samoa) also noted that there had been no change in the budget for small island countries. but that there would be a decrease in current programmes because inflation and other costs would not be borne by the global budget. Financial constraints were therefore inevitable in small countries. He requested explanation of the minor changes that would affect the proposed programme
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budget for small island countries, and noted that the budget had been prepared along the lines suggested by the major contributors. Dr DURHAM (New Zealand), while congratulating the Regional Director on a clear and informative document, expressed some disappointment at several of the increases. She concurred with other representatives that outsourcing of some functions, such as publishing, should be considered, and that administrative costs should be contained. She requested clarification of the
increases for 2.1.4 (Director-General's and the Regional Directors' development programmes). She noted that the budget allocation for 1.1.3 (regional committees) had increased by 25%; consideration should be given to reducing the duration of the session by one day. With regard to 5.2.5.4 (AIDS and sexually transmitted diseases), she was concerned that the transition to UNAIDS had apparently not been smooth, placing the Region at risk from AIDS. Although the matter would be discussed under agenda item 10 (AIDS), she was concerned by the overall budgetary situation in relation to AIDS and sexually transmitted diseases, and its impact on country programmes. She requested clarification, particularly on action that could be taken by the Regional Director. She shared the concern of others at the closure of the Environmental Health Centre Malaysia, and hoped that the activities related to environmental health would not be undermined. Overall, she expected to see a clear relationship between the proposed programme budget and regional priorities, in the context of Nell' horizons in health. If a new regional priority were to be adopted, which priority would be dropped? Even if a priority were to be funded largely from 111
serious
extrabudgetary resources, such resources might then not be available for one of the other priorities. and she requested an explanation in that regard. Dr BELLAMY (United Kingdom of Great Britain and Northern [reland) said that he shared the concerns expressed by other representatives. [n view of the Director-General's earlier comments on the need to reduce expenditure on appropriation sections I and 6, he requested clarification on the proposed 25% increase in the budget allocatior. for 1.1.3 (Regional committees) and 30% increase in the allocation for 6.3.1 (Budget and finance). Similarly he was concerned by the restoration of 2.1.4 (Director-General's and the Regional Directors' development programmes) to its 1994-1995 level. Could the proposed allocation for that specific programme not be reduced to its 1996-1997 leveL and the balance reallocated to country programmes?
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In a number of programmes, the proposed budget allocation had been increased between 20% and 57% to allow for staffing at current costs. He requested clarification on whether staff costs had indeed increased by that amount in the past two years. With regard to contingency planning, he. drew attention to resolution WHA49.2, requesting the Director-General "to dew lop a financial plan for 1996-1997 and beyond to bring expenditure into line with expected income and to minimize internal borrowings", which reflected the concern of the governing body about the financial situation of the Organization. There might be continued and prolonged arrears in the payment of assessed contributions. In those circumstances, the governing bodies might agree to a financial plan that involved a reduced budget. Did the Regional Director have a contingency plan for such a scenario that could be debated during the meeting? Dr WILLIAMS (Cook Islands) noted that the total proposed programme budget was the same as in the previous biennium, which meant a decrease in real terms. How would the Region meet its commitments in 1998, especially if no extrabudgetary funds were forthcoming from partners? He felt that the Committee should consider the suggestion to shorten the duration of its session if the efficacy of its work would not be affected. He welcomed the positive comments made by the representative of the United States of America. Mr ROKOV ADA (Fiji) congratulated the Regional Director on the formulation and presentation of the proposed programme budget for 1998-1999. His delegation shared some of the concerns raised by other representatives. He was concerned that the allocation to Fiji from UNAIDS was only US$ 60 000, well below the US$ 362 000 allocated by the former Global Programme on AIDS. Fiji was endeavouring to ensure continuity of services, despite the fact that the UNAIDS allocation had not yet been received. The reduction in funding from UNFPA was also causing concern, as UNFPA supported Fiji's maternal and child health, family planning and reproductive health programmes. Moreover, it
appeared that the UNICEF programme which supplied Fiji with vaccines was being phased out. Mr PARK (Republic of Korea) said that after two decades of successful implementation of health care programmes in collaboration with WHO, it was time for his country to contribute its experience and know-how to the rest of the world. His Government intended to make a voluntary contribution to WHO on the occasion of the forty-seventh session of the Regional Committee.
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The REGIONAL DIRECTOR thanked representatives for their numerous comments and questions, which reflected the deep interest they took in the work of WHO in the Region. [n
preparing the programme budget, every effort had been made to maintain the content and delivery of programmes at the same level as in previous bienniums. At the country level in particular,
allocations would not fall below the actual amount implemented for the 1994-1995 biennium in dollar terms, although there might be some reduction in real terms. [n order to safeguard operations at country level, he had looked at possibilities of restructuring. He had reduced the number of technical divisions at the Regional Office from four to three on a trial basis, and 51 out of the total of 358 posts had been frozen or left vacant in the 19981999 budget. He recognized that salaries were a major item in the programme budget. However, there had been no significant salary increase for professional staff since the early 1970s, although there had been a slight adjustment in July 1990. On several occasions a proportion of post adjustment had been incorporated into the base salary, which increased the staff member's pensionable remuneration but left take-home pay unchanged. General service staff, on the other hand, were covered by a salary review mechanism that applied to the entire United Nations system and over which WHO had no control. On the basis of cost-of-living surveys, their salaries had been increased by approximately 50% since 1992. A further restructuring measure proposed was the closure of the Environmental Health Centre in Malaysia, which had functioned satisfactorily for the past 17 years. Fortunately the closure coincided with the plans of the Malaysia Government for opening an Environmental Health Research Centre, and transfer of the Centre's activities to the Regional Office would result in a saving of US $1 million without sacrificing programme content. The REGIONAL DIRECTOR then responded to specific points raised by representatives. The financial plan requested by the representative of Australia was in fact the responsibility of WHO headquarters. The plan would take inti) account the payment of assessed contributions and how to deal with the shortfall in payments. He understood that preparation of the plan was under way and that the picture regarding the payment of contributions by the major contributor was somewhat brighter. It was anticipated that amounts acquired through internal borrowing could be repaid within about two years. He added that \ 0% of the budget allocation to the Region for the
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current biennium was being withheld by the Director-General. He had not previously informed the Regional Committee of that fact as there was a prospect that the amount would be restored. The financial plan would be discussed further at the meeting of the WHO Global Policy Council. of which he was a member. in November 1996 at headquarters. Some representatives had queried the increases in allocations to certain programmes in the proposed programme budget for 1998-1999 as compared with the allocations for the current biennium. The 25% increase in the allocation for regional committees reflected the fact that the item had been underbudgeted in the past. Actual expenditure on regional committees in the 1994-1995 biennium had been US$ 513 000. Although the estimate of US$ 500 000 for 1998-1999 was 25% above the 1996- 1997 figure. it was based on current costs and took into account the transfer of Mongolia to the Region. The Regional Director assured representatives that he was actively seeking ways of reducing the cost of the Regional Committee, for example by training Regional Office staff to take on precis-writing duties normally performed by staff from Europe. The 30% increase in the allocation for budget and finance (programme 6.3) was accounted for by the salary increases for general service staff. who held very high grades because they were all highly qualified. Those locally recruited staff members were very efficient. and cost the
Organization only one-fifth as much as an expatriate professional. The proposed allocation for the Regional Director's Development Programme was up by 95% because in the previous biennium. the Director-General of WHO had, without consultation, preallocated half of the allocation and utilized the funds for primary health care. The purpose of the Programme was to enable the Regional Director to respond to unforeseen problems at country level. For example, he would be able to allocate the funds to control outbreaks of diphtheria and cholera or deal with sudden increases in malaria transmission. He always reported fully to the Committee on the use made of the funds. Replying to comments on the 30% increase shown for 2.4.2 (Publishing, language and library services), he said that the increase had arisen as a result of restructuring; the typing pool, comprising five staff members was now included under that programme. References had been made to
"outsourcing" for the production of publications. However, Regional Office publication capabilities were excellent and, through an investment to update printing equipment, publications would be produced in-house at a cheaper rate than local commercial companies.
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Referring to collaboration with bilateral partners, he assured representatives that he would continue to promote complementary rather than competitive activities and, wherever possible, to encourage the channelling of extrabudgetary funding through WHO. As indicated previously, he would make every effort to mobilize additional extrabudgetary funding. Replying to the representative of Japan, he explained that the Region did not prepare programme budgets on the basis of a "zero-growth ceiling". They were prepared in the hope that cost increase and exchange rate facility aspects would be covered by the appropriation resolution adopted following consideration of the consolidated proposed programme budget at the World Health Assembly. For 1996-1997, the programme budget had required cost increases of 15%. However, an increase of only 2.7% had been approved, leaving a shortfall of 12.3% which had had to be covered by reprogramming and restructuring. The consideration process would be similar for the 1998-1999 programme budget. Further, the possibility of absorbing cost increases as suggested by the
representative of the United States of America was difficult to assess, since it was impossible to know in advance how much of the increases would be covered by the appropriation resolution adopted at the Health Assembly. There had been a suggestion that the duration of Regional Committee sessions might be reduced to save costs. While he was in favour of making sessions as efficient as possible, there was now an additional Member State, Mongolia, in the Region, and for all countries whose assessed rate was the minimum 0.0 I %, WHO funded the fares of representatives. Certain costs were therefore incurred regardless of the duration of the session: in fact reducing the session by one day would save only US$ 16400. Reference had been made to the period of time allowed to Member States for the preparation of their contributions to the proposed programme budget. Regrettably, the schedule was very tight. For the 1998-1999 programme budget, for example, formulation guidance and an indication of the regional allocation had only been received from headquarters in October 1995. They had been
discussed by the Region's WHO Representatives in November 1995 and guidance had then been sent out to Member States. Because of time constraints in producing the proposed programme budget in time for the Regional Committee, deadlines had had to be set. Late receipt of even a single country contribution could cause a serious delay in finalizing the programme budget. Unfortunately, it was difficult to see how the schedule could be improved. However, it might be possible to provide
further support to some countries in preparing their contributions in some cases.
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The representative of the United States of America had referred to the relatively small increase in the budget allocation for integrated control of disease. However it was anticipated that that area would attract substantial extrabudgetary and bilateral funding. For example, China had
been able to immunize 80 million people against poliomyelitis in two days thanks to a US$ 7 million donation by Japan for vaccine procurement. Unfortunately the final level of such funding was not known in advance, although it would in due course be reported to the Regional Committee. More than 20% of the budget was allocated to the regional priority activities to developing human resources for health, including fellowships. Assessment of fellowships was continuing, to ensure that full use was made of trained fellows in their area of expertise after return to their countries. The officer responsible had attended a meeting of fellowships officers held in the SouthEast Asia Region so that the Western Pacific Region's experiences in assessment were being shared. Turning to 2.1.1 (Executive management) he explained that the proposed increase was entirely due to staff costs. The representative of the United States of America had commented on the elimination of programme 2.3.2 which related to intensified cooperation with countries and peoples in greatest need. In fact there was no programme of intensified cooperation as such in the Region, although there was close collaboration between WHO and all those concerned to help the least developed among developing countries through a comprehensive rather than a vertical approach. In fact there had been no reduction in the allocation for those activities; the two posts concerned had been reclassified, but the activities would continue. The United States representative had also asked about the lack of allocations for 5.2.7 (Special Programme for Research and Training in Tropical Diseases) and the small budget devoted to 5.2.4 (Emerging diseases including cholera and other epidemic diarrhoeas, zoonoses and antimicrobial resistance). Since the former was a headquarters programme, the Region was not
usually involved in identifying research areas or investigators. However some activities related to the Region had been undertaken by one staff mt!m ber. That post had now been frozen and thost!
activities had been transferred to the officer responsible for vector biology control. The activities would thus continue, although they were not shown as a separate budget line. Programme 5.2.4 was relatively new and therefore the allocation was still small. Should the Committee approve, he was willing to earmark 20% of the Regional Director's Development Programme for that programme.
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He confirmed that the matter mentioned by the representative of Tonga referred to a one-time transfer and there would be no further action in that regard. He gave an assurance to small countries such as Samoa that every effort would be made to ensure that they would be given special attention so that they would not be affected by shortages in funding. Detailed discussion of HIV/AIDS would follow under item 10 of the Agenda. However, it was clear that funding to countries had fallen from just over US$ 4 million in 1994-1995 allocated from the WHO Global Programme on AIDS to US$ 1.6 million in 1996-1997 allocated from the newly established UNAIDS. Nevertheless he was making every effort to collaborate closely with UNAIDS.
It had been suggested that if the management and control of new, emerging and re-emerging diseases were adopted as a seventh regional priority it might be appropriate to maintain the total at six by dropping one of the other priorities. If the Committee agreed, he would prefer to retain all of the original six priorities for the time being and the new priority. However, the eradication of
poliomyelitis and elimination of leprosy were making good progress, and in a couple of years time it might therefore be appropriate to drop control of those selected priority diseases as a priority. Referring to comments on collaboration with UNFPA :Inri UNICEF, he noted that a representative of UNFPA was present at the session and would no doubt transmit the concerns of representatives to his organization. He would continue to make every effort to collaborate closely with the two organizations for the benefit of Member States. He expressed appreciation for the additional voluntary contribution of US$ 150 000 received from the Republic of Korea in 1995, and welcomed the announcement made by that country's representative that a further voluntary contribution was anticipated. Since that country was abC'ut to join OECD he hoped that it would consider increasing its voluntary contributions still further. The CHAIRMAN requested the Rapporteurs to prepare appropriate draft resolutions on the proposed programme budget for 1998-1999 and on the closure of the WHO Western Pacific Environmental Health Centre. He also wished to record as a decision of the Committee the inclusion of a seventh regional priority, the management and control of new, emerging and re-emerging diseases (see decision WPRlRC47(2)).
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Turning to the method of work of the Committee, he recalled two changes related to the consideration of resolutions. As usual, draft resolutions would be circulated as Conference Papers. However, those would now be considered after the morning coffee break rather than at the beginning of the morning meeting to allow representatives sufficient time to consider them. That change had been initiated at the suggestion of a representative at the previous session of the Committee. The second change was that Rapporteurs would no longer read out the drafts; the Committee would proceed directly to discuss the text.
The meeting rose at 5.20 p.m.