(WPR/RC36/SR/5)
SUMMARY RECORD OF THE FIFTH MEETING WHO Conference Hall, Manila Wednesday, 18 September 1985, at 9 a.m. CHAIRMAN: Dr Terepai Haoate (Cook Islands) CONTENTS
1. 2.
Consideration of draft resolutions •••••••••.•••••••••••••••••• Correlation of the work of the World Health Assembly, the Executive Board and the Regional Co111Jlittee • • • • • • • • • • • • • • . • • . . • . • • . • . . . • . . . . . . . . . . . . . • .
146
152
2.1
Consideration of resolutions of the Thirty-eighth World Health Assembly and the Executive Board at its seventy-fifth and seventy-sixth sessions ••••••••••••• Consideration of the agenda of the seventy-seventh session of the Executive Board, the thirty-sixth session of the Regional Committee and the Thirty-ninth World Health Assembly ••••••••••••.•....•.••.•.•••••••.•••
152
2.2
155 155
3.
Guidelines for preparing a regional programme budget policy •••••••••••••••••••••••••••••••••••••••••••••••••
- 145 -
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1.
CONSIDERATION OF DRAFT RESOLUTIONS The Committee considered the following draft resolutions:
1.1
Report of the Regional Director
(Document WPR/RC36/Conf. Paper No. 1) was adopted without comment (see
Decision: The draft resolution resolution WPR/RC36.Rl). 1.2
Dr CHRISTMAS (New Zealand) said that, while the wording.appropriately conveyed the views of the Regional Committee, he would like to suggest a rearrangement of operative paragraph 1. From the health professional point of view, the order of priorities was perhaps correct, with surveillance and reporting of the disease being placed first. However, having heard the admirable presentation of the representative of Australia, he felt that priority should be given to informing and educating the public. He therefore proposed that subparagraphs (1) and (2) of operative paragraph 1 be transposed. Dr NG KWOK CHOY (Singapore) supported that proposal. attention to a typographical error in the spelling "lymphadenopathy" in the English text. He also drew of the word
Dr KHALID (Malaysia) supported the proposal made by the representative of New Zealand. There appeared to be a difference in meaning between the English and French texts of the second preambular paragraph. Listening to the English interpretation of the French text which had been read by the Rapporteur, he had understood the words "approximately 14 000 AIDS cases", whereas the English text read "more than 14 000 AIDS cases". The REGIONAL DIRECTOR said that in the French text the words "plus de" should be replaced by the word "environ", and in the English text the words "more than" should be replaced by the word "some". The new wording more accurately reflected current knowledge. Dr DEL ROSARIO (United States of America) suggested that, if data were available on the number of AIDS cases in the Western Pacific Region, they should be included in the resolution. He supported the proposal made by the representative of New Zealand. Further, since the media were probably partly responsible for the spread of panic that had occurred, it might be appropriate to include some reference to education of the media in the resolution. He presumed that the recommended activities of the Regional Office would be undertaken in collaboration with Headquarters and felt that some reference to that should also be included. 'Mr LECLERC (France) felt that the word "serious" 1.n the fourth preambular paragraph overemphasized the magnitude of the problem in the Region, perhaps affecting the psychological impact of the resolution.
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Dr TAPA (Tonga) • was satisfied with the arrangement of operative paragraph 1 as drafted. It was necessary to identify the disease before informing the public about it. However, if the arrangement was made, some editorial revision would be necessary, so that the name of the disease was given in full in eub-paragraph (1). The REGIONAL DIRECTOR, in answer to the point raised by the representative of France, said that the wording of both the French and English texts indicated that the disease might become a serious public health problem in the Region in the future. In Australia, the disease had become a serious problem in the relatively short period of one to two years, and Australia was not primarily a tourist country. In many other countries of the Region, the economy depended to some extent on tourism and it was felt that tourists might well introduce the disease, which might then become a serious public health problem. He felt that no change in wording was necessary. In sub-paragraph (l) of operative paragraph 2, the words "case management of LAV/HTLV-III infections" had a broader meaning than "le traitement des infections par LAV/HTLV-III". Some revision was necessary to bring the two versions into line. The current figure for the Region was 132 confirmed cases of AIDS, which would be included in the resolution. Dr DE SOUZA (Australia) agreed on the number of confirmed cases. He pointed out that there were also many hundreds of cases of lymphadenopathy syndrome (category B), a proportion of whom would develop the full condition over the next few years, so that use of the word "serious" in the fourth preambular paragraph was indeed appropriate. The REGIONAL DIRECTOR, in reply to the point made by the representative of the United States of America, said that a further sub-paragraph might be included in operative paragraph 2 to the effect that the Regional Director should collaborate in global activities. He would, of course, be making a report to the Executive Board in January 1986, in which he would present matters of importance raised by the Regional Committee. Dr DE SOUZA (Australia) felt that the important point about educating the media, raised by the representative of the United States of America, should also be included. It was perhaps more a question of seeking their cooperation in conveying the message in an unemotive, accurate and informed way, and he hoped that aome such wording might be incorporated 1n the resolution. The CHAIRMAN asked the Rapporteurs to revise the draft resolution in the light of the discussions and submit it for further consideration at a subsequent meeting. (For consideration of the revised draft resolution, see the seventh meeting, section 1.1).
1.3
on illllllunization Conf. Paper No. 3) Decision: The draft resolution was resolution WPR/RC36.R3). adopted without comment (see
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1.4
Pro ramme Document
of diarrhoeal diseases Paper No. 4 was adopted without comment (see
The draft resolution Dec is ion: resolution WPR/RC36.R4). 1.5
S ecial Pro ramme for Research Joint Coordinating Board Document The draft resolution Decision: resolution WPR/RCJ6.R5). was adopted without
Diseases; comment (see
1.6
Sub-Coaaittee on Trad1t1onal med1c1ne Decision: The draft resolution resolution WPR/RCJ6.R6). was adopted without
Countries: comment (see
1.7
of Work: Con£. word "problem" 1n the
Alcohol second the
Dr TAPA (Tonga) suggested that the preambular paragraph be put in the plural.
Dr BAYAN (Philippines), on behalf of the Rapporteurs, suggestion.
accepted
Dr DE SOUZA (Australia) thought that sub-paragraph (4) of operative paragraph 1 should mention encouraging the public to drink beer with a lower alcohol content as well as encouraging brewers to manufacture it. Dr HAN (Director, Programme Management) said that the Rapporteurs had considered that for WHO to encourage people to drink low-alcohol beer would be against its policy of advocating a reduction in alcohol consumption. Dr BAYAN (Philippines) thought they should mention in addition the use of alcohol-free alternatives to beer. Dr DE SOUZA (Australia) preferred a pragmatic appr<:'ach which would result in a reduced total intake of alcohol as had actually happened in Australia, rather than an attempt to stop people drinking alcohol at all, which gave rise to all kinds of conflicts with industry and the revenue authorities as well as being impossible to bring about in practice. The CHAIRMAN did not agree that stopping alcohol consumption was impossible since the group had seen societies in which non-alcoholic beverages were the rule. The problem before the Committee was where to put the emphasis. Dr CHRISTMAS (New Zealand), endorsing the comments of the representative of Australia, said that the public health problem arose from the total intake of alcohol, not from the beverage in which it was contained. Ideally there should be a move away from beverages that contained alcohol but the process was likely to take a long time. It had taken up to 25 years for antismoking campaigns to have an appreciable
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impact. Meanwhile, it would be reasonable to urge manufacturers to reduce the alcohol content of beverages; the public should at the same time be encouraged to choose alternatives. The resolution should therefore contain at least a phrase urging the community to reduce its alcohol intake. The DIRECTOR-GENERAL said that, although they had no scientific proof, he thought that 95% of people would not detect a difference in taste if the alcohol content of beer were reduced, even down to 1%. Perhaps studies should be undertaken to seek scientific evidence in that regard. It would be better for WHO to talk of low alcohol content than of lowering alcohol content; in a country he knew well there was beer with an 11% content of alcohol; to reduce it to 10% would not do much good. Dr WONG FAT (France) stated that the Rapporteurs had had two objectives in mind. The first was to encourage brewers to produce low-alcohol beers and the second to reduce driving while under the influence of alcohol. If implementation of the resolution produced results on both counts. they would have scored a major victory. Dr DE SOUZA (Australia) considered that, while traffic accidents as a result of driving under the influence of alcohol were obviously the most important category, a host of other types of accident were also due to a high alcohol level in the blood. It was for that reason that he had stressed the importance of reducing total alcohol intake. Dr SIALIS (Papua New Guinea) concurred. He hoped that his country would not see any extension of the alcohol-related problems that had begun to occur. Dr KRALID (Malaysia) agreed with the representative that the ultimate objective should be to reduce the alcohoL That particular objective was not compatible with manufacture and consumption of low-alcohol beer. With that in agreement with the general tenor of the draft resolution. of New Zealand consumption of advocacy of the proviso, he was
The DIRECTOR-GENERAL thought it essential that the resolution should take into account the case of countries where for religious, cultural or other reasons the consumption of alcohol was totally inadmissible. The distinguished representative of Australia could perhaps be asked to find suitable wording. Mr TIXIER (Cook Islands) considered that emphasis should be placed on operative paragraph 1, sub-paragraph (2). It was human beings who had to be influenced and human behaviour which had to be changed. Mr MAETIA (Solomon Islands) said that alcohol abuse had caused serious social and moral problems in his country. The Government had been contemplating doubling or tripling import duties in an attempt to discourage drinking but the real solution was to condemn it strongly and educate people in regard to its dangers. Individuals should then be left to make their own choice of high or low alcohol content in full knowledge of the facts. Dr BIUMAIWAI (Fiji) said that there had been an unpublicized voluntary lowering of the alcohol content of beer in Fiji about three years before and most drinkers had not noticed the fJlct. A factor that should be
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mentioned publicity sporting banned or
in sub-paragraph (4) of the first operative paragraph was the for alcoholic beverages generated by the sponsorship of televised activities by alcohol manufacturers, which should perhaps be reduced.
Dr TAPA (Tonga) recalled that the Sub-Committee•s report had mentioned the development and promotion of alternatives to alcohol, but no reference to the subject appeared in the draft resolution. He proposed adding at the end of sub-pJragraph (2) of the first operative paragraph 11 and the development and promotion of alternatives to a lcohol 11 • He thought also that it would be wrong to encourage the drinking of beer, even if it had a low alcohol content, and therefore suggested adding at the end of sub-paragraph (4) of the first operative paragraph the words 11 and to discourage the drinking of any beer". Dr DEL ROSARIO (United States of America) wondered whether drink-driving 11 was the same as 11drunk-driving 11 • The question of the alcohol content of beverages was for business to decide on the basis of the laws of supply and demand. In view of the controversy it was arousing, the sub-paragraph should perhaps be omitted. 11
Dr DE SOUZA (Australia) said that all the fine words uttered over many years about reducing alcohol consumption had not produced any result. In Australia, however, the laudable cooperation of the brewers with the Government in lowering the alcohol content of beer had for the first time led to a decrease in alcohol consumption. The cause-and-effect relationship had been reliably demonstrated. That was what led him to advocate the pragmatic approach, which worked, rather than more fine words, which would not. The CHAIRMAN considered that, in view of the fact that education and posters calling attention to the danger of lung cancer had successfully reduced the number of smokers, the same could be done in regard to alcohol. Dr SIALIS (Papua New Guinea) thought that as much money should be spent on advertising health as was spent by the manufacturers in promoting the sales of tobacco and alcohol. The REGIONAL DIRECTOR said there were differences between the smoking and alcohol problems. Smoking was definitely and provenly harmful·· to the health of all smokers and of others. The use of alcoholic beverages had a very long history and the problems varied from country to country. In the South Pacific, many people had never been exposed to alcohol at all unti 1 very recently. For Australia, as a predominantly beer-drinking country, it made sense to act by reducing the alcohol content of beer. In a wine-drinking country it would be more effective to reduce that of wine. The CoDIDittee was discussing the problems of the Western Pacific Region. Those of the South Pacific, Australia, New Zealand and to some extent South-east Asia were largely due to beer, which was why the Australian representative had laid such emphasis on promoting low-alcohol beer. The important thing was to reduce alcohol intake and at the same time promote the consumption of non-alcoholic beverages. A pragmatic solution was called for.
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151
Dr DE SOUZA (Australia) invited the Committee to give ita reactions to two possible amendments that reflected points made in the discussion. First, operative paragraph 1(4) might be replaced by wording along the following lines: "to note that in some countries where the production and consumption of alcohol is legal, reduction of alcohol content in certain beverages, e.g. beer, baa had a aeasure of success in reducing total alcohol consumption". A new operative paragraph 1(5) would then be added as follows: "to encourage reduction of the intake of alcohol and, where appropriate, to seek the cooperation of industry in substantially reducing the alcohol content of beer (or of alcoholic beverages)". Those amendments reflected four points: that the measures suggested did not apply to some countries; that some countries, including his own, had achieved a clear measure of success in reducing overall consumption by reducing alcohol content; that the intake of alcohol should be reduced; and that, where appropriate, industry' • cooperation should be sought. If the CoDDDittee agreed, he and the Rapporteurs might prepare a revised text on that basis. Mr MAETIA (Solomon Islands) confessed to being somewhat confused as to the role and objectives of WHO in the alcohol issue. In his country, alcohol was the doorway to many other diseases, particularly sexually transmitted diseases, and could be a serious problem among young people. Unless consumption was reduced, AIDS too would spread if it arrived. Alcohol also affected the crime and accident rates, and caused social problems. He urged the Committee to take a stand from the health viewpoint, not the consumers' or the economic viewpoint. Dr DEL ROSARIO (United States of America} took it that the earlier Regional Coumittee resolutions cited in the present draft dealt with the concerns expressed by the Solomon Islands representative. In the United States, industry had not lowered the alcohol content of beer because of the urging of the health authorities but because it had found a large market for a product the public liked; the result had been a reduction in total alcohol consumption. In general, he agreed with the two Australian amendments. Something might be added on health education to discourage abuse of alcohol and on the prevention of drunken driving through such organizations as IDOthers' and students' clubs. Dr PHAK SONG (Viet Nam) considered that WHO's role was essentially one of promotion. He supported the draft resolution, which left it to Member States to take the necessary initiatives in the light of their own economic and social conditions. Dr TIXIER {Cook Islands) supported the draft resolution as amended by the Australian representative. Dr CAT! (Kiribati) said that alcohol and drug abuse was a recognized problem that had also affected his country. The Collllllittee was evidently discussing two different aspects: the developed countries' proposals and those of the saaaller countries. He agreed with the Viet Nam representative's remarks, and supported the draft resolution as now amended by Australia.
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Dr CHRISTMAS (New Ze4land) concurred with the Kiribati representative. Dr FURUICHI (Japan) said that the consumption of alcohol in his country had increased in recent years, especially among young people and housewives - the so-called "kitchen drinkers". Accordingly, the Ministry of Health and Welfare had established a foundation to promote a reasonable manner of drinking alcohol. The Ministry was also looking into the question of autoaatic distributors, which made alcoholic drinks very easy to obtain in Japan. Dr KHALID (Malaysia) suggested that, in view of the general agreement with the Australian proposals, the Rapporteurs should prepare a revised text with the help of a few representatives. Mrs TORRES (Philippines) supported the Australian amendments. However, she considered that "beer" should not be singled out, and that the text should refer to "alcoholic drinks" in general. The CHAIRMAN asked the Rapporteurs, together with the representatives of Australia, Malaysia, Solomon Islands and the United States of America, to draw up a revised draft resolution in the light of the Commit tee • s comments. (For consideration of the revised draft resolution, see the seventh meeting, section 1.2). 1.8
ear 2000 Decision: The draft resolution resolution WPR/RC36.R8). was adopted without comment (see
1.9
and Vaccines Decision: The draft resolution resolution WPR/RC36.R9). was adopted without comment (see
2. 2.1
CORRELATION OF THE WORK OF THE WORLD HEALTH ASSEMBLY, THE EXECUTIVE BOARD AND TH.E REGIONAL COMMITTEE: Item 14 of the Agenda Assembly sevent -sixth
The REGIONAL DIRECTOR said that document WPR/RC36/8 contained resolutions adopted by the Thirty-eighth World Health Assembly and the Executive Board at its seventy-fifth session which were considered to be of significance for the Western Pacific Region. A number of other resolutions had been adopted by the Health Assembly, which needed to be brought to the attention of the Committee. Those resolutions were related to other items of the agenda and were being considered as each item was discussed. The Committee would wish to consider each resolution separately.
SUMMARY RECORD OF THE FIFTH MEETING
153
2.1.1
Re$olution WHA38.14 -Number of members of the Executive Board
The REGIONAL DIRECTOR said that in 1984 the Regional Committee had adopted resolution WPR/RC35.Rl0 recommending that the Executive Board and, through it, the World Health Assembly should examine the possibility of increasing from three to four the number of members from the Western Pacific Region entitled to designate a member of the Executive Board. After consideration of the two distinct elements justifying that proposal the recent increase in the number of Member States of the Western Pacific Region on the one hand and the size of the population of the Region on the other - the Health Assembly had adopted resolution WHA38.14 recognizing the need to increase the number of members from the Western Pacific Region. However, increasing the membership of the Executive Board was not a simple matter as it involved an amendment to the Constitution and, for that amendment to come into force, it would have to be ratified by two-thirds of the Member States of the Organization. It was obvious, therefore, that, if they were to achieve success, laborious lobbying on the part of the Member States of the Region would be required. Dr KOINUMA (Japan) said that it was not surprising that the role of the Region in WHO activities had increased considerably in recent years, since the Region covered such a vast area and had such a huge population. The number of Member States in the Region had also grown following the entry of several island states in the Pacific to membership of the Organization. His delegation considered the number of seats for the Region on the Executive Board was unreasonably small in relation to the number of its Member States, as well as to the size of its population. He was not pressing for any dra1tic changes in the present structure of the Board, nor for any new criteria for membership, but simply for an increase in the number of seats on the Board from 31 to 32. It was important that the Committee should take fully into consideration resolution WHA38.14, which had been adopted without any objection in May of that year, and should take the necessary steps to enable Articles 24 and 25 of the Constitution to be amended as soon as possible. Dr LIU XIRONG (China) endorsed the views expressed by the Japanese representative. All Member States were united in the desire for the number of Members of the Executive Board to be increased to 32. The Health Assembly was considering the matter, but certain procedures still needed to be completed. He urged the Regional Office to press for the completion of those procedures so that the desired change could be made. Dr KHALID (Malaysia) said that one hurdle had been cleared, but two still remained. The draft amendments to the Constitution would have to be referred back to the Health Assembly at ita next session; once those amendments had been approved, they would have to be ratified by the individual countries concerned. He urged Mamber States to continue their efforts so that ratification could take place with the minimum delay, and the changes in Board membership could come into effect as soon as 'possible.
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2.1.2
Resolution WHA38.18 - Prevention of disability and rehabilitation of the disabled
The REGIONAL DIRECTOR drew attention to operative paragraph 1. There were no comments. 2.1.3
Resolution WHA38.21 - Maintenance of national health budgets at a level compatible with attainment of the objective of health for all by the year 2000
The REGIONAL DIRECTOR drew attention to operative paragraph 1. There were no comments.
2.1.4
Resolution WHA38.22 - Maturity before childbearing and promotion of responsible parenthood The REGIONAL DIRECTOR drew attention to operative paragraph 1. There were no comments.
2.1.5
WHA38. 30 Resolution noncommunicable diseases
Prevention
and
control
of
chronic
The REGIONAL DIRECTOR drew attention to operative paragraph 2. Dr DEL ROSARIO (United States of America) wished to reiterate his Government's interest in exchanging information with Member States, and in discussing possible training opportunities in regard to the subject under consideration. 2.1.6 Resolution WHA38.31 Collaboration with nongovernmental organizations in implementing the global strategy for health for all
The REGIONAL DIRECTOR drew attention to operative paragraph 5 requesting the regional committees to consider ways and means of strengthening the involvement of national and regional nongovernmental organizations in the implementation of regional and national strategies for health for all. The Committee might wish to take note of the recommendations made in resolution WHA38.31. Dr KHALID (Malaysia) noted that the resolution contained a specific request to regional committees to consider ways and means of strengthening the involvement of nongovernmental organizations in the implementation of strategies. Since there was not time at the present session to discuss that question, he suggested that it be referred to the Sub-C01DIDittee on Programmes and Technical Cooperation, which could then report back to the Committee's next session. Dr TAPA (Tonga) urged that, whether the matter was referred to the Sub-Committee or placed on the agenda of the Committee itself, some specific action should be taken.
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155
The REGIONAL DIRECTOR said that the Director of Prograrmne Management would be holding a meeting within the next few days, at which it would be decided whether the Sub-Committee would handle the question, or whether the Secretariat would make a study of it with a view to its inclusion as a separate item on the agenda of the Committee's next session. The CHAIRMAN asked the Rapporteurs to prepare an appropriate draft resolution. (For consideration of the draft resolution, see the seventh meeting, section 1.3). 2. 2 Consideration of the agenda of the seventy-seventh session of the Executive Board, the thirty-sixth session of the Regional Committee and the Thirt}-ninth World Health Assembly: Item 14.2 of the Agenda (Document WPR RC36/9)
The REGIONAL DIRECTOR said that he had reported for a number of years on the correlation between the work of the Regional Committee, the Executive Board and its Prograaae Co11111ittee, and the World Health Assembly. At the current session, not only was the Regional Committee again taking the lead in introducing issues which might need to be discussed in the governing bodies of the Organization, such as urban primary health care and new strategies in education for the twenty-first century, but it was also discussing from an informal point of view issues that would be discussed in the global forums. The Programme Committee of the Executive Board would discuss, among other things, the public health problem of AIDS. The Member of the Executive Board designated by Australia, together with himself as Regional Director, would attend the meeting in question. In the absence of co11111ents, the CHAIRMAN asked the Rapporteurs to prepare an appropriate draft resolution. (For consideration of the draft resolution, see the seventh meeting, section 1.4). 3. GUIDELINES FOR PREPARING A REGIONAL PROGRAMME BUDGET POLICY: Item 15 of the Agenda (Documents WPR/RC36/10 and WPR/RC36/10 Add.l)
The REGIONAL DIRECTOR observed that, with barely fifteen years left before the year 2000, increasing concern had been expressed by the Director-General, some members of the Executive Board and some delegates to the World Health Assembly regarding the need to ensure that WHO's resources were carefully allocated to supporting Member States in achieving the goal of health for all by the year 2000. The use of WHO's resources in countries and the related support from the regional level had been given particular attention in view of their overriding importance, such resources comprising almost 70% of the total WHO regular budget. The discussions on that issue at the seventy-fifth session of the Executive Board in January 1985 and the Thirty-eighth World Health Assembly in May 1985 had led to the adoption of resolution EB75.R7, requesting regional committees to prepare regional progr&Jae budget policies, and to resolution WHA38.ll indicating the Health Assembly's strong support of the Board's request. Two documents had been prepared for the Regional CoDDIIittee for its consideration of the issue. The main document, WPR/RC36/10, contained the guidelines for preparing a regional programme budget policy and had been
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formulated by the Secretariat to serve as a frame of reference in order to facilitate preparation by the regional coiiiDittees of such policies. However, to facilitate the diacueaions, an executive suiDID8ry had been prepared. There was nothing really new in the proposed guidelines, which were a systeutic cQnaolidation of existing policies collectively agreed upon by Member States in WHO's governing bodies through the years. The Regional COallllittee wae requested to prepare the proposed 1988-1989 regional prQgra~ae budget and subsequent prograDIIle budget proposals in accordance w~th that policy. Althoqg~ it was realized that simultaneous preparation o~ the 1988-1989 pr()gi'a..mebudget and regional programme budget policy might perhaps pose eoae · practical difficulties, no real conflict was foreseen in pu~auing those action:8 in p, a rallel. · The views of the Regional Cqagit.tee were requested on how it wished to proceed with the development of the regional programme budget policy for the Region. Qne alternative was for · the Committee to adopt the guidelines as they were, with appropriate modifications to reflect regional priorities and other regional considerations; another alternative would be for the Committee to prepare a regional prograDIIle budget policy using the guidelines only · as a basis. · Whatever alternative the Committee chose, it would have to consider the question of how much detail it wished the policy to go into. While a detailed programme budget policy might have the advantage of being comprehensive, it might not offer as much flexibility 1.n implementation as that of a policy written in more general terms. The Regional Director said that the Committee might also wish to consider assigning to its Sub-Committee on Programmes and Technical Cooperation the work relating to preparation of the regional programme budget policy, which would receive the full support of the Secretariat. With regard to the proposal for monitoring the use of WHO's resources through financial audit in policy and programme terms, the Regional Director said that the audit, which would in no way replace existing financial auditing practice, would identify how, and on the basis of what policy and by whom decisions and expenditures had been planned and decided upon. Even before the proposal came to light, the Regional Office had already taken ~teps to strengthen its programming process, both during the development stage and during implementation. There were well-established mechanisms for reviewing proposals for WHO cooperation received from Member States. In the course of implementation, programme budget monitoring had been strengthened through more effective use of programme budget information systems, computerized project implementation monitoring and periodic reviews of the programme at various levels. The Secretariat was continuing to expl()re ways 'of further strengthening the monitoring process. in DEL ROSAJUO {United St4tes of America) said that his delegation strongly supported the ideas behind the regional programme policy as stated.
Dr CHRISTMAS (New Zealand) · said that he had found it extremely difficult to underst~nd the precise intentions and direction of the guidelines, and he welcomed the Secretariat's clear, concise and readable
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interpretation. It was asking much of those representatives who had English as their second language to expect them to make sense of the guidelines as written. He urged those preparing such papers in future to draft them in such a way that they could be easily absorbed. After substantial reading and analysis, he had reached the conclusion that the guidelines were an effort on the part of those involved in the administration of the global funds to ensure that they were being used effectively. He commended the Secretariat on the reasonable solution it had proposed, but his first reaction to the proposal had been that a cold analytical appraisal of a support service that was an essential requirement of the Organization was being embarked upon. He had some difficulty in accepting the idea that joint accounting could be an "enjoyable venture". The process would have to be handled S)1Dpathetically and sensibly. The audit should be carried out on a cooperative basis and he welcomed the suggestion that nationals should be included in the group. Unless it was handled in that manner, the approach would be an impersonal and unsympathetic one. The use of funds must certainly be examined analytically, and that would probably be the responsibility of the amalgamated Sub-Committee. The needs of national agencies for support and the need for a sensitive and helpful approach should be borne in mind. Dr KOINUMA (Japan) expressed his delegation's strong support for the preparation of a regional prograllllle budget policy. In the light of the need for efficient and effective use of WHO's limited resources and bearing in mind that the amounts directly allocated to countries accounted for the greater part of the regional allocation, the preparation of regional programme budget policies in accordance with the guidelines would facilitate the optimum use of resources and development of the most efficient health-for-all strategy. His delegation considered the issue extremely important, and it hoped that its country could contribute to the discussion in the amalgamated Sub-Committee. Dr TAPA (Tonga) said that his delegation supported the establishment of a regional prograiiiDe budget policy. As observed in section V of the executive summary (DG0/85.1), there was nothing really new in such a policy, which was rather a systematic consolidation of policies that had been approved by WHO's governing bodies. The aim. as set forth in section I of the same summary, was to enable Member States to make the best possible use of WHO's resources for health development in their country. and in particular for their policy and strategy for health for all by the year 2000. Since all countries of the Region were committed to the primary health care strategy and the goal of health for all by the year 2000. the exercise should be attempted, and he supported the suggestion that the amalgamated Sub-Committee on Programmes and Technical Cooperation should undertake it. The REGIONAL DIRECTOR. replying to the rep-resentative of New Zealand. said that the regional Secretariat had also h~d difficulty in understanding the guidelines. Similar difficulties had been experienced by some Members of the Executive Board and delegates to the Health Assembly. Nevertheless, the principle behind the guidelines was fully justifiable and should be followed, particularly since 70% of WHO's resources were devoted to country
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activities, and all Member States participating in WHO's work, particularly the major contributors, were concerned about the optimum and rational use of resources at the country level. Most representatives appeared to share the view that the amalgamated Sub-CoiiiDittee should be responsible for examining the regional programme budget policy. No opinion had yet been given as to whether it was better to have a detailed regional programme policy or some general guidelines that would allow flexibility. Members of the Regional Committee might wish to give their views on the matter, or it might alternatively be referred to the amalgamated Sub-Committee for consideration. Dr CHOLLAT-TRAQUET (Man•gerial Process for WHO's Programme Development, WHO, Geneva), replying to the point raised by the representative of New Zealand concerning the need for cooperative auditing, said that the exercise in question was not really an audit of accounts in the traditional meaning of the term but was rather a matter of checking regionally that the WHO funds expended were used for the support of national prograllllles according to the guidelines adopted by the Regional Committee or the World Health Assembly. In undertaking the exercise for the first time, WHO would base itself on the practice of the other major international agencies. The Regional Director for Europe had agreed that the idea should be tested first in the European Region. It would then be tried out in the African Region and the Americas.
The meeting rose at noon.