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REPORT OF THE REnIONAL COMMITl'EE
33 .ANNEX 3
REPORT OF THE SUB-COMMITTEE ON PROGRAMME AND BUDGET 1 1.1
INTRODUCTION At its seventh session, the Regional COmmittee, in resolution
WP/RCJ7. Fri', decided ''that the establishment of a sub-committee on programme and budget, consisting of six members plus the Chairman of the Regional Committee, should become a routine activity of the Regional Committee"; and recommended that lithe membership of this sub-committee be rotated among the Representatives of various members, subject to the provision that any Representative desiring to be a member of the sub-committee should be entitled to participate". The Sub-Committee on Programme and Budget met on 14 and 18 September 1961, under the chairmanship of Dr C. K. Chang (China). ,fas as follows: Members in accordance with the principle of rotation Australia Dr H.E. Downes Dr J. S. Boxal1 Mr G.N. Bilney Dr E.S. Stuckey Dr T. C. Hsu Dr T.S. Chen Dr K. Y. Fan Mr The
attendance
China
Japan New Zealand Republic of Korea United Kingdom Viet-Nam
K. Watanabe
Dr C.N.D. Taylor Dr Kyong Shik Chang Mr Chang Souk Kim Dr C.H. Gurd Dr S. Tapa Dr
r.e
NOOn Thuan
REGIONAL COMMITl'EE: EIGHTEENTH SESSION
-,
Other members of the Committee also in attendance lTere: Country Portugal Singapore United States of America Dr J. B. Pinheira
Dr F. 16tias Dr C. Lim Kim loan
Mrs. S. Baharuddin Dr R. K. C. Lee Dr J.E. Banta Dr J.K. Shafer
1.2 In the course of its meetings, the Sub-Committee examined the proposed programme and budget estimates in accordance with the guidelines on page 48. 2 REGULAR PROGRAM>1E AND BUOOET ESTIMATES
2.1
Level of the proposed programme and budget estimates for 1969 The
Sub-Committee noted that the level of operations proposed for
the Region under the regular budget in 1969 amounted to approximately ~4.85
million, an increase of
~l
600, or 10.5i over 1968.
Of this
amount, a little over $528 000 had been allocated to the Regional. Office and approximately $4.33 million to the field programme. 2.2 Programme aspects In introducing the programme and budget estimates, the Regional
-l
Director drevl attention to the following aspects. 2.2.1 National health planning had been e~hasized
on many occasions
by the Executive Board, the World Health Assembly and during meetings of this regional committee. As feu people had had experience in this
field, provision had been made for a regional training programme for key national staff, so that as many senior public health administrators as possible could have an opportunity of obtaining the lmowledge required.
REP9BT OF THE REGIONAL COMMITTEE
35
Provision had. also been made for an inter-country adviser in national health planning. Pending the establishment of this post and in order
not to lose time, a senior staff member in the Regional Office had been assigned a major responsibility in this field. activities for some years to come. 2.2.2 The delays encountered in some of the malaria pre-eradication programmes as a result of the lacl;: of basic rural health services to maintain and consolidate achievements had focused attention on the urgent need .t-
These v[ould be continuing
to develop an effective and integrated health structure.
The staffing
pattern of the Regional Office had been revised to include an adviser in community health services. One of his first responsibilities would be to
achieve the closer co-ordination of community health and malaria programmes. 2.2.) An important component of the education and training programme was the continuation of assistance towards improving the standard of teaching in medical schools. A notable trend was the replacement of long-term
project staff by consultants .Tho would be called upon to advise on specific problems or on particular aspects of a teaching programme. The
practice of awarding long-term fellolTships for the training abroad of faculty members would be continued. ~dical
schools in the Region which
would benefit from WHO's advisory services and fellovTship programme in 1969 included the Faculty of Medicine, University of Malayaj the School of Medicine, LaOSj the University of Singapore and the University of Viet-Nam. A travelling seminar on medical education vTOuld afford an
Hue,
opportunity for the deans of medical schools to visit several neighbouring countries for the purpose of studying new developments and current trends, as well as existing problems in medical education in the Region.
REGIONAL COMMITTEE: EIGll!L'EENTH SESSION
--,
Another important activity was a project designed to evaluate the regional fellol,ship programme. 2.2.4 Increasing pressure on future hospital expenditures was expected
due to economic, social and scientific factors influencing health services in the developing countries. Ivays and means must be devised to keep this With the appointment of the new
pressure within practical requirements.
regional adviser in medical care, it vTas believed that the future would see an expanded programme in this field. 2.2.5 The need to strengthen health laboratory services, not only to provide the necessary laboratory support for epidemiological work and to improve medical care but also for vaccine production, vTaS
evident.
The post of regional health laboratory services adviser had been included in the 1969 proposals and following this appointment it was hoped that a stronger programme and more effective epidemiological services would develop. 2.2.6 Now that interest had been aroused in nutrition activities, an A
increasing number of requests ,.;ere being received for assistance.
number of applied nutrition programmes were developing, mainly in the rural areas, in co-operation with FAO and UNICEF. Urban nutrition was
being emphasized and the considered approach covered nutrition education and supplementary feeding activities} food technology and processing and. food hygiene and sanitation. The
further development of permanent
nutrition centres or institutes vras planned. 2.2.7 In the field of communicable disease control, provision had
been made for consultants to assist countries in the production of freeze-d.ried smallpox vaccine and for fellowships to train national
REPORT OF' THE REGIONAL COMMI':roiE
'57
staff in the clinical diagnosis of cases.
In view of the increasing
number of cases of haemorrhagic fever and Japanese encephalitis in some countries, a seminar on mosquito-transmitted virus diseases had been included. Apart from the assistance being provided to a number of
national tuberculosis programmes, a refresher course was planned for medical officers in the South Pacific and a regional training course for lcey personnel responsible for the planning and execution of national programmes. A symposium on BCG vaccine production had also been included.
The last one had been held in 1959 and. 1969 would appear to be an appropriate year to discuss again production problems and quality control. 2.2.8 By 1969, almost every developing country in the Region would
have an environmental health programme receiving WHO assistance.
Needs
were growing faster than the ability of governments to satisfy them. This had emphasized the ·importance of making plans for the construction of >laterworks and sewerage systems for which financing agencies might be >Tilling to provide loans. Included in the programme proposals was
an inter-country adviser who would assist governments to prepare such plans. 2.2.9 There .rere no proposals in the regular programme and budget
covering occupational health and the control of pharmaceutical substances, both very important from the point of view of social and economic development. National economic planning bodies might well consider projects
in these fields suitable for inclusion in their requests to the United Nations Development Programme. 2.3 SUpplementary List The Sub-Committee was informed. that as the total requests received from Member governments exceeded the regular budget allocation proposed
38
REDIONAL COMMI'l"l'EE: EIGHrEENTH SESSION
by the. Director-General for this region. certain requests had had to be re~egated
to the
Supp~ementary
List (additional projects requested by
governments and not included in the proposed programme and budget estimates) for possible implementation if savings became available. These additional projects totalled. almost $842 000. 2.4 Discussion 2.4.1 General 2.4.1.1 The Representative of China referred to the resolution adopted at the Twentieth World Health Assembly requesting the Director-General to increase assistance to developing countries whose financial requirements exceeded their resources for meeting their basic health needs. The Director-General explained that there was a resolution of the Health Assembly asking him to study the possibility of' changing the Organization I s policy and to report on the matter to the Elcecutive Board and the next Assembly. There could be no change until the Board and the
Assembly had considered the question. 2.4.1.2 The Representative of Japan drew attention to the number of requests or components of requests which could not be accommodated in the proposed allocation and had been placed in the Supplementary List. He understood that the magnitude of the increase suggested by the World Health Assembly for 1969 was about
9%. He wished to Imow whether the
Regional Director. on receiving the target allocation for this region and realizing that it was not enough. could request the Director-General for an increase. The Director-General stated that the Constitution of l'iHO gave to the Director-General and only to him. the responsibility to propose
•
REPORT OF THE RIDIONAL COMMCl'rEE
39
the programme and budget of the Organization to the Ilorld Health Assembly. The Executive Board could not change the proposals of the Director-General, it could make
recommendations.
One of the functions of the Regional The Regional
Committee was to study the proposed programme for the Region.
Committee's views were submitted to the Director-General as recommendations concerning both programme and budget estimates. The Assembly last year had approved a resolution giving an order of
magnitude as an orientation for the preparation of the budget for 1969. .'-
This was only an orientation because one Health Assembly could not commit the next. The order of magnitude for 1969 was 9%.
ActuaJ.ly the Director-
GeneraJ. had suggested that 10-12'% llould be a reasonable increase but the proposal tabled was 7% and thiS, after a long discussion, became 9%. In making an allocation to each region, he had taken into consideration this recommendation of the Assembly. had received more than a
This meant that some regions The increase for
9%
increase and others less.
Headquarters activities had been cut to a minimum.
He had allocated
10.5% to the Ilestern Pacific.
The RegionaJ. Directors, with whom he had
discussed this subject, were aware of the difficulties in making aJ.locations to the Regions. malre
The RegionaJ. Committee was completely free to
recommendations for a larger allocation to the Region.
He would
only wish to remind it, that if all RegionaJ. Committees made the same plea, the increase in the global budget would become a great deal higher than
9%. The Representative of the United states of America enquired
•
2.4.1.3
whether the reallocation of unexpended funds was controlled by the
•
Regional Director, whether they iTere
g1ven
back to the Member country
concerned, or distributed to other countries.
40
The Regional Director stated that it was a regular budgetary practice to take into account d.elays in filling new posts. Based on past averages If
a delay of four months was applied to every new post.
the filling of
a post was delayed beyond four months, the funds saved could be used to iMplement some of the activities requested by governments and which had been placed in the Supplementary List. 2.4.1.4 The RepresentatiVe of Australia stated that his delegation
would like to see a higher figUre than 10.5% being allocated. to the Ivestern Pacific Region as long as the increase in the overall programme and budget estimates was not greater than 2.4.1.5 9~.
The Representative of the United States of America drew atten-
tion to the substantial differences in the amounts sho,m for various items llhen comparing the 1968 and 1969 regional budget proposals. For
example, in the 1968 budget document reviewed last year, the total had been $3 891 660 for field projects. for 1968 was given as $4 007 000. In the present document, the total
His delegation wished to know whether
these changes were made in Geneva or by the Regional Director and hOll they llere determined. in tl~
It also wished to draw attention to the fact that
summary, there was a communicable disease heading, which was not
in last year's document. The Director-General informed the Sub-Committee that the Representative of the United States of America had attempted to compare two documents which were not readily comparable. The programme and budget
recommendations of the Regional Committee were taken into account by the Director-General, but were subject to necessary budgetary modifications llhen he prepared the programme and budget estimates for the
•
•
REPORT OF THE REGIONAL
COMMI'l'.l'~
41
Orgunization as a whole for presentation to the Executive Board and the Health Assembly. Since last year, the Executive Board had asked for a reclassification of main subject headings and this had resulted in certain changes. example, the heading "communicable diseases II did not appear in the For
•
previous budget document.
These changes added to the difficulties in
attempting to compare the two documents. The Director-General also wished to make it clear that the World Health Assembly did not actually a~prove
projects.
It only reviewed
the proposed programme and approved the appropriation resolution which usually contained about nine lines) as shovln in the Official Record containing the Director-General's proposed programme and budget estimates for a given year. The proposed programme was contained in the annexes This gave
which did not require any specific approval by the Assembly.
the Director-General and the Regional Directors flexibility in making r ~.
_
programme changes during the implementation year in order to meet the needs of Members. 2.4.1.6
•
The Representative of the United States of America asked
vhether the Regional Director had any criteria for dealing with requests for fellowships from Member governments, whether a high priority was given to countries that needed fellOWship support and not to those that had good training facilities, and. iThether consideration was being given to the developing countries. The Regional Director stated that priority was given to requests for fellowships connected .lith active projects because these were for the training of staff who ,Tould eventually replace the international -~
42
staff.
As far as requests for fello"ships not connected >lith projects
were concerned, a decision as to \fhich of these deserved priority was made after consultation with the regional advisers countries and the WHO representative concerned. 2.4.1.7 The Representative of the United Kingdom considered that the ~rho
had visited these
discussion of the proposed programme and budget estimates might be facilitated if the Regional Director were to omplify the introduction or to provide some supplementary notes on how the budget vas established and on any major alterations or rearrangement of subject headings so that Members could be better informed before the actual discussions took place. Australia. This proposal was sup)?orted by the Representative of
The Regional Director agreed to provide this information in the future. 2.4.2 Regional Office
The SUb-Committee noted that of the fifty-four professional posts in the Regional Office in 1967, none was vacant. 2.4.3 Regional Advisers and WHO Representatives
•
2.4.3.1 The Representative of the United States of America asked what criteria the Regional Director used in determining which countries should have a WHO representative. He noted that their number had
increased through the years and asl.ad if the Regional Director
had a
long-range plan for such posts and "hether more would be created in the future. He believed that the HHO representatives were not as
important as the specialized advisers needed in the Regional Office. The Regional Director said there had been no increase during the last few years and there was no plan to increase the number of posts
REPORT OF THE REGIONAL COMMrTTEE
in the foreseeable future. stationed in Fij~
There vere seven WHO representatives: one
who also covered the entire South Pacific area; one
stationed in China (Taiwan), who also covered Japan, Hong Kong, Macao, Guam, the United States Trust Territories in the Pacific and the Ryukyus, in addition to China (Taivan) j and one in M:l.laysia, \Tho covered East and West Malaysia, Singapore and Brunei. Cambodia, Laos, the Republic of
Korea and Viet-Nam each had a representative. The Representative of the United Kingdom supported the maintenance of the posts of \iHO representatives, as he considered they were essential in a structure of an organization such as WHO. the structure incomplete. Their absence wouldma.ke
The IlHO representatives provided very capable
representation at all levels of government and they had also an impOrtant role to play in co-ordination.
2.4.).2 The Representative of China called the attention of the Regional Director to the question of duty travel for the regional
, "
>.
advisers.
He noted that only a slight increase was proposed for 1969.
He considered that provision for the travel of regional advisers should be greater to allow them to carry out their functions efficiently. The
Regional Director stated that if a field visit was consid.ered The amount budgetted
essential, money would be found for this purpose.
for duty travel between 1967 and 1969 had been increased by $12 000 in order to accommodate as many requests for technical assistance from the regional advisers as possible. 2.4.1~
Country Projects The
Representative of the United States of America aslred whether
I-lHO uould be involved in the operation of the project in the Philippines
44
REGIONAL COMMITXEE: EIG:aTEENTH SESSION
,
entitled "a master plan for a se,rerage system for the M9.nila metropolitan area". The Regional Director explained that this ,TaS
a Special Fund
project to which WHO assigned a "Project Manager". would undertake the preparation of 11
A consultant firm IThen this had been
master plan.
developed, and this would probably talre two years, the Government would have a plan which could be utilized in obtaining a loan from, say, the Asian Development Bank or the "I{orld Bank. have an operational role in the project. 2.4.5 2.4.5.1 Inter-Country Programmes The Representative of the United States of America thought that e~gensive
,. -,
\-IHO did not, and would not,
some of the inter-country advisory teams might be very
and
that the money thus spent might be used to give a different kind of support to Member countries. The
Regional Director was requested to provide
information on the type of services rendered and how long these teams were stationed in a specific area. The Regional Director gave as an example the tuberculosis advisory team, which had been established some years ago with no fixed duty station unless members were to spend more than six months in one place. The team
"
had five members who were assigned either as an entire team, or as part of a team or individually depending on the requirements of a country. Their length of stay varied considerably. They could be in one place from two to eight months or even slightly longer. The objective of
their assignment was to assist the national tuberculosis control programme in prevalence surveys, in training, or in the laboratory or statistical aspects of the programme. They were bound by a schedule
which had to be presented to him for approval in advance.
REPORT OF THE REGIONAL COMMITTEE
The
maternal and child health and. environmental health advisory teams Many of the territories in the South Pacific had
were both based in Suva.
rather small populations and it vas not economical to assign a full team to each territory. Worlcing as inter-country advisory teams, they could
go from one territory to another, spending three to six months in each place starting programmes or assisting in training and returning again possibly in the following year. The high incidence of communicable diseases
and \Tater-borne infections and the efforts being directed towards the development of basic health services, using maternal and. child health as a spearhead, emPhasized the imil0rtance of these tuo teams. 2.4.5.2 The Representative of China referred to the increasing problem of Japanese encephalitis and asked if the Regional Office had plans to include an inter-country epidemiologist or virologist to carry out work in this field. The Regional Director informed the Sub-Committee that IlliO Head-
..,
quarters had agreed to assign a team to study the various aspects of encephalitis. The original proposal lias that this team vTOuld be based
either in the Republic of Korea or in China (Taiwan).
Because of the
groYing importance of this disease, he had suggested to Headquarters that it might possibly consider assigning tvo teams, one to the Republic of Korea and the other to China (Taiuan).
3
VOLUNTARY FUND FOR HEALTH PROMOTION The Sub-Committee noted that a number of proposals had been made
under this fund.
These Vlere complementary to the programmes included
in the regular budget of the Region and Vlould only be implemented to
the extent that voluntary contributions became available to the fund..
The
total proposed in 1969 was approximately $526 000 compared ,dth a little over $279 000 in 1968. 4 UNITED NATIONS DEVELOPMENT PROGRAMME
4.1 Technical Assistance 4.1.1 The Sub-Committee was informed that the estimates shown in the
document were the Regional Director's suggestions of activities which could be considered for financing from this source. this heading did not represent government requests. The proposals uxxier They were tentative
only and should be considered as a basis for discussions vith the national health authorities, the United Nations Development Programme resident representatives concerned and the national co-ordinating bodies. They were either currently operating projects which were planned for continuation in 1969, or projects that were believed to have demonstrable economic development qualities and therefore could be an integral part of national economic development plans. a little under $1.03 million. The proposals for 1969 amounted to
4.2 Special Fund The
Sub-Committee noted that there was only one project financed This related to a master plan for the
from the Special Fund component.
sewerage system for the Manila metropolitan area, which had already commenced operations and vTaS
expected to be completed during 1969.
The
funds allocated for the project were approximately $172 000 in 1969 and
:)305 000 in 1968.
_ _ _ _ _ _ _ _.;:.:REP=,ORT OF THE REGIONAL COMMITl'EE
5
GENERAL CONCLUSIONS
The Sub-Colllll1ittee found that the proposed programme and budget
estimates were acceptable and follolTed the general programme of worIt approved by the Regional Colllll1ittee and the World Health Assembly.