WORLD HEALTH ORGANIZATION
REGIONAL OffiCE FOR THE WESTIRN ftACI'IC BUREAU REGIONAL DU PACIFIQUE OCCIDENTAL
•
ORGANISATION MONDIALE DE LA SANT~
REGIONAL COMMI'1'TEE Thirty-first session Manila 9-15 September 1980 Agenda item 18 HEALTH 2000 RESOURCES GROUP
WPR/RC3l/l7 Add. 1 10 September 1980 ORIGINAL: ENGLISH
The Regional Director has the honour to present to the Regional Committee the following background documentation relating to the establishment of a Health 2000 Resources Group by the Director-General:
1.
Resolution WHA29.32
Operative paragraph 3: URGES that all existing and potential sources of extrabudgetary funds should provide the Organization with increased support for the expansion of its efforts in the health field. Operative paragraph 4(2): REQUESTS the Director-General to continue to develop appropriate mechanisms for attracting and coordinating an increased volume of bilateral and multilateral aid for health purposes.
2.
Resolution WHA30.43
Operative paragraph 2: CALLS UPON all countries urgently to collaborate i~ the achievement of this goal lattainment by all citizens of the ;orld by the year 2000 of a level of health that will permit them to lead a socially and economically productive lif~7 through the development of corresponding health policies and programmes at the national, regional and interregional level and the generation, mobilization and tra.,ter of resources for health, so that they become more equitably distributed, particularly among developing c9untrles.
WPR/RC3l/l7 Add. 1 page 2
3.
Formulating strategies for health for all by the year 2000, Geneva,
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Paragraphs 9S and 109: regarding the strengthening of mechanisms for attracting bilateral and multilateral funds and for ensuring that they are channelled into priority activities in countries. Reference is made in paragraph 9S to the November 1978 consultations mentioned in paragraph 3 of document WPR/RC3l/l7. Operative paragraph 8: INVITES Member States to consider the immediate use of the document entitled "Formulating strategies for health for all by the year 2000", individually as a basis for formulating national policies, strategies and plans of action, and collectively as a basis for formulating regional and global strategies. Reference is made to this resolution in paragraph 4 of document WPR/RC3l/l7. Study of WHO's structures in the light of its functions Paragraph 3S: regarding the catalytic role to be played by WHO in agreements between developing and developed countries, an outstanding example of which will be the servicing of a global health resources group_ Health 2000 Resources Group: explaining the background, proposed terms of reference and composition of the Health 2000 Resources Group. This document is virtually the same as Regional Committee document WPR/RC3l/l7. Study of WHO's structures in the light of its functions: which recommends to the World Health Assembly the adoption of a resolution based on the report contained in document EB6S/1B. Operative paragraph 2.1(6):' DECIDES to influence the channelling of all available health resources, including those of other relevant sectors and nongovernmental organizations, into support for national, regional and global strategies for health for all. Operative paragraph 2.3(4): URGES the regional committees to foster the channelling of external funds for health into priority activities in the strategies for health for all of the countries most in need.
4.
Resolution WUA32.30
5.
Document EB65/l8 and subsequently document A33/2
6.
Document EB6S/INF.DOC./3
7.
Resolution EB65.R12
WPR/RC3l/l7 Add.l page 3
8.
leaolution WHA33.l7
Study of the Organization's structures in the light of its functions, which accepts the above-mentioned recommendation of the Executive Board. Operative paragraph 1(6): DECIDES to influence the channelling of all available health resources, including those of other relevant sectors and nongovernmental organizations, into support for national, regional and global strategies for health for all. Operative paragraph 3(6): URGES the regional committees to foster the channelling of external funds for health into priority activities in the strategies for health for all of the countries most in need.
At the sixty-fifth session of the Executive Board during discussion on docwaent EB65/l8, the Director-General made the two following statements, a. reported in the sUilbary records: (1) "The DIRECTOR-GENERAL said that his constant concern since taking office had been to uphold democracy in all the organs of WHO, and to assemble and disseminate - particularly for tbe benefit of the Third World countries - the maximum possible amount of information which would help the Organization to meet its challenges. Having been criticized by Board members in the past for setting up bodies to help him in that task - even when such bodies were internal to the Secretariat and established in accordance with the Director-General's prerogative - he had redoubled his 1 effo~l:s to ensure the transparency of his initiatives." "The Health Assembly had asked him to continue. to develop appropriate mechanisms for attracting and coordinating an increased volume of bilateral and multilateral aid for health purposes, and the main task of the health resources group would be to influence and augment the actual and potential flow of resources for health towards the goal of health for all by the year 2000. He noted the hesitancy which had been expressed in regard to that group having close relationships with the proposed Global Health Development Advisory Council. In fact, initially some donor countries had favoured having such a group outside WHO. He pointed out however that no group concerned with
(2)
~ocument EB65/1980/REC/2, summary records of the twelfth meeting, page 146. 2Ibid , page 155.
WPR/RC3l/l7 Add. 1 page 4
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the international transfer of resources could exist in WHO without the presence of recipient countries; it was essential that both donors and recipients should be able to express their opinions freely, and that was the reason why WHO had offered its facilities. Paragraph 8 of document EB65/INF.DOC./3 was not a categorical statement and the terms of reference of the proposed group could be redrafted to take into account the concern which had been expressed by the Board. He hoped that the Board would agree to the establishment of such a group, subject to all the necessary safeguards."l
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~eeting,
lDocument EB65/l980/REC/2, summary records of the twelfth page 155.
Resolution WHA29.32, WHO Handbook of Resolutions and Decisions, Vol. II, 1979 ,17 I'XU'\lTIVI' BOARD
143
approach to the development of the Organization's programmes, all prugramme activities at all levels being mutually supportive and parts of a whole;
3, STRESSES the importance of programme planning being view'td as a joint endeavour in which national authoritIes, WHO representatives, regional committees, regional oflices. the Executive Board, the World Health Assembly and WHO headquarters should all be involved; 4. URGES that the Organization's mechanism for the allocation and reallocation of resources, not only within programmes and regions, but also between programmes and regions, should comply with the principle of responding to integrated programme planning; and 5, RfQUESTS the Oirector-General to apply the conclusions and recommendations in the formulation and implementation of future programmes of the Organization. May 1975 226, 14
6. INVITES the attention of the Health Assembly to the analysis of the problem made in the study, and to the far-reaching implications for the Organization in its search for resources to promote health activities in developing countries and additional extrabudgetary funds to complement the work beina carried out under the regular budget; and 7. RECOMMEN[)S to the Twenty-ninth World Health Assembly that it adopt the following resolution:' "The Twenty-ninth World Health Assembly. "'. AGREES that the study has far-reaching implications for the furthering of the work of the Organization;
"2. EMPHASIZES the importance of the study as a basis for the further fulfilling of WHO's constitutional mandate as the directing and coordinating authority on international health work;
Jan. 1976 231, 24 -"T.
TilE PLANNING FOR ANI) IMPACT OF EXTRABUDOETARY RESOURCES ON WHO's PROORAMMF.'I AND POLICY
WHA29.32 EB57.R33 The Executive Board, Recalling resolution WHA27.19, by which the World Health Assembly requested the Executive Board to carry out an organizational study on the planning for and impact of extrabudgetary resources on WHO's programmes and policy, and also resolution WHA28.3 I requesting the Executive Board to report on this study to the Twenty-ninth World Health Assembly; Bearing also ill mind resolution EB55.R43.' whcreby the Executive Board noted the Director-Gcncral's efforts to strengthen further WHO's .:oordinating activities in relation to bilateral and multilateral aid progtammes; and Having considered the report on the organizational study' presented by the Working Group constituted for this purpose by the Executive Board, I. THANKS the Chairman and membcrs of the Working Group for their report;
The Twenty-ninth World Health Assembly.
Having considered the organizational study prepared by the Executive Board on the planning for and impact of extrabudgetary resources on WHO's programmes and policy,' I. AGREES that the study has far-reaching implications for furthering thc work of the Organization and that i.t constitutes a suitable basis for the fulfilment of WHO's constitutional mandate as the directing and coordinating authority on international health work;
2. NOTES with appreciation the contributions already obtained by or pledged to the Organization and to developing countries for activities in the health field; 3. URGES that all existing and potential sources of extrabudgetary funds should provide the Organization with increased support for the expansion of its efforts in the health field;
2.
TRANSMITS
the study to the Twenty-ninth World Health
A~scrnbly;
4. REQUESTS the Director-General, within the established policies of the Organization: (I)
3. [NJ)ORSF.~ the importance of WHO's fulfilling its constitutional mandate as the dirccting and coordinating authority on international health w(Jrk along the lines set out in the study; 4. NOTrS \\ ith satisfaction the initiative alrcady taken by the Director-Gcnc.-al. in his approaches to sources of cxtrabudgctary funds, to promote interest and enlist support for work in thc health ficld:
to take particularly into account the promotion of those planned health programmes that could attract additional resources for the benefit of the developing countries;
(2) to continue to develop appropriate mechanisms for attracting and coordinating an increased volume of bilateral and multilateral aid for health purposes; to continue his efforts on an interagency basis to harmonize programme budget cycles and planning and operational procedures of the major United Nations funding agencies with those applied to the regular programmes of the organizations in the United Nations system. (3)
5. URGES the Rcginnal Dircctors to continue to prol11ote and sponsor regional meetings and other activities designed to improvc coordination and cooperation with international. multilateral and bilateral organizations and institutions in the furtherance of national and regional health plans; " I' 1-
May 1976 233. 17 , The Ikallh As.<embly adopled. as resolul;on WlfA29.J2. Ihe leX! recommended IlY Ihe Board. aner replacing Ihe paragraphs reprodul'ed below by Ihe 1 .. 1 or para·'
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",I Rt.'tOld, ' " 2,ll. 1,-)71,.
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graph 1
Resolution WHA30.43, WHO Handbook of Resolutions and Decisions, Vol. II, 1979 1.2 GENERAL PROGRAMME DEVELOPMENT AND MANAGEMENT
3
programme budget policy necessary to give full effect to resolution WHA28.76 and this resolution. May /976 233, 30
and transfer of resources for health, so that they become more equitably distributed, particularly among developing countries; 3. REQUESTS the Executive Board and the Director-General to pursue the reorientation of the work of WHO for the development of technical cooperation and transfer of resources for health in accordance with one of the Organization's'most important functions as the directln, and coordlnatln, authority in international health work, May 1977 240, 2' EB6I.R19 The Executive Board, Noting the resolution of the thirtieth sessjon of the Regional Committee for South-East Asia entitled "Programme budget strategy for technical cooperation in WHO";' Recalling recent resolutions of the Health Assembly establishing the Organization'S programme budget policy and strategy for the development of technical cooperation;
WHAJO.43 The Thirtieth World Health Assembly, Faced with the mllgnitude of health problems and the inadequate and intolerably inequitable distribution of health resources throughout the world today; Considering that health is a basic human right and a worldwide social goal, and that it is essential to the satisfaction of basic human needs and the quality of life; Reaffirming that the ultimate constitutional objective of WHO is the attainment by all peoples of the highest possible Icvel of health; Recalling resolutions WHA28.75. WHA28.76 and WHA29.48 on (he principles governing technical cooperation with developing countries; I. . \l!'.("lnES that the main social target of governments and WHO in the coming decades should be the attainment by all the citizens of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life;
I. RHAFFIR~S that, in accordance with the Organization's new programme budget policy and stratc!gy, WHO's technical cooperation with and services to governments represent an integrated approach to the achievement of its constitutional objectives; ,. I • I • f I ,
2. CAliS UPON all countries urgently to collaborate in the achievement of this goal through the development of corresponding health policies and programmes at the national, regional and interregional level and the generlltion, mobilization
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Jat!. /978 244, 13 • Resolution SEA/RC30/R7 (WHO OftIclal ReeordI, No. <145, 1978, p. 47).
1.2 GENERAL PROGRAMME DEVELOPMENT AND MANAGEMENT
1.2.1
LONG-TERM PROGRAMMING For previous resolutions, see Volume I, page 5.
EB55.R26 The Executive Board, Recalling resolution WHA26.36 by which the Health Assembly requested the Executive Board to carry out an organizational study on the interrelationships between the central technical services of WHO and programmes of direct assistance 10 Member States, 2. TRANSMITS its study' to the Twenty-eighth World Health Assembly; J. DRAWS THE ATTI'NTION of the Assembly to its findings, conclusions nnd recommendations, and in particular to the necessity of an integrated approach to the development of the Organil.ation·s programmes, all programme activities at all levels being mutually supportive and parts of a whole; 6. RfQUESTS the Director-General to apply the conclusions and recommendations in the formulation and implementation of ruture programmes of the Organization. Jan. 1975 223,16
WHAlI.30 The Twenty~ighth World Health Assembly, Having examined the report of the Executive Board on the organizational study on the interrelationships between the central technical services of WHO and programmes of direct assistance to Member States;'
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2. NOTES with appreciation its findings, conclusions and recommendations, and in particular the necessity of an integrated approach to the development of the Organization's programmes, all programme activities at all levels being mutually supportive and parts of a whole; 3. STR.ESSES the importance of programme planning being viewed as a joint endeavour in which national authorities, WHO representatives, regional committees, regional offices, the Executive Board, the World Health Assembly and WHO headquarters should all be involved; 4. URGES that the Organization's mechanism for the allocation and reallocation of resources, not only within programmes and regions, but also between programmes and regions, should comply with the principle of responding to integrated programme planning; and 5. REQUESTS the Director-General to apply the conclusions and recommendations in the formulation and implementation of future programmes of the Organization. May 1975 226, 14
EXTRACT FROM "FORMULATING STRATEGIES FOR HEALTH FOR ALL BY THE YEAR 2000". GENEVA, 1979
II
Health for all by the year 2000
Ir
global means of evaluating progress towards the attainment of the goal of health for all by the year 2000. 93. The paragraphs that follow illustrate the various components of a global strategy and issues which have to be considered when formulating it. 94. The global strategy should include the promotion, at the Global highest governmental and nongovernmental international levels, of . promotion and the idea that an acceptable level of health for all by the year 2000 is support feasible. It should serve to stimulate international interest in and support for this idea throughout the world. To this end, use should be made of all appropriate global fora. Maximum use will have to be made of WHO, notably through the Health Assembly and the Executive Board, as well as of other global fora both within and outside the health sector, such as the United Nations, its Economic and Social Council, UNDP, UNICEF and the specialized agencies. The Alma-Ata report and the present document should be brought to the attention of the Economic and Social Council and the United Nations General Assembly at an appropriate time. 95. The global strategy should envisage the strengthening of global mechanisms, such as the establishment of an appropriate body of participating countries I for attracting bilateral and multilateral funds and for ensuring that they are channelled into priority activities in countries. For this purpose, estimates should be made of the orders of magnitude of the total resources required for health development in the world, including those required for transfer between countries and regions. 96. To foster intersectoral support, efforts should be made to establish or strengthen appropriate political, economic and technical relationships with the United Nations, its relevant services, I For example. a body of the type mentioned at a meeting of representatives or these countries held at WHO headquarters in November 1978.
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EXTRACT FROM "FORMULATING STRATEGIES FOR HEALTH FOR ALL -BY THE YEAR 2000" , GENEVA, 1979
VI. The role of WHO
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106. According to its Constitution, WHO is an organization of Member States cooperating among themselves and with others to promote and protect the health of all peoples. Such cooperation among Member States makes it possible for WHO to fulfil its constitutional functions of acting as the directing and coordinating authority on international health work and of furnishing appropriate technical cooperation upon the request or acceptance of gov~ ernments. 107. In carrying out these interrelated and mutually supportive functions, WHO has a central role in developing strategies for attaining an acceptable level of health for all by the year 2000. WHO will fulfil this role through the promotion, coordination and support of the efforts described in the previous sections, in coun~ tries individually and through their collective action at regional and global levels. lOR. WHO will be instrumental in promoting worldwide under- Role of WHO in standing that an acceptable level of health for all by the year 2000 is promotion and feasible, and that primary health care is the key to this. WHO will coordination carry out such promotion among policy makers at top government level, and among professional groups in the health and related social and economic sectors. It will also actively promote the idea among the general public. WHO will stimulate the interest and support of other international organizations both within and outside the United Nations system, as well as through international nongovernmental organizations.
109. at
arn~ngements
all
WHO will use its constitutional organs and regional to ensure the coordinated development of strategies 9perational levels and will support countries individually and
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EXTRACT FROM "FORMULATING STRATEGIES FOR HEALTH FOR ALL BY THE YEAR 2000" , GENEVA, 1979
Health for all by the year 2000
development. This group would work in close liaison with the regional groups of a similar nature mentioned in paragraph 85. Reference is again made in this context to the Executive Board organizational study mentioned in paragraph 86 above. 103.
1
Global monitoring and evaluation
A global evaluation framework will have to be agreed upon. This will include monitoring the worldwide efforts and evaluating their impact in attaining health for all by the year 2000. A short list of indicators will have to be selected that are applicable in the global perspective. In addition, guidelines will need to be prepared to support regions and countries in selecting and using health and related socioeconomic indicators for monitoring the implementation of strategies and plans of action and evaluating their impact in improving the health status of the people as described in paragraphs 61-67 above. These guidelines should also include the methods and means required to collect and analyse the information, including reporting by nonprofessional health workers as appropriate. 104.
Role of WHO
105. The role of WHO, including its headquarters, in formulating and implementing the global strategy for health for all by the year 2000 is outlined in the following section, in paragraphs 125-131.
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EXTRACT FROM DOCUMENT IB65/18, PARAGRAPH 35 EB65/1S page 14
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developing countries, economic cooperation among developing countries in health matters, and technical cooperation between developing and developed countries. 34. Since the Organization's support to cooperation among
its Member States should permeate all its activities, no special structures to fulfil this function are required. What is required is alertness on the part of Member States and the Secretariat at all policy and operational levels to the possibility of contributing to health improvement through such cooperation. 35. An important activity of the Organization to facilitate
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cooperation between countries is the collection, organization and dissemination of information on available resources, technology and expertise in the health and related sectors. WHO can also be highly useful in catalysing agreements between developing countries, between developing and developed countries, and also between developed countries, on policy, technical and commercial matters relating to health. standing example of this catalytic role is the proposed servicing by the Director-General of a global health resources group. composed of representatives of developed and developing countries as well as bilateral and multilateral agencies, whose aim is to mobilize resources for health and rationalize their flow in support of strategies for health for all by the year 2000 in the developing countries. Nongovernmental 9r pnlzationa 36. While WHO is an intergovernmental organization. it has An out-
to pay increasing attention to nongovernmental organi!st!ons that are interested in collaborating for the attainment of health for all. This is so in view of the importance of mobilizing all forces to this end and of the potentia l1y significant contribution of such organizations, including their participation in genuine health technology "assessment. increased awareness of the potential usefulness of these organizations, and selective support. starting with the support of governments to nongovernmental organizations in theit country that are ready to apply the policies determined in WHO. and continuing through the regional and global levels. No structural changes are required for this purpose, but rather
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RESOLtn'ION BB65.lt12. OPERATIVE PAlAGltAPH 2.1(6) (J)OCUHEMT EB65/1980/ltBC/l) RESOLUTIONS AND DECISIONS Recalling that, in accordance with its Constitution. WHO is an organization of Member States cooperating among themselves and with others to promote the health of all people, and that this cooperative action embodies the truly international nature of the Organization; Mindful of WHO's constitutional functions of acting as the directing and coordinating authority on international health work and of entering into technical cooperation with its Member States and facilitating technical cooperation among them; Convinced that through its international health work the Organization can be a .powerful instrument in helping to reduce international tension, to overcome racial and social discrimlnation. and to promote peace: Realizing that, in consequence of the above, unprecedented efforts will be required in the health and related socioeconomic sector. throughout the world: 1.
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DECIDES: (1) to concentrate the Organization's activities over the coming decades •.as far as is possible in the light of all its constitutional obligations, on support to national. regional and global strategies for attaining health for all by the year 2000; (2) to focus the Organization's cooperative activities within the United Nations system on joint efforts to support health as part of development, to devise the New International Development Strategy and to establish the New International Economic Order; (3) to strengthen the roles of the organization in promoting action for health in addition to indicating how such action might be carried out. and in developing heal th techno logies that are effective, socially acceptable and ,economically feasible, and ensuring that they are available to Member States; (4) to take all possible measures to maintain the unity of the Organization within its complex structures, to harmonize policy and practice throughout the Organization, and to ensure a proper balance between centralized and decentralized activities; (5) to ensure that the Organization's directing. coordinating and technical cooperation functions are mutually supportive and that the work of the Organization at all levels is properly interrelated; (6) to influence the channelling of all available health resources, including those of other relevant sectors and nongovernmental organizations. into support for national, regional and global strategies for health for all; (7) to increase the Health Assembly's monitoring and control function with respec t to the work of the Organization, including the follow-up and review of the implementation of resolutions adopted by it; (8) to improve further the Health Assembly's work methods and in particular to consider carefully the practicability of resolutions and other policies before adopting them, and to promote greater -initiative by the regional conunittees in proposing resolutions to the Health Assembly;
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2. URGES Member States, in the spirit of the policies, principles and programmes they have adopted collectively in WHO: (1) to review the role of their ministries of health, strengthening them as necessary so that they can fully assume the function of directing and coordinating authority on national health work;
RESOLUTION 'XB65. R12, OPERATIVE PAltAGRAPR 2.3(4) (poCUMElft EB6Sl1980/REC/l) It
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EXECUTIVE BOARD, SIXTY-FIFTH SESSION (2) to mobilize all possible resources in their countries that can contribute to health development, including those of other relevant sectors and nongovernmental organizations; (3) to tighten their coordinating mechanisms so as to ensure the mutual relevance and support of their own health development strategy on the one hand and their technical cooperation with WHO and with other Member States of WHO on the other; (4) to ensure that WHO's action in their countries reflects adequately resolution WHA31.27 concerning the conclusions and recommendations of the Executive Board's organizational study on "WHO's role at the country level, particularly the role of WHO representatives", and in particular the shift from technical assistance to technical cooperation; (5) to consider the possibility of increasing the use of their Organization as an effective intermediary to facilitate cooperation among them; (6) to establish or strengthen mechanisms for ensuring continuing dialogue and cooperation with their Organization with a view to making sure that national and international health programmes are well coordinated; (7) to coordinate their representation at regional cpmmittees and the Health Assembly, and to designate representatives to the regional committees and delegates to the Health Assembly who will later be in a position to influence national health policy so as to make it consistent with collective health policy adopted in WHO; (8) to take into account as far as possible the multidisciplinary nature of health activities when establishing their delegations to the Health Assembly and t~e regional committees; (9) to bring their national health policies to the attention of the regional committees; (10) to coordillate their representation in WHO and in the United Nations and the specialized agencies on all matters relating to health, and par'ticularly the role of health in development; 3. URGES the regional committees: (1) to intensify their efforts to develop regional health policies and programmes in support of national, regional. and global strategies for health for all, and to consider establishing or strengthening appropriate subcommittees to this end; (2) to promote greater interaction in the regions between the activities of WHO and those of all other bodies concerned, including bodies of the United Nations system and nongovernmental organizations, in order to stimulate common efforts for attaining health for all by the year 2000; (3) to support technical cooperation among all Member States, particularly for attaining health for all; (4) to foster the channelling of external funds for health into priority activities in the strategies for health for all of the countries most in need; (5) to extend and deepen their analysis of the interregional, regional and national implications of Health Assembly and Board resolutions, and to provide such analyses to Member States; (6) to increase their monitoring, control and evaluation functions so as to ensure the proper reflection of national, regional and global health policies
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RESOLUTION OF THE WORLD HEALTH ASSEMBLY THIRTY-THIRD WORLD HEALTH ASSEMBLY
WHA33.17 21 May 1980
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STUDY OF THE ORGANIZATION'S STRUCTURES IN THE LIGHT OF ITS FUNCTIONS The Thirty-third World Health Assembly, Recalling that the main social target of governments and WHO in the coming decades is the attainment by all the people of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life; Guided by the Declaration and recommendations of the International Conference on Pri.ary Health Care held in Alma-Ata, and by resolution WHA32.30 concerning the formulation of strategies for health for all by the year 2000; Noting with satisfaction the United Nations General A8sembly resolution 34/58 on health as an integral part of development. which reinforces the responsibilities entrusted to WHO in connexion with the attainment of health for all by the year 2000; Recalling that, in accordance with its Constitution WHO is an organization of Member States coopera'ting among themselves and with others to promote the health of all people, and that this cooperative action embodies the truly international nature of the Organization; Mindful of WHO's constitutional functions of acting as the directing and coordinating authority on international health work and of entering into technical cooperation with its Member States and facilitating technical cooperation among them; Convinced that through its international health work the Organization can be a powerful instrument in helping to reduce international tension, to overcome racial and aocial discrimination, and to promote peace; Realizing that, in consequence of the above, unprecedented efforts will be r.quired in the health and related socioeconomic sectors throughout the world; 1.
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DECIDES: (1) to concentrate the Organization's activities over the coming ~e~ade8. far a. is possible in the light of all its constitutional obligations, on support to national, regional and global strategies for attaining health for all by the year 2000:
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(2) to focus the Organization's cooperative activities within the United Nation. sy.tem on joint efforts to support health as part of development, to devise the New International Development Strategy and to establish the New International Economic Order~ (3) to strengthen the roles of the Organization in promoting action for health in addition to indicating how luch action might be carried out, and in developing health technologies that are effective, socially acceptable and economically feasible. 4Qd ensuring that they are available to Member States; (4) to take all possible measures to maintain the unity of the Organization within itl comp lex structures. to harmonize pol icy and practice throughout the Organi.&ation, and to ensure a proper balance between centralized and decentralized activiti •• :
~~3.17 pal. 2 (5) to ensure that the Organization's directing, coordinatins and technical cooperation functions are mutually supportive and that the work of the Organization at all levels is properly interrelated; (6) to influence the channelling of all available health resources, including those of other relevant sectors and nongovernmental organizations, into support for national, regional and global strategies for health for all; (7) to maintain to the full the Health Asaembly's constitutional authority as the supreme organ for determining WHO's policies as well as the other powers vested in it and to increase its monitoring and control functions with respect to the work of the Organization, including the follow-up and review of·the implementation of resolutions adopted by it; (8) to improve further the Health Assembly's work methods and in particular to consider carefully the practicability of resolutions and other policies before adopting them, and to promote greater initiative by the regional committees in proposing resolutions to the Health Assembly; 2. URGES Member States, in the spirit of the policies, principles and programmes they have adopted collectively in WHO: (1) to review the role of their ministries of health, strengthening them as necesaary so that they can fully assume the function of directing and coordinating authority on national health work, and to establish or strengthen ~ltisectoral national health councils; (2) to mobilize all possible resources in their countries that can contribute to health development, including those of other relevant sectors and nongovernmental organizations; (3) to tighten their coordinating mechanisms so as to ensure the mutual relevance and support of their own health development strategy on the one hand and their technical cooperation with WHO and with other Member States of WHO on the other; (4) to ensure that WHO's action in their countries reflects adequately resolution WHA31.27 concerning the conclusions and recommendations of the Executive Board's organizational study on '\rnO's role at the country level. particularly the role of WHO representatives", and in particular the shift from technical assistance to technical cooperation; (5) to consider the possibility of increaSing the use of their Organization as an effective agent to facilitate cooperation among them; (6) to establish or strengthen mechanisms for ensuring continuing dialolue and cooperation with their Organization with a view to making sure that national and international health programmes are well coordinated; (7) to coordinate their representation at regional committees and .the Health Assembly, and to designate representatives to the regional committees and delegates to the Health Assembly who will later be in a position to influence national health policy so as to make it consistent with collective health policy adopted in WHO; (8) to take into account as far as possible the multidisciplinary nature of health activities when establishing their delegations to the Health Assembly and the fegional committees;
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(9) to bring their national health policies to the attention of the committees;
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wBA33.17 3 (10) to coordinate their representation in WHO and in the United Nations and the specialia.d agencies on all matters relating to health, and particularly the role of health in development; 3. II
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URGES the regional committees: (1) to take a more active part in the work of the Organization and to sub.it to the Execut'ive Board their recollllllendations and concrete proposals on I18tters of regional and global interest; (2) to intensify their efforts to develop regional health policies and programme. in .upport of national, regional and global strategies for health for all, and to consider establishing or strengthening appropriate subco. .ittees to this end; (3) to promote greater interaction in the regions between the activities of WHO and those of all other bodies concerned. including bodies of the United Nation. syste. and nongovernmental organizations, in order to stimulate common efforts for attaining health for all by the year 2000; (4) to support technical cooperation among all Member States, particularly for attaining health for all;
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(5) to provide support for the establishment or strengthening of aultieectoral national health councils to Member States who so desire; (6) to foster the channelling of external funds for health into priority activities in the strategies for health for all of the countries most in need; (7) to extend and deepen their analys1s of the interregional, regional and national implications of Health Assembly and Board resolutions, and to pro~id. auch analya•• to Member States; (8) to increase their monitoring, control and evaluation functions so as to ensure the proper reflection of national, regional and global health policies in regional programmes and the proper implementation of thes. prolrammes. and to include in their programmes of work the review of WHO's action in individual Heaber States within the regions; \...
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4.
REQUESTS the Executive Board: (1) to strengthen its role in giving effect to the decisions and policies of the Health Assembly and in providing advice to it, particularly with respect to ways of attaining health for all by the year 2000, among other things by ensuring that the Organization's general programmes of work, medium-term programmes. and prolramme budgets are optimally oriented towards supporting the strategies for health for all ,of Member States; (2) to become increasingly active in presenting majo'r issues to the Health Assembly and in responding to the comments of delegates; (3) to foster the correlation of its work with that of the regional committeea' and the Health Assembly. among other things by reviewing carefully and drawing conclusions from the policy proposals of ' the regional committees in matters of worldwide intere.t, particularly in preparation for the ensuing Health Assembly; (4) to monitor on behalf of the Health Assembly the way the regional committees reflect the Assembly's policies in their work, and the manner in which the Secretariat provides support to Member States individually. as well as collectively in the regional committees. Executive Board and Health Assembly;
WHA33.17 page 4 (5) to review regularly measures taken by the rdev;)nt bodies of the United Nations system in the areas of health and develupment, and to ensure the coordination of WHO's activities with the activities of those bodies in order to promote an intersectoral approach to health development, thus facilitating the attainment of the goal of health for all by the year 2000; 5. REQUESTS the Director-General and Regional Directors to act on behalf of the collectivity of Member States in responding favourably to government requests only if these are in conformity with the Organization's policies; 6. REQUESTS the Director-General: (1) to continue to exercise to the full all the powers entrusted to him by the Constitution in his capacity as chief technical and administrative officer of the Organization, subject to the authority of the Board and the Health Assembly;
•
\'
(2) to ensure the provision of timely, adequate and consistent Secretariat support to the Organization's Member States, individually and collectively, and to this end to take all the measures within his constitutional prerogatives that he considers neces8ary; (3) to expand the engagement of national staff of the country concerned in the execution of collaborative projects, to review the engagement of international WHO field staff, and to take any measures required so that such WHO staff become fully involved with the collaborative national programmes; (4) to redefine the functions of the regional offices and of headquarters in such a way as to ensure that they provide adequate and consl.stent support to Member States in their cooperation with WHO and among themselves, and to adapt accordingly the organizational structures and staffing of the regional offices and of headquarter •• reporting to the regional committees, the Executive Board and the Health AIlJ.ellbly as appropriate on his projects and plans in conformity with the constitutional functions of these bodies; (5) to monitor the implementation of the decisions in lhis resoJution and to keep the regional committees, the Executive Board nnd the Ileal th Assembly fully informed on progress.
~
.,.
Sixteenth plenary meeting, 21 May 1980 :or A33jvR/16
EXTRACT FROM DOCUMENT EB65/1980/REC/2 146
EXECUTIVE BOARD. SIXTY-FIFTH SESSION
inadvisable to institutionalize matters by creating standing bodies, since it was the task of the Board to monitor and evaluate the Organization's programmes. He also agreed on the ne~d to clarify the terms of reference of the Global Health Development Advisory Council and would join in the request for more details as to its exact composition. He had some doubts about the suggestion that the Council's membership should be changed after two years, and considered that its members should be appointed for longer periods to ensure that it had the requisite stability. Also~ he did not agree that the members of the Council should be appointed by the Director-General. The experience with the Advisory Committee on Medical Research provided an example of the misunderstandings that could arise on that score. Although matters had improved, that Committee was still not responsible to the Board. In his view, it should be, or its recommendations should at least be submitted to the Board.
If it were decided that some advisory machinery was needed, he wondered whether it should not be similar in type to the UNICEF/WHO Joint Committee on Health Policy (JCHP). He would appreciate the Director-General's views on that point, as also on the United Nations General Assembly resolution 34/58 which called on the relevant bodies in the United Nations system to coordinate their activities with those of WHO. Possibly, pursuant to that resolution, an inter secretariat body could be appointed. Lastly, he suggested that the Board might establish a budget and finance committee to consider questions of financing both from budgetary and extrabudgetary resources. Dr BR~T. endorsing Dr Christiansen's suggestions, said that, in his view, the Organization should not hesitate to seek advice in such a complex matter. The Global Health Development Advisory Council, representing as it would a range of competence in a number of disciplines, could greatly assist the Director-General in that respect. With regard to possible duplication of the role of the Organization's established bodies, it seemed, from his reading of the Director-General's report, that the Council would not, and indeed should not, be making decisions on the Organization's behalf. It would not be formulalatingresolutions or instructing the Director-General in any formal sense but only advising him on the technical matters in which the Board had great interest but to which it could devote little time, In so doing, it could draw on a large reservoir of world thinking before submitting its conclusions to the Director-General. who could then make its advice available to the other bodies of the Organization as he deemed fit. The DIRECTOR-GENERAL said that his constant concern since taking office had been to uphold democracy in all the organs of WHO, and to assemble and disseminate - particularly for the benefit of the Third World countries - the maximum possible amount of information which would help the Organization to meet its challenges. Having been criticized by Board members in the past for setting up bodies to help him in that task - even when such bodies were internal to the Secretariat and established in accordance with the Director-General's prerogatives· he had redoubled his efforts to ensure the transparency of his initiatives. Dr Venediktov had rightly indicated that ~IO was working well with the United Nations Children's Fund within the framework of the Joint Committee on Health Policy (JC"~)l moreover, the Organization was striving in many dynamic ways and in accordance with its mandate from the United Nations to promote a unified and harmonious approach to various issues. such as that of rural development, through formal arrangements with other organizations of the United Nations system. It was. nevertheless, clear that the involvement of other sectors in what were primarily the concerns of WHO - being related to health - left much to be deSired. and parochial resistaQce was still encountered in certain quarters, He was thinking. for example, of the r,~uctance of agricultural ministries to assume their responsibilities with regard to Primary hellhh care, water supplies and sanitation in rural areas. and of the difficultiss encountered witll national and international agricultural authorities with regard to joint responsibility for nutrition. It was against that background of multisectoral support for health developmen~ that he ha4 set the matter before the Thirty-second World Health Assembly, suggesting that the Oraanization, as the representative of the health sector. might seek suitably qu~lified advice oQ ~~ys and means of ensuring such support.
EXTRACT PRON DOCUMENT EI65/1980/REC/2 SUMMARY RECORDS: TWELFTH MElTING
155
Dr BARAKAMFITIYE concurred with Dr Bryant's and Professor Aujaleu'. comment. on the proposed health resources group, and said that he supported its establishment. Like Professor Aujaleu, he was glad to note the second sentence 1n paragraph 33 of document BB6S/18; he thought that instead of deleting operative paragraph 2(5) of the draft resolution i t would be better to redraft it on the lines of paragraph 33. Dr PATTERSON said that a great new challenge was facin8 the Oraanisation aDd to . .et it there mult·be new machinery. She therefore appreciated the Director-General', new lnltt •• tives. The task would cost a great deal in te~. of money, p.~.oftn.l and .uppl'•• and lome mechanism for attracting and coordinating resources was neee •• ary. She aSf.ed vtth tho •• who had said that the functions of the health resources gr~p must b. well .pelt QUt but Ibe emphasized that there was a need for a body which could take ,etlon on a global ,cale ana to which Member States would have access, II II II
II
It.
Coordination of the resources entering a country at country level wat Vital. Many Member States did not have sufficient experience or expertise to undertake lucb coordination themselves and would like to receive help from WHO. Some members had euggested that the word "neutral" implied passivity, but to her i t meant that the Organiaation belonged to aU Member States without bias and that they could trust it. She therefore .upported tbe new health resources group, subject to the comments on itl structure and fuftCtlontn, .ad. by otb~ members. The DIRECTOR-GENERAL recalled that when he had worked in the Orsanization'l CUbel'culosil programme he had seen that more than three-quarters of all the bilateral re.ource. betas given to developing countries for use in the field of tuberculosis were beins emplO1ed in a way which went against the collective policy of Member States as recOII1IIIended by ..pert co.lttees and approved by the Executive Board and the Health Assembly. It must be termed a "poisoned gift" when donors insisted on providing a tuberculolis sanatorium to • country, a gift that was so costly that the country would not be in a position to afford to tr••t Such decisions were taken at a politteal level by more than 1% of its tuberculosis patients. foreign ministers or presidents - not by health worker., who asked WHO to protect th_ frOilD such gifts. I t must be conceded that at least half of the US$ 2000 million or 10 C\1t\"ei\tly being transferred annually for health as part of development assistance waf not bein. correctly employed for the essentials of primary health care. With regard to the question of individual and collective responsibility" he found it hard to understand that, while the Member govermnents of most developmental ageucl•• wre Members of WHO and as such had agreed on what they wished for health by the year 2000,tboae same Member States could support bilateral health programmes which vere utterly cont~ary to policies and principles adopted in WHO. There was thus a divorce between policy and practice. Nevertheless, he believed that some 90% of major donor agenciel were now becoming truly aligned towards the concepts of WHO health policy for primary health care. and that val aD important step forward. Moreover. it had been possible to mobilize more support than ever before for specific WHO programmes, and those funds were directly controlled by WHO in its role as executing agency. The Health Assembly had asked him to continue to develop appropl'iate mechani8tl\B for attracting and coordinating an increased volume of bilater~l and mUltilateral aId for health purposes, and the main task of the health resources group vould be to influence and augment the actual and potential flow of resources for health towards the goal of health for all by the year 2000. He noted the hesitancy which had been expressed in regard to that group 11't having c lose relationships with the proposed Global Health Development Advf.aoryCouncll. fact, initially some donor countries had favoured having such a group outside wHo. He poin· . ted out however that no group concerned with the internationAl transfer of resources eoUld exist in WHO withollt the presence of recipient countries; it vas essential that both donors and recipients should be able to express their opinions freely, and that was the reason Why WHO had offered its facilities. Paragraph 8 of document EB65/INF.OOc./3wasnot a categorical statement and the terms of reference of the proposed group could be redrafted to take into account the concern which had been expressed by the Board. He hoped that the BOard would agree to the establishment of such a group, subject to all the necessary safeguards.
/ WORLD HEALTH ORGANIZATION
ORGANISATION MONDIALF DE LA SANTE·
.
REGIONAL OFFICE FOR THE WESTERN PACIFIC BUREAU RtGIONAL DU PACIFIQUE OCCIDENTAL
REGIONAL COMMITTEE Thirty-first session Manila 9-15 September 1980 Provisional agenda item 18 HEALTH 2000 RESOURCES GROUP
WPR/RC3l/17 29 July 1980 ORIGINAL: ENGLISH
At the thirtieth session, the Regional Committee for the Western Pacific was of the unanimous opinion that until plans to establish the proposed Health/2000 Resources Group (HRG) became definite and the Committee had been provided with sufficient background information to enable it. to make a decision, it was unable to consider nominating a member from the Western Pacific Region. This document p-cesents, in some detail, the background to the decision to establish HRG, which held its first meeting on 1 and 2 May 1980. At that meeti~g the Group itself accepted the proposal that its ' membership of 20 should include a representative of a developing country in the Western Pacific Region, who would attend meetings of HaG in his expert capacity. It is hoped that the Regional Committee will now be able to consider nominating that member, whose period of tenure would extend to 31 December 1982.
WPR/RC3l/17 page 2
Background 1. In 1976 the Twenty-ninth World Health Assembly, on the basi's of the Executive Board's organizational study on the planning for and impact of extrabudgetary resources on WHO's programmes and policy,l adopted resolution WHA29.32 in which it urged that "all existing and potential sources of extrabudgetary funds should provide the Organization with increased support for the expansion of its efforts in the health field". At the same time, the Director-General was requested, inter alia, "to continue to develop appropriate mechanisms for attracting and coordinating an increased volume of bilateral and multilateral aid for health purposes".
2. In 1978 the Executive Board noted the progress made towards strengthening the basis for the mobilization of increased support to attain the social goal of health for all by the year 2000 and at its sixty-third session, in January 1979, adopted resolution EB63.R24 recognizing this progress. 2 3. Subsequently, the Director-General reported 3 to the Executive Board at its sixty-fourth session (May 1979) on the results of his consultations in November 1978 with major contributors and representatives of developing countries and on the proposal to set up an international health funding group to advise on how best the Organization could secure extrabudgetary support for the growing demands, which far exceeded the resources of WHO's regular budget. 4. The Thirty-second World Health Assembly, in its resolution WHA32.30,4 adopted the Board's document entitled "Formulating strategies for health for all by the year 2000", which put forward proposals for strengthening global mechanisms "such as the establishment of an appropriate body of participating countries for attracting bilateral and multilateral funds".5 5. The Thirty-third World Health Assembly, acting on a recommendation of the Executive Board adopted at its sixty-fifth session, decided, in its resolution WHA33.l7, "to influence the channelling of all available health resources, including those of other relevant sectors and nongovernmental organizations, into support for national, regional and global strategies for health for all" and further urged the regional committees "to foster
lWHO Official Records, No. 231, 1976, Annex 8. 2See document EB63/48, page 29. 3S ee document EB64/8. 4See document WHA32/l979/REC/l, page 27. 5See document WHA32/l979/REC/l, Annex 2, paragraphs 95 and 109; the Board's document is also published separately (WHO, Geneva, 1979).
WPR/RC3l/l7 page 3
the channelling of external funds for health into priority activities in the strategies for health for all of the countries most in need".l Also on a recommendation of the Executive Board, the Health Assembly requested the Director-General "to take full advantage of the international climate of support at all levels and in all sectors for achieving the health goals of the Organization, through the recognition by all Member States and the Whole United Nations system of the essential role of health in development". 2 Consultations 6. In September and December 1979 the Director-General convened two informal consultations at WHO headquarters, bringing together in an expert capacity specialists from major contributors, developing countries, organizations of the United Nations system, and nongovernmental organizations. These consultations strongly recommended the establishment of a Health/2000 Resources Group whose main task would be to influence and augment the actual and potential flow of resources for health towards the goal of health for all by the year 2000. Composition of HRG 7. The consultations recommended that BRG's composition should not exceed a maximum of 20 persons drawn from the following: Organization for Economic Cooperation and Development Development Assistance Committee Western Pacific Western Europe The Americas Scandinavia 1 2 1 1 2 I
5
Council for Mutual Economic Assistance/Eastern Europe Organization of Petroleum Exporting Countries Nongovernmental organizations/Foundations -r
2 4
United Nations system United Nations Children's Fund (UNICEF) United Nations Development Programme (UNDP) United Nations Fund for Population Activities (UNFPA) World Bank
lSee resolution WHA33.l7, paragraph 3(g). 2See resolution WHA33.24, paragraph 4(1).
WPR/RC3l/l7 page 4
,,
Development banks and funds Developing countries (each member to be nominated by a regional committee to represent developing countries of that region) African Region Region for the Americas Eastern Mediterranean Region South-East Asia Region Western Pacific Region 1 1
1
5
1 1
1
20
8. While tenure of office would in principle be for two years, a system of rotation was recommended, with selected persons in the first HaG remaining in office for three years to ensure continuity. Meetings of BRG 9. The first meeting of BRG was held on 1 and 2 May 1980. meeting will be held on 5 December 1980. Terms of reference of BRG 10. At its meeting on 1 and 2 May 1980, BRG recommended that: The second
"The HRG should be constituted as a consultative group to be appointed by the Director-General, under the auspices of WHO, in fulfilment of its constitutional function as the coordinating authority on international health work. The HaG will be composed of members from developed and developing countries, multilateral agencies and nongovernmental organizations, who will act in their personal capacity, with the following mandate: to promote the rationalization of all available resources required for primary health care activities in develo?ing countries, aimed towards health for all by the year 2000, in accordance with the priorities recognized by WHO Member State£ and incorporated in the resolutions of the World Health Assembly and the United Nations General Assembly; to stimulate the mobilization of resources, including those of developing countries themselves and of external donors, to achieve the world community's social goal of health for all by the year 2000, using primary health care as the main method, and to facilitate appropriate utilization of these resources by donor organizations and recipient countries, according to source, recipient, topic, or other relevant criteria."
WPR/RC31/17 page 5
"Within this context, the lIRG will particularly concern itself with the following issues related to the resources necessary to achieve health for all by the year 2000:
t \
(1)
t (2) (3) I
to develop improved simplified methods of relating resources to the needs of developing countries and of ensuring continuity of funding; to encourage the application of these methods by all bilateral, multilateral and nongovernmental agencies concerned; to devise ways of promoting in all relevant sectors of the government the high priority due to the development of primary health care activities in the attainment of health for all; to facilitate the achievement of better relation of resources to needs between countries and agencies; to review and disseminate critically analysed information related to needs, resources and their utilization; to identify constraints relating to exte-rnal funding for the attainment of health for all and suggest ways to overcome them; to encourage and support governmental and nongovernmental sectors, with a view to minimizing duplication in technical areas and maximizing substantive collaboration in planning and achieving health development; to advise the Director-General on the use of and review the Health Development Initiative Fund.
I
(4) (5) (6) (7)
(8)
,--
The lIRG will arrange its periodic meetings in such a way as to ensure fulfilment of its objectives and will keep these terms of reference under review ... I Conclusions and recommendations of first meeting of lIRG 11. In addition to the above-mentioned recommendations with regard to its terms of reference, lIRG recommended that: (1) the lIRG should be composed of members from developed and developing countries, multilateral agencies and nongovernmental organizations, appointed by the Director-General (see also Chapter 7 above); the members of the HaG should act in their personal expert capacity;
(2)
lWorld Health Organization. Report on the First Meeting of the Health 2000 Resources Group, 1-2 May 1980, Geneva (WHO document lIRG.l/80/9).
WPR/RC31/17 page 6
(3) (4)
the Director-General should set up a trust fund, to be known as the "Health Development Initiative Fund"; an interim planning group should be set up to direct pre~arations for the second full meeting of the HaG in December 1980.
Decision of the Regional Committee with regard to BaG 12. In relation to the composition of HaG (see paragraph 7 above) the Regional Committee, at its thirtieth session, expressed the wish to postpone nomination of a representative from the Region until the current session; that is until plans to establish BaG were more definite and until the Regional Committee was in possession of adequate information with regard to HaG and its terms of reference. 13. It is hoped the Regional Committee will now feel that it has been provided with sufficient background information to enable it to nominate a Member State to send a representative to the next meeting of BaG on 5 December 1980 and to subsequent meetings during the period ending on 31 December 1982.
1Tbe interim planning group met on 23 June 1980 and will meet again in September. After the meeting of HaG in December, at which a decision is expected to be taken as to the Secretariat, inCluding its functions, size, physical location and place within the WHO organizational structure, the interim planning group might no longer be necessary.
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