REPORT OF THE REGIONAL COMMI'ITEE
ANNEX
3
REPORT OF THE SUB-COMMITI'EE ON PROGRAMME AND BUDGET 1. ,-...-,.
INTRODUCTION At its seventh session, the Regional Committee, in resolution
wp/RC7. R7, decided "that the establishment of a sub-committee on programme and budget l consisting of six members plus the Chairman of the Regional Committee; should become a routine activity of the Regional Committee II; and recommended. that ''the membership of this sub-committee
be rotated among the Representatives of various Members, subject to the provision that any Representative d.esiring to be a member of the subcommittee should be entitled to participate". f
The
members of the Sub-Committee and their alternates and advisers
were as follows: t
Australia China Japan Malaya New Zealand United Kingdom Viet-Nam
Dr R.FoR. Scragg (Chairman) Dr C.K. Chang Dr J. Ohmura Mr Y. Matsuda (alternate) Dato Dr MOhamed Din bin Ahmad Dr Raji Abbas bin Haji Alias (alternate) Dr D. Po Kennedy
Dr Le-Cuu-Truong
The meetings were also attended by Dr C. Haszler (Australia), Dr H.E. Downes (Australia), Dr Kila Wari (Australia), Dr Suk Woo Yun (Korea), Dr E.L. Villegas (Philippines), Dr R.K.C. Lee (United States of America) and Dr Saipele Matagi (United States of America).
REGIONAL COMMITrEE: FOURTEENTH SESSION
• In the course of its meetings on 6 and 9 September, the Sub-Committee,
in accordance with the guide-lines given on po~ 41, made a detailed examination and analysis of the proposed programme and budget estimates. 2. GENERAL BEVIEW OF THE PROPOSED PROG~ AND BUDGET ESTDfATES FOR
THE FINANCIAL YEAR 1 JANUARY - 31 DECEMBER 1965 (Document WP/RC14/3) In introducing the proposed programme and budget in the Sub-COmmittee,
the Regional Director stated that the effective working budget proposed for the Region under the regular programme in 1965, excluding mal.aria activities, amounted to $2 477 000, an increase of $414 147 or 20 per cent over the level for 1964. Of the proposed increase, $387 599 were allocated
to field activities and only $26 580 to the Regional Office.
This was in
line with the policy that the major proportion of any increase should be directly applied to field activities. The increases in the Regional Office, 6-1/2 per cent, the Regional
•
Advisers, 1 per cent, and the WHO Representatives, 2-1/3 per cent, were attributable to statutory increases and uneven distribution of home leave between the two years. The Regional Director pointed out that the proposed programme for
1965 was based on government requests, taking into account continuing cOmmitments, previously established criteria for regional programme priOrities, and the allocation provided by the Director-General. From
the summary of field activities, it would be seen that the 1965 field activities proposals totalled $2 038 904, representing an increase of $387 559, 23 per cent, over the corresponding estimate for 1964. One
hundred and twenty-one projects were proposed under 19 different major subject head1ngs compared to 92 in 1964; country projects; 107 were country and 14 inter-
130 fellowships were included in the proposals and 33,
25 per cent, of these were for study within the Region.
REPORT OF THE REGIONAL COMMITTEE
31
The Regional Director referred to document V~/RC14/P&B/2 (see page 43) which showed the differences between the proposed estimates
for 1965 and the corresponding estimates for 1964 by amounts and percentages. It would. be noted that in 1965 continuing projects Emphasis
accounted for approximately 74 per cent of the estimates.
continued to be placed on projects relating to the basic needs and problems of the Region, including public health administration, education • :<:
and training, strengthening of nursing and maternal and child health services, environmental health activities, and campaigns against communicable diseases. The largest individual percentase of funds
continued to be budgeted for public health administration, with 26.78 per cent of the total, followed by education and training, 12.93 per cent, and nursing, 10.35 per cent. In line with the recommendations of previous meetings of the
Regional Committee supporting projects benefiting more than one country, various region-wide activities were proposed. These included the
continuation of the regional tuberculosis advisory and inter-country treponematoses teams, seminars on filariasis and haemorrhagic fevers and a conference on the public health aspects of' protection against ionizing radiation. In addition, provision was made for an intra-
regional survey of dental diseases.
The remaining inter-country projects
covered consultant services and fellowships. Despite the Significant increase in the proposed programme for
..
1965, it was still impossible to accommodate all the requests submitted by Member governments. It had, therefore, been necessary to relegate
certain requests amounting to $728 100 to the supplementary list for possible implementation if funds became available.
REGIONAL COMMITTEE: FOURTEENTH SESSION
The Regional Director explained that the 1965 Technical Assistance programme printed in the document was, of course, tentative as government requests for the 1965/66 biennium had not yet been submitted to the Technical Assistance Board. This included continuing commitments of long-
term projects, which had already been approved beyond 1964 by the Technical Assistance Board, and recommendations of the Regional Office covering project extensions or modifications, and new activities for the
1965/66 biennium.
He stressed the importance of health administrations
ensuring that the final submission to the Technical Assistance Board should contain full provision for both continuing projects and new requirements. In the current biennium there had been instances where
the amounts requested and approved were not sufficient for the proposed programme. A great deal of difficulty had been encountered in attempting The Regional Office supplied governments
to cover deficits by savings.
with cost estimates for their Technical Assistance projects based on WHO's costing averages. Failure to use these co stings would result in
incorrect amounts being approved by the Technical Assistance Board and would jeopardize the successful operation of the programme. The overall
importance and relationship of health programmes to the economic and social growth of developing countries was of the highest importance and this should be made clear to national co~ordinating ,
•
bodies when the
Technical Assistance programme was being planned. The Regional Director informed the Committee that commencing in
1964, a separate allocation had. been provided. within the regular budget to cover all malaria activities, except those carried under the Technical Assistance budget. The proposals for malaria activities remained at '\
apprOximately the same level as in 1964.
A slight increase in the
prOvision for Regional Advisers was mainly attributable to statutory
REPORT OF THE REGIONAL COMMITTEE
33
increreen"Gs and hOlr:e leave costs.
There were no char:..ges in the staffing
•
pattern.
At present five countries in the Region had full malaria
eradication projects in operation, namely, China, North Borneo, Philippines,
."
Ryukyu
Islands and
Sarawal~.
Assj,stance to China would be discontinued in
~'
1965 as it was expected that malaria would be eradicated by the end of 1964. It was prorosed to commence a pre-eradication programme in Laos
during 1965. Pro:posals under the Special Account for Community Water Supply were tentative and subject to the contributions received. In addition to
projects providing expert or consultant services to seven countries of the Region, a regional seminar on water utility problems in urban development had been included in the proposals.
In concluding, the Regional Director considered that the proposed budgetary increase for 1965 was reasonable, particularly if one viewed the many requests which had had to be allocated to the supplementary list because of limitations in funds.
3·
DErAILED EXAMINATION AND ANALYSIS OF THE PROPOSED PROGRAMME AND BUDGET ESTIMATES
In the course of the Sub-Committee's study, the following matters were discussed: 3.1 3.1.1 Country ;?rojects Cambodia 9 - Rural health training programme (pages 25-26) It was noted that the duration of assistance to this project was estimated to be ten yeexs and information was requested on the number of personnel to be trained. The Regional Director stated that he could not provide a definite figure of the n~~ber
involved but that students from the School of ~dicine
Nursing and the Royal School of
used this training centre for
F.EGIONAL
COMMIT~EE:
FOURI'EENTH SESSION
rural health experience. undertaken.
The training of sanitary agents was also being
The project had been faced with a number of difficulties,
one of which was the recruitment of suitable counterparts for WHO personnel. The situation was, however, improving and a senior counterAs he had pointed out in his Annua.l
part had recently been appointed.
Report, unless governments provided counterparts, WHO staff would have to remain in the country longer than originally planned. therefore, be necessary for the next four years. 3.1.2 China 3)+ - Trachoma control (pages 33-34) Information was requested on this project which it was noted was an extensive one which had been going on for a number of years. It It would,
assistance to this project to continue for
was felt that the moment had possibly come to evaluate progress and determine whether the desired results were being achieved. The Sub-Committee was informed that the programme had been originally
designed to provide treatment for schoolchildren and also, in certain areas, blanket treatment of family contacts. As the results had not
been satisfactory, epidemiological studies had been carried out in 1960-1961 by a
"mo
team, composed of a trachomatologist and an epidemioTherapeutic trials had been ~
logist/ statistician, and the national team.
,
carried. out at the same time to cLl1Ipare the effectiveness of continuous and intermittent treatment with antibiotic ointment. It had been found
that trachoma was not confined to the school-age groups and that the highest prevalence was conSistently found in the 15-20 age group I irrespective of overall prevalence rate,and the decline beyond this peak was very gradual.
The therapeutic trials had showed that inter-
mittent treatment by achromycin ointment yielded results which were
superior or at least as good as those of continuous treatment.
REPORT OF THE REGIONAL COMMITTEE
.. The project had been redefined to provide for the treatment of all age
groups in the belief that the approach used would. reduce the average prevalence. In undertaking the revised prograw~,
the enormity of the
task had impressed the Government and the terun, and therefore very careful and detailed. plans had been made. There had been trials of all
proposed methods to test their practicability in the field before starting the mass campaign. The survey teams which were dOing case-finding and
treatment had covered to date over most cases up to the progr~
90 per cent of the population,and in
99 per cent, indicating the effectiveness with which It was realized that such a
was being carried out.
programme, to be effective, depended upon a systematic approach and, if possible, on a 100 per cent coverage. It was a tremendous challenge
but it was expected that the results would be satisfactory.
Provision
had been made for an annual evaluation of the programme by a consultant
and in the last year there would be a consultant team which would do a complete evaluation.
3·1.3
Korea 19 - Tuberculosis control (pages 55-56)
Attention was dravm to the fact that, although this project had started in 1963 or earlier and was expected to finish in 1967, there was no evidence of any diminution in WHO assistance. It was felt that this
point covered a number of programmes and it appeared that in many cases there was no tapering off of WHO assistance until the completion of the project. It should be possible for competent counterparts to replace d1minjshing
the WHO staff gradually SO that assistance was given on a scale.
The Regional Director pointed out that in many cases the budget
provision was to meet the cost of fellowships to be awarded to train
REGIONAL COMMITTEE: FOURTEENTH SESSION
local. people.
In 1965, for e~le, there was provision for fellowships
in the amount of $9800, which represented intensified training of national. staff. The tuberculosis project in Korea had only just started and one
could not expect the government staff to take over within such a short period of time as four years. The aim was not merely to delOOnstrate During the past
tuberculosis control but to work out a national plan.
months, the progress achieved had been quite impressive.
3.1.4
Malaya 40 - As~1.stance to the University of Malaya (pages 77-78)
The Sub-Com:n:i.ttee was informed that the medical education programme in Malaya was being e>:;panded and developed. The representative of MaJ.a.ya.
asked, therefore, if the fellowships appearing in the proposed programme and budget could perhaps be advance-awarded. consultants would also be desirable. The early assignment of the
He further requested that the two-
year fellowship for study of vital statistics in the United Kingdom should be changed to a two-year fellowship for study of epidemiology and statistics in tbe United states of America, and that the reference to London University, followed by practiCal. training in Africa and India, in connection with the nutrition fellowship, should be deleted..
3.1. 5
New Zealand 200 - Public bealth administration (pages 79-80)
The Regional Director was requested to amend the text to read "To enable an office inspector in the Department of Health to study public health administration and finance".
3.1.6
Papua and New Guinea
(pages 85-88)
The Sub-Committee ims informed that a majority of the fellowships
awarded in past years
~o
Papua and New Guinea had. been taken by Europeans, This would not
as there had been no medically tre.ined local. personnel. be so in
1965, as all but one fellowship in the surgery of leprosy were
for nationaJ.. personnel and this trend would be followed in future years.
REPORT OF THE REGIONAL COMMITTEE
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37
3.2 3.2.1
Inter-country Programmes (pages 127-142) Site of inter-country seminars and meetings
The Sub-Committee noted that, in general, seminars and inter-country meetings were held. in Na.nila. A suggestion was macle that some of these
might be held elsewhere, as it was considered that M=mber countries would derive more benefit from this arrangement. The Regional Director stated that he appreciated this proposal which
would, hO"Wever, present economic difficulties.
Since the programme and
budget was prepared two years ahead, it was not know then whether any M=mber governments wished to act as host and the Regional Office was, therefore, used as the central point and basis for the calculation of t
expenses.
It would also be a pity not to use the regional office
facilities for conference purposes since quite a large amount had been spent for this purpose. If, however, a government wished to invite WHO to hold
a seminar or meeting in its country, this could be arranged, but the additional costs would have to be borne by the government concerned. It was suggested that Member governments should be provided with a record of the places where seminars, conferences or meetings had. been held over the last five years, as this would be a valuable guide in deciding which country might be suitable for a particular meeting for example, Japan for radiation and Malaya for haemorrhagic fever. Following further discussion, it was decided that the draft resolution presented to the Committee should contain a reference to the fact that if a seminar were held outside of regional headquarters, the additional expenses should be met by the host country. 3.2.2 Participation in educational meetings (pages 141-142)
FollOwing a query by a member of the Sub-Committee as to the prOvision under Participation in Educational Meetings, the Regional
REGIONAL COMMITrEE: FOURTEENTH SESSION
Director stated that, normaJ.ly, WHO did not finance participation in congresses and similar meetings. There were, however, times when a
fellow was already, for example, in Europe and wished to attend a meeting there; payment for his attendance could be made from this particular allocation. On
other occasions, it might be of interest to
governments to send participants to meetings sponsored by WHO Headquarters or other regions. This, too, would be covered under this allocation.
3.3
Malaria Eradication Programme (pages 147-162) A question was asked as to whether the integration of the malaria
budget into the regular budget had resulted in governments prOviding further support for the malaria programme in the form of increased appropriations. The representative of the Philippines stated that as a result of the assistance given by WHO, the interest of his Government had been greatly stimulated in malaria eradication activities. If' the amount:
,
of money appropriated five or ten years ago was compared with that appropriated at the present time, it could be said that the expenditure for malaria had increased tenfold. The Regional Director believed that all governments embarking on
such programmes had done everything possible to increase their own appropriations in order to reach the objective of eradication. ~Cial
Account for the Community Water pages 164-169)
Supp1r Programme
The SUb-Committee noted that the community water supply programme
was entirely financed by voluntary contributions and that planning had,
therefore, to be done on a yearly basis.
The proposed programme
was
therefore a very tentative one and its inq>lementation would depend on whether WHO received suff'icient voluntary contributions in 1965 to support it.
REPORT OF THE REGIONAL COMMI'1'1'EE
_.
3.5
Supplementary List (pages 186-201) In reply to a question, the Regional Director stated that the number
of projects included in this year's supplementary list was slightly smaller than in the previous year. $933 000, whereas in 1965 it was In 1964, the total had been approximately
$728 100.
At the request of the representatives concerned, the following items were added to the supplementary list: Philippines A twelve-month i'ellowship in health education for study in the United states of America
A three-month consultant in hospital administration in support of the programme at the Institute of Hygiene Japan A six-month fellowship in the organization, planning and administration of medical rehabilitation services. It was hoped this fellowship could perhaps be advanceawarded in 1964.
4.
OTHER POINTS RAISED
It was noted that there was an increase of 20 per cent in the proposed budget. It was pOinted out, howver, that in the past years
there had. been a great many requests from the African :Region whose budget bad. been rather larger than that of the Western Pe.cific Region.
It would
appear, therefore, appropriate that the Western Pacific Region should not be neglected and in 1965, therefore, the Region had received an increased allocation. The hope was expressed that similar increases would not be
...
brought forward by all the regions of WHO when the proposed programme and budget was considered by the World Health Assembly. The SUb-Committee noted that the proposal covering the es.tabl1shDent of a special progr~
and bud8et committee had. been based on
the bellef
that a sma.l.Ulr committee would be able to d.1scuss the budget more
40
<
REGIONAL COMMITTEE: FOURl'EENTH SESSION
thoroughly.
The representative of the Philippines suggested -that
consideration might perhaps be given to the possibility ot having the programme and budget discussed in plenary session by all representatives, rather than sub-dividing the Committee and rotating membership among the various countries. It was pointed out by other representatives that
although the Sub-Committee was composed of certain countries, any country not a member of the Sub-Committee was always free to participate in the discussions. It was finally agreed that the representative of
the Philippines should present this proposal to the Committee when the programme and budget was discussed, should he so desire.
5.
CONCLUSlONS The Sub-Committee agreed that the programme was balanced and
followed the general programme of work approved by the Regional Committee and the World Health Assembly, and that the priorities established were acceptable.