(wpRlRC46/SRl4)
SUMMARY RECORD OF THE FOURTH MEETING WHO Conference Hall Manila Tuesday 12 September 1995 at 2.30 p.m. CHAIRMAN: Dr Joseph Williams (Cook Islands)
CONTENTS ~
1.
Programme budget .. "." .. " .. """." .. " ... "" ... "" .... ""."" .... ".""" ... " .... "" ... ""."."""". 1.1
128 128 133
1.2
Programme budget 1994-1995: Budgetperformance (interim report) " .... " ..... " ... " ................................ " .. " ........... " .... " ...... """"."... Changes in the 1996-1997 programme budget and in future programme budgeting ..... " .. """ ..... """ ........ " ......... " ... "" ..... " .... " .. "."" .. "."..
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I. 1.1
PROGRAMME BUDGET: Item 9 of the Agenda Pro~mme
budiet 1994-1995: Budget perfonnance (interim JllPort): Item 9.1 ofthe
Agenda (Document WPRlRC46/4) Introducing the 1994-1995 interim report on budget performance, the REGIONAL DIRECTOR said that document WPRlRC46/4 had been prepared to provide the Regional Committee with a preliminary report on the implementation of the regular budget. The narrative account of the management of the budget was contained in the main document, and supporting information was presented in the annexes. The various changes in the budget were outlined, first in general terms in Annex I, and then in detail, including financial implementation as at 31 May 1995, in Annex 2. A third annex provided brief notes only on the programmes where implementation was less than 80% of the current operating budget. The interim report was intended to keep the Committee informed of progress in implementation. It explained many of the problems the Committee had been warned of in 1993, and the measures taken to overcome them. The Regional Director went on to highlight the main issues addressed during the period, and thanked all the Member States for their cooperation and the understanding they had shown over those difficulties. In 1993, the amount of accumulated underbudgeting had come to US$9.4 million. In addition, there had been no significant change with regard to those contributors who had not met their commitments for the current biennium. The Director-General, therefore, had decided to withhold 4.2% of all regional allocations to compensate for unpaid contributions. For the Western Pacific Region, that meant a budget reduction of US$3 045 000, or 4.2% of the budget. On a pro-rata basis, the reduction at the country level had been US$l 570 100. That brought the shortfall to US$12.4 million. A prioritization exercise had then been carried out to remain within the working budgetary figures. That resulted in a reduction of US$7 020 800 at the country level, and US$5 424 200 at the Regional Office, WHO Representatives' offices and intercountry levels. His concern throughout the process had been to make sure that countries were as little affected as possible by the changes. Although only US$1 592000 or 2.2% out of the 4.2% had been given back to the Region by the Director-General, he had decided to make a reinstatement to countries of the full amount that had been reduced.
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Those adjustments, along with reprogrammings initiated at country level, had been incorporated into an operating budget. It was against this budget that comparisons had been made in the document regarding actual implementation. The interim actual expenditures or obligations as at 31 May 1995, showed a total of US$50 124462, which was equivalent to 70.43% implementation. The final report on the budget performance would, however, be presented to the Regional Committee at its forty-seventh session in 1996. The Regional Director concluded that it was expected that the budget would then have been fully implemented, and discussion could then take place on the fmal implementation results. Nevertheless, he would be pleased to answer any questions the Committee might have on the interim report. Mr BOYER (United States of America) said that reading the interim report gave a special appreciation of the difficulties of managing a budget that was under constant change, and the United States expressed its sympathy to the staff for having to cope with such frequent changes. Last year, the United States delegation had commended the staff for the inclusion for the first time of a column in the table in Annex 2 showing "Other sources of funds implemented", which were extrabudgetary funds. The column did not appear in the present interim report and it was to be hoped that it would be restored to the final report on the biennium when that item was presented in 1996. The presentation of information on extrabudgetary funds was also important for budgeting in future years. There would be increased constraints on the regular budget, and overall, WHO's extrabudgetary resources exceeded the amount of its regular budget. budget and extrabudgetary funds - was required. It was difficult to understand from the interim report the amount of real programme reductions. The Regional Director had said it was US$12.4 million, and that figure appeared in the final paragraph on page 2 of document WPRfRC46/4. However, it could not be found in the tables, especially in column 7 of Annex 2: it was stated in the document that the figure of US$12.4 million was explained in column 7, but that column showed no net change. It appeared that money had been moved around, with increases here and decreases there, but that had not resulted in any real reduction in programme funds. He therefore requested an explanation from the Regional Director. Individual entries in column 7 of the table raised certain questions. There had been an increase of US$2.1 million in support services and of US$276 000 in management, both of which seemed to be primarily overheads. However, there had been very large decreases in health If the Committee was to do its job well, the total picture of available resources - both the regular
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programme areas, with decreases of US$1.8 million in health systems based on primary health care and US$935 000 in disease prevention and control, and US$242 000 in the promotion of environmental health. That was puzzling; the overall goal should have been to preserve funds in the programme areas and not to have diverted them to support services and overheads. With regard to other changes in the budget reflected in other columns of Annex 2, especially columns 2 and 4, it appeared that the increases and decreases had been applied across the board without judgement having been exercised as to which programmes were more important than others. The United States had argued in many forums that there was a need to establish priorities. The constant juggling by WHO of the amount of money available to the Region demonstrated the need, and the opportunity, to make some shifts in resources according to true priorities. He hoped that in future, judgement would be exercised in such situations. In terms of programme implementation, it seemed strange that the overhead-related sections of the budget appeared to have been implemented at very high percentage levels, while some of the programmes had comparatively low rates of implementation. Support services had been implemented at 93%, and executive management at 97%, while in the programme areas, disease prevention and control had been implemented at only 67%, essential drugs and vaccines at 40% and protection and promotion of the health of specific population groups at only 46%. He wondered why the support programme was being implemented almost in full and far in advance of the rest of the programme budget. In terms of the balance of the budget yet to be implemented. his delegation had noted that the World Health Assembly, in drawing up the 1996-1997 budget, had agreed to a number of shifts in priorities. Although they had been intended for the next biennium - 1996-1997 - he wondered why it had not been possible to begin to make some of those shifts in the current biennium for the remainder of 1995. It would be important to do so since they reflected the latest thinking by headquarters and Member States on what were WHO's leading priorities. Finally, in terms of implementation, it was stated on page 3 of the document that only 70.43% of the regular budget had been implemented by the end of May 1995. While recognizing that prudence was called for when questions arose in relation to funding, he asked whether it was possible for the Regional Office to do an effective job of implementation if it was rushing to complete its expenditure by the end of the biennium. The United States would not wish to see unwise decisions made simply in order for the money to be spent on time. Mr SAKAI (Japan) said it was important for the Regional Office to implement
programmes efficiently to utilize fully its limited budget while maximizing its impact on health
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in the Region. In that connection, some programmes, such as those for AIDS and for drug and vaccine quality, safety and efficacy, were still suffering from low implementation rates, although the reasons were mentioned briefly in Annex 3 of the document. Dr ADAMS (Australia) said he wished to echo what had been said by the representatives
of the United States of America and Japan, but he frrst wished to congratulate the Regional Director and his staff on their increasingly transparent presentation of the budget. However, he sought some explanation of column 7 in Annex 2 in which he noted that five programmes had experienced increases of more than US$4 million; he also wished to know why increases had occurred in what appeared to be non-priority areas, especially in relation to the priorities set by the Executive Board. There was, in his view, a need to present the budget in a way that linked the extrabudgetary funds with the programmes concerned so that the reader would be able easily to find out what the Region was spending on individual programmes. There had been fairly large variations in expenditure to date, with high-level expenditure on some programmes and apparent under-expenditure in others. He sought reassurance that the allocation for each programme would have been fully expended by the end of the biennium. The REGIONAL DIRECTOR, in reply to representatives' questions, said that when the Regional Committee came to review total implementation of the programme budget in the final report, the column giving extrabudgetary resources would be provided, as it had been in the previous final report. At the stage of the interim report, when the Regional Office was still receiving and implementing extrabudgetary funds, that column was not included. In addition to the regular budget, there was an additional amount of US$31-$32 million in extrabudgetary funds. That would be shown in the final report of the budget implementation for 1994-1995. Turning to the question on the level of real programme reduction, he confirmed that there had been a reduction in activities in order to remain within the approved budgetary allocation figure. As for the different rates of implementation, he said that support services costs were mainly staff salaries; these were normally implemented in full, which accounted for the high implementation rate. In technical programme areas, different components might be delayed in their implementation, which explained the lower rates noted by the representative of the United States of America. Regarding prioritization, the Regional Office had not unilaterally made a decision on adjusting the budget to take account of the shortfall; it had sent the information back to countries, asking them to readjust their programme budgets in terms of activities, taking account
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of the global priorities set by the Director-General and the Executive Board, as well as the regional priorities and, especially, country priorities. Sometimes country priorities did not necessarily coincide with other priorities. The Regional Office respected the priorities outlined by countries, and had reflected those in the changes resulting from the Priority X exercise. As for the portion of the budget which had not yet been implemented, the Regional Office had not taken account of a shift of 5% of the 1996-1997 allocation to the five priority areas which had been identified by the Executive Board. It would apply the 5%, as intended, in the
1996-1997 biennium. It was too late to apply it for the remainder of the current biennium. The 1994-1995 programme budget was still being implemented, and 70.43% of it had been obligated by the end of May 1995. By the end of the biennium, 100% would have been spent in monetary terms, although some reprogramming might take place between programmes. Turning to the point made by the representative of Japan regarding the AIDS budget, he emphasized that the Regional Office had only allocated US$21 800 from the regular budget for this programme. Headquarters had advised against putting funds required for AIDS into the regular budget, encouraging the office to seek extrabudgetary funding for AIDS-related activities. In view of the initiation of UNAIDS from 1996, he had made provision for funding one medical officer post with a secretary from 1 January 1996. He would see what other measures could be taken for an appropriation under the regular budget for important programmes such as AIDS. Mr BOYER (United States of America) said that when a regional director advised countries to reduce their expenditure, those reductions should be in line with the recommendations of the Director-General, the Executive Board and the World Health Assembly. Dr Han seemed to be saying that countries were deciding the priorities for themselves, which would appear to impede WHO in focusing its resources. The REGIONAL DIRECTOR said that a misunderstanding seemed to have arisen between the United States representative and himself. The Western Pacific Region was most transparent in its accounts, justifying expenditure to the last dollar. Countries had never been permitted to utilize their allocations as they wished, and as long as he was Regional Director that position would not change: the budget represented money entrusted to his care by Member States to be used efficiently and effectively. When countries were requested to make adjustments, discussion took place as to how the allocation should be spent, but this was within the priority areas set by the Director-General and the six regional priorities.
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Dr RODGERS (Solomon Islands) confirmed from the standpoint of a recipient country that priorities set well in advance might be subject to alteration, for example, if the government changed, which could cause understandable difficulties for the Regional Office. He emphasized that all Solomon Islands programmes were implemented in accordance with the guidelines of the Regional Office, and that no WHO funds were "misused" through being applied to priorities other than the given WHO priorities in the country.
1.2
Chanaes in the 1996-1997 proiramme budact and in future prQiJ'amme budaetini: Item 9.2 of the Agenda (Documents WPRJRC46/5 and WPRJRC46/lNF.OOC.l2) The REGIONAL DIRECTOR said that there were many complex issues contained in
document WPRlRC46/5.
It was therefore important to brief the Committee fully on the
developments which had taken place since the proposed programme budget for 1996-1997 had been presented to the Committee in 1994. At that session, the Regional Director said, he had tried to present the proposed programme budget in a very transparent way. He had hoped that with the readjustments made for past underbudgeting, a programme budget could be worked out that met the regional priorities, was fully costed, and could be delivered in its entirety. He had also stressed the fact that in order to deliver the entire programme, it would be necessary to have a realistic cost increase. Anything less would jeopardize the proposed programme budget, and programme reductions might be necessary. The Regional Committee had supported that position by adopting resolution WPRJRC45.R2 requesting the Regional Director to convey to the Director-General the need for a realistic cost increase so as to enable full implementation in both financial and programme terms. The regional programme budget had been forwarded to headquarters, where a revised Classified List of Programmes had been applied before the global budget was presented to the Executive Board. The programme budget considered by the Committee in 1994 had classified the Western Pacific Regional Office activities under 59 programme headings, whereas the global consolidation used only 19, as part of the ongoing budgetary reform process. The Executive Board had recommended, and the Director-General had agreed, to a shift of 5% of the 1996-1997 allocation to five priority areas which had been identified by the Executive Board. In the Western Pacific Region, a total of $3 190900 had been shifted, which was slightly more than requested. He had written to inform the Member States about that in February 1995.
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The shifts made had affected the Regional Director's Development Programme, fellowships in some country programme budgets, and the intercountry team for health situation and trend assessment based in Fiji. The Director-General had requested a global cost increase of 11.54% from the World Health Assembly which had included the Region's estimated requirements of 15.15%. However, after consultation with a number of Member States, the Director-General had requested a revised global increase of 7.49%. The Assembly had not agreed with the compromise proposal and had adopted resolution WHA48.32 which provided an increase of only 2.5% or $20 553 000 above the 1994-1995 approved programme budget. The increase was made up of 4.17% for currency adjustment and a negative cost factor of 1.67%. The same resolution also provided for the use of casual income, if available, of up to $10000000 per year in 1996-1997 for expenditure on priority country programmes. It had not yet been decided how that amount would be distributed. It was hoped that a meeting of regional directors with the Director-General would be held to
discuss that matter in October 1995. For the Region, the Assembly's decision meant receiving a cost increase of 1.94%, or US$1 390000 and a currency adjustment of 0.77% or US$550 000, making a total regional allocation ofUS$73 471 000 for the biennium 1996-1997. As a 15.15% cost increase had been required by the Region, and only 1.94% had been received, reductions of about 13%, or US$9 444 000 had been required from the fully costed programme budget. That had necessitated a very comprehensive review and a series of measures detailed (on page 5) in the document. He was pleased to inform the Committee that, as a result of those measures, it would not be necessary to make reductions to the country programme budgets. He added that in some countries there would be a cost increase, which would be apportioned to provisions for long-term staff. In addition, certain Member States that had joined recently and had low country planning figures, would be provided with supplementary funding during the implementation period. Utmost efforts had been made to spare countries from any additional cuts and disruptions so close to the commencement of the biennium. However, in addition to initiating stringent cost economy measures, it had been necessary to make considerable reductions to activities at the regional and intercountry levels and, to a lesser extent, at the WHO Representatives' offices. In particular, a number of long-term professional posts had had to be frozen either fully or partially for the biennium. That would mean managing programmes with a greater proportion of shortterm staff on intermittent assignments. In other cases, existing staff would be called upon to
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assume additional responsibilities so that the level of technical support required could still, it was hoped, be provided. That would not be easy but everyone would work hard. That was the message already given to all Regional Office staff, at staff meetings and in writing, and he was confident of their understanding, and their loyalty to the Organization in such difficult times. It should be appreciated that the preparation of the programme budget for 1996-1997 had
been a particularly long and complex exercise.
While the measures taken would allow the
delivery of the programme in 1996-1997, the more serious implication was that underbudgeting would probably arise in the 1998-1999 budget exercise unless a realistic cost increase was received for the next biennium. Alternatively, WHO should consider returning to the previous system where an agreed budget allocation, including the amount of cost increase, was provided at the time of preparation of the programme budget. As explained in the document, there was a further change in the 1996-1997 budget. Both the Executive Board and the World Health Assembly had endorsed the concept of strategic budgeting on the understanding that detailed plans of action would be prepared nearer to the time of implementation. The detailed programme budgets should now be adapted into plans of action for 1996-1997. The principal new component was the "product", but further additional information was also required to link the plans of action with the targets of the Ninth General Programme of Work and to provide a harmonized set of data for use at the global level. The Regional Director would be writing to request Member States to undertake the exercise and to provide them with detailed guidance. WHO Representatives would have information on that and computer software to facilitate the process of conversion of the data into the new format. As some plans of action would be reviewed by the Executive Board starting in January 1996, it was important that the exercise was completed as soon as possible. However, he was concerned that the exercise of finalizing the plans of action would delay the implementation of the programme budget in 1996. To ensure that operations started in January, he would shortly be sending the Comprehensive Exchange of Letters for the biennium, attaching the detailed programme budget prepared in 1994. That would form the legal basis for collaboration, and the plans of action which followed would be the operational document for implementation. The Comprehensive Exchange of Letters would be with Member States in early October, and it was hoped that the plans of action would be fmalized by the beginning of November.
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One feature that would be unfamiliar to Member States would be the naming and numbering of programmes, as the existing total of over 59 programme areas had had to be compressed into the 19 major programmes. All of the information for 1996-1997 would be converted to the new global classification to maintain consistency for the Ninth General Programme of Work. In information document WPRlRC46IlNF.DOC.l2, a table for easy reference had been provided, showing the titles and number of programmes used during the development of the regional programme budget, the global programme budget and the reference list that would be used for the reclassified detailed programme budget and for the plans of action to be prepared. It was hoped that the exercise would not be too confusing, but it was important that the
collaborative operation for 1996-1997 should commence promptly, with a clear understanding of what should be done. The Regional Director would be happy to provide any further clarification or support which might be needed. Dr DURHAM (New Zealand) understood that WHO intended to achieve greater efficiency and to focus on both setting priorities and aligning resources with priorities. The measures described under the heading referring to the "budgetary crisis" on page 5 of document WPRlRC46/5 were not consistent with the steps various countries in the Region had taken to achieve gains in efficiency, given that WHO was aiming to implement comparable managerial reforms. New Zealand welcomed the focus on priorities and "products", noting however that it must be reflected in planning and budgetary activities. She asked the Regional Director to explain how the measures indicated would affect the "product", and result in efficiency while maintaining coverage of priority programmes. In relation to the matter raised by the United States representative under item 8 of the agenda concerning "health outcome targets", she felt that the Regional Committee also needed assurance that the resources invested would result in gains in health status. Ms NESBITT (Australia) said that her delegation regarded the Executive Board's recommendations as an encouragement for all levels of WHO to focus on priority-setting in a broader management approach rather than as an accounting exercise. which should result in more strategic budget-setting, and greater efficiency being achieved through improved methods of work and cost reductions.
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Regarding the adjustment of the 1996-1997 proposed programme budget resulting from resolution WHA48.32, she requested information on the specific activities stated on page 5 of document WPRlRC46/5 which were said to have been given lower priority. Any reduction in force (referred to in paragraph 2 on that page) should also reflect the strategic approach. She sought further information from the Regional Office on that matter. The cost-containment measures described in paragraph 3(a), (c) and (d) on page 5 concerned programme provisions at a level too detailed for access by representatives, who should not become involved in "micro-management". However an explanation of the intent of those provisions would be appreciated. While commending the Regional Director on rapid response to a significant reduction in the expected budgetary provision in 1996-1997, she expressed some disappointment at the lack of detail on the adjustments made and on the basis for his decisions. Mr BOYER (United States of America) regretted the compression of programmes into 19 major programmes presented to the World Health Assembly in May, and hoped that the next regional budget would not have to reflect that, as it made it impossible to tell what was planned for expenditure on specific programmes such as those for malaria or tuberculosis control. He urged the Regional Office to continue to give a detailed presentation of regional programme budgets. Regarding lower priorities, he reiterated the request of the representative of Australia that the specific activities should be identified, and details on how the decisions were made should be given. Measures to protect country allocations should be emphasized. It had been disappointing to note that 8% had been cut from country programmes in the Region in the previous budget after the Director-General had issued instructions for an increase of3%. It appeared that a comparable recentralization of resources was occurring at the global level. After the World Health Assembly had approved in May 1995 a budget increase of 2.5% for 1996-1997, information was needed on how that additional money could be applied. It appeared that most of it had gone to WHO headquarters in Geneva and very little to the regional and country programmes. expended. He expressed concern at the implication in section II of the document that shortfalls resulting from underbudgeting of cost increases could be carried over from one budget period to the next. The United States of America did not agree with that policy; once the World Health That was not how the Member States expected the funds to be
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Assembly had adopted a budget at a fixed level, the Organization should make do with that sum and not seek to restore any shortfall through overbudgeting in the following biennium. In a wider context, as he had said at the previous World Health Assembly, many countries, including the United States of America, could no longer continue to make contributions to international organizations at the same rate as in the past. As a result of current legislative processes, it was expected that United States appropriations to the United Nations, its agencies and similar bodies (some 50 in all) would show a shortfall of 15% or more for the fiscal year commencing on 1 October 1995. Even with zero growth or budget reductions, it was therefore unlikely that the United States would pay its assessed contributions in full - a situation that was likely to continue for the foreseeable future. Other countries had similar difficulties. Given the high proportion of the budgets of international organizations funded by the United States, those organizations would have to learn to operate with fewer resources. Member States would therefore need to review how WHO spent its resources to determine where sacrifices could be made in the interests of giving maximum support to programmes of real priority. He hoped that any instructions given to regional offices concerning the development of the 1998-1999 programme budget had not been based on the assumption that WHO could continue as before. Serious efforts must be made to streamline operations, focusing only on activities of genuine importance - across-the-board cuts were not the solution. He doubted that the realistic cost increases called for by the Regional Director would be possible if major contributors were unable to maintain their current level of contributions. The 1996-1997 budget should be implemented only to the extent for which money was available. The 2.5% increase provided for the 1996-1997 biennium would probably not be realized. He regretted having to make such comments, which did not reflect any ill feeling on the part of the United States Government towards WHO or other organizations. Mr SAKAI (Japan), recognizing the serious implications of the current budgetary situation
for the activities of WHO, including those of the Western Pacific Regional Office, commended the Regional Director on his efforts to maintain the effectiveness of programmes and expressed the hope that future plans of action would be carefully formulated to minimize any negative impact. Countries were currently assessed for their contributions to WHO in accordance with their United Nations assessed contribution. As a result the contribution for Japan was set to rise by more than 20% in the following biennium - a difficult increase to meet given the country's current economic difficulties. Japan would nevertheless strive to maintain its regular budget contributions and to expand its extrabudgetary donations to WHO activities.
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Dr SODNOMPIL (Mongolia) thanked the Regional Director and his staff for the rapid implementation of activities under the 1994-1995 programme budget. The programme budget for 1996-1997 had been finalized, again with support from WHO staff. He was pleased to note that the regular budget allocation to Mongolia had not been reduced; some 30 projects were envisaged. He agreed that country activities and funds should be focused on areas of real priority and where results could be achieved quickly. Mongolia was therefore concentrating on the reduction of maternal mortality and on the control of respiratory infections which accounted for 60% of infant deaths. Other priorities included the strengthening of management, the maintenance of high immunization coverage and control of meningococcal infections and diphtheria. He thanked the Japanese Government for its support to the diphtheria immunization programme. Increased funds and appropriate country methodologies were required for a further priority, adolescent health. Although Mongolia had transferred to the Western Pacific Region only a few months earlier, he was pleased to note the transparency of the Region's budgeting process, as shown in the documents provided, and that the actions of the Regional Director were always aimed at ensuring maximum benefits at the country level. He commended the systematic approach to tackling problems taken in the Region, as reflected in the 1996-1997 programme budget, and was confident that with WHO support and guidance Member States would achieve their objectives. Dr LI (China) said that the difficult financial situation experienced by the Organization, including the Western Pacific Region, in recent years had necessitated repeated adjustments to its programmes. For each of these adjustments, the Regional Office had consulted Member States well in advance to mitigate effects at country level, although this had necessitated cuts in intercountry programmes and the freezing of posts at the Regional Office. Those efforts were greatly appreciated by Member States. All Member States, particularly the major contributors, should examine how best the current financial situation of WHO could be improved. Health was such a vital issue that ways of increasing support should be sought. Member States should also collaborate with the Regional Office to ensure that maximum benefit was obtained from the resources available in accordance with the priorities set at global, regional and country levels; they should also seek to mobilize the limited domestic resources and strengthen management to enhance the cost effectiveness of programme activities.
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Dr ROXAS (Philippines) welcomed the transparent approach to budgeting and planning in the Region. However, the figures given in the document New horizons in health clearly indicated that there were considerable variations in the values of selected health indicators among the Region's Member States. For example, infant mortality ranged from 5 per 1000 live births in Japan to 117 per 1000 live births in Lao People's Democratic Republic. Furthermore, tuberculosis was a particular problem in the Philippines. Programmes were oriented towards the control of specific diseases or vulnerable groups and it might be worth examining the possibility of focusing such programmes on the countries or areas with the poorest figures, in order to reduce the current wide gaps observed. The planning procedures in both countries and WHO should take greater account of such needs. Dr NGO VAN HOP (Viet Nam) congratulated the Regional Director on the transparent presentations in relation to the 1996-1997 programme budget and welcomed efforts to minimize cuts at the country level. He endorsed the proposals outlined in document WPRlRC46/S. He appreciated the approach to budgeting in the Region and the opportunity for Member States to consult with the WHO Representatives in determining country needs and in planning activities in conformity with regional and global priorities and objectives, for example in vaccination programmes, the control of diarrhoeal diseases, malaria, and tuberculosis, and in primary health care development. That approach was the best way to enable each country to prepare and implement each biennial programme in accordance with its own needs. Dr TAITAI (Kiribati) endorsed the comments of the representative of Solomon Islands (under agenda item 9.1) concerning the position of small island countries receiving financial and technical support from WHO, and thanked the Regional Director for his understanding of the constraints such countries faced while adhering to Executive Board and World Health Assembly directives concerning the prioritization of programmes. The maintenance of an effective Regional Office Secretariat was crucial to the successful implementation of programmes in countries such as Kiribati where technical expertise was scarce. Regional Office staff had been able to undertake some of the functions normally performed by short-term consultants, which had spared some funds for other priority programmes. He was confident that the Regional Director would make appropriate use of the resources at his disposal in responding to the health needs of the Region's Member States. Dr TAUFA (Papua New Guinea) welcomed the report and the opportunity for all Member States, however small, to have a say in the programme budget. She had listened with interest to
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the exchanges between the representative of the United States of America and the Regional Director regarding the utilization of WHO resources. The Committee had already discussed two important documents, New horizons in health and the Yanuca Island Declaration, both of which outlined the specific programme priorities of Pacific islands. WHO had recognized those needs and had adjusted the programme budget accordingly. The Regional Director had indicated that country-level allocations remained intact, which was most reassuring to her. Countries and WHO had also formulated guidelines for the use of extrabudgetary funds. Experience had shown that major donors tended to dictate how such resources should be used, with little country input. That had obstructed the progress of externally funded health services projects. Papua New Guinea was grateful for the technical and financial support provided by WHO. Mr CHUA (Malaysia) shared the Regional Director's concerns at the proportion of total funds allocated to the Western Pacific Region as compared to other regions, in particular Africa and the Eastern Mediterranean, and asked why such a situation had arisen. While he appreciated the rationale for an increased allocation to the African Region, the Western Pacific's per capita allocation was only 20% of the African Region's, and 25% of the Eastern Mediterranean Region's. The Western Pacific Region contained 28% of the world's population and seven of the least developed countries. Furthermore, there were great disparities between countries within the Region, with, for example, a difference in life expectancy of 30 years. Given the comments of the representatives of the United States of America and Japan, it appeared that the total resources available to WHO in coming bienniums would be reduced. There was clearly a need for the Committee to examine seriously how the Region's case could be presented effectively to the governing bodies to ensure that the Region received a fairer share of the funds available, or at the very least, maintained its current share. The CHAIRMAN indicated that the Regional Director would reply to the comments of the representative of Malaysia under item 9.3 of the Agenda. Mr LOUECKHOTE (France) thanked the Regional Director for taking account of the priority needs of New Caledonia in making interim adjustments to the 1994-1995 programme budget. Given the comments of the representatives of the United States of America and Japan, it appeared that the preparation and implementation of the 1996·1997 programme budget adopted by the World Health Assembly would prove difficult.
He therefore endorsed the Regional
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Director's proposals, which emphasized technical and scientific posts, and the maintenance of fellowships and short-term consultants, which were vital for the training of national staff who could take charge of future programme implementation. However, he was not sure that that was sufficient and would welcome further information on the freezing of posts. The management approach should give priority to programme activities over accounting procedures, and that should be reflected in an appropriate balance between salary costs and expenditures in the field. It was of course essential to adjust expenditure to income.
Dr SIPELI (Niue) asked how the country allocations were arrived at. The allocations as currently calculated were insufficient to enable small island countries to achieve and maintain satisfactory health indicators. Niue was heavily reliant on external aid for improving its people's health status, and welcomed any supplement to its country budget for 1996-1997. The REGIONAL DIRECTOR, replying to the representative of New Zealand, said that in readjusting the 1996-1997 programme budget he had tried to avoid making cuts at country level and had therefore made sacrifices mostly at intercountry and regional levels. Allocations to the priority activities defined by the Executive Board would be maintained at 66.84%, and allocations to the regional priority areas would amount to 74.9% (or 75.35% including Mongolia). He would endeavour to minimize the effect of the cuts on the efficiency of programme delivery. When a post was frozen, for example, he would consider using a consultant to carry out programme activities or assigning additional responsibilities to another staff member. He would try to ensure the effectiveness of final products during his discussions with Member States to prepare plans of action for 1996-1997. The representative of Australia had asked for examples of the measures taken to meet the budgetary crisis. The Programme Committee of the Regional Office had been asked by the Regional Director to make recommendations on the readjustment of the programme budget, and it had proposed a number of principles: to give global and regional priorities precedence over programmes of lesser importance; not to reduce country budgets, but to absorb the shortfall at intercountry and regional levels; to keep country planning figures at least at the 1994-1995 level in dollar tenns; and to give cost increases to countries with long-term staff. If a reduction in force became necessary, it would be applied to general service staff at each duty station separately. For professional staff, however, it would have to be applied worldwide. The procedure was extremely complicated: the abolition of a post in the Western Pacific Region, for example, might result in someone in another region losing his or her job. He had held a meeting with all staff at the Regional Office, calling upon them to be prepared to assume additional responsibilities to safeguard programme delivery. He was pleased to announce
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that no reduction in force would be necessary in the Region. However, due to low programme requirements one intercountry post had been deleted. An appropriate position for the person affected had been identified and was subject to the agreement of the government concerned. The situation was under control, and he asked the Committee to leave the management to him. He advised the representative of the United States of America that, when the Director-General had decided to simplify the presentation of the programme budget by reducing the classified list of programmes from 59 categories to 19, the regional directors attending the Global Policy Council in June 1995 had insisted on retaining the 59 categories in their regional proposals, as those proposals had already been approved by the respective regional committees. For the 1998-1999 programme budget, the Region would of course use the programme classification adopted at the global level. management. The representative of the United States of America had also queried the allocation of the 2.5% budget increase granted by the Forty-eighth World Health Assembly. The representative was correct in that the greater portion of net increase (US$39.9 million) was for currency adjustments at the global and headquarters levels. Strict application of the principle of "equal misery" would have meant a decrease in doJlar terms over the 1994-1995 budget for the African and American regions. Accordingly the Director-General had agreed to transfer some $11 million from the headquarters allocation to those two regions in order to maintain their allocations at the 1994-1995 level in dollar terms. The Western Pacific Region had received an increase of 2.71 %, made up of a 1.94% cost increase and 0.77% currency adjustment. The Director-General had withheld 3% of the total budgetary allocation for country-level priority programmes. That was subsequently passed on to the regional offices. The Region had received $2 146 000, which had been distributed among country-level programmes except for $450 000 earmarked for malaria control activities under the intercountry programme. He agreed that underbudgeting was undesirable. It meant that he had repeatedly had to inform the Regional Committee of adjustments to the programmes previously agreed upon. If major contributors were unable to pay their assessed contributions, or if the World Health Assembly decided not to grant a cost increase, he had to accept that as a reality. However, he needed to have that information before he asked Member States to draw up the Region's programme budget. He would prefer a fixed amount to be allocated to the Region, so that a realistic programme budget could be drawn up in strict compliance with the priorities set by the Executive Board. Personally he would prefer to maintain the more detailed classification at the regional level, for the purposes of day-to-day operational
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The Regional Director advised the representative of Niue that country planning figures could not be detennined on a mathematical basis. Population size, health problems, a country's commitment and capacity to absorb support were all taken into account. Special consideration was given to the least developed countries. Very small countries like Niue faced particular hardship because their country planning figure might be less than the assessed contribution, and in such cases every effort was made in the course of programme implementation to provide additional support. The Chainnan asked the Rapporteurs to prepare a suitable draft resolution.
The meetjo& rose at 4 50 P m