REGIONAL COMMITTEE
Provisional Agenda item 18.1
Sixty-third Session Bangkok, Thailand 7–10 September 2010
SEA/RC63/14 (Rev.1) 16 July 2010
Governing Bodies: Key issues and challenges arising out of the Sixty-third World Health Assembly and the 126th and 127th sessions of the WHO Executive Board The working paper highlights the most significant and relevant decisions and resolutions emanating from the Sixty-third World Health Assembly, held in Geneva from 17-21 May 2010 (see the complete list of decisions and resolutions in Annex 1), as well as the 126th and 127th sessions of the Executive Board, held from 18-23 January 2010 and on 22 May 2010 respectively. These decisions and resolutions are particularly relevant to the Member States of the WHO South-East Asia (SEA) Region, and have obvious and immediate implications for them. They would merit follow-up actions by Member States and WHO. The background of the selected decisions/resolutions including the highlights from main operative paragraphs, as well as the regional implications of each decision and/or resolution, as applicable, and actions proposed for Member States and WHO have been presented in the paper. The High-Level Preparatory (HLP) Meeting held in the Regional Office in New Delhi from 28 June to 1 July 2010 reviewed the working paper and made the following recommendation: Action by WHO-SEARO •
The working paper on this agenda item needs to be updated and revised with additional items (resolutions and topics of regional interest related to the Sixtythird World Health Assembly), and the revised version needs to be submitted to the Sixty-third Session of the Regional Committee for its consideration.
The revised working paper incorporating the additional texts is submitted to the Sixtythird Session of the Regional Committee for review and noting, as appropriate.
Contents
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Introduction ......................................................................................................................... 1 Resolutions ........................................................................................................................... 2 1. 2. 3. 4. 5. 6. 7. 8. 9. Pandemic Influenza preparedness: sharing of influenza viruses and access to vaccines and other benefits (WHA63.1) ............................................................................. 2 Advancing food safety initiatives (WHA63.3) ...................................................................... 3 Partnerships (WHA63.10) ................................................................................................ 4 Availability, safety and quality of blood products (WHA63.12) .............................................. 6 Global strategy to reduce the harmful use of alcohol (WHA63.13)......................................... 7 Marketing of food and non-alcoholic beverages to children (WHA63.14) ............................... 9 Monitoring of the achievement of the health-related millennium development goals (WHA63.15) ................................................................................................................ 10 WHO global code of practice on the international recruitment of health personnel (WHA63.16) ................................................................................................................ 12 Birth defects (WHA63.17).............................................................................................. 14
10. Viral hepatitis (WHA63.18) ............................................................................................ 15 11. WHO HIV/AIDS Strategy for 2011-2015 (WHA63.19) ....................................................... 17 12. WHO’s role and responsibilities in health research (WHA63.21) ......................................... 18 13. Infant and young child nutrition (WHA63.23) ................................................................... 21 14. Accelerated progress towards achievement of Millennium Development Goal 4 to reduce child mortality: prevention and treatment of pneumonia (WHA 63.24) ................. 22 15. Improvement in health through safe and environmentally sound waste management (WHA63.25) ................................................................................................................ 24 Decisions ........................................................................................................................... 26 1. Substandard/spurious/falsely-labelled/falsified/ counterfeit medical products – WHA63 (10) ................................................................................................................ 26
Annex Decisions and Resolutions of the Sixty-third World Health Assembly
SEA/RC63/14 (Rev.1)
Introduction The Sixty-third World Health Assembly and the 126th session of the Executive Board adopted a number of resolutions and decisions during the course of their deliberations. These decisions and resolutions relate to both health matters and financial subjects. Decisions and resolutions on technical matters that have significant implications for the SEA Region have been presented in this paper, highlighting salient information from the operative paragraphs that would be relevant to WHO and the Member States of the Region, and briefly describing the actions to be taken. Copies of all the decisions and resolutions of the governing bodies have been annexed to this paper, for easy reference.
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Resolutions 1. Pandemic Influenza preparedness: sharing of influenza viruses and access to vaccines and other benefits (WHA63.1) Background •
There have been several issues and concerns on sharing of highly pathogenic influenza virus (H5N1), notably with regard to intellectual property rights over viruses and equitable access to products developed from them. To address these issues and concerns the World Health Assembly (WHA) had earlier adopted resolutions WHA60.28 and WHA62.10. Furthermore, the 126th session of Executive Board (EB) had made progress on Standard Material Transfer Agreement and benefits sharing, but there remained unresolved and outstanding issues. To resolve the remaining elements, the EB agreed to establish an Open-Ended Working Group of Member States (OEWG). The OEWG which met 10-12 May 2010 produced a report which noted that among others, the need for further considerations and studies.
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Main operative paragraph and its implications on collaborative activities with Member States •
The resolution WHA63.1 requested the Director-General: i) to continue to work with Member States and relevant regional economic integration organizations, on the Pandemic Influenza Preparedness Framework for the Sharing of Influenza Viruses and Access to Vaccines and Other Benefits; ii) to convene the OEWG before the 128th session of the Executive Board. It also requested the Director General to undertake technical consultations and studies as necessary in order to support the work of the OEWG in reaching a final agreement. The WHA decided that the OEWG report through EB at its 128th session to the Sixty-fourth World Health Assembly. Recognizing that there are still unresolved elements of the Framework; WHA63.1 called for implementing a fair and transparent, equitable, efficient and effective system for sharing of viruses and access to vaccines and other benefits. It also notes that solutions to address these may include separate, but complimentary Standard Material Transfer Agreements: one within WHO Network, and one for outside the Network. This has implications on collaboration of Member States with regional and global partners (WHO and other stakeholders) in influenza virus sharing, laboratory networking, research and development of vaccines and antivirals.
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Actions already completed in the Region •
Member States of the WHO South East Asia Region have actively pursued the need for global framework that benefits everyone. Regional and global consultations on influenza, which also deliberated on issues related to virus sharing, and equitable access to products developed from them were organized. The delegates from SEA Member States have actively participated in global consultations including at the World Health Assembly, EB, and OEWG meetings.
Actions to be taken in the Region •
In view of the above resolution, which notes remaining unresolved issues and recognizes the need to address these challenges, WHO/SEARO and its Member States need to further enhance regional cooperation including in building core capacities for surveillance and response, research on influenza (and application of findings), and in technology transfer (for production of antivirals, vaccines, and lab reagents). It is equally important to further promote cooperation, multisectoral collaboration and networking among centers of excellence in the Region. Member States of the SEA Region may also wish to continue dialogue and exchange of views and information on intellectual property rights and on the proposed terms for the Material Transfer Agreements. To ensure that remaining issues are resolved in a fair and transparent way, WHO SEA Member States as the have done before, need to remain engaged in the process including Regional consultation and participation at the OWEG meeting which will further deliberate on the subject.
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Advancing food safety initiatives (WHA63.3) Background •
The World Health Assembly resolution WHA 63.3, agenda item 11.8, entitled ‘Advancing Food Safety Initiatives’ has considered the report of the Secretariat highlighting the public health implications of foodborne diseases; chemicals and toxins in food supply; the effects of unsafe food on family and individual food insecurity and resultant malnutrition; and the need for closer collaboration with the health sector. The Ten-Point Regional Strategy for Food Safety in the South-East Asia Region has been endorsed by all Member States although its implementation varies among them. In general, national food safety programmes are multisectoral where each component is fragmentally managed with lack of coordination and cooperation between the parties. Two different food safety systems function - one for the export market and the other for domestic consumption, and are subjected to low level of enforcement and compliance. Stronger political commitment and more resources are needed to strengthen the safety of food for domestic consumption.
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Main operative paragraph and its implications on collaborative activities with Member States •
To enhance food safety considerations to include food aid, food security and nutrition interventions in order to reduce the occurrence of foodborne diseases and improve the health outcomes in populations. Second, to strengthen the components of the International Food Safety Authorities Network (INFOSAN) for food safety events– development of systems for surveillance for foodborne disease and food contamination; risk assessment, traceability; food safety emergency response; and strengthened laboratory capacity.
Actions already taken in the Region •
Technical assistance to improve safety of food for domestic consumption by promoting healthy markets and safe street foods; assessment of national food safety programmes; integrated food safety, nutrition and food security approaches in response to the impact of climate change; updating of existing food laws, legislation and regulatory mechanisms in Member States; training in food safety emergencies as part of Asia FoodNet network; and total diet studies to assess dietary intake and residual levels of chemical contaminants in populations. Capacity building of national Codex and national INFOSAN committees and improved communication with Codex Trust Fund and Codex Commission.
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Actions to be taken in the Region •
In order to estimate the dietary intake of chemical and toxic contaminants in population groups, additional “total diet studies” would need to be conducted in Member States along with the strengthening of analytical capability, especially in laboratory infrastructure and personnel’s skill to analyse a wide range of contaminants. Foodborne disease surveillance and monitoring systems should be strengthened to monitor and detect more resistant foodborne pathogens and/or new emerging foodborne diseases. Attempts should be made to improve safety of food for domestic consumption, especially street food and food served in restaurants, with regard to their health impacts on the population.
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Partnerships (WHA63.10) Background •
The policy submitted as an annex to the resolution was endorsed by the World Health Assembly. It provides the framework that will guide WHO’s assessment of, and decisions concerning, potential engagement in different types of health partnerships; it also provides specific principles to be applied in cases where WHO agrees to host a formal partnership.
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Main operative paragraph and its implications on collaborative activities with Member States • •
Endorses the “policy on WHO’s engagement with global health partnerships and hosting arrangements”; Calls upon Member States to take the policy into account when seeking engagement by the Director-General in partnerships, in particular with regard to hosting arrangements; Invites concerned organizations of the United Nations system, international development partners, international financial institutions, nongovernmental organizations, representatives of communities affected by diseases, and privatesector entities to enhance their collaboration with WHO, in a synergistic manner, in order to attain the strategic objectives contained in the Medium-term Strategic Plan 2008–2013; Requests the Director-General (i) to continue collaboration with concerned organizations of the United Nations system, international development partners, international financial institutions, nongovernmental organizations, representatives of communities affected by diseases, and private-sector entities in implementing the Medium-Term Strategic Plan 2008-2013 in order to advance the global health agenda contained in the Eleventh General Programme of Work, 2006–2015; (ii) to create an operational framework for WHO’s hosting of formal partnerships; (iii) to apply the policy on WHO's engagement with global health partnerships and hosting arrangements, to the extent possible and in consultation with the relevant partnerships, to current hosting arrangements with a view to ensuring their compliance with the principles embodied in the policy; (iv) to submit to the Executive Board any proposals for WHO to host formal partnerships for its review and decision; (v) to report on progress in implementing this resolution to the Sixtyfifth World Health Assembly through the Executive Board at its 129th session, and the various actions taken by the Secretariat in relation to partnerships in implementing the policy on partnerships.
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Actions already taken in the Region •
The Regional Office will continue to collaborate with concerned organizations of the United Nations system, international development partners, international financial institutions, nongovernmental organizations, representatives of communities affected by diseases, and private-sector entities in implementing the Medium-term Strategic Plan 2008-2013 in order to advance the global health agenda contained in the Eleventh General Programme of Work, 2006–2015; The Regional Office does not host any regional partnerships, however, it may consider developing its own guidelines for engaging in regional partnerships;
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Through its technical units and country offices, the Regional Office will continue to provide technical assistance and support to Member States to help maximize the benefits and minimize the challenges to countries of engagement with health partnerships.
Actions to be taken in the Region •
A regional conference of partners on health development is proposed to be held in the last quarter of 2010 to enhance partner involvement in health development in the SEA Region.
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Availability, safety and quality of blood products (WHA63.12) Background •
To improve access to blood and blood components and assure their quality and safety, the World Health Assembly endorsed resolution WHA63.12 that requests Member States to take all necessary steps to establish, implement and support nationally-coordinated and efficiently-managed and sustainable blood and plasma programmes according to the availability of resources, with the aim of achieving selfsufficiency, updating their national regulations to establish quality systems, building human resource capacity and systems for the safe and rational use of blood products. The resolution also requests WHO to guide Member States to meet internationally recognized standards in updating their legislation, national standards and regulations for effective control of the quality and safety of blood products, build capacity in Member States on leadership and management of blood supply systems, provide international biological reference materials (WHO International Standards), develop, provide and disseminate guidance and technical support to strengthen nationally coordinated blood and plasma programmes, provide guidance, training and support to Member States on safe and rational use of blood products; and encourage research on new technologies for producing safe and effective blood substitutes.
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Main operative paragraph and its implications on collaborative activities with Member States •
Member States to take all necessary steps to establish, implement and support nationally-coordinated, efficiently-managed and sustainable blood and plasma programmes according to the availability of resources, with the aim of achieving selfsufficiency.
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Actions already taken in the Region •
All countries have been advocated the use of WHO strategy that calls for nationally coordinated blood transfusion services that encourage voluntary blood donations, which are screened by quality-assured techniques for infectious markers and promote preparation and rational use of blood and blood products. Seven countries were supported in developing national blood policy. By 2013, all Member States will have national blood policies. National programme managers have been oriented in better management through training workshops that were conducted to strengthen programme management in 2008, 2009 and 2010. The World Blood Donor Day is being celebrated in all Member States since 2007. Several countries are financially supported. The WHO Collaborating Centre located at National Blood Centre, Bangkok was extensively used to build national capacity in different areas of blood transfusion services.
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Actions to be taken in the Region • •
Ensure the supply of International Reference Standards through WHO headquarters (HQ). Provide technical support to enhance component preparation and ensure quality of all activities including haemovigilance.
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Global strategy to reduce the harmful use of alcohol (WHA63.13) Background • •
Alcohol is ranked as the third leading risk factor for the global burden of disease almost at par with unsafe sex (second leading risk factor globally). This Agenda item is in response to the World Health Assembly resolution 61.4 which was discussed at the Sixty-first World Health Assembly in May 2008, requesting WHO to prepare a draft global strategy to reduce the harmful use of alcohol, a strategy based on all available evidence and existing best practices. Member States were able to provide a detailed response to the draft of the policy that was discussed in Nonthaburi, Thailand, during a regional technical consultation, 24-26 February 2009. The draft strategy covers 10 policy options. All policy options with some adaptations are relevant to Member States of the SEA Region. Of particular importance are two
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policy options (i.e. community action and reducing the public health impact of illicit and informally produced alcohol). •
The draft global strategy was discussed at the 126th session of the Executive Board held in January 2010, and was approved and subsequently adopted by the Sixtythird World Health Assembly.
Main operative paragraph and its implications on collaborative activities with Member States • •
The draft of the global strategy generally has good support from experts in the Region. There is increasing awareness of harm from alcohol use in many Member States (Bhutan, India, Indonesia (select provinces), Myanmar, Nepal and Thailand). Some countries (India and Thailand) are already implementing programmes to reduce harmful use of alcohol. Other countries (Bhutan) are likely to develop and implement programmes in the near future.
Actions already taken in the Region •
Advocacy with governments: The Regional Office for South-East Asia has hosted several high-level meetings at which various policy options for prevention of harm from alcohol use have been discussed. Intercountry workshops with experts: The Regional Office for South-East Asia (SEARO) has hosted several intercountry workshops to discuss the issue of harm from alcohol use in the community and how this can be taken forward by countries Support provided to countries for development of alcohol policy Support provided for community action to reduce harm from alcohol use – five sites in India, and two sites each in Sri Lanka and Thailand Development of advocacy documents: A series of eight documents have been prepared.
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Actions to be taken in the Region •
The global strategy, is only a strategy that is not legally binding on any Member State. Some countries may propose a legally binding option for alcohol on the lines of the Framework of Convention for Tobacco Control. Such a legally binding treaty could be considered later after the Global Strategy to Reduce Harmful Use of Alcohol has been accepted.
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How this strategy will impact the issue of free trade agreements may be raised, particularly restrictions on and taxation of imported alcohol. There is no violation if domestic and imported alcohol is treated equally. Actual implementation of the strategy in Member States on programmes to reduce harm from alcohol use. Community action is particularly important in the SEA Region where illicit and informally produced alcohol is widely available. The optimum method of control of harm from alcohol, particularly illicit and informally produced alcohol is through community action. Policy options, such as pricing and controlling availability and marketing can supplement community action.
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Marketing of food and non-alcoholic beverages to children (WHA63.14) Background •
Marketing of food rich in fats, sugar and salt to children is extensive and shapes their food choices. This has profound health implications and fuels pandemic of noncommunicable diseases (NCDs).
Main operative paragraph and its implications on collaborative activities with Member States •
A report on “Prevention and control of NCDs: implementation of the global strategy” submitted to the Sixty-third World Health Assembly contained an annex with a set of recommended actions on marketing of food and nonalcoholic beverages to children. The Health Assembly adopted a resolution urging Member States to implement the recommendations proposed in the annex, to identify suitable policy approaches, to establish a system for monitoring and evaluating the implementation, to establish intergovernmental collaboration and to cooperate with civil society and with public and private stakeholders in implementing the recommendations. The resolution requests the Director-General of WHO to provide technical support to Member States, to cooperate with civil society and with public and private stakeholders, to strengthen international cooperation, and to report on implementation of recommendations to the Sixty-fifth World Health Assembly.
Actions already taken in the Region •
A regional review of existing policies to reduce the impact of marketing of food to children was conducted in 2009. Bangladesh, Bhutan, DPR Korea, India, Myanmar, Sri Lanka and Timor-Leste have no specific policies while Indonesia and Nepal already have some policy in this regard. Thailand has a specific policy related to NCDs, and to marketing of food children. There is also a regulation for television
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broadcasting on the use of marketing techniques and timing of advertising. In Maldives there is a screening mechanism for food and beverage advertisements. • •
There also are some industry association-based voluntary codes in the Region though with little control over their implementation. A meeting of the regional NCD network held by WHO in June 2009 deliberated on marketing of food and non-alcoholic beverages to children. It agreed that governments should take the lead role in policy development and in its monitoring and evaluation, and that the private sector and NGOs should be involved. Though the private sector has a financial stake in opposing regulatory initiatives that would limit their commercial activity it should be consulted and should share responsibility in improving children’s health through self-regulation and voluntary mesures. Nongovernmental Organizations have a responsibility to educate and empower consumers, and also to work on capacity-building and research.
Actions to be taken in the Region •
There is a need to: compile regional evidence on the effects of marketing on foodrelated behaviour; address informal marketing techniques and strategies focused on reaching children through marketing to parents; strengthen regulatory systems; and identify existing trade policy conflicts in the Region. The supply side should be addressed in addition to the demand side. Introducing taxation of certain unhealthy food products may be considered. Effective “counter measures” such as obligatory disclaimers on unhealthy food products and positive nutritional advertisements may be considered. WHO will assist Member States in developing, implementing and evaluating approaches aimed to reduce the health impact of marketing of food and non-alcoholic beverages to children.
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Monitoring of the achievement of the health-related millennium development goals (WHA63.15) Background •
World Health Assembly Resolution - WHA 63.15 was brought to ensure the progress of achieving Millennium Development Goals (MDGs) by strengthening health systems through primary health care approach, in collaboration with Member States, relevant international organizations, international health initiatives, and other stakeholders in order to increase synergies between international and national priorities and to promote adequate investment on appropriate interventions to sustain the progress achieved and to counteract with adverse issues that may deteriorate the achievements of Member States already made.
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Main operative paragraph and its implications on collaborative activities with Member States •
To strengthen health systems so that they deliver equitable health outcomes as a basis of a comprehensive approach towards achieving Millennium Development Goals 4, 5 and 6, underlining the need to build sustainable national health systems and strengthen national capacities through attention to, inter alia, service delivery, health systems financing, health workforce, health information systems, procurement and distributions of medicines, vaccines and technologies, sexual and reproductive health care and political will in leadership and governance; To review policies, including those on recruitment, training and retention that exacerbate the problem of the lack of health workers and their imbalanced distribution, within countries and throughout the world which undermines the health systems of developing countries To reaffirm the values and principles of primary health care including equity, solidarity, social justice, universal access to services, multisectoral action, transparency, accountability, decentralization and community participation and empowerment as the basis for strengthening health systems through support for health and development taking into account leadership, public policy, universal coverage and service delivery reforms necessary for strengthening primary health care. To take into account health equity in all national policies that address social determinants of health and to consider developing and strengthening universal comprehensive social protection policies, including health promotion, infectious and non communicable disease prevention and health care, and promoting availability of and access to goods and services essential to health and well being
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Actions already taken in the Region • • • • • •
Technical assistance to all Member States to strengthen national health systems through primary health care approach. Development of health system assessment guideline to identify health system gaps for health system strengthening proposal development. Capacity building of national health care financing assessments and addressing of social determinants for health Technical assistance to develop human resource for health in all the Member States in the Region Technical and financial assistance to strengthen country health information systems and apply standard methodologies in data collection up to reporting. Technical assistance to develop national essential drug list and to facilitate to procure essential drugs and vaccines.
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Publication of Frequently Asked Questions on Primary Health Care for better understanding of Primary Health Care revitalization efforts. Publication of Self care handbook to improve community awareness on self care as community empowerment.
Actions to be taken in the Region • •
Further assistance to strengthen national health systems through the six building blocks through primary health care approach. Need to produce data/information at sub national, district and sub district levels and by other social determinants to compare and monitor the progress of achieving Millennium Development Goals among all the under privileged population groups. Improving country capacity to analyze data at national and sub national levels for better planning and implementation of health programmes, including data collection and management of health care services from private sector. Improving health information dissemination at community level. SEARO is planning to develop a “Blue trunk library” for health center, using information technology to increase access for health information comprising health promotion and disease prevention as well as curative interventions.
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WHO global code of practice on the international recruitment of health personnel (WHA63.16) Background •
World Health Assembly under its resolution WHA57.19 requested the DirectorGeneral to develop a voluntary code of practice on the international recruitment of health personnel in consultation with all relevant partners. In response, the WHO Secretariat initiated a global consultation process and developed a draft WHO Global Code of Practice on international recruitment of health personnel. This draft code of practice was presented to the 124th session of the Executive Board in January 2009, which concluded that more consultations at both country and regional levels were essential before finalizing and adopting the code. Since January 2009, national, regional and international meetings have discussed the issues related to the draft code. The subject was also discussed at the Sixty-second Session of the Regional Committee for South-East Asia. Member States in the Region also held national consultations on the draft code, the outcome of which was shared and discussed at a regional consultation organized by WHO-SEARO in December 2009.
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Main operative paragraph and its implications on collaborative activities with Member States •
The Sixty-third World Health Assembly under its resolution WHA63.16 adopted the WHO Global Code of Practice on the International Recruitment of Health Personnel, in accordance with Article 23 of the Constitution. The first review of the relevance and effectiveness of the WHO Global Code shall be made by the Sixty-eighth Health Assembly. The resolution requested the Director General to give all possible support to Member States for implementation of WHO Global code.
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Actions already taken in the Region •
Countries in the SEA Region have already been informed of the adoption of the code by the Sixty-third Health Assembly, encouraging them to publicize and implement the code in collaboration with all stakeholders. The HRH focal points in WHO country offices have been sensitized to liaise with their country counterparts and suggest advocacy activities that they propose to hold for publicizing the code
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Actions to be taken in the Region •
The Regional Office proposes to hold a regional consultation in November 2010 to discuss and develop specific strategic plans of action for implementation of the WHO Global Code of Practice on the international recruitment of health personnel, including initiation of advocacy activities involving the media and other key stakeholders. Orientation workshops are to be organized in Member States with key media personalities and the Press to publicize the code, which will be followed by national workshops. Countries will, to the extent possible, and according to legal responsibilities, working with relevant stakeholders, maintain a record, updated at regular intervals, of all recruiters authorized by competent authorities to operate within their jurisdiction. They should, to the extent possible, encourage and promote good practices among recruitment agencies by only using those agencies that comply with the guiding principles of the code. During the period 2011-2015, countries of the Region will hold national meetings initially to create awareness about the Code of Practice followed by establishing a process for its implementation and subsequent monitoring and evaluation of progress.
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Countries will periodically inform the Regional Office every three years, beginning with an initial data report within two years after adoption of the code by the Health Assembly, on the measures taken, results achieved, difficulties encountered and lessons learnt, all contained in a single report.
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Birth defects (WHA63.17) Background •
At its 125th session in May 2009, the Executive Board decided to postpone the discussion on Agenda item on birth defects to its 126th session. At the 126th session of the Board in May 2010, the updated report on birth defects was reviewed and recommendations were made to the Sixty-third World Health Assembly. Congenital malformations were at 11.1 %, among the most common causes of neonatal deaths In Nepal while in Sri Lanka congenital malformations accounted for 50% of stillbirths. Among the most common conditions contributing to a higher incidence of birth defects in the SEA Region are (i) periconceptional folic acid deficiency leading to midline birth defects; (ii) maternal iodine deficiency; (iii) lack of vaccination against rubella; (iv) birth after 35 years of maternal age; (v) maternal substance abuse including alcohol and tobacco; (vi) teratogenic medications; (vii) consanguinity; and (viii) the lack of prenatal diagnosis and termination of pregnancy for the severely affected fetus. Lack of reliable epidemiological data on prevalence and determinants, and the low priority accorded to birth defects as a contributor to perinatal morbidity and mortality, coupled with poor provision of maternal and newborn care in the SEA Region, have been expressed as causes for concern and attention. However, there is an unprecedented opportunity to prevent or ameliorate many birth defects at reasonable cost. Low-cost and highly effective public health measures like rubella vaccination, iodine and folic acid supplementation and fortification of staple foods must be included in public health, social and developmental sector policies.
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Main operative paragraph and its implications on collaborative activities with Member States • • •
WHA63.17 urged Member States to raise awareness about the importance of birth defects as a cause of child morbidity and mortality. It also urged to develop expertise and to build capacity on the prevention of birth defects and care of children with birth defects. WHA63.17 also requested WHO to promote collection of data on the global burden of morbidity and mortality due to birth defects, and to support Member States in developing national plans for implementation of effective interventions to prevent and manage birth defects.
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Actions already taken in the Region •
Awareness-creation programmes for all stakeholders on the risks of conceptions after maternal age 35, alcohol and smoking before and during pregnancy have reduced the incidence of Down syndrome, cerebral palsy, and fetal alcohol syndrome in developed countries. This combined with opportunities for genetic screening and counselling for parents, are effective interventions for reducing birth defects. A multipronged approach to the prevention and management of birth defects through the primary health care system needs to be developed to contribute to achievement of Millennium Development Goal (MDG 4) in the Region. An in-house expert group has been established in the Regional Office to provide stewardship and technical assistance to Member States to plan interventions for prevention and management of birth defects. A review of existing networks and registry at national level has been initiated. Proposal to mobilize resources is being developed.
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Actions to be taken in the Region • •
Advocacy for developing programme for prevention and management of birth defects in Member States through intersectoral collaboration. Initiate collection and analysis of epidemiological information related to birth defects through improved civil birth and death registration, hospital health management information system (HMIS) and community based data capture and dedicated registries. Regional and national knowledge networks on birth defects need to be created to promote research and understanding in the Region. Assist Member States to mobilize additional resources for epidemiological understanding and develop strategies to address birth defects.
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Viral hepatitis (WHA63.18) Background •
Hepatitis due to viral infections is a major public health problem in the SEA Region. Proper and adequate applications of public health control measures have an important role in preventing these infections. Additionally, hepatitis due to hepatitis A and B viruses can be prevented by immunization. Many countries have introduced hepatitis B immunization in their national immunization schedule. However, vaccine against hepatitis C is still not available; and 80% hepatitis C infections become a chronic infection.
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Main operative paragraph and its implications on collaborative activities with Member States •
The resolution calls for action on strengthening surveillance, a comprehensive and multisectoral approach, including linkages with HIV and blood safety, health promotion, vaccination and infection control measures, and approaches tailored to the needs of local communities, and observance of 28 July each year, or as decided by Member States, as World Hepatitis Day. There are implications for both Member States and WHO. The key ones are as given below: (1) A comprehensive approach to prevention and management of all viral hepatitis infections will require clear guidelines and good coordination among the relevant sectors in government and within WHO; Considerable financial and technical resources will be required to support these approaches; and New guidelines and tools will need to be developed and made available to Member States.
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Actions already taken in the Region • •
Hepatitis B immunization has been introduced in all Member States in the Region, with a phased plan in India. The WHO Regional Office for South-East Asia convened an informal consultation on “Viral hepatitis in the context of HIV and the way forward” from 7 to 9 June 2010 in New Delhi. The meeting concluded with the consensus that there was a need to raise the profile of hepatitis as a preventable and treatable disease among all stakeholders.
Actions to be taken in the Region • • • • • •
Establish a focal person/unit for hepatitis in the ministries of health/national AIDS programmes. Synergize surveillance for hepatitis B and C with HIV surveillance. Generate/collate data on the disease burden of hepatitis B and C in countries of the SEA Region (i.e. make hepatitis a notifiable disease). Document/synthesize existing surveillance and research data and disseminate these to stakeholders to generate awareness of the problem and sensitize them. Increase community awareness of hepatitis and prevention and control methods. Set national goals on increasing immunization coverage for hepatitis B, particularly for hard-to-reach and most-at-risk populations.
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WHO HIV/AIDS Strategy for 2011-2015 (WHA63.19) Background •
The global HIV epidemic continues to remain a serious public health problem. An estimated 33.4 million (31.1 million–35.8 million) people are currently living with HIV. Women account for 50% of people living with HIV, which is the major cause of mortality among women of reproductive age and was responsible for the death of 280000 children in 2008, thereby undermining the efforts to achieve MDG Goals 4 and 5. The significant gains achieved in prevention and treatment of HIV/AIDS need to be sustained and expanded.
Main operative paragraph and its implications on collaborative activities with Member States •
The resolution noted that a sustainable HIV response requires a comprehensive and multisectoral approach, including integrating into maternal, neonatal, child health and sexual and reproductive health, tuberculosis, harm reduction and primary health care, and noted in particular that sustaining these efforts was challenging in light of the global financial crisis. The resolution urges Member States to strengthen targeted prevention measures and achieve universal access to antiretroviral treatment, within the framework of respect for human rights, gender equality, and reduction of stigma and discrimination. There are implications for both Member States and WHO. Some key considerations are as below: (1) Incorporate, based on national contexts, the policies, strategies, programmes and interventions and tools recommended by WHO in order to implement effective HIV prevention measures, early diagnosis, treatment and care; and take further steps towards minimizing social stigmatization and discrimination, which hamper access to prevention, treatment and care; Take forward new WHO priorities, including revitalization of primary health care, integrated service delivery, and equitable access to health services; and Strengthen the links between and among HIV, TB, sexual and reproductive health (SRH) and maternal and neonatal child health (MNCH) and other programmes and services in order to ensure sustainability, and to maximize efficiencies and effectiveness.
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(2) (3)
Actions already taken in the Region •
All Member States have developed their five-year national HIV/AIDS strategies until 2010-2011.
SEA/RC63/14 (Rev.1) Page 18
• • •
External reviews of health sector response to sexually transmitted infections and HIV/AIDS have been conducted in several countries. Member States are preparing to update their new five-year strategic plans. The SEA Region Training Modules on Strategic and Operational Planning for the Health Sector Response to HIV are being finalized.
Actions to be taken in the Region • • • •
Conduct consultation meetings to discuss the draft Global WHO HIV/AIDS Strategy for 2011–2015 in the context of the SEA Region. Develop regional WHO HIV/AIDS strategy recommendations from the regional consultation. for 2011–2015 following
Conduct a regional training on strategic and operational planning for the health sectors, response to HIV as planned. Support country adaptation and adoption of the regional HIV/AIDS strategy for 2011–2015.
12.
WHO’s role and responsibilities in health research (WHA63.21) Background •
Recalling the World Health Assembly resolution WHA58.34 on the Ministerial Summit on Health Research; resolution WHA60.15 on WHO’s role and responsibilities in health research; resolution WHA61.21 on the global strategy and plan of action on public health, innovation and intellectual property and relevant recommendations of the WHO Commission on Social Determinants for Health; and the outcomes of the Global Ministerial Forum on Research for Health (Bamako, Mali, November 2008); resolution WHA63.21 endorsed the WHO strategy on research for health in May 2010.
Main operative paragraph and its implications on collaborative activities with Member States • •
WHO will monitor the regional and national research needs and opportunities, within the global research policy framework of WHO. WHO is also responsible to support countries in drawing up and implementing national health research agendas, strengthen national research capability through collaboration with research councils and analogous bodies, collaborating centres and other institutions in countries, support countries in the development and
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maintenance of national research information systems that will continuously update the evidence-based information to be used for policy formulation and programme improvements, and foster good managerial practices in research promotion and development at national and institutional levels. •
The main implication of the operating paragraph on collaborative activities is the lack of financial support and proper training for WHO country offices and Centres of Excellence in Member States. Furthermore, the task of sensitizing the WHO Collaborating Centres with regard to their roles and responsibilities in the area of research needs to be further strengthened. Constant and regular capacity development at the grassroots level is a must and is one of the crucial tasks of WHO.
Actions already taken in the Region •
To ensure that WHO streamlines and effectively implements its research activities to harmonize the regional strategy on research for health and the global strategy, a SEARO Staff Dialogue Workshop on WHO Strategy on Research for Health was held in collaboration with WHO-HQ on 10-11 January 2008 at SEARO, New Delhi, India. The Asia-Pacific Preparatory Meeting for the 2008 Bamako Global Ministerial Forum on Research for Health (Theme: Strengthening National Health Research Systems) was jointly organized by the Regional Offices for South-East Asia and the Western Pacific regions, and headquarters, from 10-12 June 2008 in Bangkok, Thailand. Furthermore, The Thirty-first Session of the WHO South-East Asia Advisory Committee on Health Research (SEA-ACHR) was held in Kathmandu, Nepal from 21-23 July 2009; drafts of regional and national strategy on research for health were developed; and the SEA-ACHR Sub-Committee on Vaccines and Drugs Development was established in September 2009. Moreover, the status of national research capacity for health and development in Bhutan, Maldives and Timor-Leste was assessed by teams of consultants at the end of 2009 and in March 2010. The Regional Office promoted international research ethics standards recommended by the Thirtieth meeting of the SEA-ACHR, in collaboration with national medical research councils, national research institutions and the Forum for Ethical Review Committees in Asia and the Pacific (FERCAP). WHO advocated, provided financial support and facilitated enhancement in research ethics, as well as in the capacity of ethics review committees (ERC) of Member States by providing a series of international training courses on: (i) protection of human research subjects; (ii) the Standard Operating Procedures (SOPs); (iii) the Surveying and Evaluating Ethics Committees for International Standard Recognition Programme. Various ERCs of academic and ministry of health institutions in eight countries in the SEA Region joined the training workshops for worldwide recognition programme on the Strategic Initiative for Developing Capacity in Ethical Review [SIDCER/WHO Programme on Tropical Diseases Research (TDR)].
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SEA/RC63/14 (Rev.1) Page 20
•
This resulted in ten new ERCs: Thailand (6); India (2); Indonesia (1); and Sri Lanka (1), which were recognized for international standard review system by external evaluator teams from FERCAP/SIDCER in July 2008, February 2009, July 2009 and October 2009 respectively. Moreover, the national ERCs in Bangladesh, Bhutan, and Nepal have made very good progress in conducting series training and preparing an international evaluation in 2010. An Expert group meeting to finalize the module on teaching of ethics in the undergraduate medical curriculum was held on 25-26 September 2008 at the Regional Office. A regional workshop on capacity building for the Ethical Review Committee of Health Sciences Research was conducted in Bangkok on 19-20 October 2009, for sharing and harmonizing the research ethics review and regulation system including training and networking in Member States of the Region. WHO-SEARO continued to support the annual meetings of the forum for Ethical Review Committee in Asia and the Pacific Region (FERCAP), held from 24-26 November 2008 in Bangkok, and from 23-25 November 2009 in Chiangmai, Thailand. Also, according to the recommendations of the Thirtieth session of the SEA-ACHR, two regional task forces were established. A regional task force on avian influenza (AI) was established and a framework of strategy and priority areas on AI research was developed. The linkages between national influenza centres, institutions and WHO collaborating centres for AI reference laboratories were also established. The first meeting of the Regional Task Force for Research on Avian Influenza (AI) was convened from 3-5 March 2008 in Bali, Indonesia. A regional task force on health research management and capacity building was formed by the Regional Director for the SEA Region. The first meeting of the task force was held on 6-7 March 2008; its recommendations led to refinement of the ten health research management modules as a self-learning package at the intercountry workshop on research management, held in Bali, Indonesia from 3-6 June 2008. Health research management workshops were planned in all countries. Four countries (Bhutan, India, Myanmar and Nepal) conducted country workshops in 2008. Four countries (Bangladesh, Indonesia, Sri Lanka and Thailand) conducted the country workshops in 2009.
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•
• •
•
Actions to be taken in the Region • • • •
Capacity building of countries on implementation of research for health; Strengthening health research system and management; Enhancing the capacity in ethical review and regulation of health research; and Supporting research infrastructure for enhancing the quality of health research.
SEA/RC63/14 (Rev.1) Page 21
13.
Infant and young child nutrition (WHA63.23) Background •
The Agenda item 11.6 entitled “Infant and young child nutrition” has considered the report of the Secretariat on the implementation of the Global Strategy for Infant and Young Child Feeding; the status of national measures to be taken to comply with the International Code of Marketing of Breast-milk substitutes; complementary foods; WHO Child Growth Standards; types of malnutrition and childhood obesity. While the operational targets of the global strategy on infant and young child feeding have been implemented with various degrees of achievement in SEAR member states, the overall approach to improve infant and young child nutrition remains incomplete in nature with unsatisfactory implementation of policies and plans of action. Only a quarter (25%) of all infants in the SEA Region are exclusively breastfed for the first six months of life. The prevalence of “underweight” in children below the age of five years ranges from 9% to 49% while stunting or chronic malnutrition in the same age group ranges from 12% to 54%. The prevalence of anaemia in children between the ages of 6 months to 5 years is high (range 25% to 82%).
•
•
Main operative paragraph and its implications on collaborative activities with Member States •
Worldwide malnutrition accounts for 11% of the global burden of disease leading to long-term poor health and disability, and poor educational and developmental outcomes. In addition, achievement of the MDGs will require reduction in maternal and child malnutrition. Political commitment in Member States should be increased in order to prevent and reduce malnutrition in all its forms; also implementation of the global strategy for infant and young child feeding should be strengthened and expedited.
•
Actions already taken in the Region • •
Identifying integrated nutrition, food security and food safety interventions with focus on climate change and emerging high food prices in Member States. Technical assistance to improve national growth monitoring practices; nutrition surveillance systems; standardized management of severe malnutrition in hospital settings; integrated counselling workshops to improve infant and young child feeding practices; and national control and prevention programmes for iodine deficiency disorders. Participation in the global survey on nutrition policy and action including implementation of the International Code of Marketing of Breast-milk Substitutes.
•
SEA/RC63/14 (Rev.1) Page 22
Actions to be taken in the Region • •
To develop or review the current national approaches addressing the double burden of malnutrition including food security. Technical assistance to scale up interventions for improving infant and young child nutrition in an integrated manner – promoting exclusive breastfeeding; appropriate regulatory mechanisms to control the marketing of breastmilk substitutes; appropriate complementary feeding; prevention and timely management of severe malnutrition; growth monitoring and nutrition surveillance systems; and the control of vitamin and mineral deficiencies.
14.
Accelerated progress towards achievement of Millennium Development Goal 4 to reduce child mortality: prevention and treatment of pneumonia (WHA 63.24) Background •
Pneumonia is responsible for about 1.8 million of the total estimated 9 million annual deaths of children under-five worldwide. It is closely followed by diarrhoea together in terms of under-five mortality; these two illnesses are the main impediments to achieving Millennium Development Goal 4. Out of the estimated 156 million new cases every year globally, about 61 million new cases occur in the South-East Asia Region. The risk factors for high incidence of pneumonia in children include poverty, malnutrition, poor hygiene, exposure to indoor air pollution, low immunization coverage, suboptimal care-seeking and poor access to health services. More than 98% of deaths from childhood pneumonia occur in developing countries, mostly in poor communities; mortality is strongly linked to poverty, malnutrition and access to care. Strategies available based on the evidence and currently being implemented for the prevention and control of pneumonia include: improved nutrition practices; immunization for measles and pertussis and the now available Haemophilus influenzae type b (Hib) and S. pneumonia vaccines; case management guidelines in the community, health centres and hospitals; control of indoor air pollution; and prevention and management of HIV infection. Coverage and quality of these interventions in SEA Region Member States has been rather variable.
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SEA/RC63/14 (Rev.1) Page 23
Main operative paragraph and its Implications on collaborative activities with Member States: •
All countries in the Region are pursuing the agenda for achieving MDGs but many of them are not on track to achieve MDG 4 by 2015. Addressing prevention and control of pneumonia in children, as well as diarrhoea, through integrated strategies would help accelerate progress towards achieving MDG 4. Integrated management of childhood illness (IMCI) covering prevention and treatment of pneumonia and diarrhoea (mainly at the first-level health facilities) is under implementation in nine Member States. Community-based management of pneumonia is being implemented in only a few countries. Routine immunization coverage has to be sustained at a high level and inclusion of newer vaccines like pneumococcal and Hib considered. Collaboration among various related programmes in the health sector and across other sectors needs to be pursued to maximize resources and efficiency. Mobilization of additional human as well as financial resources would be required to ensure optimal coverage and quality of existing and new interventions.
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• • • •
Actions already taken in the Region • •
Selected Member States are being supported to adapt guidelines and training materials on community case management of sick child (pneumonia and diarrhoea). Protocols for assessment of quality of hospital care of severely sick children (including severe pneumonia and severe dehydration) have been adapted with technical support of WHO in Indonesia and Bangladesh. Proposal for mobilizing additional resources on integrated management of pneumonia and diarrhoea submitted.
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Actions to be taken in the Region •
The Member States that are implementing IMCI need to accelerate coverage across all sub-national regions. Strengthening the health system and family practices (built in to the IMCI strategy) will be crucial. Advocacy with Member States for large-scale implementation of community-based interventions for prevention and management of pneumonia through community health workers (CHW). Necessary policy decisions will be required to empower CHWs to use antibiotics to treat pneumonia and to strengthen systems to support this.
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SEA/RC63/14 (Rev.1) Page 24
• • • •
Member States need to strengthen referral systems and ensure good quality services in hospitals for management of children admitted with severe pneumonia. Management of paediatric HIV should be scaled up. Intersectoral collaboration for integrated response to prevent pneumonia needs to be promoted. WHO to provide technical assistance to Member States to plan interventions for prevention and management of childhood pneumonia, such as scaling up of implementation of IMCI, routine immunization, community-based management of sick children, strengthening the quality of care of children in hospitals, paediatric HIV interventions. WHO to assist Member States to mobilize additional resources for achieving high coverage of these interventions of good quality.
•
15.
Improvement in health through safe and environmentally sound waste management (WHA63.25) Background •
Safe and environmentally sound waste management is a broad and complex concept. According to the Basel Convention this concept means “taking all practicable steps to ensure that hazardous wastes or other wastes are managed in a manner that will protect human health and the environment”. The ministers and other heads of delegations from the Parties to the Basel Convention and from other States had made a declaration in Bali, Indonesia in 2008 on waste management for human health and individuals and invited the World Health Assembly to consider a resolution related to the improvement of health through safe and environmentally sound waste management. The World Health Assembly resolution WHA63.25 covers all wastes including domestically generated or imported waste, toxic and dangerous waste, and hazardous and non-hazardous waste including its traffic and disposal, control and transboundary movement and the adverse effects of such wastes.
Main operative paragraph and its implications on collaborative activities with Member States •
In the SEA Region at present the health sector’s focus on waste management is mainly on health care waste. Waste generated by health care activities includes a broad range of materials, from used needles and syringes to soiled dressings, body parts, diagnostic samples, blood, chemicals, pharmaceuticals, medical devices and radioactive materials. A significant amount of work has been undertaken regarding safe elimination of mercury in hospital equipments and waste disposal. Waste generated in other sectors, however, remains the responsibility of those sectors.
SEA/RC63/14 (Rev.1) Page 25
•
Poor management of health care waste has the potential to expose health care workers, waste handlers, patients and the community at large to infection, toxic effects and injuries, and thereby risks polluting the environment. It is essential that all medical waste materials are segregated at the point of generation, appropriately treated and disposed of safely. The World Health Assembly resolution WHA63.25 requires addressing a much broader range of issues and types of waste in addition to health care waste. Waste such as chemical waste and electronic waste will require the health sector to work with governmental and organizations such as NGOs, other UN organizations and civil society organizations. Overall, the resolution calls for establishing greater partnerships with UNEP and the Secretariat of the Basel Convention.
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Actions already taken in the Region A number of activities have been implemented in the SEA Region on management of waste in ways that reduce the harm to human health. •
Several countries of the Region have developed health care waste management policies and legislation, as well as national strategies and guidelines on management of health care wastes. Capacity of countries has been developed through training courses on strengthening of management (handling to disposal) of health care wastes, including used syringes, and through training of national focal points on sound management of health care waste. In a regional initiative on phasing out mercury-based health sector equipment, several countries of the Region carried out assessments, explored how mercurybased equipment could be replaced in the health sector and also initiated phasingout of mercury. The Regional Office and the Indira Gandhi National Open Unviersity (IGNOU), New Delhi, India, developed a distance learning course on health care waste management (HCWM) that is being implemented by the latter. Indonesia, Thailand and Sri Lanka have received funding from the strategic approach to international chemicals management (SAICM) Quick Start Programme (QSP) to implement projects on strengthening national capacities for sound management of priority industrial carcinogens and updating national chemical profiles that will pave the way for actions resulting from the resolution WHA63.26.
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•
•
Actions to be taken in the Region In addition to establishing new partnerships for implementing this resolution, other actions to be taken in the Region include: •
Undertake health impact assessments as a tool to measure health effects of waste.
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• • • • • •
Raise awareness about the link between waste management and health, and livelihood and the environment. Strengthen regional cooperation on waste and health issues. Improve controls on transborder shipments of waste. Improve cooperation between the health and other sectors related to waste management. Increase capacity and develop appropriate technology for the safe management of waste. Broaden the focus of action from the narrow view of health care waste management to all waste that is potentially harmful to health.
Decisions 1. Substandard/spurious/falsely-labelled/falsified/ counterfeit medical products – WHA63 (10) Background •
On the advice of the 124th session of the WHO Executive Board held in January 2009, the Director-General submitted a revised report on counterfeit medical products to the Sixty-second World health Assembly in May 2009. The Health Assembly, however, decided to postpone consideration of the matter to next Assembly. The subject was also debated at the Sixty-second session of the Regional Committee for South-East Asia, which adopted resolution SEA/RC62/R6, focusing on improving access to safe, efficacious, affordable medicines of good quality by strengthening national drug regulatory authorities, incorporating public health safeguards, and not decreasing access through intellectual property policies. The Sixty-third World Health Assembly in May 2010 took up the subject of “Counterfeit medical products” for consideration under Agenda item 11.20. The Secretariat had submitted two documents: (i) “Report of the Secretariat on counterfeit medical products” (Document A63/23); and (ii) “Report of the Secretariat on International Medical Products Anti-counterfeiting Taskforce—IMPACT” (Document A63/INF.DOC./3). After intense deliberations on the subject, a number of Member States tabled all together five draft resolutions and decisions for discussion, including the following three draft resolutions: –
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A63/A/Conf.Paper No 4 Rev. 1: “Plan of work to support the prevention and control of falsified medical products” (proposed by the delegation of Ecuador on behalf of the Union of South American Nations (UNASUR)).
SEA/RC63/14 (Rev.1) Page 27
– –
A63/A/Conf.Paper No 5: “Counterfeit products” (proposed by the delegations of Member States from Africa). A63/A/Conf.Paper No 7: “Measures to ensure access to safe, efficacious, quality and affordable medical products” (proposed by the delegations of India and Thailand)
•
During the initial discussion some 26 interventions were made, several on behalf of more than one Member State, e.g. those by 47 African Union States, and 27 EU members. The intensive debate during the WHA and some follow-up debate during the 127th session of the Executive Board demonstrated that the opinions were quite divided. There was no consensus for any of the three proposals. After further discussions, two draft decisions were tabled, as follows: –
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A63/A/Conf.Paper No 12: “Substandard, spurious, falsely-labelled, falsified, counterfeit medical products” (draft decision proposed by the delegations of Ecuador on behalf of the Union of South American Nations, and India on behalf of Member States of the South-East Asia Region). A63/A/Conf.Paper No 13: “Spurious, falsely-labelled, falsified, and counterfeit medical products” (draft decision proposed by the delegations of Spain on behalf of the European Union and Switzerland).
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•
After further debate, the Sixty-third World Health Assembly adopted a decision— WHA63 (10)—at its plenary session on 21 May 2010.
Main operative paragraph and its implications on collaborative activities with Member States •
Decision WHA63(10) on “Substandard/spurious/falsely labelled/counterfeit medical products” reaffirmed the fundamental role of WHO in ensuring the safety, efficacy, quality and efficacy of medical products, and also noted the work of WHO in ensuring safety, quality and efficacy of medical products. The World Health Assembly decided to establish a time-limited and resultsorientated working group on substandard/spurious/falsely-labelled/falsified/ counterfeit medical products comprised of and open to all Member States. It also requested the Director-General to convene and facilitate the work of this working group. Under operative paragraph 3, the World Health Assembly decided that the working group would examine the following matters from a public health perspective, excluding trade and intellectual property considerations: –
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• •
WHO’s role in ensuring availability of quality, safe, efficacious and affordable medical products;
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– –
WHO’s relationship with IMPACT; WHO’s role in the prevention and control of medical products of compromised quality, safety and efficacy, such as substandard/ spurious/falselylabelled/falsified/counterfeit medical products from a public health perspective, excluding trade and intellectual property considerations; Any issues raised in the proposal contained in documents A63/A/Conf.Paper no.4 rev.1, A63/A/Conf.Paper no.5 and A63/Conf.Paper no.7.
– •
The working group is to report on progress in implementing the above decision of the Health Assembly to the 128th session of the WHO Executive Board, and to make specific recommendations in relation to the issues set out in operative paragraph 3 above to the Sixty-fourth World Health Assembly.
Actions already taken •
The Director-General, in consultation with the Regional Directors, planned to convene the working group meeting on substandard/spurious/falselylabelled/falsified/counterfeit medical products in late 2010 or early 2011. The draft agenda item of the 128th session of the Executive Board has included an item on “substandard/spurious/falsely-labelled/falsified/ counterfeit medical products” under agenda item no. 4.7.
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Actions to be taken in the Region •
Member States need to participate fully in the work of the proposed time-limited and results-orientated working group on substandard/spurious /falselylabelled/falsified/counterfeit medical products.
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Annex
Decisions and Resolutions of the Sixty-third World Health Assembly
SIXTY-THIRD WORLD HEALTH ASSEMBLY
A63/DIV/3 8 June 2010
Decisions and list of resolutions I. DECISIONS
WHA63(1)
Composition of the Committee on Credentials
The Sixty-third World Health Assembly appointed a Committee on Credentials consisting of delegates of the following Member States: Angola, Austria, Bangladesh, Eritrea, Israel, Nauru, Nicaragua, Oman, Singapore, The former Yugoslav Republic of Macedonia, Trinidad and Tobago, Zambia. (First plenary meeting, 17 May 2010)
WHA63(2)
Election of officers of the Sixty-third World Health Assembly
The Sixty-third World Health Assembly elected the following officers: President: Vice-Presidents: Mr M. Zenaidi (Tunisia) Dra. M.I. Rodríguez (El Salvador) Dr R. Sezibera (Rwanda) Professor R. Akdağ (Turkey) Mrs G.A.A. Gidlow (Samoa) Professor Mya Oo (Myanmar) (First plenary meeting, 17 May 2010)
WHA63(3)
Election of officers of the main committees
The Sixty-third World Health Assembly elected the following officers of the main committees: Committee A: Committee B: Chairman Chairman Dr M. Mugitani (Japan) Dr W. Jayantha (Sri Lanka) (First plenary meeting, 17 May 2010)
A63/DIV/3
The main committees subsequently elected the following officers: Committee A: Vice-Chairmen Mr U. Scholten (Germany) Dr D. Chiriboga (Ecuador) Dr P. Mishra (Nepal) Dr G.J. Komba-Kono (Sierra Leone) Dr N. El Sayed (Egypt) Dr A.-P. Sanne (Norway)
Rapporteur Committee B: Vice-Chairmen
Rapporteur
(First meetings of Committees A and B, 17 and 19 May 2010, respectively)
WHA63(4)
Establishment of the General Committee
The Sixty-third World Health Assembly elected the delegates of the following 17 countries as members of the General Committee: Burkina Faso, Cape Verde, Chad, Chile, China, Cuba, Democratic Republic of the Congo, Estonia, France, Jamaica, Jordan, Libyan Arab Jamahiriya, Russian Federation, Spain, United Kingdom of Great Britain and Northern Ireland, United Republic of Tanzania, United States of America. (First plenary meeting, 17 May 2010)
WHA63(5)
Adoption of the agenda
The Sixty-third World Health Assembly adopted the provisional agenda prepared by the Executive Board at its 126th session, with the deletion of four items and the transfer of one item from Committee B to Committee A. (Second plenary meeting, 17 May 2010)
WHA63(6)
Verification of credentials
The Sixty-third World Health Assembly recognized the validity of the credentials of the following delegations: Afghanistan; Albania; Algeria; Andorra; Angola; Antigua and Barbuda; Argentina; Armenia; Australia; Austria; Azerbaijan; Bahamas; Bahrain; Bangladesh; Barbados; Belarus; Belgium; Benin; Bhutan; Bolivia (Plurinational State of); Bosnia and Herzegovina; Botswana; Brazil; Brunei Darussalam; Bulgaria; Burkina Faso; Burundi; Cambodia; Cameroon; Canada; Cape Verde; Central African Republic; Chad; Chile; China; Colombia; Comoros; Congo; Cook Islands; Costa Rica; Côte d’Ivoire; Croatia; Cuba; Cyprus; Czech Republic; Democratic People’s Republic of Korea; Democratic Republic of the Congo; Denmark; Djibouti; Dominican Republic; Ecuador; Egypt; El Salvador; Equatorial Guinea; Eritrea; Estonia; Ethiopia; Fiji; Finland; France; Gabon; Gambia; Georgia; Germany; Ghana; Greece; Guatemala; Guinea; Guinea-Bissau; Guyana; Haiti; Honduras; Hungary; Iceland; India; Indonesia; Iran (Islamic Republic of); Iraq; Ireland; Israel; Italy; Jamaica; Japan; Jordan; Kazakhstan; Kenya; Kiribati; Kuwait; Kyrgyzstan; Lao People’s Democratic Republic; Latvia; Lebanon; Lesotho; Liberia; Libyan Arab Jamahiriya;
2
A63/DIV/3
Lithuania; Luxembourg; Madagascar; Malawi; Malaysia; Maldives; Mali; Malta; Marshall Islands; Mauritania; Mauritius; Mexico; Micronesia (Federated States of); Monaco; Mongolia; Montenegro; Morocco; Mozambique; Myanmar; Namibia; Nepal; Netherlands; New Zealand; Nicaragua; Niger; Nigeria; Norway; Oman; Pakistan; Palau; Panama; Papua New Guinea; Paraguay; Peru; Philippines; Poland; Portugal; Qatar; Republic of Korea; Republic of Moldova; Romania; Russian Federation; Rwanda; Saint Lucia; Samoa; San Marino; Sao Tome and Principe; Saudi Arabia; Senegal; Serbia; Seychelles; Sierra Leone; Singapore; Slovakia; Slovenia; Solomon Islands; Somalia; South Africa; Spain; Sri Lanka; Sudan; Suriname; Swaziland; Sweden; Switzerland; Syrian Arab Republic; Tajikistan; Thailand; The former Yugoslav Republic of Macedonia; Timor-Leste; Togo; Tonga; Trinidad and Tobago; Tunisia; Turkey; Turkmenistan; Tuvalu; Uganda; Ukraine; United Arab Emirates; United Kingdom of Great Britain and Northern Ireland; United Republic of Tanzania; United States of America; Uruguay; Uzbekistan; Vanuatu; Venezuela (Bolivarian Republic of); Viet Nam; Yemen; Zambia; Zimbabwe. (Sixth plenary meeting, 19 May 2010)
WHA63(7)
Election of Members entitled to designate a person to serve on the Executive Board
The Sixty-third World Health Assembly, after considering the recommendations of the General Committee, elected the following as Members entitled to designate a person to serve on the Executive Board: Armenia, Barbados, China, Ecuador, Mongolia, Morocco, Mozambique, Norway, Seychelles, Timor-Leste, United States of America, Yemen. (Seventh plenary meeting, 20 May 2010)
WHA63(8)
United Nations Joint Staff Pension Fund: appointment representatives to the WHO Staff Pension Committee
of
The Sixty-third World Health Assembly nominated Dr A.A. Yoosuf (Maldives) as a member and Mr R. Chacon (Guatemala) as an alternate member of the WHO Staff Pension Committee for a three-year term until May 2013. (Seventh plenary meeting, 20 May 2010)
WHA63(9)
Selection of the country in which the Sixty-forth World Health Assembly would be held
The Sixty-third World Health Assembly, in accordance with Article 14 of the Constitution, decided that the Sixty-fourth World Health Assembly would be held in Switzerland. (Eighth plenary meeting, 21 May 2010)
3
A63/DIV/3
WHA63(10)
Substandard/spurious/falsely-labelled/falsified/counterfeit medical products
The Sixty-third World Health Assembly, Reaffirming the fundamental role of WHO in ensuring the safety, quality and efficacy of medical products; Noting the work of WHO in ensuring safety, quality and efficacy of medical products, 1. DECIDED to establish a time-limited and results-oriented working group on substandard/spurious/falsely-labelled/falsified/counterfeit medical products comprised of and open to all Member States;1 2. REQUESTED the Director-General to convene and facilitate the work of the working group;
3. DECIDED that the working group will examine the following matters from a public health perspective, excluding trade and intellectual property considerations: (a) WHO’s role in measures to ensure the availability of quality, safe, efficacious and affordable medical products; (b) WHO’s relationship with the International Medical Products Anti-Counterfeiting Taskforce; (c) WHO’s role in the prevention and control of medical products of compromised quality, safety and efficacy such as substandard/spurious/falsely-labelled/falsified/counterfeit medical products from a public health perspective, excluding trade and intellectual property considerations; (d) any issue or issues raised in the proposals contained in documents, A63/A/Conf.Paper No.4 Rev.1, A63/A/Conf.Paper No.5 and A63/A/Conf.Paper No.7,2 starting with those issues referred to in subparagraphs (a)–(c) above; 4. DECIDED that the working group shall make specific recommendations in relation to the issues set out in paragraph 3 above and report to the Sixty-fourth World Health Assembly, and shall report on progress in implementing this decision to the Executive Board, at its 128th session. (Eighth plenary meeting, 21 May 2010)
1 2
And, where applicable, regional economic integration organizations. Attached below.
4
A63/DIV/3
Agenda item 11.20
A63/A/Conf.Paper No.4 Rev.11
18 May 2010
Plan of work to support the prevention and control of falsified medical products Draft resolution proposed by the delegation of Ecuador on behalf of the Union of South American Nations (UNASUR)2
The Sixty-third World Health Assembly, PP1 Considering resolutions WHA41.16 and WHA47.13 on the need to provide guidelines to Member States on the development of their own structures and the adoption of national measures to prevent and control falsified medical products; PP2 Bearing in mind the Conference of Experts on the Rational Use of Drugs (Nairobi, 25–29 November 1985) which first addressed this issue at the international level; PP3 Aware of the risks that falsified medical products entail for the population; PP4 Observing that the falsification of medical products has an international dimension and that the prevention and control of this problem necessitates cooperation at the regional and subregional levels and between countries; PP5 Reaffirming that health authorities must perform an important function in applying health regulations that strengthen a chain of safe, high-quality and efficacious medical products, DECIDES: (1) to establish an intergovernmental working group comprising delegates of Member States and the Secretariat to consider and implement cooperation at the regional and subregional levels and between countries, with a view to preventing and controlling falsified medical products from a public-health perspective, excluding commercial and intellectual property considerations; (2) that the working group should examine the following topics: (a) education measures such as training of consumers and public-health sector stakeholders;
1 2
Reissued for technical reasons.
Argentina, Bolivia (Plurinational State of), Brazil, Chile, Colombia, Ecuador, Guyana, Paraguay, Peru, Suriname, Uruguay and Venezuela (Bolivarian Republic of).
5
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(b) measures to strengthen the chain of production and distribution of medical products, specifically in relation to regulation and inspection; (c) action strategies at the national, subregional and regional levels providing for mechanisms to improve sharing of information and experiences between countries; (d) strategies to improve the capacity of the health sector to apply health regulation measures; (3) that, with the approval of Member States, the working group should be authorized to form technical subgroups of an ad hoc and provisional nature, and to invite experts to examine specific issues.
Agenda item 11.20
A63/A/Conf.Paper No.5 19 May 2010
Counterfeit medical products Draft resolution proposed by the delegations of Algeria, Angola, Benin, Botswana, Burkina Faso, Burundi, Cameroon, Cape Verde, Central African Republic, Chad, Comoros, Congo, Côte d’Ivoire, Equatorial Guinea, Ethiopia, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Lesotho, Liberia, Madagascar, Malawi, Mali, Mauritius, Namibia, Niger, Nigeria, Rwanda, Senegal, Sierra Leone, South Africa, Swaziland, Togo, Uganda, United Republic of Tanzania, Zambia and Zimbabwe
The Sixty-third World Health Assembly, PP1 Having considered the report on counterfeit medical products;1 PP2 Recalling resolution WHA41.16 on the rational use of drugs requesting the Director-General to initiate programmes for the prevention and detection of export, import and smuggling of falsely labelled, spurious, counterfeited or substandard pharmaceutical preparations; PP3 Recalling resolution WHA47.13 on the rational use of drugs requesting the Director-General to support Member States in their efforts in combating the use of counterfeit drugs; PP4 Recalling resolution WHA52.19 on the revised drug strategy and in particular the request to the Director-General to develop and disseminate uniform guidelines on the regulatory control,
1
Document A63/23.
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export, import and transit conditions of pharmaceutical products; and to develop standards of practice for entities involved in international trade in pharmaceuticals and pharmaceutical starting materials; PP5 Recalling the continuous and repeated request from drug regulatory authorities of Member States that met in the framework of the International Conferences of Drug Regulatory Authorities to WHO to assist Member States to adopt measures to combat counterfeit medicines; PP6 Concerned about the situation in which counterfeit medical products continue to move in international commerce, representing a major threat to public health, especially in the poorer areas of developing countries where regulatory capacities and law enforcement authorities are weak, and in which counterfeit medical products pose a challenge to the credibility and effectiveness of health systems; PP7 Recognizing that the primary focus of combating the manufacture, distribution and use of counterfeit medical products is the protection of public health and that the main victims of counterfeiters are patients and the general public; PP8 Recognizing that combating counterfeit medical products is one specific aspect of assuring quality, safety and efficacy of medical products; PP9 Recognizing the importance of ensuring that combating counterfeit medical products does not result in hindering the availability of legitimate generic medicines; PP10 Recognizing the various initiatives and progress achieved since 1988 by specific WHO guidelines for combating counterfeit medical products, and improvement of guidelines on import procedures for pharmaceutical products, inspection of drug distribution channels and good distribution practices for pharmaceutical products; PP11 Aware of the importance of ensuring effective collaboration among patients, health professionals, the private sector and government institutions to combat counterfeit medical products effectively; PP12 Cognizant of the importance of ensuring international collaboration and exchange of information in order to combat counterfeit medical products effectively; PP13 Noting with satisfaction that the Director-General has intensified activities aimed at strengthening international collaboration to combat counterfeit medical products and that WHO has a leading role in these activities; PP14 Recognizing the contribution of all parties concerned to the fulfilment of their responsibilities in compliance with the components of resolutions WHA41.16, WHA47.13 and WHA52.19 that specifically focus on combating counterfeit medical products, and encouraging all parties to continue that action; PP15 Inviting bilateral agencies, multilateral bodies inside and outside the United Nations system, and voluntary organizations to collaborate and to provide support to developing countries in setting up and carrying out programmes aimed at combating counterfeit medical products, and acknowledging the work of those countries that are already doing so;
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PP16 Requesting governments, pharmaceutical manufacturers and other concerned parties to cooperate in the detection, investigation and prevention of the increasing incidence of counterfeited or other substandard medical products moving in international commerce; PP17 Aware of the public health impact of counterfeit medicines in achieving Millennium Development Goal 8 as it relates to international collaboration, in particular Target 8.E on the availability and access to quality medicines, 1. URGES Member States: (1) to reaffirm their commitment to develop, implement and monitor national policies and to take all necessary measures in order to ensure access to medical products that meet regulatory standards; (2) to establish and enforce legislation and regulations that prevent counterfeit medical products from being manufactured, exported, imported or traded in international transactions as well as to regulate and monitor the supply and distribution systems; (3) to establish effective mechanisms of coordination and collaboration, including exchange of information among health, law enforcement and other relevant authorities in order to improve prevention, detection, investigation and prosecution of cases of counterfeit medical products; (4) to promote awareness among health professionals and consumers of the risks posed by the use of counterfeit medical products including those acquired through unauthorized outlets including Internet sites; 2. REQUESTS the Director-General: (1) to continue to address counterfeit medical products as an integral part, within the existing framework, of standard setting for quality, safety and efficacy; (2) to provide support to Member States in developing and implementing policies and programmes aimed at combating counterfeit medical products, including facilitating the exchange of information at the international level and the development of tools, guidelines, training and awareness initiatives, and methodology for evaluation and monitoring; (3) to continue the development and dissemination of independent and timely information on instances of counterfeit medical products; (4) to cooperate with Member States, at their request, and with international organizations and other relevant parties in detecting, monitoring and analysing cases of counterfeit medical products and their impact on public health; (5) to report to the Sixty-fifth World Health Assembly, through the Executive Board, both on progress achieved and problems encountered in the implementation of this resolution.
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Agenda item 11.3
A63/A/Conf.Paper No.7 18 May 2010
Measures to ensure access to safe, efficacious, quality and affordable medical products Draft resolution proposed by the delegations of India and Thailand
The Sixty-third World Health Assembly, PP1 Recalling the Constitution of WHO, which states that “the objective of WHO shall be the attainment by all peoples of the highest possible level of health”; PP2 Recalling the principles of the Global strategy and plan of action on public health, innovation and intellectual property as adopted by the World Health Assembly in resolution WHA61.21; PP3 Emphasizing the importance of ensuring access to affordable medicines, technologies and other health products among people in need while ensuring the quality, safety and efficacy of medical products1 and promoting the rational use of medicines; PP4 Concerned about reports of medical products with compromised quality, safety and efficacy, and stressing the need to ensure the availability of safe, efficacious, quality and affordable medical products; PP5 Recognizing that falsely labelled or substandard medical products can have serious consequences for the health of the population; PP6 Noting that the term and definition of “counterfeit” relates to infringement of intellectual property rights and should not be equated with medical products with compromised quality, safety and efficacy; PP7 Noting that the definition in the Agreement on Trade-related Aspects of Intellectual Property Rights definition that “counterfeit trademark goods” shall mean any goods, including packaging, bearing without authorization a trademark which is identical to the trademark validly registered in respect of such goods, or which cannot be distinguished in its essential aspects from such a trademark, and which thereby infringes the rights of the owner of the trademark in question under the law of the country of importation;2
The term “medical products” hereafter should be understood to include vaccines, diagnostics and medicines in accordance with resolution WHA59.24. 2
1
Agreement on Trade-related Aspects of Intellectual Property Rights Article 51, footnote 14(a).
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PP8 Recognizing that issues of protection and enforcement of intellectual property rights are distinct from issues of quality, safety and efficacy of medical products; PP9 Seriously concerned about numerous incidences of intellectual property enforcement measures that have resulted in unwarranted seizures of generic medicines, affecting timely access to efficacious affordable medical products for people in developing countries, including least-developed countries; PP10 Recognizing that infringement of intellectual property rights is being confused with the issues of quality, safety and efficacy; PP11 Recognizing that high prices of medical products result in inequitable access and facilitate proliferation of medical products with compromised quality, safety and efficacy; PP12 Resolving to take immediate steps to promote the availability of affordable, quality, safe, and efficacious medical products; PP13 Recognizing the need to promote measures to address quality, safety and efficacy of medical products that do not themselves become barriers to timely availability of affordable medical products and production of generic medical products; PP14 Recognizing that the International Medical Products Anti-Counterfeiting Taskforce, or its Terms of Reference, has not been approved by any governing body of WHO and that there are conflicts of interest in its composition, 1. URGES Member States: (1) to take measures to strengthen national drug regulatory authorities by enhancing their capacity to ensure for all, and particularly to vulnerable groups, access to safe, efficacious, quality and affordable medical products; (2) to address the basic causes of the circulation of medicines with compromised safety, efficacy and quality such as weak regulatory capacity, unethical promotion of medicines, and high prices of medical products; (3) to take measures to remove barriers to access to quality, safe, efficacious and affordable medical products; (4) to ensure incorporation of public health safeguards, including as reaffirmed by the Doha Declaration on the TRIPS Agreement and Public Health, in their domestic intellectual property legislation; (5) to implement trade, intellectual property and other policies without constraining policy space for health, including access to quality, safe, efficacious and affordable medical products and production of generic medical products; (6) to refrain from applying measures to enforce intellectual property rights, such as the seizure of medical products in transit, that result in creating barriers to legitimate trade of generic medicines and impeding access to medical products, particularly in developing countries;
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A63/DIV/3
(7) to promote close collaboration among the national drug regulatory authorities to share information inspection techniques and testing methods; 2. REQUESTS the Director-General: (1) to provide support to Member States, upon request, in strengthening their national drug regulatory authorities with a focus on enhancing their capacity, technical knowledge, infrastructure, facilities, and promoting robust systems to ensure that medical products available in their jurisdiction are of quality, safe and efficacious; (2) to provide support for the development of new techniques and test methods for the use of national drug regulatory authorities to ensure the quality, safety and efficacy of medical products; (3) to replace WHO’s involvement in the International Medical Products Anti-Counterfeiting Taskforce with an effective programme to address the issues of quality, safety and efficacy as detailed in this resolution and ensure that the new programme avoids conflicts of interests, is evidence-based, transparent and Member-driven; (4) to advocate that WHO does not get involved with infringement of intellectual property rights and other measures that could potentially undermine availability of quality, safe, efficacious and affordable medical products and production of generic medical products; (5) to create measures to ensure that intellectual property enforcement does not inhibit access to affordable medical products; (6) to report on implementation of this resolution to the Sixty-fourth World Health Assembly and subsequently biennially, through the Executive Board.
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II. RESOLUTIONS WHA63.1 Pandemic influenza preparedness: sharing of influenza viruses and access to vaccines and other benefits Health conditions in the occupied Palestinian territory, including east Jerusalem, and in the occupied Syrian Golan Advancing food safety initiatives Financial report and audited financial 1 January 2008 – 31 December 2009 Scale of assessments 2010–2011 Safety and security of staff and premises The Capital Master Plan Report of the External Auditor Salaries of staff in ungraded posts and of the Director-General Partnerships Agreements with intergovernmental organizations Availability, safety and quality of blood products Global strategy to reduce the harmful use of alcohol Marketing of food and non-alcoholic beverages to children Monitoring of the achievement of the health-related Millennium Development Goals International recruitment of health personnel: draft global code of practice Birth defects Viral hepatitis WHO HIV/AIDS strategy for 2011–2015 Chagas disease: control and elimination WHO’s strategy on research for health Human organ and tissue transplantation statements for the period
WHA63.2
WHA63.3 WHA63.4
WHA63.5 WHA63.6 WHA63.7 WHA63.8 WHA63.9 WHA63.10 WHA63.11 WHA63.12 WHA63.13 WHA63.14 WHA63.15
WHA63.16 WHA63.17 WHA63.18 WHA63.19 WHA63.20 WHA63.21 WHA63.22
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A63/DIV/3
WHA63.23 WHA63.24
Infant and young child nutrition Accelerating progress towards achievement of Millennium Development Goal 4 to reduce child mortality: prevention and treatment of pneumonia Improvement of health through safe and environmentally sound waste management Improvement of health through sound management of obsolete pesticides and other obsolete chemicals Strengthening the capacity of governments to constructively engage the private sector in providing essential health-care services Establishment of a consultative expert working group on research and development: financing and coordination
WHA63.25 WHA63.26
WHA63.27
WHA63.28
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SIXTY-THIRD WORLD HEALTH ASSEMBLY Agenda item 11.1
WHA63.1 19 May 2010
Pandemic Influenza Preparedness: sharing of influenza viruses and access to vaccines and other benefits The Sixty-third World Health Assembly, Having considered the report of the Open-Ended Working Group of Member States on Pandemic Influenza Preparedness: sharing of influenza viruses and access to vaccines and other benefits that met in Geneva on 10–12 May, 2010;1 Recalling resolutions WHA60.28 and WHA62.10, which relate to the Pandemic Influenza Preparedness Framework for the Sharing of Influenza Viruses and Access to Vaccines and Other Benefits,2 as well as resolutions WHA56.19 and WHA59.2 on pandemic influenza preparedness; Taking note of all experiences and lessons from the pandemic (H1N1) 2009, the ongoing work of the IHR Review Committee, and lessons learnt from the ongoing outbreaks of influenza H5N1; Recognizing the continued challenge of improving pandemic influenza preparedness, notably to increase: national and global preparedness and response capacities; improved laboratory and surveillance capacity; global influenza vaccine, antivirals and diagnostics production capacity, and access to vaccines, antivirals and diagnostics, particularly in affected and developing countries, and with special attention to least developed countries; Recognizing the need to implement a fair and transparent, equitable, efficient and effective system for the sharing of viruses and access to vaccines and other benefits on an equal footing; Recognizing that the solutions to address these challenges involve the implementation of multiple tools, interlinked as necessary, which may include: separate, but complementary Standard Material Transfer Agreements for relevant materials, one within the WHO Network, and one for transfers outside the WHO Network; strengthening support for WHO’s Global Pandemic Influenza Action Plan to Increase Vaccine Supply;3 surveillance capacity building under the International Health Regulations (2005); and ensuring sustainable financing and solidarity mechanisms;
1 2 3
Document A63/48. See document A62/5 Add.1. Document WHO/IVB/06.13 – WHO/CDS/EPR/GIP/2006.1.
WHA63.1
Recognizing the role of industry as an important contributor to addressing the above challenges in a sustainable and predictable manner; Considering that some of the remaining elements require further consideration, and studies, as necessary, in order to reach final agreement, 1. REQUESTS the Director-General: (1) to continue to work with Member States and relevant regional economic integration organizations, on the Pandemic Influenza Preparedness Framework for the Sharing of Influenza Viruses and Access to Vaccines and Other Benefits1 as decided in resolution WHA62.10 and to convene the Open-Ended Working Group before the 128th session of the Executive Board; (2) to undertake technical consultations and studies as necessary in order to support the work of the Open-Ended Working Group in reaching a final agreement; 2. DECIDES that the Open-Ended Working Group shall report through the Executive Board at its 128th session to the Sixty-fourth World Health Assembly.
Sixth plenary meeting, 19 May 2010 A63/VR/6
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As contained in document A62/5 Add.1.
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SIXTY-THIRD WORLD HEALTH ASSEMBLY Agenda item 13
WHA63.2 20 May 2010
Health conditions in the occupied Palestinian territory, including east Jerusalem, and in the occupied Syrian Golan The Sixty-third World Health Assembly, Mindful of the basic principle established in the Constitution of WHO, which affirms that the health of all peoples is fundamental to the attainment of peace and security; Recalling all its previous resolutions on health conditions in the occupied Arab territories; Recalling resolution EB124.R4, adopted by the Executive Board at its 124th session, on the grave health situation caused by Israeli military operations in the occupied Palestinian territory, particularly in the occupied Gaza Strip; Taking note of the report of the Director-General on the health conditions in the occupied Palestinian territory, including east Jerusalem, and in the occupied Syrian Golan; Noting with deep concern the findings in the report of the Director-General on the specialized health mission to the Gaza Strip; Stressing the essential role of UNRWA in providing crucial health and education services in the occupied Palestinian territory, particularly in addressing the emergency needs in the Gaza Strip; Expressing its concern at the deterioration of economic and health conditions as well as the humanitarian crisis resulting from the continued occupation and the severe restrictions imposed by Israel, the occupying power; Expressing its deep concern also at the health crisis and rising levels of food insecurity in the occupied Palestinian territory, particularly in the Gaza Strip; Affirming the need to guarantee universal coverage of health services and to preserve the functions of the public health services in the occupied Palestinian territory; Recognizing that the acute shortage of financial and medical resources in the Palestinian Ministry of Health, which is responsible for running and financing public health services, jeopardizes the access of the Palestinian population to curative and preventive services;
WHA63.2
Affirming the right of Palestinian patients and medical staff to have access to the Palestinian health institutions in occupied east Jerusalem; Deploring the incidents involving lack of respect and protection for Palestinian ambulances and medical personnel by the Israeli army, which have led to casualties among Palestinian medical personnel, as well as the restrictions on their movements imposed by Israel, the occupying power, in violation of international humanitarian law; Affirming that the blockade is continuing and that the crossing points are not entirely and definitely opened, meaning that the crisis and suffering that started before the Israeli attack on the Strip are continuing, hindering the efforts of the Ministry of Health of the Palestinian Authority to reconstruct the establishments destroyed by the Israeli military operations by the end of 2008 and in 2009; Expressing deep concern at the grave implications of the wall on the accessibility and quality of medical services received by the Palestinian population in the occupied Palestinian territory, including east Jerusalem; Expressing deep concern also at the serious implications for pregnant women and patients of restrictions on movement imposed by Israel on Palestinian ambulances and medical personnel, 1. DEMANDS that Israel, the occupying power: (1) immediately put an end to the closure of the occupied Palestinian territory, particularly the closure of the crossing points of the occupied Gaza Strip that are causing the serious shortage of medicines and medical supplies therein, and comply in this regard with the provisions of the Israeli Palestinian Agreement on Movement and Access of November 2005; (2) abandon its policies and measures that have led to the prevailing dire health conditions and severe food and fuel shortages in the Gaza Strip; (3) comply with the Advisory Opinion rendered on 9 July 2004 by the International Court of Justice on the wall which, inter alia, has grave implications for the accessibility and quality of medical services received by the Palestinian population in the occupied Palestinian territory, including east Jerusalem; (4) facilitate the access of Palestinian patients and medical staff to the Palestinian health institutions in occupied east Jerusalem and abroad; (5) ensure unhindered and safe passage for Palestinian ambulances as well as respect and protection of medical personnel, in compliance with international humanitarian law; (6) improve the living and medical conditions of Palestinian detainees, particularly children, women and patients, and demands that the occupying power, Israel, provide the detainees who are suffering from serious medical conditions worsening every day, with the necessary medical treatment; (7) facilitate the transit and entry of medicine and medical equipment to the occupied Palestinian territory;
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WHA63.2
(8) assume its responsibility with regard to the humanitarian needs of the Palestinian people and their daily access to humanitarian aid, including food and medicine, in compliance with international humanitarian law; (9) halt immediately all its practices, policies and plans, including its policy of closure, that seriously affect the health conditions of civilians under occupation; (10) respect and facilitate the mandate and work of UNRWA and other international organizations, and ensure the free movement of their staff and aid supplies; 2. URGES Member States and intergovernmental and nongovernmental organizations: (1) to help overcome the health crisis in the occupied Palestinian territory by providing assistance to the Palestinian people; (2) to help meet urgent health and humanitarian needs, as well as the important health-related needs for the medium and long term, identified in the report of the Director-General on the specialized health mission to the Gaza Strip; (3) calls upon the international community to exert pressure on the government of Israel, to lift the siege imposed on the occupied Gaza Strip in order to avoid a serious exacerbation of the humanitarian crisis therein, and to help lift the restrictions and obstacles imposed on the Palestinian people including the free movement of people and medical staff in the occupied Palestinian territory, and to bring Israel to respect its legal and moral responsibilities, and ensure the full enjoyment of basic human rights for civilian populations in the occupied Palestinian territory, particularly in east Jerusalem; (4) to remind Israel, the occupying power, to abide by the Fourth Geneva Convention relative to the Protection of Civilian Persons in Time of War of 1949, which is applicable to the occupied Palestinian territory including east Jerusalem; (5) calls upon all international human rights organizations, particularly the International Committee of the Red Cross, to intervene on an urgent and immediate basis vis-à-vis the occupying power, Israel, and compel it to provide adequate medical treatment to Palestinian prisoners and detainees who are suffering from serious medical conditions worsening every day, and urges civil society organizations to exercise pressure on the occupying power, Israel, to save the lives of detainees and ensure the immediate release of critical cases and to provide them with external treatment, and to allow Palestinian women prisoners to receive maternity care services and medical follow up during pregnancy, delivery and postpartum care, and to allow them to give birth in healthy and humanitarian conditions in the presence of their relatives and family members and immediately to release all children detained in Israeli prisons; (6) to support and assist the Palestinian Ministry of Health in carrying out its duties, including running and financing public health services; (7) to provide financial and technical support to the Palestinian public health and veterinary services;
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WHA63.2
3. EXPRESSES deep appreciation to the international donor community for their support of the Palestinian people in different fields, and urges donor countries and international health organizations to continue their efforts to ensure the provision of necessary political and financial support to enable the implementation of the 2008–2010 health plan of the Palestinian Authority and to create a suitable political environment to implement the plan with a view to putting an end to the occupation and establishing the state of Palestine as proposed by the Government of Palestine, which is working seriously to create the proper conditions for its implementation; 4. EXPRESSES its deep appreciation to the Director-General for her efforts to provide necessary assistance to the Palestinian people in the occupied Palestinian territory, including east Jerusalem, and to the Syrian population in the occupied Syrian Golan; 5. REQUESTS the Director-General: (1) to provide support to the Palestinian health and veterinary services including capacity building; (2) to submit a fact-finding report on the health and economic situation in the occupied Palestinian territory, including east Jerusalem, and in the occupied Syrian Golan; (3) to support the establishment of medical facilities and provide health-related technical assistance to the Syrian population in the occupied Syrian Golan; (4) to continue providing necessary technical assistance in order to meet the health needs of the Palestinian people, including the handicapped and injured; (5) to also provide support to the Palestinian health and veterinary services in preparing for unusual emergencies; (6) to support the development of the health system in the occupied Palestinian territory, including development of human resources; (7) to establish, in cooperation with the International Committee of the Red Cross, an international committee of specialized medical teams to diagnose the serious health conditions of Palestinian prisoners and detainees in Israeli jails and provide them with all necessary and urgent treatment in accordance with relevant international conventions and agreements; (8) to make available the detailed report prepared by the specialized health mission to the Gaza Strip; (9) to report on implementation of this resolution to the Sixty-fourth World Health Assembly.
Seventh plenary meeting, 20 May 2010 A63/VR/7
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SIXTY-THIRD WORLD HEALTH ASSEMBLY Agenda item 11.8
WHA63.3 20 May 2010
Advancing food safety initiatives The Sixty-third World Health Assembly, Having considered the report on food safety,1 Recalling resolution WHA53.15 on food safety, which requested the Director-General to put in place a global strategy for the surveillance of foodborne diseases and for the efficient gathering and exchange of information in and between countries; Recalling resolution WHA55.16 on the global public health response to natural occurrence, accidental release or deliberate use of biological and chemical agents or radionuclear material that affect health, which noted that such agents can be disseminated through food- and water-supply chains; Noting the endorsement by the Executive Board in 2002 of WHO’s global strategy for food safety,2 which had as its aim the reduction of the health and social burden of foodborne disease; Noting also, that other food safety-related activities identified in resolutions WHA53.15 and WHA55.16 have been undertaken, including: the revision of the International Health Regulations in 2005; the establishment of the International Food Safety Authorities Network in 2005; the establishment of WHO’s Foodborne Disease Burden Epidemiology Reference Group in 2006; and increased participation, particularly by developing countries, in the elaboration of international food safety standards by the Codex Alimentarius Commission; Recognizing that the Codex Alimentarius Commission presents a unique opportunity for all countries to join the international community in formulating and harmonizing food standards and ensuring their global implementation, and in particular the participation of developing countries in this regard should be encouraged; Further recognizing the important roles of WHO and FAO in support of the Codex Alimentarius Commission as the international reference point for developments associated with food standards; Confirming that foodborne disease continues to represent a serious threat to the health of millions of people in the world, particularly those in developing countries with poor nutritional status;
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Document A63/11. Document EB109/2002/REC/2, summary record of the fourth meeting.
WHA63.3
Mindful of the inextricable links between food safety, nutrition and food security, and acknowledging the instrumental role of food safety in eradicating hunger and malnutrition, in particular in low-income and food-deficit countries; Aware of increasing evidence that many communicable diseases, including emerging zoonoses, are transmitted through food, and that exposure to chemicals and pathogens in the food supply is associated with acute and chronic diseases; Acknowledging that climate change could be a factor in the increasing rates of some foodborne diseases, including those of zoonotic origin, owing to the more rapid growth of microorganisms in food and water with higher temperatures, resulting in the emergence of toxins in new geographical areas and possibly in higher levels of toxins or pathogens in food; Recognizing that the global trade in food is increasing every year, contributing to the risk of spread of pathogens and contaminants across national borders, thereby creating new challenges for food authorities and necessitating more efficient global sharing of food safety information, taking into account that protection of food safety cannot lead to discrimination or a disguised restriction on international trade; Acknowledging the continuing need for closer collaboration between the health sector and other sectors, and increased action on food safety at the international and national levels, across the full length of the food-production chain, in order to reduce significantly the incidence of foodborne disease; Noting the continuing need for updated and comprehensive internationally agreed standards and agreements for risk assessments and scientific advice to support measures and interventions to improve the safety and nutritional quality of food; Recognizing the importance of international agreement on global management of food safety, the application of scientific principles in finding solutions, the efficient exchange of monitoring and surveillance data, and practical experience, 1. URGES Member States:1 (1) to continue to establish and maintain the activities and measures elaborated in resolutions WHA53.15 on food safety and WHA55.16 on the global public health response to natural occurrence, accidental release or deliberate use of biological and chemical agents or radionuclear material that affect health; (2) to further develop and implement the core capacities as defined in Annex 1 of the International Health Regulations (2005), as applicable, and those required for participation in the International Food Safety Authorities Network, specifically for food-safety events, including the development of systems for: surveillance for foodborne disease and food contamination; risk assessment, traceability, risk management, including the Hazard Analysis and Critical Control Points system, and risk communication; food safety emergency response; product tracing and recall; and strengthened laboratory capacity;
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And, where applicable, regional economic integration organizations.
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WHA63.3
(3) to participate fully as members of the International Food Safety Authorities Network in its activities, including supporting the timely transmission of data, information and knowledge about food-safety emergencies through the Network in a transparent manner; (4) to enhance the integration of food-safety considerations into food aid, food security and nutrition interventions in order to reduce the occurrence of foodborne diseases and improve the health outcomes of populations in particular the vulnerable groups; (5) to establish or improve the evidence base for food safety through systematic efforts on disease-burden estimation and surveillance, and through comprehensive risk and risk-benefit assessment, and to provide support for international activities in these areas, in particular, WHO’s initiative to estimate the global burden of foodborne diseases from all major causes (microbiological, parasitic and chemical); (6) to contribute to the timely conduct of international risk assessments through the provision of relevant data and expertise in order to tackle more efficiently and consistently foodborne diseases and food-safety issues that threaten global public health security; (7) to continue to develop and maintain sustainable preventive measures, including food safety-education programmes, aimed at reducing the burden of foodborne diseases through a systems approach encompassing the complete food-production chain from farm to consumption; (8) to promote dialogue and collaboration among human health, veterinary and food-related disciplines, within and among Member States, focused on an integrated effort of foodborne risk reduction along the whole food-production chain, including consideration of zoonotic risks; (9) to participate actively in the Codex Alimentarius Commission’s standard-setting process and to adopt Codex standards whenever appropriate; 2. REQUESTS the Director-General: (1) to develop the International Food Safety Authorities Network further through the implementation of the WHO’s global strategy for food safety; to encourage communication and technical exchange of risk assessments and best practices among members of the Network; to facilitate Member States’ involvement in the Network’s operation and development; and to encourage additional membership into the International Food Safety Authorities Network; (2) to strengthen the emergency function of the International Food Safety Authorities Network as a critical component of WHO’s preventive and emergency operations relative to food safety, and linkages to other relevant international organizations and networks in this area; (3) to continue to provide global leadership in providing technical assistance and tools that meet the needs of Member States and the Secretariat for scientific estimations on foodborne risks and foodborne disease burden from all causes; (4) to promote the inclusion of food safety into the international debate on food crises and hunger emergencies, and provide technical support to Member States and international agencies for considering food safety, nutrition and food security issues in a comprehensive, integrated manner;
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WHA63.3
(5) to monitor regularly and report to Member States on the global burden of foodborne and zoonotic diseases from the country, regional and international perspectives; (6) to promote research, including the safety and quality of traditional foods, and investigation of the association of foodborne hazards with acute and chronic diseases, in order to support evidence-based strategies for the control and prevention of foodborne and zoonotic diseases such as the Hazard Analysis and Critical Control Points system; (7) to provide support to Member States in building relevant capacity to improve crosssectoral collaboration and action at international, regional and national levels along the whole food-production chain, including the assessment, management and communication of foodborne and zoonotic risks; (8) to develop guidance on the public health aspects arising from zoonotic diseases that originate at the human-animal interface, in particular prevention, detection and response; (9) to provide adequate and sustainable support for the joint expert bodies of FAO and WHO, the Codex Alimentarius Commission and the International Food Safety Authorities Network in order to advance the international development, provision, use, and sharing of scientific risk assessments and advice; to support the development of international food standards that protect the health and nutritional well-being of consumers; and to address and communicate more effectively on food safety issues at the national and international levels; (10) to establish with the International Food Safety Authorities Network an international initiative for the collaboration of laboratory partners in support of surveillance of foodborne disease, identification of food contamination and emergency response, including outbreak investigation and linking product to illness in order to support recall, with that initiative also including the establishment of mechanisms for data sharing; (11) to report to the Sixty-fifth World Health Assembly, through the Executive Board, on progress in implementing this resolution.
Seventh plenary meeting, 20 May 2010 A63/VR/7 = = =
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SIXTY-THIRD WORLD HEALTH ASSEMBLY Agenda item 15.1
WHA63.4 21 May 2010
Financial report and audited financial statements for the period 1 January 2008 – 31 December 2009 The Sixty-third World Health Assembly, Having examined the Financial report and audited financial statements for the period 1 January 2008 – 31 December 2009;1 Having noted the second report of the Programme, Budget and Administration Committee of the Executive Board to the Sixty-third World Health Assembly;2 ACCEPTS the Director-General’s Financial report and audited financial statements for the period 1 January 2008 – 31 December 2009.
Eighth plenary meeting, 21 May 2010 A63/VR/8
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Document A63/32. Document A63/51 Rev.1.
SIXTY-THIRD WORLD HEALTH ASSEMBLY Agenda item 15.4
WHA63.5 21 May 2010
Scale of assessments 2010–2011 The Sixty-third World Health Assembly, Having considered the report on scale of assessments 2010–2011,1 Considering that a new United Nations scale of assessments was adopted for the period 2010– 2012,2 Recalling that the Health Assembly, in resolution WHA56.33, decided to accept henceforth the latest available United Nations scale of assessment for assessed contributions of Member States, taking into account differences in membership between WHO and the United Nations, DECIDES that the scale of assessments for the year 2011 shall be as follows: Members and Associate Members Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia (Plurinational State of) WHO scale for 2011 % 0.0040 0.0100 0.1280 0.0070 0.0100 0.0020 0.2870 0.0050 1.9331 0.8511 0.0150 0.0180 0.0390 0.0100 0.0080 0.0420 1.0751 0.0010 0.0030 0.0010 0.0070
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Document A63/31. United Nations General Assembly resolution 64/248.
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Members and Associate Members Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Central African Republic Chad Chile China Colombia Comoros Congo Cook Islands Costa Rica Côte d’Ivoire Croatia Cuba Cyprus Czech Republic Democratic People’s Republic of Korea Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana
WHO scale for 2011 % 0.0140 0.0180 1.6111 0.0280 0.0380 0.0030 0.0010 0.0030 0.0110 3.2072 0.0010 0.0010 0.0020 0.2360 3.1892 0.1440 0.0010 0.0030 0.0010 0.0340 0.0100 0.0970 0.0710 0.0460 0.3490 0.0070 0.0030 0.7361 0.0010 0.0010 0.0420 0.0400 0.0940 0.0190 0.0080 0.0010 0.0400 0.0080 0.0040 0.5660 6.1234 0.0140 0.0010 0.0060 8.0186 0.0060 0.6910 0.0010 0.0280 0.0020 0.0010 0.0010
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Members and Associate Members Haiti Honduras Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People’s Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Lithuania Luxembourg Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia (Federated States of) Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Niue
WHO scale for 2011 % 0.0030 0.0080 0.2910 0.0420 0.5340 0.2380 0.2330 0.0200 0.4980 0.3840 4.9994 0.0140 12.5309 0.0140 0.0760 0.0120 0.0010 0.2630 0.0010 0.0010 0.0380 0.0330 0.0010 0.0010 0.1290 0.0650 0.0900 0.0030 0.0010 0.2530 0.0010 0.0030 0.0170 0.0010 0.0010 0.0110 2.3562 0.0010 0.0030 0.0020 0.0040 0.0580 0.0030 0.0060 0.0080 0.0010 0.0060 1.8551 0.2730 0.0030 0.0020 0.0780 0.0010
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Members and Associate Members Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Republic of Korea Republic of Moldova Romania Russian Federation Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Tajikistan Thailand The former Yugoslav Republic of Macedonia Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia
WHO scale for 2011 % 0.8711 0.0860 0.0820 0.0010 0.0220 0.0020 0.0070 0.0900 0.0900 0.8281 0.5110 0.0010 0.1350 2.2602 0.0020 0.1770 1.6021 0.0010 0.0010 0.0010 0.0010 0.0010 0.0030 0.0010 0.8301 0.0060 0.0370 0.0020 0.0010 0.3350 0.1420 0.1030 0.0010 0.0010 0.3850 3.1772 0.0190 0.0100 0.0030 0.0030 1.0641 1.1301 0.0250 0.0020 0.2090 0.0070 0.0010 0.0010 0.0010 0.0010 0.0440 0.0300
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Members and Associate Members Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom of Great Britain and Northern Ireland United Republic of Tanzania United States of America Uruguay Uzbekistan Vanuatu Venezuela (Bolivarian Republic of) Viet Nam Yemen Zambia Zimbabwe Total
WHO scale for 2011 % 0.6170 0.0260 0.0010 0.0060 0.0870 0.3910 6.6045 0.0080 22.0000 0.0270 0.0100 0.0010 0.3140 0.0330 0.0100 0.0040 0.0030 100.0000
Eighth plenary meeting, 21 May 2010 A63/VR/8
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SIXTY-THIRD WORLD HEALTH ASSEMBLY Agenda item 15.7
WHA63.6 21 May 2010
Safety and security of staff and premises The Sixty-third World Health Assembly, Having considered the report on safety and security of staff and premises and the Capital Master Plan: safety and security of staff, and noting the related report of the Programme, Budget and Administration Committee of the Executive Board to the Sixty-third World Health Assembly;1 Concerned about the vulnerability of the Organization with regard to staff safety and security; Acknowledging the financial mechanism put in place by the Secretariat in order to ensure sustainable funding for security; Recognizing the urgent requirements that have been identified and the associated financing needed for ensuring safety and security of staff and premises; Considering the inadequate balance in the Security Fund, 1. RESOLVES to appropriate US$ 10 million from Member States’ non-assessed income to the Security Fund in order to cover the costs of urgent actions to ensure the safety and security of staff and premises; 2. REQUESTS the Director-General to report to the Executive Board at its 128th session in January 2011 on the implementation of projects funded through the Security Fund.
Eighth plenary meeting, 21 May 2010 A63/VR/8
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Document A63/35.
SIXTY-THIRD WORLD HEALTH ASSEMBLY Agenda item 15.7
WHA63.7 21 May 2010
The Capital Master Plan The Sixty-third World Health Assembly, Having considered the report on safety and security of staff and premises and the Capital Master Plan: the Capital Master Plan1 and noting the related report of the Programme, Budget and Administration Committee of the Executive Board to the Sixty-third World Health Assembly; Recalling the need for a strategic approach to the management of the Organization’s physical infrastructure through the Capital Master Plan for the period 2010–2019; Recognizing that much of WHO’s building stock is old and in need of renovation, and no longer meets acceptable standards of safety, security and energy efficiency; Having considered the actions taken by other organizations in the United Nations system to finance major renovations, construction and acquisitions; Having also considered the Organization’s immediate and continuing needs for renovations, construction and acquisitions, and the options for financing the Capital Master Plan; Having further considered the merits of the options for establishing a sustainable mechanism for funding the Real Estate Fund, 1. RESOLVES to appropriate US$ 22 million from Member States’ non-assessed income to the Real Estate Fund in order to cover the costs of urgently needed renovation; 2. AUTHORIZES the Director-General: (1) to allocate, at the end of each financial period, up to US$ 10 million, as available, from the Member States’ non-assessed income to the Real Estate Fund in order to finance the projects identified in the Capital Master Plan; (2) to proceed with the technical studies and initiate work on the urgent projects identified in the report,1 particularly those pertaining to the headquarters perimeter and construction of associated facilities;
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Document A63/36.
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3. REQUESTS the Director-General to report to the Executive Board at its 128th session in January 2011 on the implementation of projects funded through the Real Estate Fund.
Eighth plenary meeting, 21 May 2010 A63/VR/8
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SIXTY-THIRD WORLD HEALTH ASSEMBLY Agenda item 16.1
WHA63.8 21 May 2010
Report of the External Auditor The Sixty-third World Health Assembly, Having considered the report of the External Auditor to the Health Assembly;1 Having noted the eighth report of the Programme, Budget and Administration Committee of the Executive Board to the Sixty-third World Health Assembly,2 ACCEPTS the report of the External Auditor to the Health Assembly.
Eighth plenary meeting, 21 May 2010 A63/VR/8
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Document A63/37. Document A63/56 Rev.1.
SIXTY-THIRD WORLD HEALTH ASSEMBLY Agenda item 17.4
WHA63.9 21 May 2010
Salaries of staff in ungraded posts and of the Director General The Sixty-third World Health Assembly, Noting the recommendations of the Executive Board with regard to remuneration of staff in ungraded posts and of the Director-General, 1. ESTABLISHES the salaries of Assistant Directors-General and Regional Directors at US$ 183 022 gross per annum before staff assessment, resulting in a modified net salary of US$ 131 964 (dependency rate) or US$ 119 499 (single rate); 2. ESTABLISHES the salary of the Deputy Director-General at US$ 201 351 gross per annum before staff assessment, resulting in a modified net salary of US$ 143 878 (dependency rate) or US$ 129 483 (single rate); 3. ESTABLISHES the salary of the Director-General at US$ 247 523 gross per annum before staff assessment, resulting in a modified net salary of US$ 173 890 (dependency rate) or US$ 154 641 (single rate); 4. DECIDES that those adjustments in remuneration shall take effect from 1 January 2010.
Eighth plenary meeting, 21 May 2010 A63/VR/8
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SIXTY-THIRD WORLD HEALTH ASSEMBLY Agenda item 18.1
WHA63.10 21 May 2010
Partnerships The Sixty-third World Health Assembly, Having considered the report on partnerships;1 Recognizing the critical need for, and contribution of, collaborative work by WHO to achieve health outcomes and the diversity of such collaborations; Noting that WHO’s Constitution, the Eleventh General Programme of Work, 2006–2015 and the Medium-term strategic plan 2008–2013 describe collaboration and coordination as core functions of the Organization; Noting further that the growth of health partnerships and other forms of collaboration have increased greatly in the past decade; Considering the need for WHO to have a policy governing its engagement in, and hosting of, partnerships in a manner that avoids duplication of WHO’s core responsibilities in partnerships’ activities. Welcoming the collaboration of WHO with stakeholders based on clear distinction of roles that creates added value, synergies and coordination among different programmes that support achievement of global and national health outcomes and reduced transaction costs, 1. ENDORSES the policy (as annexed) on WHO’s engagement with global health partnerships and hosting arrangements; 2. CALLS UPON Member States to take the policy into account when seeking engagement by the Director-General in partnerships, in particular with regard to hosting arrangements; 3. INVITES concerned organizations of the United Nations system, international development partners, international financial institutions, nongovernmental organizations, representatives of communities affected by diseases, and private-sector entities to enhance their collaboration with WHO, in a synergistic manner, in order to attain the strategic objectives contained in the Medium-term strategic plan 2008–2013;
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Documents A63/44 and A63/44 Corr.1.
WHA63.10
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REQUESTS the Director-General: (1) to continue collaboration with concerned organizations of the United Nations system, international development partners, international financial institutions, nongovernmental organizations, representatives of communities affected by diseases, and private-sector entities in implementing the Medium-term strategic plan 2008–2013 in order to advance the global health agenda contained in the Eleventh General Programme of Work, 2006–2015; (2) to create an operational framework for WHO’s hosting of formal partnerships;
(3) to apply the policy on WHO’s engagement with global health partnerships and hosting arrangements, to the extent possible and in consultation with the relevant partnerships, to current hosting arrangements with a view to ensuring their compliance with the principles embodied in the policy; (4) to submit to the Executive Board any proposals for WHO to host formal partnerships for its review and decision; (5) to report on progress in implementing this resolution to the Sixty-fifth World Health Assembly through the Executive Board at its 129th session, the various actions taken by the Secretariat in relation to partnerships in implementing the policy on partnerships.
ANNEX POLICY ON WHO ENGAGEMENT WITH GLOBAL HEALTH PARTNERSHIPS AND HOSTING ARRANGEMENTS 1. This document presents WHO’s policy that provides a framework to guide WHO’s assessment of, and decision concerning, potential engagement in different types of health partnerships; it also provides specific parameters to be applied in cases where WHO agrees to host a formal partnership. 2. The set of criteria noted below aims to guide WHO’s decision making about when and how to engage in partnerships, and how to develop, revise or terminate that engagement. WHO favours, as a general principle, mechanisms within WHO that facilitate collaboration without involving separate governance structures. 3. The number of global health partnerships, initiatives and other forms of collaboration has increased steadily over the past decade. The term “partnerships” is being used generically to include various organizational structures, relationships and arrangements within and external to WHO for furthering collaboration in order to achieve better health outcomes. These range from legally incorporated entities with their own governance to simpler collaborations with varied stakeholders. Diverse terms such as “partnership”, “alliance”, “network”, “programme”, “project collaboration”, “joint campaigns,” and “task force” may be used in the title of these partnerships, although this list does not represent a typology. 4. Examples of different partnerships include legally incorporated entities external to WHO (e.g., Global Fund to Fight AIDS, Tuberculosis and Malaria, the GAVI Alliance, the Medicines for
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Malaria Venture) and unincorporated partnerships within WHO with their own governance (e.g., Stop TB Partnership, Partnership for Maternal, Newborn and Child Health, Roll-Back Malaria Partnership, UNITAID, the Global Health Workforce Alliance, and the Health Metrics Network). 5. As part of its core functions, WHO manages several collaborative efforts that are fully under its managerial control and accountability and for which there are no separate governance arrangements, and are designed to provide a means to collaborate with multiple stakeholders. Examples include networks, programmes, task forces and project collaborations such as the Global Outbreak and Response Network, Global Noncommunicable Disease Network, Guinea Worm Eradication Program, Meningitis Vaccine Project, Global Polio Eradication Initiative, and the Global Task Force on Cholera Control.
Definition 6. For the purposes of this policy, the term “formal partnerships” refers to those partnerships with or without a separate legal personality but with a governance structure (for example, a board or steering committee) that takes decisions on direction, workplans and budgets. WHO currently serves as the host organization for several formal partnerships which have not been established as legal entities. WHO’s decision-making process for engaging in partnerships, outlined below, applies in all cases whether or not the partnership is external to the Organization.
Criteria for WHO’s engagement in a partnership 7. In all situations in which the Secretariat identifies a need for, or is asked to participate in, a partnership it will use a decision tree (see Appendix) based on the criteria below to review such requests and identify alternatives as necessary. This process applies to all forms of partnership regardless of whether WHO is hosting it, or those not hosted by WHO in which WHO seeks, or is asked, to serve as a partner at a technical level. 8. The following criteria will be used to assess future partnerships and will guide the relationship with the existing formal partnerships. (a) The partnership demonstrates a clear added value for public health in terms of mobilizing partners, knowledge and resources, and creating synergy, in order to achieve a public-health goal that would otherwise not be met to the same extent. (b) The partnership has a clear goal that concerns a priority area of work for WHO reflected in WHO’s strategic objectives, and for which realistic time frames are provided. Participation would represent an extension of WHO’s core functions, policies, and relative strengths to other organizations, and would reinforce the quality and integrity of WHO’s programmes and work. (c) Partnerships are guided by the technical norms and standards established by WHO.
(d) The partnership supports national development objectives. In cases where a partnership is active at country level and seeks to help to build capacity in-country, WHO’s engagement would help to harmonize efforts and thus reduce the overall management burden on countries.
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(e) The partnership ensures appropriate and adequate participation of stakeholders. The agreed goals of the partnership shall be ensured through the active participation of all relevant stakeholders (including, as relevant, beneficiaries, civil society and the private sector) and the respect of their individual mandates. Partnerships may benefit from the contribution of organizations and agencies outside the traditional public-health sector as relevant. (f) The roles of partners are clear. In order for WHO to participate in a partnership, the latter must clearly articulate the strengths of the partners, avoid duplication of WHO’s and partners’ activities, and the introduction of parallel systems. (g) Transaction costs related to a partnership must be evaluated, along with the potential benefits and risks. Expected additional workloads for WHO (at all levels) shall be assessed and quantified. (h) Pursuit of the public-health goal takes precedence over the special interests of participants. Risks and responsibilities arising from public–private partnerships need to be identified and managed through development and implementation of safeguards that incorporate considerations of conflicts of interest. The partnership shall have mechanisms to identify and manage conflicts of interest. Whenever commercial, for-profit companies are considered as potential partners, potential conflicts of interest shall be taken into consideration as part of the design and structure of the partnership. (i) The structure of the partnership corresponds to the proposed functions. The design of the structure of the partnership should correspond to its function. For example, those with a significant financing element may require a more formal governance structure, with clear accountability for funding decisions. Those whose role is primarily a coordinating one could most effectively operate without a formal governance structure. Task-focused networks can be highly effective and efficient in achieving partnership goals with maximum flexibility, and can limit the transaction costs often associated with formal structures and governance mechanisms. (j) The partnership has an independent external evaluation and/or self-monitoring mechanism. The time frame, purpose, objectives, structure and functioning of a partnership shall be regularly reviewed and modified as appropriate. Criteria for modifying or ending a partnership shall be clearly presented, along with consideration for transition plans.
Hosting arrangements 9. In some cases, WHO agrees to host a formal partnership without a separate legal personality. Hosting should be considered an exceptional arrangement that must be in the overwhelming interest of all parties. 10. For formal partnerships hosted by WHO, overarching considerations include ensuring that the overall mandate of the partnership and its hosting are consistent with WHO’s constitutional mandate and principles and do not place additional burdens on the Organization, that it minimizes transaction costs to WHO, adds value to WHO’s work, and adheres to WHO’s accountability framework. 11. The decision for WHO to serve as the host will depend first and foremost on WHO’s participation in the partnership as a strategic and technical partner. Most importantly, WHO must be a member of, and fully participate in, the steering body of the partnership. The partnership must also
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recognize, be in harmony with, and complement WHO’s mandate and core functions, without duplicating or competing with them. 12. WHO will ensure that its hosting of the partnership and provision of its secretariat is congruent with WHO’s accountability framework1 and operational platform (covering political, legal, financial, communication and administrative activities) and protects WHO’s integrity and reputation. The consideration and implementation of hosting arrangements will be in accordance with WHO’s Constitution, Financial Regulations and Financial Rules, Staff Regulations and Staff Rules, and administrative and other relevant rules (“WHO’s rules”). When WHO acts as the host, the operations of the partnership’s secretariat must, in all respects, be administered in accordance with WHO’s rules. 13. The hosting of a partnership by WHO goes beyond the simple provision of administrative services. The secretariat of a hosted partnership is part of WHO’s Secretariat and, as such, shares the legal identity and status of the Organization. In particular, the staff of the partnership will, as staff members of WHO, enjoy the applicable privileges and immunities for the protection of their functions. To this end, it is essential that the function of the secretariat be, and be seen as, part of the functions of WHO. This consideration is particularly relevant for Switzerland, the host country of WHO’s headquarters, which has granted privileges, immunities and facilities to the Organization and its staff for the performance of its constitutional mandate. In order to comply with the host agreement between WHO and the Swiss Federal Council, the functions of the partnership secretariat must be part of the overall functions of WHO and may not be seen as separate from them. The Director-General will consult with the Swiss authorities when considering the hosting of formal partnerships. 14. The Director-General shall submit to the Executive Board any proposals for WHO to host formal partnerships for its review and decision.
Human resources 15. Although the organizational structure and specific duties of the partnership secretariat are normally determined by the steering body of the partnership, the secretariat staff are selected, managed and evaluated in accordance with WHO’s rules. The staff members of the partnership secretariat will be recruited solely for service with the partnership secretariat. 16. As regards the head of a partnership secretariat, he or she will be appointed by the DirectorGeneral in compliance with WHO’s Staff Regulations, Staff Rules and selection procedures and in consultation with the partnership’s steering body. Similarly, the performance of the head of the partnership secretariat will be assessed under WHO’s Performance Management and Development System, with an opportunity to receive feedback from the partnership’s steering body.
Programme and financial management 17. Formal partnerships, where WHO’s role is not exclusive in respect of governance, strategic and operational planning, will be outside the programme budget. This approach differentiates formal partnerships from WHO programmes. Separate accounts shall be established for each partnership so With particular reference to Article 37 of WHO’s Constitution which reads: “In the performance of their duties the Director-General and the staff shall not seek or receive instructions from any government or from any authority external to the Organization. They shall refrain from any action which might reflect on their position as international officers. Each Member of the Organization on its part undertakes to respect the exclusively international character of the Director-General and the staff and not to seek to influence them.” 1
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that relevant income and expenditure is recorded and reported upon in a manner separate from WHO’s accounts. WHO shall invest any available balances of cash or cash equivalents in accordance with its own regulations for the use of the partnership. Although these partnerships are outside the programme budget, their work must be synergistic with WHO’s respective strategic objectives. 18. Regardless of programme budget status, all payments from the respective partnership accounts must be in accordance with WHO’s Financial Regulations and Financial Rules in order to enable appropriate monitoring of the financial accountability of grantees and other recipients and of progress towards programme objectives. 19. As regards financial management for formal partnerships outside the programme budget, the partnership secretariat will need to prepare separate financial statements of income and expenditure, certified by the Office of the Chief Accountant of WHO, which will be provided to the partnership’s board on an annual basis. The statements will normally require a separate audit opinion from WHO’s External Auditor. All partnerships are in addition subject to internal audit in accordance with WHO’s Financial Regulations, Financial Rules and practices. Before the selection of a new head of a partnership secretariat, the Director-General may request an internal audit of the partnership. 20. As an exception to the above, a small number of formal partnerships exists in which WHO’s role in respect of governance is not exclusive, but where the partnerships concerned contribute directly and fully to the achievement of the Organization-wide expected results and indicators as set out in the Programme budget. The work of these entities is exclusive to and follow strictly WHO’s results hierarchy. These partnerships are included within the programme budget under the budget segment “Special programmes and collaborative arrangements”. Most notable in this small group are longestablished research programmes whose activities have been embedded in WHO’s work for many years.1 21. Where WHO programmes provide direct contributions to supporting a hosted partnership, these costs shall be included in the WHO programme budget’s relevant expected results, budget and workplans.
Resource mobilization and cost recovery 22. Each hosted partnership shall be responsible for mobilizing adequate funds for its effective operation, including the costs of its secretariat and all related activities provided for in its budget and workplan. The obligation of WHO to implement any particular aspect of the partnership’s workplan will be conditional on WHO having received all necessary funding. Resource mobilization by hosted partnerships shall be closely coordinated with WHO, and those partnerships shall be required to indemnify the Organization for any financial risks and liabilities incurred by the latter in the performance of its hosting functions. Fundraising by a WHO-hosted partnership from the commercial private sector shall be subject to WHO’s guidelines on interaction with commercial enterprises. 23. Unless otherwise stated in the hosting arrangement, WHO shall be reimbursed for its programme support costs as determined by the Health Assembly and/or WHO’s internal policy. Hosted partnerships can impose heavy workloads on different parts of the Organization, including at regional and country levels. WHO will seek to be reimbursed for all administrative and technical UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases and UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction. 1
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support costs incurred in providing hosting functions for partnerships and implementing or supporting their activities. Similarly, partnerships that may have human resource implications for WHO at the regional and country levels shall be required to meet the related costs. Hosting arrangements will also require hosted partnerships to indemnify WHO for costs, expenses and claims incurred as a result of activities carried out by the partnership secretariat.
Communications 24. In order to protect the integrity of the partnership and of WHO, the partnership secretariat will follow WHO’s guidelines and administrative procedures for internal and external communications (including media products, publications, technical reports and advocacy material). Official communications by the partnership secretariat with Member States, WHO offices and staff will follow WHO’s normal channels.
Evaluation and “sunset clauses” 25. WHO’s arrangements with all its hosted partnerships will contain an “evaluation and sunset clause”, whereby an assessment will be carried out before the expiration of the hosting arrangement based on the past performance of the partnership, its relationship with WHO, the continued demand or emerging alternatives to fostering collaboration, and future expectations. Working with the partnerships, WHO will design a monitoring and evaluation framework for such an assessment. 26. Following the assessment, WHO and the partnership will discuss the results with a view to choosing one of four possible approaches, namely: (1) continuing the current arrangement for a new specified period; (2) making recommendations for changes to the partnership structure and/or purpose and for revision of WHO’s hosting arrangement; (3) integrating the partnership into WHO with clear specifications for ensuring broad and inclusive collaboration with partners; or (4) separating the partnership from WHO. 27. The application and impact of this policy will be periodically reviewed and updated. 28. The Director-General will prepare guidelines and operating procedures for the implementation of this policy by the Secretariat.
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APPENDIX Decision tree for evaluating the criteria for WHO engagement
1 Proposed partnership demonstrates clear added value for public health No Engage with partners to strengthen existing collaboration
Yes 2 Proposed partnership addresses WHO priority area reflected in Medium-term strategic plan; extension of WHO's core functions, policies, and relative strengths to other organizations
No
Yes 3 WHO technical norms and standards are used by the partnership. No Engage with partners to ensure WHO norms and standards used. No
Yes 4 Where partnership is active at country level, it is aligned w ith country priorities and principles of best practice, builds national capacity, and supports national development objectives
No
Engage with partners to modify strategic approaches
No
Yes 5 Agreed goals of proposed partnership ensured through participation of stakeholders and respect of their respective mandates
No
Engage with partners to ensure full participation of key stakeholders and res pect of their mandates
No Disengage from partnership development process
Request for clarification 6
Yes
Roles and comparative strengths of partners clearly identified and agreed, including harmony w ith WHO's mandate and functions
No
Engage with partners to clarify roles and responsibilities
No
Yes 7
Transaction costs, risks and benefits assessed and quantified
No
Yes
8 Potential conflicts of interest can be identified and addressed No
Yes 9 Proposed structure appropriately reflects main functions of partnership No Engage with partners to modify proposed structure and governance No
Yes
Submit partnership proposal for review and decision
Based on the evaluation of each case, the Director-General decides on: - engaging in or establishing new global health partnerships or collaborations - defining the optimal means of collaboration - suggestions for revisions to or separation of existing partnerships - consulting with the Executive Board, if WHO is requested to host a partnership (inclusive of its secretariat).
Eighth plenary meeting, 21 May 2010 A63/VR/8 = 8
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SIXTY-THIRD WORLD HEALTH ASSEMBLY Agenda item 18.3
WHA63.11 21 May 2010
Agreements with intergovernmental organizations The Sixty-third World Health Assembly, Having considered the report on agreements with intergovernmental organizations: collaboration between WHO and the Office International des Épizooties1 with its proposed amendment to the Agreement between the Office International des Épizooties and the World Health Organization;2 Considering Article 70 of the Constitution of WHO, APPROVES the following amendment to the Agreement between the Office International des Épizooties and the World Health Organization: Article 4 is amended by the addition of the following text to be inserted as subparagraph 4.7: “Joint development of international standards relating to relevant aspects in animal production which impact on food safety, in collaboration with other appropriate international agencies.”
Eighth plenary meeting, 21 May 2010 A63/VR/8
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Document A63/46. Basic documents, 47th edition. Geneva, World Health Organization, 2009.
SIXTY-THIRD WORLD HEALTH ASSEMBLY Agenda item 11.17
WHA63.12 21 May 2010
Availability, safety and quality of blood products The Sixty-third World Health Assembly, Recalling resolution WHA58.13 on blood safety: proposal to establish World Blood Donor Day and preceding related resolutions since resolution WHA28.72 on utilization and supply of human blood and blood products, which urged Member States to promote the full implementation of wellorganized, nationally coordinated and sustainable blood programmes with appropriate regulatory systems and to enact effective legislation governing the operation of blood services; Recognizing that achieving self-sufficiency, unless special circumstances preclude it, in the supply of safe blood components based on voluntary, non-remunerated blood donation, and the security of that supply are important national goals to prevent blood shortages and meet the transfusion requirements of the patient population; Conscious that plasma-derived medicinal products for the treatment of haemophilia and immune diseases are included in the WHO Model List of Essential Medicines1 and of the need to facilitate access to these products by developing countries; Concerned by the unequal access globally to blood products, particularly plasma-derived medicinal products, leaving many patients in need of transfusion and with severe congenital and acquired disorders without adequate treatment; Aware that a major factor limiting the global availability of plasma-derived medicinal products is an inadequate supply of plasma meeting internationally recognized standards for fractionation; Bearing in mind that treatment using labile blood components is gradually being included in medical practice in developing countries and that thereby increased quantities of recovered plasma should become available for fractionation into plasma-derived medicinal products to meet their needs; Concerned that in developing countries, blood components separation technology and fractionation capacity are lacking, and that, because of insufficient regulatory controls and failure to implement appropriate practices in blood establishments, plasma from developing countries is often unacceptable for contract fractionation, with considerable wastage of plasma as a result;
1 The WHO Model List of Essential Medicines identifies individual medicines that together could provide safe and effective treatment for most communicable and noncommunicable diseases. This List includes plasma-derived medicinal products, namely immunoglobulins and coagulation factors, which are needed to prevent and treat a variety of serious conditions that occur worldwide (http://www.who.int/medicines/publications/essentialmedicines/en/index.html).
WHA63.12
Convinced that assuring the suitability of plasma for fractionation requires the establishment of a nationally coordinated and sustainable plasma programme within a properly organized, legally established and regulated national blood programme; Recognizing that, as the capacity to collect plasma is limited and would not suffice to produce enough essential medicines to cover global needs, it is essential that all countries have local capacity to collect plasma of acceptable quality and safety from voluntary and unpaid donations in order to meet their needs; Convinced that fractionation should be set up as close to the source as possible, and that, where national plasma fractionation capacities are lacking, there should be an option for supply of fractionation capacity in other countries, ensuring that the supply of plasma derived medicinal products can be made available to meet local needs in the country of the plasma supplier; Recognizing that access to information about strategies to ensure supplies of blood products sufficient to meet demand, effective mechanisms of regulatory oversight, technologies to ensure the quality and safety of blood products, and guidelines on the appropriate clinical use of blood products and the risks of transfusion have become more and more necessary; Bearing in mind that voluntary and non-remunerated blood donations can contribute to high safety standards for blood and blood components, and being aware that the safety of blood products depends on testing of all donated blood for transfusion-transmissible infections, and correct labelling, storage and transportation of blood products; Bearing in mind that patient blood management means that before surgery every reasonable measure should be taken to optimize the patient’s own blood volume, to minimize the patient’s blood loss and to harness and optimize the patient-specific physiological tolerance of anaemia following WHO’s guide for optimal clinical use (three pillars of patient blood management); Recognizing that excessive and unnecessary use of transfusions and of plasma-derived medicinal products, unsafe transfusion practices, and errors (particularly at the patient’s bedside) seriously compromise patient safety; Concerned that unsafe and/or poor-quality blood products can render patients vulnerable to avoidable risk if the blood programmes are not subject to the level of control now exercised by experienced national or regional regulatory authorities; Alarmed that patients in developing countries continue to be exposed to the risk of preventable transfusion-transmitted infections by bloodborne pathogens such as hepatitis B virus, hepatitis C virus and HIV; Noting the increasing movement across boundaries of blood products and blood safety-related in vitro diagnostic devices, together with their rapid development and introduction into health-care systems of both developed and developing countries; Recognizing the value of international biological reference materials (WHO International Standards) for the quality control of blood products and related in vitro diagnostic devices for detection of known and emerging bloodborne pathogens;
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Convinced that traceability at all stages of the preparation of blood products, from the donor to the recipient and vice versa, is essential to identify risks, particularly the transmission of pathogens and transfusion reactions, and to monitor the efficacy of corrective measures aiming to minimize such risks; Convinced that good practices need to be implemented for recruiting voluntary, nonremunerated healthy blood and plasma donors from low-risk donor populations and testing of all donated blood for transfusion-transmissible pathogens, and that the whole chain of processes in the production of blood products, i.e. correct processing, labelling, storage and transportation, needs to be covered by relevant, reliable quality-assurance systems; Recognizing that stringent regulatory control is vital in assuring the quality and safety of blood products, as well as of related in vitro diagnostic devices, and that special effort is needed to strengthen globally the technical capacity of regulatory authorities to assure the appropriate control worldwide; Recalling previous resolutions of the Health Assembly mentioning the vital need to strengthen blood establishments and ensure the quality, safety and efficacy of blood products, 1. URGES Member States:1 (1) to take all the necessary steps to establish, implement and support nationally-coordinated, efficiently-managed and sustainable blood and plasma programmes according to the availability of resources, with the aim of achieving self-sufficiency, unless special circumstances preclude it; (2) to take all the necessary steps to update their national regulations on donor assessment and deferral, the collection, testing, processing, storage, transportation and use of blood products, and operation of regulatory authorities in order to ensure that regulatory control in the area of quality and safety of blood products across the entire transfusion chain meets internationally recognized standards; (3) to establish quality systems, for the processing of whole blood and blood components, good manufacturing practices for the production of plasma-derived medicinal products and appropriate regulatory control, including the use of diagnostic devices to prevent transfusiontransmissible diseases with highest sensitivity and specificity; (4) to build human resource capacity through the provision of initial and continuing training of staff to ensure quality of blood services and blood products; (5) to enhance the quality of evaluation and regulatory actions in the area of blood products and associated medical devices, including in vitro diagnostic devices; (6) to establish or strengthen systems for the safe and rational use of blood products and to provide training for all staff involved in clinical transfusion, to implement potential solutions in order to minimize transfusion errors and promote patient safety, to promote the availability of transfusion alternatives including, where appropriate, autologous transfusion and patient blood management;
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And regional economic integration organizations, where applicable.
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(7) to ensure the reliability of mechanisms for reporting serious or unexpected adverse reactions to blood and plasma donation and to the receipt of blood components and plasmaderived medicinal products, including transmissions of pathogens; 2. REQUESTS the Director-General: (1) to guide Member States to meet internationally recognized standards in updating their legislation, national standards and regulations for effective control of the quality and safety of blood products and associated medical devices, including in vitro diagnostics; (2) to advise and build capacity in Member States on leadership and management of blood supply systems in order to strengthen national coordinated and sustainable blood and plasma programmes by sharing best practices about the organizational structure of blood supply systems in order to increase efficiency and minimize error; (3) to augment the support offered to Member States for developing and strengthening their national regulatory authorities and control laboratories so as to increase their competence in the control of blood products and associated medical devices, including in vitro diagnostic devices, and to foster the creation of regional collaborative and regulatory networks where necessary and appropriate; (4) to ensure sustainable development and provision of international biological reference materials (WHO International Standards) for use in the quality control and regulation of blood products and related in vitro diagnostic devices; (5) to improve access by developing countries to international biological reference materials and to the scientific information obtained in their validation in order to assure the appropriate use of these materials; (6) to develop, provide and disseminate guidance and technical support to strengthen national coordinated blood and plasma programmes and introduction of blood component separation and plasma fractionation technology, to meet local needs, and promote effective regulatory oversight of blood services and implementation of good manufacturing practices in plasmafractionation programmes, under the responsibility of regulatory authorities; (7) to provide guidance, training and support to Member States on safe and rational use of blood products and to support the introduction of transfusion alternatives including, where appropriate, autologous transfusion, safe transfusion practices and patient blood management; (8) to encourage research into new technologies for producing safe and effective blood substitutes; (9) to inform regularly, at least every four years, the Health Assembly, through the Executive Board, on actions taken by Member States and other partners to implement this resolution.
Eighth plenary meeting, 21 May 2010 A63/VR/8 = 4
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SIXTY-THIRD WORLD HEALTH ASSEMBLY Agenda item 11.10
WHA63.13 21 May 2010
Global strategy to reduce the harmful use of alcohol The Sixty-third World Health Assembly, Having considered the report on strategies to reduce the harmful use of alcohol1 and the draft global strategy annexed therein;2 Recalling resolutions WHA58.26 on public-health problems caused by harmful use of alcohol and WHA61.4 on strategies to reduce the harmful use of alcohol, 1. ENDORSES the global strategy to reduce the harmful use of alcohol;
2. AFFIRMS that the global strategy to reduce the harmful use of alcohol aims to give guidance for action at all levels and to set priority areas for global action, and that it is a portfolio of policy options and measures that could be considered for implementation and adjusted as appropriate at the national level, taking into account national circumstances, such as religious and cultural contexts, national public health priorities, as well as resources, capacities and capabilities; 3. URGES Member States:3 (1) to adopt and implement the global strategy to reduce the harmful use of alcohol as appropriate in order to complement and support public health policies in Member States to reduce the harmful use of alcohol, and to mobilize political will and financial resources for that purpose; (2) to continue implementation of the resolutions WHA61.4 on the strategies to reduce the harmful use of alcohol and WHA58.26 on public-health problems caused by harmful use of alcohol; (3) to ensure that implementation of the global strategy to reduce the harmful use of alcohol strengthens the national efforts to protect at-risk populations, young people and those affected by harmful drinking of others;
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Document A63/13. Document A63/13, Annex 2. And regional economic integration organizations, where applicable.
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(4) to ensure that implementation of the global strategy to reduce the harmful use of alcohol is reflected in the national monitoring systems and reported regularly to WHO’s information system on alcohol and health; 4. REQUESTS the Director-General: (1) to give sufficiently high organizational priority, and to assure adequate financial and human resources at all levels, to the prevention and reduction of harmful use of alcohol and implementation of the global strategy to reduce the harmful use of alcohol; (2) to collaborate with and provide support to Member States, as appropriate, in implementing the global strategy to reduce the harmful use of alcohol and strengthening national responses to public health problems caused by the harmful use of alcohol; (3) to monitor progress in implementing the global strategy to reduce the harmful use of alcohol and to report progress, through the Executive Board, to the Sixty-sixth World Health Assembly.
Eighth plenary meeting, 21 May 2010 A63/VR/8
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SIXTY-THIRD WORLD HEALTH ASSEMBLY Agenda item 11.9
WHA63.14 21 May 2010
Marketing of food and non-alcoholic beverages to children The Sixty-third World Health Assembly, Having considered the report on prevention and control of noncommunicable diseases: implementation of the global strategy and its annexed set of recommendations on the marketing of foods and non-alcoholic beverages to children;1 Recalling resolutions WHA53.17 on the prevention and control of noncommunicable diseases and WHA60.23 on the prevention and control of noncommunicable diseases: implementation of the global strategy; Reaffirming its commitment to acting on two of the main risk factors for noncommunicable diseases, namely, unhealthy diet and physical inactivity, through the implementation of the Global strategy on diet, physical activity and health, endorsed by the Health Assembly in 2004 (resolution WHA57.17), and the action plan for the global strategy for the prevention and control of noncommunicable diseases,2 endorsed by the Health Assembly in 2008 (resolution WHA61.14); Deeply concerned about the high and increasing prevalence of noncommunicable diseases in low- and middle-income countries which, together with the communicable diseases still affecting the poor, contribute to a double burden of disease which has serious implications for poverty reduction and economic development and widens health gaps between and within countries; Deeply concerned that in 2010 it is estimated that more than 42 million children under the age of five years will be overweight or obese, of whom nearly 35 million are living in developing countries, and also concerned that in most parts of the world the prevalence of childhood obesity is increasing rapidly; Recognizing that unhealthy diet is one of the main risk factors for noncommunicable diseases and that the risks presented by unhealthy diets start in childhood and build up throughout life; Recognizing that unhealthy diets are associated with overweight and obesity and that children should maintain a healthy weight and consume foods that are low in saturated fat, trans-fatty acids, free sugars, or salt in order to reduce future risk of noncommunicable diseases; 1 2
Document A63/12. Document A61/2008/REC/1, Annex 3.
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Cognizant of the research that shows that food advertising to children is extensive and other forms of marketing of food to children are widespread across the world; Recognizing that a significant amount of this marketing is for foods with a high content of fat, sugar or salt and that television advertising influences children’s food preferences, purchase requests and consumption patterns; Recognizing the steps taken so far by segments of the private sector to reduce the marketing of foods and non-alcoholic beverages to children, while noting the importance of independent and transparent monitoring of commitments made by the private sector at national and global levels; Recognizing that some Member States have already introduced legislation and national policies on the marketing of foods and non-alcoholic beverages to children, 1. ENDORSES the set of recommendations on the marketing of foods and non-alcoholic beverages to children;1 2. URGES Member States: (1) to take necessary measures to implement the recommendations on the marketing of foods and non-alcoholic beverages to children, while taking into account existing legislation and policies, as appropriate; (2) to identify the most suitable policy approach given national circumstances and develop new and/or strengthen existing policies that aim to reduce the impact on children of marketing of foods high in saturated fats, trans-fatty acids, free sugars, or salt; 3) to establish a system for monitoring and evaluating the implementation of the recommendations on the marketing of foods and non-alcoholic beverages to children; (4) to take active steps to establish intergovernmental collaboration in order to reduce the impact of cross-border marketing; (5) to cooperate with civil society and with public and private stakeholders in implementing the set of recommendations on the marketing of foods and non-alcoholic beverages to children in order to reduce the impact of that marketing, while ensuring avoidance of potential conflicts of interest; 3. REQUESTS the Director-General: (1) to provide technical support to Member States, on request, in implementing the set of recommendations on the marketing of foods and non-alcoholic beverages to children and in monitoring and evaluating their implementation; (2) to support existing regional networks, and where appropriate to facilitate the establishment of new ones, in order to strengthen international cooperation to reduce the impact on children of marketing of foods high in saturated fats, trans-fatty acids, free sugars, or salt;
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Document A63/12, Annex.
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(3) to cooperate with civil society and with public and private stakeholders in implementing the set of recommendations to reduce the impact of marketing of foods and non-alcoholic beverages to children, while ensuring avoidance of potential conflicts of interest; (4) to strengthen international cooperation with other international intergovernmental organizations and bodies in promoting the implementation, by Member States, of the recommendations on marketing of foods and non-alcoholic beverages to children; (5) to use existing methodologies for evaluating the action plan for the global strategy for the prevention and control of noncommunicable diseases to monitor policies on marketing of foods and non-alcoholic beverages to children; (6) to report on implementation of the set of recommendations on the marketing of foods and non-alcoholic beverages to children as part of the report on progress in implementing the global strategy on prevention and control of noncommunicable diseases and the action plan for the global strategy for the prevention and control of noncommunicable diseases to the Sixty-fifth World Health Assembly through the Executive Board at its 130th session.
Eighth plenary meeting, 21 May 2010 A63/VR/8
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SIXTY-THIRD WORLD HEALTH ASSEMBLY Agenda item 11.4
WHA63.15 21 May 2010
Monitoring of the achievement of the health-related Millennium Development Goals The Sixty-third World Health Assembly, Having considered the report on monitoring of the achievement of the health-related Millennium Development Goals;1 Recalling resolution WHA61.18 on monitoring of the achievement of the health-related Millennium Development Goals; Recalling the outcomes of the major United Nations conferences and summits in the economic, social and related fields, especially those related to global health, in particular the 2005 World Summit Outcome and the commitments made by the international community to attain the Millennium Development Goals and the new commitments made during the United Nations High-level Event on the Millennium Development Goals (New York, 25 September 2008); Stressing the importance of achieving the health-related Millennium Development Goals, especially with the objective of ensuring socioeconomic development; Concerned by the fact that achievement of the Millennium Development Goals varies from country to country and from goal to goal; Welcoming the Ministerial Declaration adopted at the annual ministerial review held by the Economic and Social Council in 2009 on implementing the internationally agreed goals and commitments in regard to global public health; Recalling United Nations General Assembly resolution 64/108 (10 December 2009) on global health and foreign policy; Recognizing that the Millennium Development Goals are interlinked, and reiterating the Health Assembly’s commitment to continued reinvigoration and strengthening of the global partnership for development, as a vital element for achieving these Goals, in particular those related to health, inter alia through capacity building, transfer of technology, sharing of best practices and lessons learnt, South–South cooperation, and predictability of resources; 1
Document A63/7.
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Recalling the Monterrey Consensus of March 2002 to “urge developed countries that have not done so, to make concrete efforts towards the target of 0.7% of the gross national product (GNP) as ODA” and “encourage developing countries to build on progress achieved in ensuring that ODA is used effectively to help achieve development goals and targets”; Reaffirming the commitments by many developed countries to achieve the target of 0.7% of gross national income on official development assistance by 2015 and to reach 0.56% of gross national income for official development assistance by 2010, as well as the target of 0.15% to 0.20% for least developed countries; Welcoming increasing efforts to improve the quality of official development assistance and to increase its development impact, such as the Development Cooperation Forum of the Economic and Social Council, the principles contained in the Paris Declaration and the Accra Agenda for Action, and the experience of the International Health Partnership and others, in order to strengthen national ownership, alignment, harmonization and managing for results; Noting the work of the Leading Group on Innovative Financing for Development and of the High-level Task Force on Innovative International Financing for Health Systems, the additional pledges made by several countries to increase financing for health, and the announcements made by several countries at the United Nations General Assembly High-level Meeting on Health (New York, 23 September 2009) to achieve universal access to affordable basic health care, including provision of free services for women and children at the point of use where countries choose, and financial mechanisms toward social health protection; Welcoming the important initiative of the United Nations Secretary-General and of the work on the Joint Action Plan to improve health of women and children and his invitation to all Member States to engage; Expressing concern at the relatively slow progress in attaining the Millennium Development Goals, particularly in sub-Saharan Africa; Expressing deep concern over the weak institutional capacity in health-information systems, the inadequate coverage and poor quality of civil registrations in developing countries which hamper monitoring progress of Millennium Development Goals; Expressing deep concern that maternal, newborn and child health and universal access to reproductive health services remain constrained by health inequities, and at the slow progress in achieving Millennium Development Goals 4 and 5 on improving child and maternal health; Welcoming the contribution of all relevant partners and progress achieved towards the goal of universal access to prevention, treatment, care and support related to HIV/AIDS; Reaffirming WHO’s leading role as the primary United Nations specialized agency for health, including its roles and functions with regard to health policy in accordance with its mandate; Welcoming WHO’s report on women and health1 as important in advancing women’s rights and gender equality, underlining the need to address women’s health through comprehensive strategies
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Women and health: today’s evidence tomorrow’s agenda. Geneva, World Health Organization, 2009.
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targeting root causes of discrimination, and stressing the importance of strengthening health systems to better respond to women’s health needs in terms of access and comprehensiveness; Recognizing that health systems based on the principles of tackling health inequalities through universal access, putting people at the centre of care, integrating health into broader public policy, and providing inclusive leadership for health are essential to achieving sustainable improvements in health; Recognizing also the growing burden of noncommunicable diseases worldwide, and recalling the importance of preventing infectious diseases that still represent a heavy burden, particularly in developing countries, the adverse impacts of the food, environmental, economic and financial crises on populations, in particular on the poorest and the most vulnerable ones, which may increase the level of malnutrition and reverse the achievement of Millennium Development Goal 1 (Eradicate extreme hunger and poverty) and the health-related Goals and the progress made in the past two decades, 1. URGES Member States: (1) to strengthen health systems so that they deliver equitable health outcomes as a basis of a comprehensive approach towards achieving Millennium Development Goals 4, 5 and 6, underlining the need to build sustainable national health systems and strengthen national capacities through attention to, inter alia, service delivery, health systems financing, health workforce, health information systems, procurement and distribution of medicines, vaccines and technologies, sexual and reproductive health care and political will in leadership and governance; (2) to review policies, including those on recruitment, training and retention, that exacerbate the problem of the lack of health workers, and their imbalanced distribution, within countries and throughout the world, in particular the shortage in sub-Saharan Africa, which undermines the health systems of developing countries; (3) to reaffirm the values and principles of primary health care, including equity, solidarity, social justice, universal access to services, multisectoral action, transparency, accountability, decentralization and community participation and empowerment, as the basis for strengthening health systems, through support for health and development; taking into account leadership, public policy, universal coverage and service-delivery reforms necessary for strengthening primary health care; (4) to take into account health equity in all national policies that address social determinants of health, and to consider developing and strengthening universal comprehensive social protection policies, including health promotion, infectious and noncommunicable disease prevention and health care, and promoting availability of and access to goods and services essential to health and well-being; (5) to further commit themselves to increased investment in financial and human resources and to strengthening the national health-information systems in order to generate accurate, reliable and timely evidence on achievement of the Millennium Development Goals; (6) to renew their commitment to prevent and eliminate maternal, newborn and child mortality and morbidity: through an effective continuum of care, strengthening health systems, and comprehensive and integrated strategies and programmes to address root causes of gender inequalities and lack of access to adequate care and reproductive health, including family
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planning and sexual health; by promoting respect for women’s rights; and by scaling up efforts to achieve integrated management of newborn and child health care, including actions to address the main causes of child mortality, in particular through interventions that increase rates of exclusive and sustained breastfeeding; (7) to expand significantly efforts towards meeting the goal of universal access to HIV prevention, treatment, care and support by 2010 and the goal to halt and reverse the spread of HIV/AIDS by 2015; (8) to maximize synergies between the HIV/AIDS response and strengthening of health systems and social support; (9) to enhance policies to address the challenges of malaria including monitoring of drug resistance in artemisinin-based combination therapy; (10) to sustain and strengthen the gains made in combating tuberculosis, and to develop innovative strategies for tuberculosis prevention, detection and treatment, including means of dealing with new threats such as coinfection with HIV, multidrug-resistant tuberculosis or extensively drug-resistant tuberculosis; (11) to sustain commitments to support the eradication of poliomyelitis and the efforts to eliminate measles; (12) to include best practices for strengthening health services in bilateral and multilateral initiatives addressed to the achievement of the Millennium Development Goals, in particular in South–South cooperation initiatives; (13) to support developing countries in their national endeavours to achieve the Millennium Development Goals, in particular the health-related Millennium Development Goals, inter alia through capacity building, transfer of technology, sharing of lessons learnt and best practices, South–South cooperation, and predictability of resources; (14) to fulfil their commitments regarding official development assistance by 2015; (15) to fulfil and sustain the political and financial commitment of developing country governments in mobilizing adequate budget allocation to health sectors; 2. INVITES concerned organizations of the United Nations system, international financial institutions, and calls upon international development partners and agencies, nongovernmental organizations and private sector entities to continue their support and consider further support to countries, particularly in sub-Saharan Africa, for the development and implementation of health policies and national health development plans, consistent with internationally agreed health goals, including the Millennium Development Goals. 3. REQUESTS the Director-General: (1) to continue to play a leading role in the monitoring of the achievement of the healthrelated Millennium Development Goals, including progress towards achieving universal coverage of services essential to these Goals;
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(2) within the framework of WHO’s Medium-term strategic plan 2008–2013, to continue to cooperate closely with all other United Nations and international organizations involved in the process of achieving the Millennium Development Goals, maintaining a strong focus on efficient use of resources based on the respective mandates and core competencies of each, avoiding duplication of efforts and fragmentation of aid, and promoting the coordination of work among international agencies; (3) to provide support to Member States in their efforts to strengthen their health systems, address the problem of the lack of health workers, reaffirm the values and principles of primary health care, address the social determinants of health, and strengthen their public policies aimed at fostering full access to health and social protection, including improved access to quality medicines required to support health care for, inter alia, the most vulnerable sectors of society; (4) to foster alignment and coordination of global interventions for health system strengthening, basing them on the primary health care approach, in collaboration with Member States, relevant international organizations, international health initiatives, and other stakeholders in order to increase synergies between international and national priorities; (5) to articulate and present to the Health Assembly as part of its action plan for the renewal of primary health care, the actions that the Secretariat envisages will strengthen its support for the achievement of Millennium Development Goals 4, 5 and 6; (6) to work with all relevant partners in order to achieve high immunization coverage rates with affordable vaccines of assured quality; (7) to lead the work with all relevant partners to help to ensure that action on the healthrelated Millennium Development Goals is one of the main themes of the United Nations Millennium Development Goals High-level Plenary Meeting (New York, 20–22 September 2010); (8) to continue to collect and compile scientific evidence needed for achieving health-related Millennium Development Goals and to disseminate it to all Member States; (9) to continue to submit annually a report on the status of progress made, including on main obstacles and ways to overcome them, in achievement of the health-related Millennium Development Goals, through the Executive Board, to the Health Assembly; (10) to assist Member States in the development of reliable health-information systems to provide quality data for monitoring and evaluation of the Millennium Development Goals.
Eighth plenary meeting, 21 May 2010 A63/VR/8
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SIXTY-THIRD WORLD HEALTH ASSEMBLY Agenda item 11.5
WHA63.16 21 May 2010
WHO Global Code of Practice on the International Recruitment of Health Personnel The Sixty-third World Health Assembly, Having considered the revised draft global code of practice on the international recruitment of health personnel, annexed to the report by the Secretariat on the international recruitment of health personnel: draft global code of practice,1 1. ADOPTS, in accordance with Article 23 of the Constitution, the WHO Global Code of Practice on the International Recruitment of Health Personnel; 2. DECIDES that the first review of the relevance and effectiveness of the WHO Global Code of Practice on the International Recruitment of Health Personnel shall be made by the Sixty-eighth World Health Assembly; 3. REQUESTS the Director-General: (1) to give all possible support to Member States, as and when requested, for the implementation of the WHO Global Code of Practice on the International Recruitment of Health Personnel; (2) to cooperate with all stakeholders concerned with the implementation and monitoring of the WHO Global Code of Practice on the International Recruitment of Health Personnel; (3) to rapidly develop, in consultation with Member States, guidelines for minimum data sets, information exchange and reporting on the implementation of the WHO Global Code of Practice on the International Recruitment of Health Personnel; (4) based upon periodic reporting, to make proposals, if necessary, for the revision of the text of the WHO Global Code of Practice on the International Recruitment of Health Personnel in line with the first review, and for measures needed for its effective application.
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Document A63/8.
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ANNEX WHO GLOBAL CODE OF PRACTICE ON THE INTERNATIONAL RECRUITMENT OF HEALTH PERSONNEL
Preamble The Member States of the World Health Organization: Recalling resolution WHA57.19 in which the World Health Assembly requested the DirectorGeneral to develop a voluntary code of practice on the international recruitment of health personnel in consultation with all relevant partners; Responding to the calls of the Kampala Declaration adopted at the First Global Forum on Human Resources for Health (Kampala, 2–7 March 2008) and the G8 communiqués of 2008 and 2009 encouraging WHO to accelerate the development and adoption of a code of practice; Conscious of the global shortage of health personnel and recognizing that an adequate and accessible health workforce is fundamental to an integrated and effective health system and for the provision of health services; Deeply concerned that the severe shortage of health personnel, including highly educated and trained health personnel, in many Member States, constitutes a major threat to the performance of health systems and undermines the ability of these countries to achieve the Millennium Development Goals and other internationally agreed development goals; Stressing that the WHO global code of practice on the international recruitment of health personnel be a core component of bilateral, national, regional and global responses to the challenges of health personnel migration and health systems strengthening; THEREFORE: The Member States hereby agree on the following articles which are recommended as a basis for action. Article 1 – Objectives The objectives of this Code are: (1) to establish and promote voluntary principles and practices for the ethical international recruitment of health personnel, taking into account the rights, obligations and expectations of source countries, destination countries and migrant health personnel; (2) to serve as a reference for Member States in establishing or improving the legal and institutional framework required for the international recruitment of health personnel; (3) to provide guidance that may be used where appropriate in the formulation and implementation of bilateral agreements and other international legal instruments;
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(4) to facilitate and promote international discussion and advance cooperation on matters related to the ethical international recruitment of health personnel as part of strengthening health systems, with a particular focus on the situation of developing countries. Article 2 – Nature and scope 2.1 The Code is voluntary. Member States and other stakeholders are strongly encouraged to use the Code. 2.2 The Code is global in scope and is intended as a guide for Member States, working together with stakeholders such as health personnel, recruiters, employers, health-professional organizations, relevant subregional, regional and global organizations, whether public or private sector, including nongovernmental, and all persons concerned with the international recruitment of health personnel. 2.3 The Code provides ethical principles applicable to the international recruitment of health personnel in a manner that strengthens the health systems of developing countries, countries with economies in transition and small island states. Article 3 – Guiding principles 3.1 The health of all people is fundamental to the attainment of peace and security and is dependent upon the fullest cooperation of individuals and states. Governments have a responsibility for the health of their people, which can be fulfilled only by the provision of adequate health and social measures. Member States should take the Code into account when developing their national health policies and cooperating with each other, as appropriate. 3.2 Addressing present and expected shortages in the health workforce is crucial to protecting global health. International migration of health personnel can make a sound contribution to the development and strengthening of health systems, if recruitment is properly managed. However, the setting of voluntary international principles and the coordination of national policies on international health personnel recruitment are desirable in order to advance frameworks to equitably strengthen health systems worldwide, to mitigate the negative effects of health personnel migration on the health systems of developing countries and to safeguard the rights of health personnel. 3.3 The specific needs and special circumstances of countries, especially those developing countries and countries with economies in transition that are particularly vulnerable to health workforce shortages and/or have limited capacity to implement the recommendations of this Code, should be considered. Developed countries should, to the extent possible, provide technical and financial assistance to developing countries and countries with economies in transition aimed at strengthening health systems, including health personnel development. 3.4 Member States should take into account the right to the highest attainable standard of health of the populations of source countries, individual rights of health personnel to leave any country in accordance with applicable laws, in order to mitigate the negative effects and maximize the positive effects of migration on the health systems of the source countries. However, nothing in this Code should be interpreted as limiting the freedom of health personnel, in accordance with applicable laws, to migrate to countries that wish to admit and employ them. 3.5 International recruitment of health personnel should be conducted in accordance with the principles of transparency, fairness and promotion of sustainability of health systems in developing
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countries. Member States, in conformity with national legislation and applicable international legal instruments to which they are a party, should promote and respect fair labour practices for all health personnel. All aspects of the employment and treatment of migrant health personnel should be without unlawful distinction of any kind. 3.6 Member States should strive, to the extent possible, to create a sustainable health workforce and work towards establishing effective health workforce planning, education and training, and retention strategies that will reduce their need to recruit migrant health personnel. Policies and measures to strengthen the health workforce should be appropriate for the specific conditions of each country and should be integrated within national development programmes. 3.7 Effective gathering of national and international data, research and sharing of information on international recruitment of health personnel are needed to achieve the objectives of this Code. 3.8 Member States should facilitate circular migration of health personnel, so that skills and knowledge can be achieved to the benefit of both source and destination countries. Article 4 – Responsibilities, rights and recruitment practices 4.1. Health personnel, health professional organizations, professional councils and recruiters should seek to cooperate fully with regulators, national and local authorities in the interests of patients, health systems, and of society in general. 4.2 Recruiters and employers should, to the extent possible, be aware of and consider the outstanding legal responsibility of health personnel to the health system of their own country such as a fair and reasonable contract of service and not seek to recruit them. Health personnel should be open and transparent about any contractual obligations they may have. 4.3 Member States and other stakeholders should recognize that ethical international recruitment practices provide health personnel with the opportunity to assess the benefits and risks associated with employment positions and to make timely and informed decisions. 4.4 Member States should, to the extent possible, under applicable laws, ensure that recruiters and employers observe fair and just recruitment and contractual practices in the employment of migrant health personnel and that migrant health personnel are not subject to illegal or fraudulent conduct. Migrant health personnel should be hired, promoted and remunerated based on objective criteria, such as levels of qualification, years of experience and degrees of professional responsibility on the basis of equality of treatment with the domestically trained health workforce. Recruiters and employers should provide migrant health personnel with relevant and accurate information about all health personnel positions that they are offered. 4.5 Member States should ensure that, subject to applicable laws, including relevant international legal instruments to which they are a party, migrant health personnel enjoy the same legal rights and responsibilities as the domestically trained health workforce in all terms of employment and conditions of work. 4.6 Member States and other stakeholders should take measures to ensure that migrant health personnel enjoy opportunities and incentives to strengthen their professional education, qualifications and career progression, on the basis of equal treatment with the domestically trained health workforce subject to applicable laws. All migrant health personnel should be offered appropriate induction and
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orientation programmes that enable them to operate safely and effectively within the health system of the destination country. 4.7 Recruiters and employers should understand that the Code applies equally to those recruited to work on a temporary or permanent basis. Article 5 – Health workforce development and health systems sustainability 5.1 In accordance with the guiding principle as stated in Article 3 of this Code, the health systems of both source and destination countries should derive benefits from the international migration of health personnel. Destination countries are encouraged to collaborate with source countries to sustain and promote health human resource development and training as appropriate. Member States should discourage active recruitment of health personnel from developing countries facing critical shortages of health workers. 5.2 Member States should use this Code as a guide when entering into bilateral, and/or regional and/or multilateral arrangements, to promote international cooperation and coordination on international recruitment of health personnel. Such arrangements should take into account the needs of developing countries and countries with economies in transition through the adoption of appropriate measures. Such measures may include the provision of effective and appropriate technical assistance, support for health personnel retention, social and professional recognition of health personnel, support for training in source countries that is appropriate for the disease profile of such countries, twinning of health facilities, support for capacity building in the development of appropriate regulatory frameworks, access to specialized training, technology and skills transfers, and the support of return migration, whether temporary or permanent. 5.3 Member States should recognize the value both to their health systems and to health personnel themselves of professional exchanges between countries and of opportunities to work and train abroad. Member States in both source and destination countries should encourage and support health personnel to utilize work experience gained abroad for the benefit of their home country. 5.4 As the health workforce is central to sustainable health systems, Member States should take effective measures to educate, retain and sustain a health workforce that is appropriate for the specific conditions of each country, including areas of greatest need, and is built upon an evidence-based health workforce plan. All Member States should strive to meet their health personnel needs with their own human resources for health, as far as possible. 5.5 Member States should consider strengthening educational institutions to scale up the training of health personnel and developing innovative curricula to address current health needs. Member States should undertake steps to ensure that appropriate training takes place in the public and private sectors. 5.6 Member States should consider adopting and implementing effective measures aimed at strengthening health systems, continuous monitoring of the health labour market, and coordination among all stakeholders in order to develop and retain a sustainable health workforce responsive to their population’s health needs. Member States should adopt a multisectoral approach to addressing these issues in national health and development policies. 5.7 Member States should consider adopting measures to address the geographical maldistribution of health workers and to support their retention in underserved areas, such as through the application of education measures, financial incentives, regulatory measures, social and professional support.
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Article 6 – Data gathering and research 6.1 Member States should recognize that the formulation of effective policies and plans on the health workforce requires a sound evidence base. 6.2 Taking into account characteristics of national health systems, Member States are encouraged to establish or strengthen and maintain, as appropriate, health personnel information systems, including health personnel migration, and its impact on health systems. Member States are encouraged to collect, analyse and translate data into effective health workforce policies and planning. 6.3 Member States are encouraged to establish or strengthen research programmes in the field of health personnel migration and coordinate such research programmes through partnerships at the national, subnational, regional and international levels. 6.4 WHO, in collaboration with relevant international organizations and Member States, is encouraged to ensure, as much as possible, that comparable and reliable data are generated and collected pursuant to paragraphs 6.2 and 6.3 for ongoing monitoring, analysis and policy formulation. Article 7 – Information exchange 7.1 Member States are encouraged to, as appropriate and subject to national law, promote the establishment or strengthening of information exchange on international health personnel migration and health systems, nationally and internationally, through public agencies, academic and research institutions, health professional organizations, and subregional, regional and international organizations, whether governmental or nongovernmental. 7.2 In order to promote and facilitate the exchange of information that is relevant to this Code, each Member State should, to the extent possible: (a) progressively establish and maintain an updated database of laws and regulations related to health personnel recruitment and migration and, as appropriate, information about their implementation; (b) progressively establish and maintain updated data from health personnel information systems in accordance with Article 6.2; and (c) provide data collected pursuant to subparagraphs (a) and (b) above to the WHO Secretariat every three years, beginning with an initial data report within two years after the adoption of the Code by the Health Assembly. 7.3 For purposes of international communication, each Member State should, as appropriate, designate a national authority responsible for the exchange of information regarding health personnel migration and the implementation of the Code. Member States so designating such an authority, should inform WHO. The designated national authority should be authorized to communicate directly or, as provided by national law or regulations, with designated national authorities of other Member States and with the WHO Secretariat and other regional and international organizations concerned, and to submit reports and other information to the WHO Secretariat pursuant to subparagraph 7.2(c) and Article 9.1.
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7.4 A register of designated national authorities pursuant to paragraph 7.3 above shall be established, maintained and published by WHO. Article 8 – Implementation of the Code 8.1 Member States are encouraged to publicize and implement the Code in collaboration with all stakeholders as stipulated in Article 2.2, in accordance with national and subnational responsibilities. 8.2 Member States are encouraged to incorporate the Code into applicable laws and policies.
8.3 Member States are encouraged to consult, as appropriate, with all stakeholders as stipulated in Article 2.2 in decision-making processes and involve them in other activities related to the international recruitment of health personnel. 8.4 All stakeholders referred to in Article 2.2 should strive to work individually and collectively to achieve the objectives of this Code. All stakeholders should observe this Code, irrespective of the capacity of others to observe the Code. Recruiters and employers should cooperate fully in the observance of the Code and promote the guiding principles expressed by the Code, irrespective of a Member State’s ability to implement the Code. 8.5 Member States should, to the extent possible, and according to legal responsibilities, working with relevant stakeholders, maintain a record, updated at regular intervals, of all recruiters authorized by competent authorities to operate within their jurisdiction. 8.6 Member States should, to the extent possible, encourage and promote good practices among recruitment agencies by only using those agencies that comply with the guiding principles of the Code. 8.7 Member States are encouraged to observe and assess the magnitude of active international recruitment of health personnel from countries facing critical shortage of health personnel, and assess the scope and impact of circular migration. Article 9 – Monitoring and institutional arrangements 9.1 Member States should periodically report the measures taken, results achieved, difficulties encountered and lessons learnt into a single report in conjunction with the provisions of Article 7.2(c). 9.2 The Director-General shall keep under review the implementation of this Code, on the basis of periodic reports received from designated national authorities pursuant to Articles 7.3 and 9.1 and other competent sources, and periodically report to the World Health Assembly on the effectiveness of the Code in achieving its stated objectives and suggestions for its improvement. This report would be submitted in conjunction with Article 7.2(c). 9.3 The Director-General shall: (a) support the information exchange system and the network of designated national authorities specified in Article 7; (b) develop guidelines and make recommendations on practices and procedures and such joint programmes and measures as specified by the Code; and
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(c) maintain liaison with the United Nations, the International Labour Organization, the International Organization for Migration, and other competent regional and international organizations as well as concerned nongovernmental organizations to support implementation of the Code. 9.4 WHO Secretariat may consider reports from stakeholders as stipulated in Article 2.2 on activities related to the implementation of the Code. 9.5 The World Health Assembly should periodically review the relevance and effectiveness of the Code. The Code should be considered a dynamic text that should be brought up to date as required. Article 10 – Partnerships, technical collaboration and financial support 10.1 Member States and other stakeholders should collaborate directly or through competent international bodies to strengthen their capacity to implement the objectives of the Code. 10.2 International organizations, international donor agencies, financial and development institutions, and other relevant organizations are encouraged to provide their technical and financial support to assist the implementation of this Code and support health system strengthening in developing countries and countries with economies in transition that are experiencing critical health workforce shortages and/or have limited capacity to implement the objectives of this Code. Such organizations and other entities should be encouraged to cooperate with countries facing critical shortages of health workers and undertake to ensure that funds provided for disease-specific interventions are used to strengthen health systems capacity, including health personnel development. 10.3 Member States either on their own or via their engagement with national and regional organizations, donor organizations and other relevant bodies should be encouraged to provide technical assistance and financial support to developing countries or countries with economies in transition, aiming at strengthening health systems capacity, including health personnel development in those countries.
Eighth plenary meeting, 21 May 2010 A63/VR/8
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SIXTY-THIRD WORLD HEALTH ASSEMBLY Agenda item 11.7
WHA63.17 21 May 2010
Birth defects The Sixty-third World Health Assembly, Having considered the report on birth defects;1 Concerned by the high number of stillbirths and neonatal deaths occurring worldwide and by the large contribution of neonatal mortality to under-five mortality; Recognizing the importance of birth defects as a cause of stillbirths and neonatal mortality; Mindful that effective interventions to prevent birth defects including provision of appropriate community genetic services within the primary health care are available that can be integrated into maternal, reproductive and child health services as well as interventions to limit exposure to risk factors for birth defects; Concerned by the inadequate coverage of maternal, newborn and child health interventions and the barriers to access to health services that still exist in countries with the highest burden of maternal, newborn and child deaths; Aware that the attainment of Millennium Development Goal 4 (Reduce child mortality) will require accelerated progress in reducing neonatal mortality including prevention and management of birth defects; Recognizing that the lack or inadequacy of vital registration systems in developing countries, and inaccurate records of the causes of death, are major barriers to estimating the size of public health problems attributable to birth defects; Recalling resolution WHA58.31, in which the Health Assembly, calling for universal coverage of maternal, newborn and child health interventions, urged Member States to commit resources and to accelerate national action to build a seamless continuum of care for reproductive, maternal, newborn and child health; and resolution WHA57.13 in which it was recognized that genomics has a significant contribution to make in the area of public health; Recognizing that the prevalence of birth defects varies between communities, and that insufficient epidemiological data may hamper effective and equitable management;
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Document A63/10.
WHA63.17
Recognizing the diversity of causes and determinants of congenital disorders, including preventable factors such as infections or nutritional factors, vaccine-preventable diseases, consumption of alcohol, tobacco and drugs, and exposure to chemical substances, notably pesticides; Deeply concerned that birth defects are not still recognized as priorities in public health; Concerned by the limited resources dedicated to prevention and management of birth defects before and after birth in particular in middle- and low-income countries, 1. URGES Member States: (1) to raise awareness among all relevant stakeholders, including government officials, health professionals, civil society and the public, about the importance of birth defects as a cause of child morbidity and mortality; (2) to set priorities, commit resources, and develop plans and activities for integrating effective interventions that include comprehensive guidance, information and awareness raising to prevent birth defects, and care for children with birth defects into existing maternal, reproductive and child health services and social welfare for all individuals and effective interventions to prevent tobacco and alcohol use during pregnancy; (3) to promote the application of internationally recognized standards regulating the use of chemical substances in the air, water and soil; (4) to increase coverage of effective prevention measures including vaccination against rubella, folic acid supplementation, programme addressing tobacco and alcohol use among pregnant women and women who are trying to conceive, health education programmes that include ethical, legal and social issues associated with birth defects for the general population and high-risk groups, and by fostering the development of parent–patient organizations and establishing appropriate community genetic services; (5) to develop and strengthen registration and surveillance systems for birth defects within the framework of national health information systems in order to have accurate information available for taking decisions on prevention and control of these birth defects and to continue providing care and support to individuals affected by birth defects; (6) to develop expertise and to build capacity on the prevention of birth defects and care of children with birth defects; (7) to strengthen research and studies on etiology, diagnosis and prevention of major birth defects and to promote international cooperation in combating with them; (8) to raise awareness among all relevant stakeholders, including government officials, health professionals, civil society and the public, about the importance of newborn screening programmes and their role in identifying infants born with congenital birth defects; (9) to take all necessary measures to ensure the full enjoyment by children with disabilities of all human rights and fundamental freedoms on an equal basis with other children and give priority to the child’s well-being and support and facilitate families in their child-care and childraising efforts;
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(10) to raise awareness among all relevant stakeholders, including government officials, health professionals, civil society and the public, about the importance of newborn screening programmes and their role in identifying infants born with birth defects; (11) to support families who have children with birth defects and associated disabilities, and ensure that appropriate habilitation and support is provided to children with disabilities; 2. REQUESTS the Director-General: (1) to promote the collection of data on the global burden of mortality and morbidity due to birth defects, and to consider broadening the groups of congenital abnormalities included in the classification when the International Statistical Classification of Diseases and Related Health Problems (Tenth Revision) is revised; (2) to continue to collaborate with the International Clearinghouse for Birth Defects Surveillance and Research in order to improve collection of data on global burden of mortality and morbidity due to birth defects; (3) to support Member States in developing national plans for implementation of effective interventions to prevent and manage birth defects within their national maternal, newborn and child health plan, strengthening health systems and primary care, including improved coverage of vaccination against diseases such as measles and rubella, of addressing tobacco and alcohol use among pregnant women and women trying to conceive, and food fortification strategies, for the prevention of birth defects, and promoting equitable access to such services; (4) to provide support to Member States in developing ethical and legal guidelines in relation to birth defects; (5) to support Member States in the provision of appropriate community genetic services within the primary health-care system; (6) to promote technical cooperation among Member States, nongovernmental organizations and other relevant bodies on prevention of birth defects; (7) to support and facilitate research efforts on prevention and management of birth defects in order to improve the quality of life of those affected by such disorders; (8) to report on progress in implementing this resolution to the Sixty-seventh World Health Assembly, through the Executive Board, in 2014.
Eighth plenary meeting, 21 May 2010 A63/VR/8
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SIXTY-THIRD WORLD HEALTH ASSEMBLY Agenda item 11.12
WHA63.18 21 May 2010
Viral hepatitis The Sixty-third World Health Assembly, Having considered the report on viral hepatitis;1 Taking into account the fact that some 2000 million people have been infected by hepatitis B virus and that about 350 million people live with a chronic form of the disease; Considering that hepatitis C is still not preventable by vaccination and around 80% of hepatitis C virus infections become a chronic infection; Considering the seriousness of viral hepatitis as a global public health problem and the need for advocacy to governments, all parties and populations for action on health promotion, disease prevention, diagnosis and treatment; Expressing concern at the lack of progress in the prevention and control of viral hepatitis in developing countries, in particular in sub-Saharan Africa, due to the lack of access to affordable, appropriate treatment and care as well as an integrated approach to the prevention and control measures of the disease; Considering the need for a global approach to all forms of viral hepatitis – with a special focus on viral hepatitis B and C, which have the higher rates of morbidity; Recalling that one route of transmission of hepatitis B and C viruses is parenteral and that the Health Assembly in resolution WHA28.72 on utilization and supply of human blood and blood products recommended the development of national public services for blood donation and in resolution WHA58.13 agreed to the establishment of an annual World Blood Donor Day, and that in both resolutions the Health Assembly recognized the need for safe blood to be available to blood recipients; Reaffirming resolution WHA45.17 on immunization and vaccine quality which urged Member States to include hepatitis B vaccines in national immunization programmes; Considering the need to reduce liver cancer mortality rates and that viral hepatitides are responsible for 78% of cases of primary liver cancer;
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Document A63/15.
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Considering the collaborative linkages between prevention and control measures for viral hepatitis and those for infectious diseases like HIV and other related sexually transmitted and bloodborne infections; Recognizing the need to reduce incidence to prevent and control viral hepatitis, to increase access to correct diagnosis and to provide appropriate treatment programmes in all regions; Further recognizing the need for universal coverage for safe injection practices as promoted through the WHO Safe Injection Global Network, 1. RESOLVES that 28 July or such other day or days as individual Member States decide shall be designated as World Hepatitis Day in order to provide an opportunity for education and greater understanding of viral hepatitis as a global public health problem, and to stimulate the strengthening of preventive and control measures of this disease in Member States; 2. URGES Member States: (1) to implement and/or improve epidemiological surveillance systems and to strengthen laboratory capacity, where necessary, in order to generate reliable information for guiding prevention and control measures; (2) to support or enable an integrated and cost-effective approach to the prevention, control and management of viral hepatitis considering the linkages with associated coinfection such as HIV through multisectoral collaboration among health and educational institutions, nongovernmental organizations and civil society, including measures that strengthen safety and quality and the regulation of blood products; (3) to incorporate in their specific contexts the policies, strategies and tools recommended by WHO in order to define and implement preventive actions, diagnostic measures and the provision of assistance to the population affected by viral hepatitis including migrant and vulnerable populations; (4) to strengthen national health systems in order to address prevention and control of viral hepatitis effectively through the provision of health promotion and national surveillance, including tools for prevention, diagnosis and treatment of viral hepatitis, vaccination, information, communication and injection safety; (5) to provide vaccination strategies, infection-control measures, and means for injection safety for health-care workers; (6) to use national and international resources, either human or financial, to provide technical support to strengthen health systems in order to provide local populations adequately with the most cost-effective and affordable interventions that suit the needs of local epidemiological situations;
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(7) to consider, as necessary, national legislative mechanisms for the use of the flexibilities contained in the Agreement on Trade-Related Aspects of Intellectual Property Rights in order to promote access to specific pharmaceutical products;1 (8) to consider, whenever necessary, using existing administrative and legal means in order to promote access to preventive, diagnostic and treatment technologies against viral hepatitis; (9) to develop and implement monitoring and evaluation tools in order to assess progress towards reducing the burden from viral hepatitis and to guide evidence-based strategy for policy decisions related to preventive, diagnostic and treatment activities; (10) to promote the observance of 28 July each year, or on such other day or days as individual Member States may decide, as World Hepatitis Day; (11) to promote total injection safety at all levels of national health-care system; 3. REQUESTS the Director-General: (1) to establish in collaboration with Member States the necessary guidelines, strategies, time-bound goals and tools for the surveillance, prevention and control of viral hepatitis; (2) to provide the necessary support to the development of scientific research related to the prevention, diagnosis and treatment of viral hepatitis; (3) to improve the assessment of global and regional economic impact and estimate the burden of viral hepatitis; (4) to support, as appropriate, resource-constrained Member States in conducting events to mark World Hepatitis Day; (5) to invite international organizations, financial institutions and other partners to give support and assign resources in strengthening of surveillance systems, prevention and control programme, diagnostic and laboratory capacity, and management of viral hepatitis to developing countries in an equitable, most efficient, and suitable manner; (6) to strengthen the WHO Safe Injection Global Network;
(7) to collaborate with other organizations in the United Nations system, partners, international organizations and other relevant stakeholders in enhancing access to affordable treatments in developing countries;
The WTO General Council in its Decision of 30 August 2003 (i.e. on Implementation of paragraph 6 of the Doha Declaration on the TRIPS Agreement and Public Health) decided that “‘pharmaceutical product’ means any patented product, or product manufactured through a patented process, of the pharmaceutical sector needed to address the public health problems as recognized in paragraph 1 of the Declaration. It is understood that active ingredients necessary for its manufacture and diagnostic kits needed for its use would be included.”
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(8) to report to the Sixty-fifth World Health Assembly, through the Executive Board, on the implementation of this resolution.
Eighth plenary meeting, 21 May 2010 A63/VR/8
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SIXTY-THIRD WORLD HEALTH ASSEMBLY Agenda item 11.4
WHA63.19 21 May 2010
WHO HIV/AIDS strategy for 2011–2015 The Sixty-third World Health Assembly, Considering that the HIV epidemic still constitutes one of the foremost challenges to health and development, both in countries with generalized epidemics and in regions with concentrated epidemics affecting most at-risk groups, such as men who have sex with men, sex workers and injecting drug users; Noting that globally HIV is the major cause of mortality among women of reproductive age and was responsible for the death of 280 000 children in 2008, thereby undermining efforts to achieve Millennium Development Goals 4 and 5; Recognizing that the significant gains made in prevention and treatment of HIV/AIDS need to be sustained and expanded for Millennium Development Goal 6 to be achieved, including the urgent need to strengthen targeted prevention measures and achieve universal access to antiretroviral treatment, within a framework of respect for human rights, gender equality, and the reduction of stigma and discrimination; Further recognizing the need to strengthen the linkages between prevention and treatment of HIV/AIDS and maternal and child health in order to achieve Millennium Development Goals 4 and 5; Recalling that WHO’s work on HIV/AIDS has been guided by a series of strategies endorsed by several World Health Assemblies, including resolutions WHA53.14, WHA56.30, WHA59.12 and WHA59.19; Considering that the WHO “3 by 5” strategy, launched in 2003, which focused on expanding access to antiretroviral treatment, was developed in the context of the Global Heath Sector Strategy for HIV/AIDS (2003–2007), endorsed by the Fifty-sixth World Health Assembly (WHA56.30); Recalling that in 2006 the UN adopted the target of Universal Access to HIV prevention, treatment and care by 2010, and WHO developed the Universal Access Plan 2006–2010, welcomed by the Fifty-ninth World Health Assembly, which has guided WHO’s work since then; keeping in mind the outcomes of the Second Independent Evaluation of UNAIDS (2009); Recognizing the need for countries to sustain commitment to addressing the HIV/AIDS epidemic at all levels, including the highest political level, and to be supported in their efforts to expand the scope, improve the effectiveness and ensure the sustainability of their HIV responses so as to enable them to achieve the Millennium Development Goals;
WHA63.19
Noting that a sustainable HIV response requires its integration into comprehensive health systems, including those for maternal, neonatal and child health, sexual and reproductive health, tuberculosis prevention and control, harm reduction for drug users,1 and primary health care, particularly noting that sustaining these efforts is challenging in light of the global financial crisis; Recognizing that antiretroviral treatment programmes take a major share of total national AIDS spending in most countries, which warrants immediate attention to review and improve the performance of those programmes through early recruitment, ensuring highest adherence to medications, limiting drug resistance, and minimizing risk behaviours and enhancing the level of national spending on HIV prevention and control measures; Expressing deep concern that the financing of HIV programmes in most developing countries relies on external financial resources contributed by donors and global health initiatives, with space for improvement in their adherence to aid effectiveness commitments; limited national financial resources, hamper the financial sustainability of HIV programmes, 1. URGES Member States: (1) to reaffirm their commitment to achieve the internationally agreed development goals and objectives, including the Millennium Development Goals, in particular the goal to halt and begin to reverse the spread of HIV/AIDS, malaria and other major diseases and to the agreements dealing with HIV/AIDS reached at all major United Nations conferences and summits, including the 2005 World Summit and its statement on treatment, and the goal of achieving universal access to reproductive health by 2015, as set out at the 2005 World Summit; (1bis) to increase governments’ commitment to HIV/AIDS programmes including increased efforts on prevention and to take steps to accelerate donor harmonization and adherence to aid effectiveness commitments; (2) to incorporate, based on national contexts, the policies, strategies, programmes and interventions and tools recommended by WHO in order to implement effective HIV prevention measures, early diagnosis, treatment and care; and take further steps towards minimizing social stigmatization and discrimination which hamper access to prevention, treatment and care; (3) to consider, whenever necessary, using existing administrative and legal mechanisms in order to promote access to affordable and cost-effective prevention, treatment and care; (4) to integrate HIV/AIDS services into comprehensive strategies in health and other relevant sectors, including those for maternal, neonatal and child health, sexual and reproductive health, tuberculosis, harm reduction1 and primary health care, in order to ensure sustainability and maximize efficiencies and effectiveness; (5) to monitor closely and evaluate HIV/AIDS programmes by ensuring the completeness, accuracy and reliability of the data and use that information to improve programme efficiency;
1 Aligned with the WHO/UNODC/UNAIDS Technical Guide for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users. Geneva, WHO, 2009.
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REQUESTS the Director-General: (1) to take the lead in convening broad consultative processes to develop a WHO HIV/AIDS strategy for 2011–2015 which will guide the Secretariat’s support to Member States in line with UNAIDS guiding policies, including the Outcome Framework1 and aligned with broader strategic frameworks, including the Millennium Development Goals and primary health care, and which builds on the five strategic directions of the Universal Access Plan, and takes into consideration the changing international public health architecture, and reflect the Paris Declaration on Aid Effectiveness; (2) to encourage and promote the translation of research results into efficient public health policies for HIV/AIDS; (3) to submit to the Sixty-fourth World Health Assembly through the Executive Board a WHO HIV/AIDS strategy for 2011–2015 for its consideration and possible endorsement.
Eighth plenary meeting, 21 May 2010 A63/VR/8
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1 UNAIDS. Joint action for results: UNAIDS Outcome Framework 2009–2011. Geneva, UNAIDS, 2010 (document UNAIDS/09.13E).
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SIXTY-THIRD WORLD HEALTH ASSEMBLY Agenda item 11.14
WHA63.20 21 May 2010
Chagas disease: control and elimination The Sixty-third World Health Assembly, Having considered the report on Chagas disease: control and elimination;1 Recognizing that all transmission routes (namely by vectors, transfusion, organ transplantation, and by vertical and oral routes) have to be tackled, and that, in particular, domestic vectorial transmission in Latin America has to be eliminated, with the understanding that elimination means stable interruption of domestic transmission; Expressing its satisfaction at the considerable progress achieved by countries towards the goal of eliminating Chagas disease, as recommended in resolution WHA51.14; Underlining that 2009 marked the centenary of the description of this disease by Dr Carlos Chagas; Recognizing the success achieved through the intergovernmental initiatives in Latin America, and acknowledging the progress made through vector-control strategies; Recognizing the increasing number of cases of Chagas disease in countries where the disease is not endemic; Taking into account the need for harmonization of diagnostic and treatment procedures; Recognizing the need for the provision of appropriate medical care for people affected by Chagas disease; Underlining the need for more effective, safe and adequate medicines, including paediatric formulations, and for better coverage and distribution of those currently available; Recalling resolution CD49.R19 adopted by the 49th Directing Council of PAHO in 2009, which urges Members States to commit themselves to the elimination or the reduction of neglected diseases and other related poverty diseases, including Chagas disease, with the aim that disease no longer represents a public health problem;
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Document A63/17.
WHA63.20
Acknowledging the significant collaboration and support among Member States and the support of other partners and appreciating their continuous assistance, 1. URGES Member States: (1) to reinforce efforts to strengthen and consolidate national control programmes especially in areas where Chagas disease has re-emerged, in disease-endemic and non-endemic countries and to establish them where there are none; (2) to establish mechanisms to ensure broad coverage of adequate control measures, including the promotion of decent and healthy living conditions, prevention and the integration of specific actions within health services based on primary care, together with strengthening community participation; (3) to harmonize systems and strengthen capacities for surveillance, data collection and analysis and dissemination of information; (4) to integrate the care of patients with acute and chronic clinical forms of Chagas disease into primary health services; (5) to reinforce the provision of existing treatments in disease-endemic countries with the aim of making access universal; (6) to promote and encourage operational research on control of Chagas disease in order: (a) to interrupt transmission by domestic insect vectors through their control and elimination; (b) to promote the development of medicines that are more suitable, safe and affordable; (c) (d) to promote the development of a valid and accessible test of cure; to reduce the risk of late complications of the infection;
(e) to establish systems of early detection, in particular for the detection of new infections, of congenital infections in newborns and the reactivation of the disease in immunocompromised patients; (f) to optimize blood transfusion safety and screening procedures in endemic countries and to consider implementation of appropriate screening procedures in countries where the disease is not endemic; (7) to strengthen and harmonize public health policies to reduce the burden of Chagas disease, particularly in countries where the disease is not endemic; (8) to promote the development of public health measures in disease-endemic and non-endemic countries, with special focus on endemic areas, for the prevention of transmission through blood transfusion and organ transplantation, early diagnosis of congenital transmission and management of cases;
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(9) to integrate, at the primary health-care level, diagnosis and treatment of Chagas disease in patients in both acute and chronic phases of the disease; 2. REQUESTS the Director-General: (1) to draw attention to the burden of Chagas disease and to the need to provide equitable access to medical services for the management and prevention of the disease; (2) to strengthen implementation of vector-control activities in order to achieve interruption of domestic transmission of Trypanosoma cruzi and to promote research to improve or develop new prevention strategies; (3) to promote in areas endemic for Chagas disease action to detect infected donors at blood banks in order to integrate strategies for safe blood; (4) to provide support to the countries of the Americas in order to strengthen intergovernmental initiatives and the technical secretariat of the Pan American Sanitary Bureau as a successful form of technical cooperation among countries, and to consider an initiative for the prevention and control of Chagas disease in non-endemic regions; (5) to collaborate with Member States and intergovernmental initiatives with the aim of setting objectives and goals for the interruption of transmission, particularly for domestic vectorial transmission in Latin American countries; (6) to support the mobilization of national and international, public and private financial and human resources to ensure achievement of the goals; (7) to promote research related to prevention, control and care of Chagas disease;
(8) to promote intersectoral efforts and collaboration, and facilitate networking between organizations and partners interested in supporting the development and the strengthening of Chagas disease-control programmes; (9) to report on progress in the elimination of Chagas disease to the Sixty-fifth World Health Assembly through the Executive Board.
Eighth plenary meeting, 21 May 2010 A63/VR/8
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SIXTY-THIRD WORLD HEALTH ASSEMBLY Agenda item 11.19
WHA63.21 21 May 2010
WHO’s role and responsibilities in health research The Sixty-third World Health Assembly, Having considered the draft of the WHO strategy on research for health;1 Recalling resolution WHA58.34 on the Ministerial Summit on Health Research and resolution WHA60.15 on WHO’s role and responsibilities in health research; Recognizing the contribution of research to the development of solutions to health problems and the advancement of health worldwide; Aware that, in a rapidly changing world facing significant environmental, demographic, social and economic challenges, research will be increasingly essential for clarifying the nature and scope of health problems, and for identifying effective life-saving interventions and strategies; Realizing the increasingly multidisciplinary and intersectoral nature of research for health improvement; Affirming the roles and responsibilities of WHO, as the leading global health organization, in health research; Recognizing the need to strengthen the capacity of the public sector in health research; Acknowledging that research activities in the private and public sectors can be mutually supportive and complementary in improving health globally; Conscious of the need to strengthen the conduct, management and coordination of WHO’s activities in health research; Cognizant of the need to better communicate WHO’s research activities and results, especially to its Member States and partners;
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Document A63/22.
WHA63.21
Noting the references to research for health in resolution WHA61.21 on the Global strategy and plan of action on public health, innovation and intellectual property and relevant conclusions and recommendations of the WHO Commission on Social Determinants for Health; Taking into account the outcomes of the Global Ministerial Forum on Research for Health (Bamako, 17–19 November 2008), 1. 2. ENDORSES the WHO strategy on research for health; URGES Member States: (1) to recognize the importance of research for improving health and health equity and to adopt and implement policies for research for health that are aligned with national health plans, that include the participation of all relevant sectors, public and private, that align external support around mutual priorities, and that strengthen key national institutions; (2) to consider drawing on the strategy on research for health according to their own national circumstances and contexts, and as part of their overall policies on health and health research; (3) to strengthen national health research systems by improving the leadership and management of research for health, focusing on national needs, establishing effective institutional mechanisms for research, using evidence in health policy development, and harmonizing and coordinating national and external support (including that of WHO); (4) to establish, as necessary and appropriate, governance mechanisms for research for health, to ensure rigorous application of good research norms and standards, including protection for human subjects involved in research, and to promote an open dialogue between policy-makers and researchers on national health needs, capacities and constraints; (5) to improve the collection of reliable health information and data and to maximize, where appropriate, their free and unrestricted availability in the public domain; (6) to promote intersectoral collaboration and high-quality research in order to produce the evidence necessary for ensuring that policies adopted in all sectors contribute to improving health and health equity; (7) to initiate or strengthen intercountry collaboration with the aim of obtaining efficiencies of scale in research through the sharing of experiences, best practices and resources, the pooling of training and procurement mechanisms, and the use of common, standardized evaluation methods for research; (8) to consider, where appropriate, establishment of regional collaborating mechanisms, such as centres of excellence, in order to facilitate access by Member States to the necessary research and expertise to meet health challenges; (9) to continue to pursue financing of research for health resolution WHA58.34 on the Ministerial Summit on Health Research; as articulated in
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3. INVITES Member States, the health research community, international organizations, supporters of research, the private sector, civil society and other concerned stakeholders: (1) to provide support to the Secretariat in implementing the research for health strategy and in monitoring and evaluating its effectiveness; (2) to collaborate with the Secretariat, within the framework of the strategy, in identifying priorities for research for health, in developing guidelines relating to research for health and in the collection of health information and data; (3) to assist the Secretariat and WHO’s research partners in mobilizing enhanced resources for the identified global priorities for research for health; (4) to pay particular attention to the research needs of low-income countries, notably in areas such as technology transfer, research workforce, and infrastructure development and the determinants of health particularly where this will contribute to the achievement of the Millennium Development Goals, health equity and better health for all and to collaborate with WHO Member States and the Secretariat to better align and coordinate the global health research architecture and its governance through the rationalization of existing global health research partnerships, to improve coherence and impact, and to increase efficiencies and equity; (5) to support, where appropriate, technical cooperation among developing countries in research for health; 4. REQUESTS the Director-General: (1) to provide leadership in identifying global priorities for research for health;
(2) to implement the strategy within the Organization at all levels and with partners, and in line with the references to research for health in the Global strategy and plan of action on public health, innovation and intellectual property; (3) to improve the quality of research within the Organization;
(4) to provide adequate core resources in proposed programme budgets for the implementation of the research for health strategy; (5) to ensure that the highest norms and standards of good research are upheld within WHO, including technical, ethical and methodological aspects and the translation into practice, use and dissemination of results and to review and align the architecture and governance of the Organization’s research activities and partnerships; (6) to provide support to Member States, upon request and as resources permit, in taking relevant actions to strengthen national health research systems and intersectoral collaborations, including capacity building in order to create a sustainable critical mass of health systems and health policy researchers in developing countries;
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(7) to strengthen the role of WHO collaborating centres as a well-established, effective mechanism for cooperation between the Organization and countries in the field of research for health; (8) to report to the Sixty-fifth World Health Assembly on the implementation of this resolution, through the Executive Board, in 2012.
Eighth plenary meeting, 21 May 2010 A63/VR/8
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SIXTY-THIRD WORLD HEALTH ASSEMBLY Agenda item 11.21
WHA63.22 21 May 2010
Human organ and tissue transplantation The Sixty-third World Health Assembly, Having considered the report on human organ and tissue transplantation;1 Recalling resolutions WHA40.13, WHA42.5 and WHA44.25 on organ procurement and transplantation and WHA57.18 requesting an update of the Guiding Principles on Human Organ Transplantation; Aware of the growing magnitude and utility of human cell, tissue and organ transplantation for a wide range of conditions in low-resource as well as high-resource countries; Committed to the principles of human dignity and solidarity which condemn the buying of human body parts for transplantation and the exploitation of the poorest and most vulnerable populations and the human trafficking that result from such practices; Determined to prevent harm caused by the seeking of financial gain or comparable advantage in transactions involving human body parts, including organ trafficking and transplant tourism; Convinced that the voluntary, non-remunerated donation of organs, cells and tissues from deceased and living donors helps to ensure a vital community resource; Conscious of the extensive cross-boundary circulation of cells and tissues for transplantation; Sensitive to the need for post-transplantation surveillance of adverse events and reactions associated with the donation, including long-term follow up of the living donor, processing and transplantation of human cells, tissues and organs as such and for international exchange of such data to optimize the safety and efficacy of transplantation, 1. ENDORSES the WHO Guiding Principles on Human Cell, Tissue and Organ Transplantation;
1
Document A63/24.
WHA63.22
2.
URGES Member States:1 (1) to implement the Guiding Principles on Human Cell, Tissue and Organ Transplantation in the formulation and enforcement of their own policies, laws and legislation regarding human cell, tissue and organ donation and transplantation where appropriate; (2) to promote the development of systems for the altruistic voluntary non-remunerated donation of cells, tissues and organs as such, and increase public awareness and understanding of the benefits as a result of the voluntary non-remunerated provision of cells, tissues and organs as such from deceased and living donors, in contrast to the physical, psychological and social risks to individuals and communities caused by trafficking in material of human origin and transplant tourism; (3) to oppose the seeking of financial gain or comparable advantage in transactions involving human body parts, organ trafficking and transplant tourism, including by encouraging healthcare professionals to notify relevant authorities when they become aware of such practices in accordance with national capacities and legislation; (4) to promote a system of transparent, equitable allocation of organs, cells and tissues, guided by clinical criteria and ethical norms, as well as equitable access to transplantation services in accordance with national capacities, which provides the foundation for public support of voluntary donation; (5) to improve the safety and efficacy of donation and transplantation by promoting international best practices; (6) to strengthen national and multinational authorities and/or capacities to provide oversight, organization and coordination of donation and transplantation activities, with special attention to maximizing donation from deceased donors and to protecting the health and welfare of living donors with appropriate health-care services and long-term follow up; (7) to collaborate in collecting data including adverse events and reactions on the practices, safety, quality, efficacy, epidemiology and ethics of donation and transplantation; (8) to encourage the implementation of globally consistent coding systems for human cells, tissues and organs as such in order to facilitate national and international traceability of materials of human origin for transplantation;
3.
REQUESTS the Director-General: (1) to disseminate the updated Guiding Principles on Human Cell, Tissue and Organ Transplantation as widely as possible to all interested parties; (2) to provide support to Member States and nongovernmental organizations in order to ban trafficking in material of human origin and transplant tourism; (3) to continue collecting and analysing global data on the practices, safety, quality, efficacy, epidemiology and ethics of donation and transplantation of human cells, tissues and organs; 1
And regional economic international organizations where appropriate.
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(4) to facilitate Member States’ access to appropriate information on the donation, processing and transplantation of human cells, tissues and organs, including data on severe adverse events and reactions; (5) to provide, in response to requests from Member States, technical support for developing national legislation and regulation on, and suitable and traceable coding systems for, donation and transplantation of human cells, tissues or organs, in particular by facilitating international cooperation; (6) to review the Guiding Principles on Human Cell, Tissue and Organ Transplantation periodically in the light of national experience with their implementation and of developments in the field of transplantation of human cells, tissues and organs; (7) to report to the Health Assembly, through the Executive Board, at least every four years on actions taken by the Secretariat, as well as by Member States, to implement this resolution.
Eighth plenary meeting, 21 May 2010 A63/VR/8
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SIXTY-THIRD WORLD HEALTH ASSEMBLY Agenda item 11.6
WHA63.23 21 May 2010
Infant and young child nutrition The Sixty-third World Health Assembly, Having considered the report on infant and young child nutrition;1 Recalling resolutions WHA33.32, WHA34.22, WHA35.26, WHA37.30, WHA39.28, WHA41.11, WHA43.3, WHA45.34, WHA46.7, WHA47.5, WHA49.15, WHA54.2, WHA55.25, WHA58.32, WHA59.21 and WHA61.20 on infant and young child nutrition, and on nutrition and HIV/AIDS and the Codex Alimentarius Guidelines for use of nutrition and health claims;2 Conscious that achieving the Millennium Development Goals will require the reduction of maternal and child malnutrition; Aware that worldwide malnutrition accounts for 11% of the global burden of disease, leading to long-term poor health and disability and poor educational and developmental outcomes; that worldwide 186 million children are stunted3 and 20 million suffer from the most deadly form of severe acute malnutrition each year; and that nutritional risk factors, including underweight, suboptimal breastfeeding and vitamin and mineral deficiencies, particularly of vitamin A, iron, iodine and zinc, are responsible for 3.9 million deaths (35% of total deaths) and 144 million disability-adjusted life years (33% of total disability-adjusted life years) in children less than five years old; Aware that countries are faced with increasing public health problems posed by the double burden of malnutrition (both undernutrition and overweight), with its negative later-life consequences; Acknowledging that 90% of stunted children live in 36 countries and that children under two years of age are most affected by undernutrition; Recognizing that the promotion of breast-milk substitutes and some commercial foods for infants and young children undermines progress in optimal infant and young child feeding; Mindful of the challenges posed by the HIV/AIDS pandemic and the difficulties in formulating appropriate policies for infant and young child feeding, and concerned that food assistance does not meet the nutritional needs of young children infected by HIV;
1 2 3
Document A63/9. Document CAC/GL/23. World Health Statistics, May 2010.
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Concerned that in emergencies, many of which occur in countries not on track to attain Millennium Development Goal 4 and which include situations created by the effects of climate change, infants and young children are particularly vulnerable to malnutrition, illness and death; Recognizing that national emergency preparedness plans and international emergency responses do not always cover protection, promotion and support of optimal infant and young child feeding; Expressing deep concern over persistent reports of violations of the International Code of Marketing of Breast-milk Substitutes by some infant food manufacturers and distributors with regard to promotion targeting mothers and health-care workers; Expressing further concern over reports of the ineffectiveness of measures, particularly voluntary measures, to ensure compliance with the International Code of Marketing of Breast-milk Substitutes in some countries; Aware that inappropriate feeding practices and their consequences are major obstacles to attaining sustainable socioeconomic development and poverty reduction; Concerned about the vast numbers of infants and young children who are still inappropriately fed and whose nutritional status, growth and development, health and survival are thereby compromised; Mindful of the fact that implementation of the global strategy for infant and young child feeding and its operational targets requires strong political commitment and a comprehensive approach, including strengthening of health systems and communities with particular emphasis on the Babyfriendly Hospital Initiative, and careful monitoring of the effectiveness of the interventions used; Recognizing that the improvement of exclusive breastfeeding practices, adequate and timely complementary feeding, along with continued breastfeeding for up to two years or beyond, could save annually the lives of 1.5 million children under five years of age; Aware that multisectoral food and nutrition policies are needed for the successful scaling up of evidence-based safe and effective nutrition interventions; Recognizing the need for comprehensive national policies on infant and young child feeding that are well integrated within national strategies for nutrition and child survival; Convinced that it is time for governments, civil society and the international community to renew their commitment to promoting the optimal feeding of infants and young children and to work together closely for this purpose; Convinced that strengthening of national nutrition surveillance is crucial in implementing effective nutrition policies and scaling up interventions, 1. URGES Member States: (1) to increase political commitment in order to prevent and reduce malnutrition in all its forms;
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(2) to strengthen and expedite the sustainable implementation of the global strategy for infant and young child feeding including emphasis on giving effect to the aim and principles of the International Code of Marketing of Breast-milk Substitutes, and the implementation of the Baby-friendly Hospital Initiative; (3) to develop and/or strengthen legislative, regulatory and/or other effective measures to control the marketing of breast-milk substitutes in order to give effect to the International Code of Marketing of Breast-milk Substitutes and relevant resolution adopted by the World Health Assembly; (4) to end inappropriate promotion of food for infants and young children and to ensure that nutrition and health claims shall not be permitted for foods for infants and young children, except where specifically provided for, in relevant Codex Alimentarius standards or national legislation; (5) to develop or review current policy frameworks addressing the double burden of malnutrition and to include in the framework childhood obesity and food security and allocate adequate human and financial resources to ensure their implementation; (6) to scale up interventions to improve infant and young child nutrition in an integrated manner with the protection, promotion and support of breastfeeding and timely, safe and appropriate complementary feeding as core interventions; the implementation of interventions for the prevention and management of severe malnutrition; and the targeted control of vitamin and mineral deficiencies; (7) to consider and implement, as appropriate the revised principles and recommendations on infant feeding in the context of HIV, issued by WHO in 2009, in order to address the infant feeding dilemma for HIV-infected mothers and their families while ensuring protection, promotion and support of exclusive and sustained breastfeeding for the general population; (8) to ensure that national and international preparedness plans and emergency responses follow the evidence-based Operational Guidance for Emergency Relief Staff and Programme Managers1 on infant and young child feeding in emergencies, which includes the protection, promotion and support for optimal breastfeeding, and the need to minimize the risks of artificial feeding, by ensuring that any required breast-milk substitutes are purchased, distributed and used according to strict criteria; (9) to include the strategies referred to in subparagraph 1(6) above in comprehensive maternal and child health services and support the aim of universal coverage and principles of primary health care, including strengthening health systems as outlined in resolution WHA62.12; (10) to strengthen nutrition surveillance systems and improve use and reporting of agreed Millennium Development Goals indicators in order to monitor progress; (11) to implement the WHO Child Growth Standards by their full integration into child health programmes;
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Available online at http://www.ennonline.net/resources/6.
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(12) to implement the measures for prevention of malnutrition as specified in the WHO strategy for community-based management of severe acute malnutrition,1 most importantly improving water and sanitation systems and hygiene practices to protect children against communicable disease and infections; 2. CALLS UPON infant food manufacturers and distributors to comply fully with their responsibilities under the International Code of Marketing of Breast-milk Substitutes and subsequent relevant World Health Assembly resolutions; 3. REQUESTS the Director-General: (1) to strengthen the evidence base on effective and safe nutrition actions to counteract the public health effects of the double burden of malnutrition, and to describe good practices for successful implementation; (2) to mainstream nutrition in all WHO’s health policies and strategies and confirm the presence of essential nutrition actions, including integration of the revised principles and recommendations on infant feeding in the context of HIV, issued by WHO in 2009, in the context of the reform of primary health care; (3) to continue and strengthen the existing mechanisms for collaboration with other United Nations agencies and international organizations involved in the process of ensuring improved nutrition including clear identification of leadership, division of labour and outcomes; (4) to support Member States, on request, in expanding their nutritional interventions related to the double burden of malnutrition, monitoring and evaluating impact, strengthening or establishing effective nutrition surveillance systems, and implementing the WHO Child Growth Standards, and the Baby-friendly Hospital Initiative; (5) to support Member States, on request, in their efforts to develop and/or strengthen legislative, regulatory or other effective measures to control marketing of breast-milk substitutes; (6) to develop a comprehensive implementation plan on infant and young child nutrition as a critical component of a global multisectoral nutrition framework for preliminary discussion at the Sixty-fourth World Health Assembly and for final delivery at the Sixty-fifth World Health Assembly, through the Executive Board and after broad consultation with Member States.
Eighth plenary meeting, 21 May 2010 A63/VR/8
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Community-based management of severe acute malnutrition: a joint statement by the World Health Organization, the World Food Programme, the United Nations System Standing Committee on Nutrition and the United Nations Children’s Fund. Geneva, WHO, 2007.
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SIXTY-THIRD WORLD HEALTH ASSEMBLY Agenda item 11.23
WHA63.24 21 May 2010
Accelerated progress towards achievement of Millennium Development Goal 4 to reduce child mortality: prevention and treatment of pneumonia The Sixty-third World Health Assembly, Having considered the report on treatment and prevention of pneumonia;1 Aware of the joint WHO/UNICEF report on a global action plan for the prevention and control of pneumonia, presented in November 2009;2 Noting the first advance market commitment on the pneumococcal vaccine and the progress made so far in integrating the Haemophilus influenzae type b vaccine into routine immunization programmes; Noting also the introduction of the pneumococcal Accelerated Development and Introduction Plans; Recalling that resolution WHA58.15 on global immunization strategy requested the DirectorGeneral to mobilize resources to promote the availability and affordability in countries of future new vaccines based on evidence of epidemiological profiles; Concerned at the lack of substantial progress towards reducing morbidity and mortality from pneumonia, despite it being globally the leading cause of mortality of children under the age of five years; Mindful that decreasing the global burden of pneumonia will be essential for reaching Target 4.A of Millennium Development Goal 4; Noting that safe and highly effective tools are available for pneumonia control in the form of WHO’s Integrated Management of Childhood Illness approach for case management at all levels, universal childhood immunization against Haemophilus influenzae type b and Streptococcus pneumoniae infections, improvement of nutrition and low birth weight, control of indoor air pollution
1 2
Document A63/26. Document WHO/FCH/CAH/NCH/09.04.
WHA63.24
arising from household use of solid fuels and second-hand smoking in households, and prevention and management of HIV infection; Further noting that affordable price of vaccines in preventing pneumonia and significant scaling up of cold-chain capacities determine the adoption and implementation of vaccination programmes particularly in developing countries; Concerned that pneumonia continues to cause more than 1.8 million preventable deaths in children less than five years of age globally each year; Noting that the GAVI Alliance and other donors have made substantial resources available, and that the International Finance Facility for Immunisation and the PAHO revolving fund for immunization provide powerful mechanisms for directing resources to immunization programmes; Welcoming the contribution to the mobilization of resources for development of voluntary innovative financing initiatives taken by groups of Member States; Noting in addition that efforts to strengthen the capacity of health systems to detect and manage pneumonia effectively are likely also to contribute positively to efforts to achieve Millennium Development Goal 5 (Improve maternal health); Aware that pandemic of influenza A (H1N1) 2009 has raised awareness of the need for systemwide strengthening of management of serious acute respiratory infections, and noting that the time is therefore opportune to build upon investments made related to the pandemic and to continue efforts to ensure that patients with acute respiratory infections receive prompt and effective treatment, 1. URGES Member States: (1) to apply, according to their specific contexts, the policies, strategies and tools recommended by WHO to prevent and treat pneumonia; (2) to establish evidence-based national policies and operational plans for strengthening health systems in order to expand coverage of populations at risk with effective preventive and curative interventions; (3) to assess programme performance including the coverage and impact of interventions in an effective and timely manner, and use this assessment to inform WHO’s country-profile database; (4) to identify national and international resources, both human and financial, for strengthening health systems and for the provision of technical support in order to ensure that the most locally and epidemiologically appropriate strategies are implemented and target populations reached; (5) to implement the recommendations in the joint WHO/UNICEF global action plan for the prevention and control of pneumonia, noting the importance of: (a) integrated case management at community, health-centre and hospital levels;
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WHA63.24
(b) immunization by accelerating the adoption of affordable and cost-effective vaccines based on evidence of national epidemiological profiles; (c) (d) (e) (f) exclusive breastfeeding for six months; improvement of nutrition and prevention of low birth weight; control of indoor air pollution, and; prevention and management of HIV infection;
(6) to encourage integrated approaches to pneumonia prevention and treatment through multisectoral collaboration and community responsibility and participation; 2. REQUESTS the Director-General: (1) to strengthen human resources for prevention and control of pneumonia at all levels, especially the country level, thereby improving the capacity of WHO’s country offices to provide support to national health programmes for coordinating the work of partners on preventing and controlling pneumonia; (2) to bring together interested Member States, organizations in the United Nations system, the GAVI Alliance, medical research councils, and other interested stakeholders in a forum in order to improve coordination between different stakeholders in the fight against pneumonia and mobilize resources to promote the availability and affordability of Haemophilus influenzae type b and pneumococcal vaccines; (3) to expand the coverage of the report to the Health Assembly through the Executive Board on the status of progress made in achieving the health-related Millennium Development Goals, requested in resolution WHA61.18, to include progress on the implementation of this resolution, starting from the Sixty-fourth World Health Assembly.
Eighth plenary meeting, 21 May 2010 A63/VR/8
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SIXTY-THIRD WORLD HEALTH ASSEMBLY Agenda item 11.18
WHA63.25 21 May 2010
Improvement of health through safe and environmentally sound waste management The Sixty-third World Health Assembly, Having considered the report on the Strategic Approach to International Chemicals Management;1 Recalling resolution WHA61.19 on climate change and health, and resolutions WHA59.15, WHA50.13, WHA45.32, WHA31.28 and WHA30.47 relating to chemical safety; Recalling also resolutions of the United Nations General Assembly 44/226 of 22 December 1989 on traffic in and disposal, control and transboundary movements of toxic and dangerous products and wastes and 43/212 of 20 December 1988 on the responsibility of States for the protection of the environment; Noting the principles set out in Agenda 21, including chapter 20 and chapter 21, as agreed upon at the United Nations Conference on Environment and Development in 1992; Noting also the Johannesburg Declaration on Sustainable Development and the related Plan of Implementation of the World Summit on Sustainable Development in 2002; Acknowledging decision 25/8 on Waste Management adopted by the Governing Council/Global Ministerial Environment Forum of the United Nations Environment Programme at its 25th session; Mindful of the outcomes of the second session of the International Conference on Chemicals Management which relate to human health; Aware that wastes, if not properly managed in a safe and environmentally sound manner, may have serious consequences for human health and livelihood; Convinced that the lack of environmentally sound management of waste will harm the environment and be detrimental to human health, through polluted air, water, land and food chains;
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Document A63/21.
WHA63.25
Concerned that poor management of health-care waste, including sharps, non-sharp materials, blood, body parts, chemicals, pharmaceuticals and medical devices, puts health-care workers, waste handlers and the community at risk of infections, toxic effects and injuries; Welcoming the Bali Declaration on Waste Management for Human Health and Livelihood adopted at the ninth meeting of the Conference of the Parties to the Basel Convention on the Control of Transboundary Movement of Hazardous Wastes and their Disposal in 2008, 1. URGES Member States1 to apply the Health Impact Assessment as one of the key tools to assess the health aspects of waste management in order to make it safe and environmentally sound and to explore options to work more closely with the United Nations Environment Programme, the Strategic Approach to International Chemicals Management, the Basel Convention on the Control of Transboundary Movement of Hazardous Wastes and their Disposal and the WHO Secretariat towards achieving their shared objectives on the improvement of health through safe and environmentally sound waste management; 2. REQUESTS the Director-General: (1) to support the implementation of the actions set out in the Bali Declaration on Waste Management for Human Health and Livelihood, within WHO’s mandate and available resources; (2) to work together with the United Nations Environment Programme and the secretariat of the Basel Convention on the Control of Transboundary Movement of Hazardous Wastes and their Disposal on environmentally sound waste management, including collaborating with governments and donor organizations to strengthen the implementation of the Bali Declaration on Waste Management for Human Health and Livelihood, with the aim in particular of: (a) promoting the raising of awareness about the link between waste management, health and livelihood, and the environment; (b) strengthening subregional and regional cooperation on waste and health issues by promoting human and appropriate technical capacities at national, regional and international levels; (c) improving controls on waste shipment and border procedures in order to prevent illegal movements of hazardous and other wastes, through means that include capacity building, technology transfer and technical assistance; (d) improving cooperation between national authorities in the waste, chemicals and health sectors and, in collaboration with other relevant authorities and stakeholders, in the development and implementation of effective and sound waste management systems; (e) increasing capacity building, promoting and, where possible, enhancing public and private investment for the transfer and use of appropriate technology for the safe and environmentally sound waste management;
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And regional economic integration organizations, where applicable.
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WHA63.25
(3) to continue supporting the prevention of health risks associated with exposure to healthcare waste and promoting environmentally sound management of health-care waste in order to support the work of the Basel Convention on the Control of Transboundary Movement of Hazardous Wastes and their Disposal and the Stockholm Convention on Persistent Organic Pollutants; (4) to explore the development of strategies aimed at minimizing the generation of healthcare waste; (5) to invite governments, relevant intergovernmental and regional economic integration organizations, relevant entities of the industry and business sectors and civil society to provide resources and technical assistance to developing countries in developing and implementing strategies and approaches to improve health through safe and environmentally sound waste management; (6) to report to the Sixty-fourth World Health Assembly, through the Executive Board, on implementation of this resolution.
Eighth plenary meeting, 21 May 2010 A63/VR/8
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SIXTY-THIRD WORLD HEALTH ASSEMBLY Agenda item 11.18
WHA63.26 21 May 2010
Improvement of health through sound management of obsolete pesticides and other obsolete chemicals The Sixty-third World Health Assembly, Having considered the report on the Strategic Approach to International Chemicals Management;1 Recalling resolution WHA59.15 on the Strategic Approach to International Chemicals Management; Recognizing the outcomes of the second session of the International Conference on Chemicals Management (Geneva, 11–15 May 2009) regarding human health and, in particular, resolution II/8 on health aspects of the sound management of chemicals which drew attention to the need for a greater involvement of health sector, Member States2 and the WHO Secretariat in the implementation of the Global Plan of Action of the Strategic Approach to International Chemicals Management3 because of the adverse effects some chemicals may have on human health, and noting that some of the global priorities for cooperative action identified within the Strategic Approach to International Chemicals Management also have to be dealt with by the health sector; Recognizing that pesticides are designed to kill or control harmful organisms and pests, and may have adverse acute and chronic effects, and that, although they are regulated in most countries, they may affect populations’ health and the environment, particularly when improperly used and stored, including when they are obsolete;4 Recalling WHO’s Constitution, and recognizing the following relevant international agreements and instruments: the Bali Declaration on Waste Management for Human Health and Livelihood (2008), the United Nations Conference on Environment and Development (Rio de Janeiro, Brazil, 1 2 3 4
Document A63/21. And, where applicable, regional economic integration organizations. Document WHA59/2006/REC/1, Annex 1.
The International HCH and Pesticides Association (IHPA) estimates that total amount of obsolete pesticides is about 260 000–265 000 tonnes in central and eastern Europe and the countries of the former Union of Soviet Socialist Republics. Estimated amounts in 25 Member States of the European Union are 22 000–24 000 tonnes, south-east Europe 36 000–41 000 tonnes, the countries of the former Union of Soviet Socialist Republics 199 000 tonnes, Africa 50 000 tonnes (estimated by FAO in its Africa Stockpiles Programme), South-East Asia 6500 tonnes (FAO, first rough indication), Central and South America 30 000 tonnes (FAO, 2005).
WHA63.26
1992), the World Summit on Sustainable Development (Johannesburg, South Africa, 2002), the adoption of the Strategic Approach to International Chemicals Management by the International Conference on Chemicals Management (Dubai, 2006), the Basel Convention on the Control of the Transboundary Movements of Hazardous Wastes and Their Disposal (1989), the Rotterdam Convention on the Prior Informed Consent Procedure for Certain Hazardous Chemicals and Pesticides in International Trade (2004, revised 2008), the Stockholm Convention on Persistent Organic Pollutants (Stockholm, 2004), and the Convention on the Prevention of Marine Pollution by Dumping of Wastes and Other Matter 1972 and 1996 Protocol Thereto (London 1972), and the International Health Regulations (2005); Recognizing that all the forums, conventions and instruments mentioned in the preceding paragraph are important global tools for the preservation and protection of human health and the environment that provide measures and guidelines to deal with certain aspects of chemicals’ life-cycle, and that, in that sense, the closely linked Stockholm Convention on Persistent Organic Pollutants and Basel Convention on the Control of the Transboundary Movements of Hazardous Wastes and Their Disposal1 foresee the development of appropriate strategies for identification of persistent organic pollutant wastes, stockpiles of persistent organic pollutants and their management; Recognizing that hazardous waste and highly toxic pesticides fall under the global priority areas identified for cooperative action within the Strategic Approach to International Chemicals Management, and that the Health Assembly in resolution WHA59.15 on Strategic Approach to International Chemicals Management urged Member States to participate in national, regional and international efforts to implement the Strategic Approach; Mindful of the new challenges and determinants of health and of the need for additional action in order to preserve and protect human health and the environment; Recognizing the risks to human health and environment from obsolete pesticides and other obsolete chemicals, particularly through local and global chemical accidents and disasters; Recognizing also the risks to human health and environment from obsolete pesticides and other obsolete chemicals, linked to the creation of stockpiles resulting from their regulation (such as withdrawal from the market without appropriate phase-out period) or inherited from past periods of pesticides over-consumption, which might further lead to spreading of improperly stored chemicals worldwide; Recalling the fact that the exposure of humans and the environment to obsolete pesticides and other obsolete chemicals may also be due to their long-range transport; Recognizing the threat of unsafe storage of obsolete pesticides and other obsolete chemicals, which, owing to illegal use, package deterioration, or accidents may cause localized or widespread pollution and represent a potential risk to human health and the environment; Mindful of the clear evidence that, besides environmental benefits, health benefits can be expected from safe and efficient handling and disposal of obsolete pesticides and other obsolete chemicals; The fundamental aims of the Basel Convention are the control and reduction of transboundary movement of hazardous and other wastes subject to the Convention, the prevention and minimization of their generation, the environmentally sound management of such wastes and active promotion of the transfer and use of cleaner technologies. 1
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Acknowledging the progress regarding obsolete pesticides made by African countries through the interagency Africa Stockpiles Programme with the support of FAO, the Global Environment Facility, the World Bank and other partners; Welcoming the work of the Basel Convention on the Control of the Transboundary Movements of Hazardous Wastes and Their Disposal in developing technical guidelines on the environmentally sound disposal of wastes containing persistent organic pollutants; Further recognizing that only a comprehensive and long-term strategy of sound management of obsolete pesticides and other obsolete chemicals can be effective, 1. URGES Member States:1 (1) to adopt, where necessary, or strengthen sound national policies and legislation on safe handling and disposal of obsolete pesticides and other obsolete chemicals; (2) to adopt, where this has not already been done in the context of the Stockholm Convention on Persistent Organic Pollutants and other existing instruments, comprehensive national implementation plans or other strategies as the basis for taking action towards the elimination of risks from obsolete pesticides and other obsolete chemicals; (3) to enhance social responsibility through awareness-raising in the area of obsolete pesticides and other obsolete chemicals and chemicals with potential transboundary risks to human health; (4) to increase support for training and capacity building, and coordinated technical activities for implementing relevant international conventions and instruments; (5) to encourage and promote cooperation between Member States in this regard;
(6) to establish or strengthen capacity for the regulation of the sound management of pesticides and other chemicals throughout their life-cycle, as a preventive measure to avoid accumulation of obsolete chemicals; 2. INVITES all relevant stakeholders, including Member States, regional economic integration organizations, bodies in the United Nations system and other intergovernmental organizations including regional, international and national nongovernmental organizations and foundations, wastemanagement companies, pesticide manufacturers, donors and the remaining international community: (1) to promote sound management of obsolete pesticides and other obsolete chemicals in order to minimize and, wherever possible, avoid adverse impacts to human health and the environment; (2) to mobilize efforts and cooperate with other stakeholders on the implementation of national implementation plans and strategies, through local, regional and global networks among other means;
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And, where applicable, regional economic integration organizations.
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(3) to consider the synergies to be gained from sharing technical experience, expertise and capacity-building efforts among international instruments, conventions, regulations and processes; 3. REQUESTS the Director-General: (1) to support the development of appropriate and efficient strategies (at national, regional and international levels) for minimizing the risks of obsolete pesticides and other obsolete chemicals and thus promote the relevant WHO policy goals and practices; (2) to enhance WHO’s capacity to foster the strategies mentioned in subparagraph 3(1) above; (3) to facilitate implementation of the strategies on sound management of obsolete pesticides and other obsolete chemicals with a view to reducing inequities in health and securing an unpolluted living environment; (4) to work with UNEP, in connection with the WHO/UNEP Health Environment Linkages Initiative and the Strategic Approach to International Chemicals Management, as well as with UNDP, FAO, the World Bank and other appropriate institutions in assisting Member States to implement their national strategies and existing guidance, for instance under the Basel Convention on the Control of the Transboundary Movements of Hazardous Wastes and Their Disposal1 and strategies for sound management of obsolete pesticides and other obsolete chemicals at the global level; (5) to include obsolete pesticides and other obsolete chemicals among WHO’s priorities in order to reduce and prevent risks to human health and the environment from their adverse effects and to support their safe disposal; (6) to ensure full support of WHO to the activities of the Secretariat of the Strategic Approach to International Chemicals Management; (7) to support the ongoing joint efforts of FAO and WHO in capacity building of Member States in the sound management of pesticides;
Technical guidelines on the safe disposal of obsolete pesticides (http://www.basel.int/meetings/sbc/workdoc/techdocs.html): • Updated general technical guidelines for the environmentally sound management of wastes consisting of, containing or contaminated with persistent organic pollutants,
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• Technical guidelines for the environmentally sound management of wastes consisting of, containing or contaminated with 1,1,1-trichloro-2,2-bis(4-chlorophenyl)ethane (DDT), • Technical guidelines on the environmentally sound management of wastes consisting of, containing or contaminated with the pesticides aldrin, chlordane, dieldrin, endrin, heptachlor, hexachlorobenzene (HCB), mirex or toxaphene or with HCB as an industrial chemical.
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(8) to report to the Sixty-fourth World Health Assembly, through the Executive Board, on progress in implementing this resolution. Eighth plenary meeting, 21 May 2010 A63/VR/8 = = =
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SIXTY-THIRD WORLD HEALTH ASSEMBLY Agenda item 11.22
WHA63.27 21 May 2010
Strengthening the capacity of governments to constructively engage the private sector in providing essential health-care services1 The Sixty-third World Health Assembly, Having considered the report on strengthening the capacity of governments to constructively engage the private sector in providing essential health-care services;2 Recognizing the variety of private providers, from faith-based and other nongovernmental non-profit organizations and individual health-care entrepreneurs, both formal and informal, to private for-profit firms and corporations, and the evidence that they play a significant and growing role in health-care delivery across the world; Noting that governments across the world are faced with the challenge of constructive engagement with the complex range of health-care providers, in ways that vary considerably according to context; Noting that the cost and quality of the care provided and the effect on health and social outcomes may vary considerably and that there are serious reasons for concern in environments where regulation is poor or absent, yet as a whole the documentation and evidence base in this regard is weak; Recognizing that governments that have the institutional capacity to govern the broad range of health-care providers can play a constructive role in providing essential health services; Concerned about evidence that in many countries effective engagement, oversight and regulation of the various private health-care providers may be constrained by imperfect strategic intelligence, limited financial influence and weak institutional capacity; Aware that building trust and constructive policy dialogue are vital for successful engagement, oversight and regulation;
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See document A63/25 Add.1 for the financial and administrative implications for the Secretariat of this resolution. Document A63/25.
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Noting that the renewal of primary health care provides a policy framework in which to set benchmarks for strengthened government capacity for constructive engagement with, and oversight of, both public and private health-care providers, 1. URGES Member States: (1) to gather, by means that include improved information systems and stronger policy dialogue processes, the strategic intelligence required for: objectively assessing the positive and negative aspects of health-care delivery by private not-for-profit and private for-profit providers; identifying appropriate strategies for productive engagement; and developing regulatory frameworks that ensure universal access with social protection and the reorientation of service delivery towards people-centred primary care; (2) to map and assess, as appropriate, the capacity and the performance of the government departments and other bodies concerned with oversight and regulation of both public and private health-care provision, including: professional councils; institutional purchasers of health services, such as public funders and state health insurance agencies, and accreditation bodies; (3) to investigate the potential contribution to the regulation of health-care provision of non-health-sector governmental and nongovernmental entities, including health-consumer protection agencies and patient groups, and, as appropriate, set up mechanisms to maximize the value of those contributions; (4) to build and strengthen for the long term the institutional capacity of these regulatory bodies, through adequate and sustained funding, staffing, and support; (5) to pursue opportunities for intercountry exchange of experience with different strategies for engagement, oversight and regulation of the full range of health-care providers; 2. REQUESTS the Director-General: (1) to provide technical assistance to Member States, upon request, in their efforts to strengthen the capacity of health ministries and other regulatory agencies in order to improve engagement with, and oversight and regulation of, the full range of public and private healthcare providers; (2) to convene technical consultations, support the research agenda set by Member States and facilitate intercountry exchange of experience in order to obtain better shared understanding and documentation of the consequences, positive and negative, of the growing diversity of healthcare providers, ensuring that particular attention is given to contexts of poor regulation and to consequences in terms of health, health equity, and health systems development; (3) also to convene technical consultations, support the research agenda set by Member States and facilitate intercountry exchange of experience in order to obtain a better shared understanding of the potential of various strategies to build up the institutional capacity for regulation, oversight and harnessing entrepreneurial dynamism and sound cooperation among various types of health-care providers;
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(4) to report to the Sixty-fifth World Health Assembly, through the Executive Board, on the progress made with the implementation of this resolution.
Eighth plenary meeting, 21 May 2010 A63/VR/8
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SIXTY-THIRD WORLD HEALTH ASSEMBLY Agenda item 11.3
WHA63.28 21 May 2010
Establishment of a consultative expert working group on research and development: financing and coordination
The Sixty-third World Health Assembly, Having considered the report on public health, innovation and intellectual property: global strategy and plan of action, and the report of the Expert Working Group on Research and Development: Coordination and Financing;1 Considering resolution WHA61.21 which requests the Director-General “to establish urgently a results-oriented and time-limited expert working group to examine current financing and coordination of research and development, as well as proposals for new and innovative sources of funding to stimulate research and development related to Type II and Type III diseases and the specific research and development needs of developing countries in relation to Type I diseases, and open to consideration of proposals from Member States, and to submit a progress report to the Sixty-second World Health Assembly and the final report to the Sixty-third World Health Assembly through the Executive Board”; Noting that although the Expert Working Group made some progress in examining proposals for financing of, and coordination among, research and development activities, as called for in resolution WHA61.21, there was divergence between the expectations of Member States2 and the output of the Group, underlining the importance of a clear mandate; Considering that, in its recommendations, the Expert Working Group states the need to conduct an in-depth review of the recommended proposals; Recognizing the need to further “explore and, where appropriate, promote a range of incentive schemes for research and development including addressing, where appropriate, the de-linkage of the costs of research and development and the price of health products, for example through the award of
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Documents A63/6 and A63/6 Add.1, respectively. And, where applicable, regional economic integration organizations.
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prizes, with the objective of addressing diseases which disproportionately affect developing countries”;1 Noting previous and ongoing work on innovative financing for health, research and development and the need to build on this work as relevant; Emphasizing the importance of public funding of health research and development and the role of the Member States2 in coordinating, facilitating and promoting health research and development; Reaffirming the importance of other relevant actors in health research and development, 1. URGES Member States:2 (1) to support the work of the Consultative Expert Working Group by: (a) providing, where appropriate, information, submissions or additional proposals;
(b) organizing and/or supporting, where appropriate, regional and sub-regional consultations; (c) 2. proposing names of experts for the roster;
REQUESTS the Director-General: (1) to make available electronically by the end of June 2010: (a) (b) (c) all the proposals considered by the Expert Working Group including their source; the criteria used to assess the proposals; the methodology used by the Expert Working Group;
(d) the list of the stakeholders that were interviewed and those who contributed information; (e) (2) sources of statistics used;
to establish a Consultative Expert Working Group that shall: (a) take forward the work of the Expert Working Group;
(b) deepen the analysis of the proposals in the Expert Working Group’s report, and in particular:
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Resolution WHA61.21, Annex, Element 5, paragraph 5.3a. And, where applicable, regional economic integration organizations.
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(i) examine the practical details of the four innovative sources of financing proposed by the Expert Working Group in its report;1 (ii) review the five promising proposals2 identified by the Expert Working Group in its report; and (iii) further explore the six proposals that did not meet the criteria applied by the Expert Working Group;3 (c) consider additional submissions and proposals from Member States, any regional and subregional consultations, and from other stakeholders; (d) in carrying out the actions in subparagraphs 2(b) and 2(c), examine the appropriateness of different research and development financing approaches and the feasibility of implementation of these approaches in each of the six WHO regions, with subregional analysis, as appropriate; (e) observe scientific integrity and be free from conflict of interest in its work; 4
(3) to provide, upon request, within available resources dedicated to the financing of the Consultative Expert Working Group, technical and financial support for regional consultations, including meetings, in order to seek regional views to help inform the work of the Consultative Expert Working Group; (4) (a) to invite Member States4 to nominate experts whose details, following consultations with regional committees to achieve gender balance and diversity of technical competence and expertise, shall be submitted to the Director-General through the respective regional directors; (b) to establish a roster of experts comprising all the nominations submitted by the regional directors; (c) to propose a composition of the Group to the Executive Board for its approval, drawing on the roster of experts and taking into account regional representation according to the composition of the Executive Board, gender balance and diversity of expertise; (d) upon approval by the Executive Board, to establish the Group and facilitate its work including its consultation with the Member States4 and other relevant stakeholders, where appropriate; (5) to put particular emphasis on the transparent management of potential conflicts of interest by ensuring full compliance with the mechanisms established by the Director-General for that purpose; Report of the Expert Working Group on Research and Development Financing. Geneva, World Health Organization, 2010, Chapter 5.3. Report of the Expert Working Group on Research and Development Financing. Geneva, World Health Organization, 2010, Chapter 5.6. 3 Report of the Expert Working Group on Research and Development Financing. Geneva, World Health Organization, 2010, Annex 2. 4 2 1
And, where applicable, regional economic integration organizations.
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(6) to ensure full transparency for Member States1 by providing the Consultative Expert Working Group’s regular updates on the implementation of its workplan, and by making available all the documentation used by the Consultative Expert Working Group at the conclusion of the process; (7) to submit the workplan and inception report of the Consultative Expert Working Group to the Executive Board at its 129th session and a progress report to the Executive Board at its 130th session with a view to submitting the final report to the Sixty-fifth World Health Assembly. Eighth plenary meeting, 21 May 2010 A63/VR/8
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And, where applicable, regional economic integration organizations.
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