(WPR/RC38/SR/5)
SUMMARY RECORD OF THE FIFTH MEETING Red Cross National Training Centre, Beijing Thursday, 10 September 1987 at 9 a.m. CHAIRMAN: Dr Terepai Maoate (Cook Islands)
CONTENTS
1. 2.
Consideration of draft resolutions ••••••••••••••••••••••• 136 Special Programme of Research, Development and Research Training in Human Reproduction: Membership of the Policy and Coordination Advisory Committee •.•...•.•..•...••...•.••••.•.•..•..•..• 140 Development of health research 141
4·
Correlation of the work of the World Health Assembly, the Executive Board and the Regional Committee ••••••••••••••••••••••••••••••••••••••• 145 4.1 Consideration of resolutions of the Fortieth World Health Assembly and the Executive Board at its seventy-ninth and eightieth sessions •••••••••••••••••••••••••••••• 145 Consideration of the agenda of the eighty-first session of the Executive Board ••••••••••••••••••••••••••••••••••••• 147
4.2
- 135 -
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1.
CONSIDERATION OF DRAFT RESOLUTIONS The Committee considered the following draft resolutions:
1.1
Report of the Regional Director (Document WPR/RC38/Conf. Paper No. 1) "The Regional Committee,
Having reviewed the report of the Regional Director on the work of WHO in the Western Pacific Region during the period 1 July 1985 to 30 June 1987; 1. NOTES with satisfaction the was planned and carried out; manner in which the programme
2. EXPRESSES its appreciation to the Regional Director and his staff and congratulates them on the work accomplished." Mr BOYER (United States of America) noted that, during the discussion on the Regional Director's report, suggestions had been made for changes and improvements. He therefore proposed that an additional paragraph be included in the resolution requesting the Regional Director to take into account the Committee's comments when preparing future reports.
Dr CHRISTMAS (New Zealand) supported the proposal of the representative of the United States of America. The new trends in the Organization's development seemed to call for a more definitive format than in the past, covering such aspects as costing and efficacy. Mr TAGUIWALO (Philippines) suggested the inclusion in operative paragraph 1 of the phrase "under the instructions previously given to the Regional Director 11 • Mr BOYER (United States of America) considered that such a phrase could not be inserted in operative paragraph 1, which referred to the manner in which the programme had been planned and carried out and not to the Regional Director's report.
Dr TAPA (Tonga) shared United States of America.
the view of
the representative of
the
Mr TAGUIWALO (Philippines) withdrew his proposal to amend operative paragraph 1, but suggested that the additional paragraph proposed by the representative of the United States of America include a statement to the effect that the present report was satisfactory from the point of view of previous perspectives, and that the comments were being made for guidance in the preparation of future reports. Decision: The draft resolution was adopted subject to the addition of a third operative paragraph reflecting the proposals of the representatives of the Philippines and the United States
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of America, the wording of which the Committee left to discretion of the Secretariat (see resolution WPR/RC38.R1). 1.2 ~ursing
the
(Document WPR/RC38/Conf. Paper No. 2)
"The Regional Committee, Having considered the report of the Regional Director for the period July 1985 to June 1987, and, in particular, the review of nursing; Recalling resolution WPR/RC33.R14, and resolution WHA30.48 which, inter alia, recommended that Member States should undertake a comprehensive review of the roles and fUnctions of the different types of personnel, including nursing/midwifery personnel, within the context of national health programmes, in order to redefine and restructure them to meet, in an interdisciplinary approach, the needs of communities for primary health care; Recognizing the contribution of nursing to primary health and to the health services in general; care
Remembering the Declaration of Tokyo, which calls for new strategies to educate health and medical manpower in the twenty-first century and affirms the reorientation of health services towards primary health care; 1. URGES Member States: (1) to give priority to strengthening nursing/midwifery personnel planning by undertaking a review of the roles and functions of each category within the national health manpower plan; (2) to establish an information system to information on the supply, performance, distribution of nursing/midwifery personnel; provide relevant utilization and
(3) to intensify training, retraining and continuing education programmes for nursing/midwifery personnel;
(4) to restructure the nursing management, supervlslon and support systems, including the establishment of appropriate nursing practice legislation based on national primary health care policies, in order to improve the delivery of health care; (5) to strengthen the necessary managerial, research and teaching skills of senior nursing/midwifery personnel so that they can effectively contribute to national health systems development, including the motivation of women in health care activities; 2. REQUESTS the Regional Director to continue to cooperate with Member States in their efforts to strengthen nursing and midwifery
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services, with special emphasis on manpower planning, information systems, training, management and research." BOYER (United States of America) had no objection to the substance of the draft resolution, but expressed reservations regarding the adoption of a resolution of such length and detail on a subject which had not figured as a specific item on the Committee's agenda. Moreover, the subject had not given rise to much discussion during the consideration of the report. Mr
Dr REILLY (Papua New Guinea) supported the remarks made by the previous speaker. Moreover, he was hesitant about singling out nursing. Many countries of the Region, including his own, relied on several types of auxiliary and other health workers, and not particularly on nurses. Dr CHRISTMAS (New Zealand) agreed with the comments made by the representative of the United States of America. The point made by the representative of Papua New Guinea should also be borne in mind. He had understood that there was a general acceptance of the importance of nursing, and its vital and specific role in primary health care had been emphasized by the Health Assembly. However, in view of the previous comments, he proposed that subparagraphs 2, 4 and 5 of operative paragraph 1 be deleted. Dr REILLY ·(Papua New Guinea) supported that proposal. Decision: The draft resolution, resolution WPR/RCJ8.R2). and Dr DE SOUZA (Australia) adopted (see Technical (Document
as amended, was
1.3
of the Sub-Committee on Report Programmes and Cooperation: Tuberculosis and malaria control WPR/RC38/Conf. Paper No. 3) "The Regional Committee,
Having considered Part I of the report of the Sub-Committee on Programmes and Technical Cooperation on its visits to Solomon Islands and Viet Nam; 1. ENDORSES the findings and recommendations of the Sub-Committee on Programmes and Technical Cooperation in relation to WHO's collaboration in tuberculosis and malaria control; 2. THANKS the Sub-Committee for its work;
J. REQUESTS the Regional Director to take the Sub- Committee's findings and recommendations into consideration in developing future programmes of cooperation in these fields; 4· REQUESTS the Sub-Committee, as par~ Qf its terms gf reference in 1988, to review and analyse the impact of WHO's cooperation with M .ember States in the field of health informatics. 11
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Mr TOEOLESULUSU SIUEVA (Samoa) proposed that operative paragraph 4 be amended to read " in the field of health information systems and health informatics". That would better reflect the situation in many countries of the Region, including his own, where health informatics was very little developed. Dr CHRISTMAS (New Zealand) fully agreed with speaker. Moreover, the proposed amendment would better recommendations of the Sub-Committee. the previous reflect the
Dr KHALID (Malaysia) understood that certain parts of the SubCommittee's report had not been accepted pending consideration of agenda item 9 - in particular, regarding the number of members and tenure of office. He also asked whether, from the point of view of termin.ology, it was correct to use the words "endorses the findings" ••. He proposed that operative paragraph 1 be amended to read "takes note of the findings and endorses the recommendations ••. ". The CHAIRMAN said that another resolution would be submitted, concerning the membership of the Sub-Committee, as referred to by the representative of Malaysia. Decision: The draft resolution, as representatives of Malaysia and Samoa, resolution WPR/RC38.R3). amended by was adopted the (see
1.4 Regional priorities under the Eighth General Programme of Work (Document WPR/RC38/Conf. Paper No.4) "The Regional Committee, Having considered Part II of the report of the Sub-Committee on Programmes and Technical Cooperation on its work in relation to the regional contribution to the Eighth General Programme of Work covering the period 1990-1995; 1. ASSIGNS to each programme under the Eighth General Programme of Work for the Western Pacific Region an order of priority as set out in Annex 1 of document WPR/RC38/6; 2. REQUESTS the Regional Director to take these priority ratings into consideration when implementing the Eighth General Programme of Work in the Western Pacific Region, due regard being given however to the specific needs of individual countries."
Mr BOYER (United States of America) noted the role of the SubCommittee in determining priorities for the future, a role that would have particular importance in terms of the next biennial programme budget to be discussed in 1988. He therefore proposed to add a paragraph to the draft resolution, the text of which he agreed to submit to the Secretariat in writing. Dr NAKATANI (Japan) endorsed the sentiments expressed by the representative of the United States of America, the text of which he
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would study. In previous discussions, the Committee had agreed on the importance of continuous review of priorities, and he therefore proposed to add a further operative paragraph, requesting the Regional Director to take appropriate steps to continuously review priority ratings. The CHAIRMAN then requested the Rapporteurs to prepare a revised draft resolution, taking into account the proposed amendments. (For consideration of the revised draft resolution, see the seventh meeting, section 3.1.) 2. SPECIAL PROGRAMME OF RESEARCH, DEVELOPMENT AND RESEARCH TRAINING IN HUMAN REPRODUCTION: MEMBERSHIP OF THE POLICY AND COORDINATION ADVISORY COMMITTEE: Item 12 of the Agenda (Documents WPR/RC38/7 and Add.1)
The REGIONAL DIRECTOR said that, as drawn up in 1985, the terms of reference of the Policy and Coordination Advisory Committee provided for four categories of member. One of those four categories, category (b), was composed of twelve members to be elected by the regional committees of WHO. Membership was for a period of three years. The Western Pacific Region had three members in that category, who were currently from the Republic of Korea, Singapore and Viet Nam. In order to conform to the rotating system of membership for category (b), the Regional Committee now needed to elect one member whose term would start on 1 January 1988. The Committee might wish to consider appointing the Philippines. The twelve major donor countries under category (a) of Committee were not eligible for election to category (b). countries concerned in the Region were Australia, China and United Kingdom. The next meeting of the the The the
Advisory Committee would be from 4 to
6 July 1988. The Addendum to document WPR/RC38/7 consisted of a report specially prepared for the Committee by the Special Programme of Research, Development and Research Training in Human Reproduction on its objectives and organization, with special emphasis on the activities supported in the Region. The CHAIRMAN reiterated the proposal to appoint the Philippines to the Policy and Coordination Advisory Committee, in category (b). It was so agreed. In the absence of further comments, the CHAIRMAN asked the Rapporteurs to prepare an appropriate draft resolution. (For consideration of the draft resolution, see the seventh meeting, section J.J.)
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3.
DEVELOPMENT OF HEALTH RESEARCH: (Document WPR/RC38/8)
Item 13 of the Agenda
The REGIONAL DIRECTOR said that document WPR/RC38/8 contained the usual information on major activities performed by the regional research promotion and development programme, which had two interrelated purposes: (i) to obtain research results that were relevant and applicable to the solution of problems related to the goals of health for all, and (ii) to strengthen the research capacity of the countries themselves. In that context, efforts had been made to promote the concept of national research coordination so as to orient research towards solving priority problems. Although there were considerable differences between countries in regard to the development of national research coordination mechanisms, there had been a growing interest in that area. The document also contained a summary of recommendations of the Western Pacific Advisory Committee Research made at its eleventh session in March 1986. the main on Health
WHO was continuing to provide training and research grants to promote problem-solving research in the priority areas identified by the Advisory Committee. The Regional Centre for Research and Training in Tropical Diseases at the Institute for Medical Research, Kuala Lumpur, also continued to focus its efforts on the strengthening of national research capabilities in the Region. Dr WEINSTEIN (United States of America) said he appreciated the continuing inclusion of research as a major item in the work of the Region, since it represented the key to advances in health services. He expressed concern, however, that the report advocated an increase in the funds allocated. It would be important to ensure that priorities were set f.or research, as had been done under the Eighth General Programme of Work. Dr DE SOUZA (Australia) expressed support for the general thrust of the initiatives proposed for research in the Region, particularly regarding national research councils. He urged all Member States in the Region to appoint a liaison officer within their national research council or ministry of health, to permit the establishment of a collaborative network. He noted with regret that the Western Pacific Advisory Committee on Health Research had not met in 1987, in line with the revised timetable of the global Advisory Committee on Health Research. He wished to know if this meant that the initiative to help with the establishment of national research councils in the Region, which had been strongly supported by the Advisory Committee in 1986, had been dropped. National research councils did not require a large secretariat, and could make use of existing facilities in the country as, for example, in universities. There was a need for greater collaboration between medical research administrators, and meetings of directors of national health research councils were important in that regard.
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Dr CHRISTMAS (New Zealand) endorsed the comments of the representative of Australia, and noted that meetings of health research administrators could help in making different research programmes complementary and in avoiding overlap. With regard to the comments of the representative of the United States of America, he agreed that it was important to set priorities, but noted that they would not necessarily correspond exactly to the priorities for existing programmes. Ideally, current programmes made use of the results of past research, while current research should help set programme priorities for the future. Dr LIU HAlLIN (China) noted with satisfaction the progress in health research development in the Region. He considered that emphasis should be placed on establishing health and biomedical research facilities, as well as training and mobilization of health personnel to tackle the important health problems in the area. He noted with satisfaction the increase in the number of WHO collaborating centres in the Region to 147, allowing more scientists from developing countries to participate in regional and global programmes. That was an important way to strengthen Member States' capabilities and permitted exchange of information and technology. He expressed appreciation of the efforts of the Advisory Committee, and endorsed the recommendations contained in the report. Dr TAPA (Tonga) thanked the Regional Director for the report and expressed satisfaction with the activities carried out during the biennium. He endorsed the recommendations contained.in the report. Dr TOEOLESULUSU SIUEVA (Samoa) requested information research projects in Member States were initiated. on how
Dr KHALID (Malaysia) thanked the Regional Director for the report and expressed appreciation of the progress made in research. The attainment of health for all was being hampered, not by lack of technologies, but by wrong use of existing technology. In that context the development of health systems research was particularly important. Medical research in the past had perhaps concentrated too much on the development of new technology. The main operational problems currently being faced were related to developing the correct structures, allocating resources, increasing productivity, and ensuring quality control. He agreed that priorities should be set in relation to researc~ which, while not corresponding exactly, should reflect the priorities set for the Eighth General Programme of Work. Dr NAKATANI (Japan) congratulated the Secretariat on the steady progress of research activities in the Region. He supported the comments of previous speakers on the need to improve coordination of research. In Japan, a special ministerial ~ommittee on health research had identified priority areas for future work. He asked for information on the progress made regarding the recommendations of the eleventh session of the Advi~ory Committee. In view of the importance attached by several speakers in previous discussions to
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technology transfer, the Committee might wish to consider adopting a draft resolution endorsing the recommendations of the two meetings on that subject held in 1985 and 1987. The REXHONAL DIRECTOR stated that setting of priorities for health research had been discussed on several occasions and three broad priority areas had been identified: health systems research, biomedical research and behavioural research. Within these areas, specific priority topics would be pinpointed. The meetings of the Advisory Committee were now held every two years, partly for financial reasons and partly to fall in line with the schedule of the global Advisory Committee on Health Research. However, meetings of working groups and sub-committees were convened at regular intervals, which permitted coordinated monitoring of regional health research activities. Experience had indeed shown that establishment of national health research councils did not require enormous resources, and the Secretariat of the Region was in favour of establishing such councils, even in developing countries. As recommended by the Advisory Committee, the report contained in document WPR/ACMR 11/86.4 had been circulated to Member States for comment. The responses would be discussed at the next meeting of the Advisory Committee. Dr MATSUSHIMA (Chief, Research and Parasitic Diseases Control) noted that many priority areas for research had been identified at previous meetings of the Advisory Committee. It was felt that a schedule of one meeting every two years in the future would be adequate. The research promotion and development programme was currently promoting programme-oriented research rather than basic research, so the results could be applied immediately. However, over 200 projects were currently under way and a review of their application was needed. Efforts were being made to strengthen the research capabilities of Member States through various channels, such as research training grants, educational activities, and collaborating centres. Referring to the comments of the representative of Malaysia, he noted that priority areas were currently based on the recommendations of the 1982 meeting of the Advisory Committee. Future meetings of the Committee would review priorities. Emphasis was being given to problem-oriented biomedical research, health systems research and socioeconomic and behavioural research. With regard to the query by the representative of Japan concerning the follow-up to the recommendations made at the eleventh session of the Regional Advisory Committee, the situation was as follows: Recommendation 1: The document in question had been circulated for comments, and would be discussed at the next session of the Advisory Committee.
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Recommendations 3 and 4: New research proposals for WHO support had been processed, and an intercountry workshop on health systems research would be held in Malaysia in December 1987. Recommendation 5: Efforts were being made to identify suitable social scientists, health economists and other experts in operational research. Recommendation 7: A meeting of the Task Force on Hepatitis had been held in Seoul on the possibility of incorporating immunization against hepatitis B in the expanded programme on immunization. Recommendation dealt with. 12: The recommendation was currently being
In reply to the question from the representative of Samoa, he said that a protocol format existed for research proposals, a copy of which would be sent to the representative of Samoa.
Mr TAGUIWALO (Philippines) noted that the discussions had focused on three areas: (i) the setting of research priorities; (ii) utilization of research output; and (iii) the research activities themselves. He believed that appropriate policies could be developed to tackle those three areas together. He requested that consideration be given regarding research funding as a regional rather than a country activity. Thus, research projects should be relevant to more than one country in the Region. Regarding health systems research, he urged that studies be carried out to address three principal aspects - equity, efficiency and effectiveness. That would allow efforts to be focused more effectively.
Dr CHRISTMAS (New Zealand) endorsed the recommendation of the representative of the Philippines that research projects should ideally be of benefit to more than one country. Exceptions might have to be made to that principle when the country concerned had a particularly large population. Perhaps more importantly , it would be useful to have a progress report on how research findings had been utilized. The research policy of WHO should ensure that findings were pragmatic and actually utilized. Dr NAKATANI (Japan), elaborating on his earlier suggestion concerning the transfer of health technology, said that two meetings on that subject had been held in 1985 and 1987, for which both the Regional Director and the participating Member States were to be commended. It was important for countries to develop a strategy and a coordinating mechanism for such transfers, and for the Regional Director to continue his efforts to set up a health technology network that would include nongovernmental organizations. He was prepared to draft a resolution a±ong the~@ :J..ines with th~ h~lp of the Rapporteur.
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Dr DE SOUZA (Australia) supported the proposals of Japan and Malaysia, which were very much in keeping with his own earlier suggestion to appoint liaison officers for technology transfer and to hold a meeting of research coordinators. In the absence of any objections, the CHAIRMAN asked the Rapporteur to draft two resolutions, one along the above lines, and the other on the report as a whole. (For consideration of the draft resolution on technology transfer, see the seventh meeting, section 3.5. For consideration of the draft resolution on development of health research, see the seventh meeting, section 3.4, and the ninth meeting, section 2.1.) 4· CORRELATION OF THE WORK OF THE WORLD HEALTH ASSEMBLY, EXECUTIVE BOARD AND THE REGIONAL COMMITTEE: Item 14 of Agenda THE the
Consideration of resolutions of the Fortieth World HeaJ.th Assembly and the Executive Board at its seventy-ninth and eightieth sessions: Item 14.1 of the Agenda (Document WPR/RC38/9) The REGIONAL DIRECTOR said that document WPR/RC38/9 contained certain resolutions adopted by the Fortieth World Health Assembly and the Executive Board at its seventy-ninth session which were considered to be of significance for the Region. There were other resolutions adopted by the Health Assembly that needed to be brought to the attention of the Committee. However, those were related to other items of the Agenda and would be considered as each item was discussed. 4.1 • 1
Resolution WHA40.18- Collaboration within the United Nations system: General matters - International Year of Shelter for the Homeless
The REGIONAL DIRECTOR said that, as the Committee was aware, housing in fringe and squatter areas lacked basic amenities. Structures were makeshift and inadequate to guard against the elements, and living space was very cramped. That situation was typical among developing Member States. He drew attention to operative par agraph 2. Dr REILLY (Papua New Guinea) said that, over and above urging countries to provide adequate shelter, he felt unsure just what action the Regional Committee was expected to take with respect to operative paragraph 2 of the resolution, which requested the regi onal committees "to initiate the establishment of regional research groups to undertake studies on the i mprovement i n health conditi ons that result from adequate housing". Dr DE SOUZA (Australia) shared that uncertainty. would such a research group do? What precisely
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Dr KHALID (Malaysia) agreed that the Regional Committee lacked the necessary information for action. Housing problems and needs varie so enormously from country to country that it might be wise first to establish what the situation actually was. Dr TAPA (Tonga) said that, although shelter was one of the basic prerequisites for health, millions simply could not afford that necessity. Endorsing the remarks of previous speakers, he proposed that the Region's existing research grqup, the Western Pacific Advisory Committee on Health Research, be requested to submit its recommendations to the Regional Committee.
Mr TAGUIWALO (Philippines) said that, while planning for shelter rarely involved ministries of health, he regretted that poor housing was seldom identified as a risk factor by disease control programmes. His interpretation of the resolution was that the health impact of inadequate shelter needed to be quantified and correlations established between different .kinds of housing and the prevalence of specific diseases. Dr WEINSTEIN (United States of America) and Dr CHRISTMAS (New Zealand) endorsed the suggestion of Tonga that the matter be referred to the Western Pacific Advisory Committee on Health Research, which should be asked to review and clarify the action needed and submit its recommendations to a future session of the Regional Committee. The RIDIONAL DIRECTOR, agreeing with this approach, suggested that it would be logical first to refer the matter for preliminary study to PEPAS.
4.1 .2
Resolution WHA40.25 Collaboration with nongovernmental organizations: Principles governing relations between WHO and nongovernmental organizations
The REGIONAL DIRECTOR said that the previous year the Regional Committee had adopted resolution WPR/RCJ?.R8 urging Member States to promote coordination and develop collaborative activities with nongovernmental organizations. Attention was drawn to section 5 of the Principles attached to resolution WHA40.25, particularly to the footnote clarifying the measures which needed to be taken prior to establishing relations between WHO and a national nongovernmental organization.
4.1 .J
Resolution WHA40.26 - Global strategy for the prevention and control of AIDS
The REGIONAL DIRECTOR drew attention to operative paragraphs 4.5 and ?. Dr DE SOUZA (Australia) suggested that, as there had already been a wide-ranging discussion on AIDS, on which a raft resolution was further to be considered referring to the Health Assembly resolution and covering many of the same points, no mo:r~ discussion under the current item was necessary.
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Australia intended to submit a resolution on AIDS to the forthcoming session of the United Nations General Assembly urging support inter alia for the Health Assembly resolution. Dr REILLY (Papua New Guinea), referring to operative paragraphs 5, 6 and 9(7) and (8), requesting inter alia contributions in cash and kind for the Special Programme on AIDS, stressed the point made in operative paragraph 9(3) that due balance be maintained with other programmes. He hoped that concentration on AIDS would not detract from the fight against other, sometimes more important, diseases and that the resolution of the Committee would emphasize that point. Dr WEINSTEIN (United States of America) said that the discussion could usefully continue when the Regional Committee considered the draft resolution on AIDS prepared that morning. 4.1.4 Resolution WHA40.28- Health of the working population The REGIONAL DIRECTOR drew attention to operative paragraph 2. Dr CHRISTMAS (New Zealand) stressed the particular role of the primary health care worker, who could draw the attention of industrial workers to hazards such as dust, noise and chemicals. WHO also had a responsibility to give technical support and expertise in helping developing countries to improve their skills and services. Resolution WHA40.34 - Diarrhoeal diseases control The 3 and 5. 4.1.6 REGIONAL DIRECTOR drew attention to operative paragraphs
Resolution WHA40.35- Towards the elimination of leprosy The REGIONAL DIRECTOR drew attention to operative paragraph 1.
In the absence of further comments, the CHAIRMAN asked the Rapporteurs to prepare an appropriate draft resolution concerning that item of the agenda. (For consideration of the draft resolution, see the seventh meeting, section 3.6.) 4.2. Consideration of the agenda of the eighty-first session Executive Board: Item 14.2 of the Agenda (Document WPR/RC38/10) of the
The REGIONAL DIRECTOR said that he had reported for several years past on the correlation between the work of the Regional Committee, the Executive Board and its Programme Committee, and the World Health Assembly. At the current session, not only was the Regional Committee once again taking the lead in introducing an issue - communication and health - which it was hoped would lead to discussions in the governing bodies of the Organization, but it was also discussing from a regional point of view issues that would be discussed in the global forums.
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Dr SHIMAO (Japan) said he wished to avail himself of the opportunity offered by that agenda item to comment on the eightieth session of the Executive Board, which he had attended thanks to the confidence shown in his country when it was selected to designate a person to serve on that body. The representative of Japan at the time had promised to reflect the views of Member States of the Region. Five major issues had been debated at the seventy-ninth and eightieth sessions of the Board and the twelfth session (in June 1987) of its Programme Committee, not counting important technical matters such as AIDS: the programme budget; optimal use of WHO's resources; the WHO structure; the election of the Regional Director; and the relations of the Health Assembly, the Executive Board and regional committees. WHO was facing a serious financial crisis due to arrears in the contributions of some Members and the fall in the exchange rate of the United States dollar against the major currencies used by Headquarters and regional offices. At the seventy-ninth session of the Executive Board and the Fortieth World Health Assembly, Japan had proposed that the entire casual income should be used to help finance the programme budget, so that the proposed 31% increase in the assessment would be reduced to some extent, in order to make the WHO budget for 1988-1989 acceptable and affordable to all the Member States. The Secretariat had replied that the use of casual income would create a financial crisis for the Organization, owing to the possible loss through nonpayment of assessed contributions and through the reduced exchange rate for the United States dollar, and finally it had been agreed to mobilize US$25 million from the casual income fund to help finance the first year of the 1988-1989 budget while maintaining programmes, so that assessments in 1988 would be increased by about 20%. The Latin American countries' delegation at the World Health Assembly had claimed that it was hardly possibly for them to increase their contributions to WHO owing to their serious economic difficulties. The proposed budget had finally been approved, and the Japanese delegation had joined others in endorsing the programme budget for 1988-1989, and expressing confidence in the DL~ector-General's explanation that he would propose reductions of US$25 million in 1989 and use another US$24.1 million from casual income if the financial situation improved. Some debate on the 1988-1989 budget in the Programme Committee had been expected, but it had not been discussed. Guidelines for preparation of the programme budget for 1990-1991 had been discussed. From the programme budget 1988-1989, US$25 million would be deducted and, taking into account the inflation adjustment of 10% for the country programme, 8% for regional activities and 6% for Headquarters, the total expenditure would be US$6 089.8 million. The Director-General had explained regional allocations under the budget, based on prevalence of diseases, size of population and social resources, as follows: Africa 30% (currently 27.6%), Americas 10% (15.1%), South-East Asia 25% (18.5), Europe 5% (9.5%), Eastern Mediterranean 15%, and Western Pacific 15% (13.4%).
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The second issue had been the management of WHO resources. At the seventy-ninth session of the Executive Board, some cases of inadequate use of WHO resources had been pointed out. As optimal use of WHO resources would increase trust in the Organization, it was very important to persuade a Member State which did not fulfil its financial obligations in 1986 to do so; the Director-General had been asked to submit a report. That was the background of document EB81/PC/WP/2, which had been included in document WPR/RC38/4 and discussed in the Programme Committee in June, when the following suggestions had been made: (1) regional committees should examine and try to use WHO resources most efficiently in the regional and country programmes according to the health-for-all policy; (2) a certain amount of the budget should be kept for use in country programmes as an incentive to those faithfully following health-for-all policy; (3) an information system should be created to ensure accountability of programmes; (4) auditing should continue; (5) members of the Board should be asked to participate more actively in regional committee sessions; (6) if threequarters of the budget for a certain programme was not used by the end of June of the second year, the remaining amount should go to the casual income fund or be used for another programme faithfully following health-for-all policy. Apart from the not very serious question of fellowships raised during discussion of the Regional Director's report at the current session, in connection with the best use of WHO resources, he felt there was little cause for concern in the Region. Auditing was a necessary exercise and it should continue, with follow-up in the form of guidance in administration to ensure the best use of WHO resources. Otherwise, reduction in assistance to needy countries would only widen the gap between them and more developed countries and the target of health for all would never be reached. The third issue was WHO structure. There seemed to be a general tendency to intensify the control of Headquarters and the Executive Board over regional and country activities, but he thought there were no serious problems in the Western Pacific Region needing stricter control by Headquarters. The fourth issue was the election of Regional Directors. At the seventy-ninth session of the Executive Board, a resolution proposing a change in the method of electing Regional Directors had been submitted, giving the Director-General more power in selecting the candidates. It had been proposed to the Programme Committee that the regional committees should nominate three candidates for consideration by the Board, and that the Director-General should nominate the Regional Director in consultation with the Board, considering the regional priority submitted by the Regional Committee. In the Programme Committee, some Board members had questioned the constitutionality and the necessity of the agreement of regional committees. It had been decided that it would be necessary to change the Rules of Procedure, but that the matter could be decided theoretically by the Board without the consent of the
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Health Assembly or regional committees. The Programme Committee had not endorsed the original plan and, after debate, it had been decided that a search committee in each region should be set up, following a standard criterion developed by the Board, and that the DirectorGeneral should be duly involved in the selection procedure. The fifth issue was the relations of the Health Assembly, the Executive Board and the regional committees. As in the case of election of Regional Directors, the Board was inclined to use more power over the regional committee. Though members of the Board were nominated b,y Member States, they were not representatives of their countries. He wondered whether the Board, consisting as it did of such members, could override the power of a regional committee, which consisted of representatives of governments. Finally, he felt that the Region was underrepresented in bodies of the Health Assembly; for example, the total number of General Committee members was 24 (14% of the total 166 Member States), of which six were from Africa (14%), five from the Americas (15%), two from South-East Asia (18%), five from Europe (15%), four from the Eastern Mediterranean (19%), and only two from the Western Pacific (10%). WHO Headquarters should be urged to increase that proportion and also correct any underrepresentation on the Committee on Nominations. Dr REILLY (Papua New Guinea) welcomed the comments of the representative of Japan. It was an initiative which he felt should be continued. Dr CHRISTMAS (New Zealand) agreed, saying that a detailed report on the proceedings of the Executive Board was very useful. In particular, an important issue that had been raised was the functioning of the Board when its members were appointed as individual experts, not as representatives of their governments; it might mean that, when the Regional Committee came to discuss agenda item 9, its role might have to be reconsidered and strengthened. Dr KHALID (Malaysia) wondered whether the initiative of the representative of Japan could be institutionalized, with a regular report by a member of the Executive Board to the Regional Committee prepared as a document for future sessions. Dr DE SOUZA (Australia) remarked that, while some form of reporting on the Executive Board's discussions would be useful to the Committee, it must be remembered, as had been pointed out by the representative of New Zealand, that members of the Board functioned in their personal capacity and not as representatives of a country or a region. The Legal Counsel should be asked to pronounce on whether formal reporting to the Committee would be constitutional. Dr SUNG WOO LEE (Republic of Korea) fully supported the Japanese representative's suggestion that the number of members of the Committee on Nominations and the General Committee be raised from 24 to 25.
SUMMARY RECORD OF THE FIFTH MEETING
151
Dr LARIVIERE (Observer), while agreeing that the statement by the representative of Japan on recent activities of the Board had been excellent, said that future reports to the Committee from Board members should perhaps be careful to separate purely factual material on the Board's activities from any purely personal opinions the speaker might hold or comments concerning the Board's intentions. In his report the representative of Japan had expressed certain opinions held by himself or his Government regarding the activities of the Programme Committee or the Board but those op~n~ons were not necessarily shared by those bodies themselves. For instance, it might appear to the Committee (and to other regional committees) from the report they had heard that the Board was attempting to put the regions under some sort of tutelage. That was not a fact. The evolution of budgetary and financial practices over the years had removed much expenditure out of the orbit of the Board and the Health Assembly and the intention had been to try to share information on such expenditures and play a more collaborative role. Dr SHIMAO (Japan) thanked the representatives for their interest in his report and assured the member of the Executive Board that in future there would be a careful separation of facts from opinions. Dr TAPA (Tonga) noted from document WPR/RC38/10, Annex 1, that four important items under consideration at the present session of the Regional Committee were also on the draft provisional agenda of the eighty-first session of the Executive Board, to be held in January 1988. He thought that the type of report on Executive Board activities which they had just listened to could be institutionalized, provided that the Executive Board member's suggestions were taken into account. The three regional representatives should take it in turn to write such a report.
Mr TAGUIWALO (Philippines) expressed his delegation's serious reservations about institutionalizing and formalizing a report by an Executive Board member to the Regional Committee. The deliberations and decisions of the Executive Board as a governing body of WHO were a matter of official record and could be used by the Committee as a basis for its discussions. In addition, all Board decisions affecting the regional committees were communicated through official channels. If an Executive Board member from the Region was asked to report formally to the Committee on what had happened at the Board, his version might conflict with what was set out in the Official Records and would have to be disregarded. Moreover, the statements by the three members from the Region on the nature of the deliberations and the background of the debate might also vary and thus create a further problem. To take up what had been said by the member of the Executive Board, the factual record of the deliberations need not be a matter of debate. Information on the background to the Board's proceedings, however, would always be useful to Member States. Dr VIGNES (Legal Counsel) felt it his duty as the Organization's legal adviser to intervene with all possible firmness in regard to certain proposals put forward in the discussion. It seemed to him
152
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impossible, for constitutional reasons, to institutionalize the presentation to the Regional Committee of a formal written report on the activities of the Executive Board by the representative of a Member State which had designated a member of the Executive Board. Members of the Executive Board acted in their personal capacity. They did not represent their governments. It was constitutionally impossible, therefore, for a person speaking in the Regional represented his government, to present Committee, where he officially his views as a member of the Executive Board, where he acted in a purely personal capacity. Dr KHALID (Malaysia) thought that the need for the Regional Committee and the Executive Board to have some sort of link, or at least to understand each other, was unquestionable. It was true that decisions of the Executive Board in the form of resolutions were available to Member States but the reasoning that led to their adoption was sometimes more significant than the decisions themselves. The proceedings of the Board were also available but formed a bulky volume which many did not have the time to read. If somebody summarized those proceedings for them, it might provide a more direct impression of the discussions that had occurred. They should try to decide whether the necessary link could be provided by someone from the Region who was a member of the Executive Board but came to the Committee in that capacity only and not as a representative of his country or by a person designated by the Executive Board but not necessarily from the Region. Dr WEINSTEIN (United States of America) said that the Legal Counsel's statement had made the dilemma very clear. As had been said, the discussions that led to a decision and the background to it were very valuable. Accordingly what the Committee was probably looking for was a member of the Executive Board who was not a member of the Committee to report to it and to be available to provide further information and clarification when required. Dr CHRISTMAS (New Zealand) agreed with the two previous speakers that better communications were required between the Executive Board as a global boqy and the Region. What was needed was an Executive Board liaison officer who would come regularly to the Regional Committee for the Western Pacific (and possibly to other regional committees too) to describe the background to the deliberations of the Executive Board. Such an arrangement should eliminate possible misconceptions of the Board's intentions, while at the same time enabling the Regional Committee to make known to the Board the Region's particular needs and concerns.
Mr TAGUIWALO (Philippines) said that it was his understanding that the Executive Board acted as a collective body when it took decisions and that individual Board members had no official standing beyond participating in the taking of those decisions. The Committee should examine the Board's decisions to see how they would affect the Region. The question of intentions had at that stage already become irrelevant. He believed that the consensus was that someone should come to the Regional Committee and provide them with an official background to the Board's decisions.
SUMMARY RECORD OF THE FIFTH MEETING
153/154
Dr DE SOUZA (Australia) endorsed the remarks by the representative of the Philippines. They must make sure, however, that any report submitted by a Board member did not include the reports of standing committees and sub-committees of the Executive Board, since they contained proposals that had not yet been ratified. The CHAIRMAN said a decision was needed on the proposal to request a member of the Executive Board to report to the Committee on the Board's activities. Dr KHALID (Malaysia) suggested deferring a decision until item 9 of the agenda had been discussed. Dr CHRISTMAS (New Zealand) endorsed that proposal.
Mr TAGUIWALO (Philippines) enquired whether discussions of the main agenda item, viz. Correlation of the work of the World Health Assembly, the Executive Board and the Regional Committee, had been concluded. Dr WEINSTEIN (United States of America) thought that correlation had been dealt with to the satisfaction of the Committee. What remained to be decided was whether to defer a decision on the question of a report to the Regional Committee on the activities of the Executive Board until the discussion on agenda item 9. Dr NAKATANI (Japan) said that his delegation wished to put forward a resolution proposing a change in the Rules of Procedure to allow an increase in the membership of the Committee on Nominations and the General Committee of the World Health Assembly from 24 to 25, thus making it possible to increase the number of representatives of the Region from two to three. Dr WEINSTEIN (United States of America) thought that better proportional representation of the Region might be attainable in other ways. There should be a discussion of the point under an appropriate item of the agenda. Dr DE SOUZA (Australia) agreed with the previous speaker that more discussion was required before the Committee made a specific proposal.
The meeting rose at 12.15 p.m.