Fifty-fourth World Health Assembly, Geneva, 14-22 May 2001: verbatim records of plenary meetings and list of participants = Cinquante-quatrième Assemblée mondiale de la Santé, Genève, 14-22 mai 2001 : comptes rendus in extenso des séances plénières et liste des participants

WHA54/2001/REC/2

FIFTY-FOURTH WORLD HEALTH ASSEMBLY Geneva, 14-22 May 2001

Verbatim records of plenary meetings and list of participants

CINQUANTE-QUATRIEME ASSEMBLEE MONDIALE DE LA SANTE Geneve, 14-22 mai 2001

Comptes rendus in extenso des seances plenieres et liste des participants

A54fVEU9,page144

Please replace with the attached page.

CORRIGENDUM RECTIF ACTIF

Veuillez la remplacer par la page ci-jointe.

A54NR/9 page 144

NINTH PLENARY MEETING

Tuesday, 22 May 2001, at 11:30

President: Dr HONG Sun Huot (Cambodia)

NEUVIEME SEANCE PLENIERE

Mardi 22 mai 2001, llh30

President: Dr HONG Sun Huot (Cambodge)

1. REPORTS OF THE MAIN COMMITTEES' (continued) RAPPORTS DES COMMISSIONS PRINCIPALES1 (suite)

Le PRESIDENT :

La seance est ouverte. Apres de longues journees de travail, nous sommes arrives aujourd'hui a la neuvieme seance pleniere, qui est la derniere seance prevue dans notre programme de travail.

Nous allons poursuivre l'examen des rapports des commissions principales. Nous commencerons par le deuxieme rapport de la Commission B, tel qu'il figure dans le document A54/52. Veuillez ne pas tenir compte de la mention « projet » puisque le rapport a ete adopte par la Commission sans amendement. Ce rapport contient quatre resolutions. La premiere est intitulee « Situation sanitaire de la population arabe dans les territoires arabes occupes, y compris la Palestine, et assistance sanitaire a cette population ».

L' Assemblee souhaite-t-elle adopter cette resolution? Je ne vois pas d'objection, la resolution est adoptee.

Le delegue d'Israel veut prendre la parole.

Mr W AXMAN (Israel):

Thank you Mr Chairman. Israel has voted against this resolution of Committee B because we feel it is political in nature and will not contribute to the well-being of the people in our area. Thank you, Mr Chairman.

Le PRESIDENT :

Merci. Y a-t-il d'autres interventions? Je donne la parole a l'observateur de la Palestine.

Dr T ARA WIYEH (Palestine):

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WHA54/2001/REC/2

WORLD HEALTH ORGANIZATION ORGANISATION MONDIALE DE LA SANTE

FIFTY-FOURTH WORLD HEALTH ASSEMBLY

GENEVA, 14-22 MAY 2001

VERBATIM RECORDS

OF PLENARY MEETINGS

AND LIST OF PARTICIPANTS

' CINQUANTE-QUATRIEME ASSEMBLEE MONDIALE ,

DELASANTE GENEVE, 14-22 MAl 2001

COMPTES RENDUS IN EXTENSO DES SEANCES PLENIERES

ET LISTE DES PARTICIPANTS

GENEVA GENEVE

2002

WHA54/200 1/REC/2

WORLD HEALTH ORGANIZATION ORGANISATION MONDIALE DE LA SANTE

FIFTY-FOURTH WORLD HEALTH ASSEMBLY

GENEVA, 14-22 MAY 2001

VERBATIM RECORDS

OF PLENARY MEETINGS AND LIST OF PARTICIPANTS

' CINQUANTE-QUATRIEME ASSEMBLEE MONDIALE ,

DELASANTE GENEVE, 14-22 MAl 2001

COMPTES RENDUS IN EXTENSO DES SEANCES PLENIERES

ET LISTE DES PARTICIPANTS

GENEVA GENEVE

2002

PREFACE

The Fifty-fourth World Health Assembly was held at the Palais des Nations, Geneva, from 14 to 22 May 2001, in accordance with the decision of the Executive Board at its 1 06th session. Its proceedings are issued in three volumes, containing, in addition to other relevant material:

Resolutions and decisions- document WHA54/2001/REC/l

Verbatim records of plenary meetings and list of participants - document WHA54/200 1/REC/2

Summary records of committees and ministerial round tables, reports of committees - document WHA54/200 1/REC/3

For a list of abbreviations used in these volumes, the officers of the Health Assembly and membership of its committees, the agenda and the list of documents for the session, see preliminary pages of document WHA54/200 1/REC/1.

In these verbatim records, speeches delivered in Arabic, Chinese, English, French, Russian or Spanish are reproduced in the language used by the speaker; speeches delivered in other languages are given in the English or French interpretation. The texts include corrections received up to end July 2001, the cut-off date announced in the provisional version, and are thus regarded as final.

AVANT-PROPOS

La Cinquante-Quatrieme Assemblee mondiale de la Sante s'est tenue au Palais des Nations a Geneve du 14 au 22 mai 2001, conformement a la decision adoptee par le Conseil executif a sa cent sixieme session. Ses actes paraissent dans trois volumes contenant notamment :

les resolutions et decisions -document WHA54/200 1/REC/1,

les comptes rendus in extenso des seances plenieres et la liste des participants - document WHA54/200 1/REC/2,

les proces-verbaux des commtsstons et des tables rondes ministerielles et les rapports des commissions- document WHA54/2001/REC/3.

On trouvera dans les pages preliminaires du document WHA54/2001/REC/1 une liste des abreviations employees dans la documentation de l'OMS, l'ordre du jour et la liste des documents de la session ainsi que la presidence et le secretariat de 1' Assembtee de la Sante et la composition de ses commissions.

Les presents comptes rend us in extenso reproduisent dans la langue utilisee par 1 'orateur les discours prononces en anglais, arabe, chinois, espagnol, fran~ais ou russe, et dans leur interpretation anglaise ou franc;aise les discours prononces dans d 'autres langues. Ces comptes rend us comprennent les rectifications rec;ues jusqu' a la fin juillet 2001, date limite annoncee clans leur version provisoire, et sont done consideres comme finals.

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INTRODUCCION

La 543 Asamblea Mundial de la Salud se celebro en el Palais des Nations, Ginebra, del 14 al22 de mayo de 2001, de acuerdo con la decision adoptada por el Consejo Ejecutivo en su 1063 reunion. Sus debates se publican en tres volumenes que contienen, entre otras cosas, el material siguiente:

Resoluciones y decisiones, y anexos: documento WHA54/200 1/REC/1

Aetas taquignificas de las sesiones plenarias y lista de participantes: documento WHA54/200 1 /REC/2

Aetas resumidas de las comisiones y de !as mesas redondas ministeriales e informes de las comisio-nes: documento WHA54/200 1/REC/3.

En las paginas preliminares del documento WHA54/2001/REC/1 figuran una lista de las siglas empleadas en estos volumenes, la composicion de la Mesa de la Asamblea y de sus comisiones, el orden del dia, y la lista de documentos de la reunion.

En las presentes aetas taquigraficas Ios discursos pronunciados en arabe, chino, espafiol, frances, ingles o ruso se reproducen en el idioma utilizado por el orador. De Ios pronunciados en otros idiomas se reproduce la interpretacion al frances o al ingles. Las aetas contienen las correcciones recibidas hasta el final de julio de 2001, fee ha limite anunciada en la version provisional, y por consiguiente se consideran definitivas.

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-V-

CONTENTS

Page

Preface . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii

VERBATIM RECORDS OF PLENARY MEETINGS

First plenary meeting

1. 2. 3.

4. 5. 6. 7. 8.

Opening of the session ......................................................................................................... . Address by the representative of the Secretary-General of the United Nations ................... . Address by the representative of the Conseil d'Etat of the Republic and Canton of Geneva .................................................................................................................................. . Address by the President of the Fifty-third World Health Assembly ................................... . Appointment of the Committee on Credentials .................................................................... . Election of the Committee on Nominations ......................................................................... . First report of the Committee on Nominations ..................................................................... . Second report of the Committee on Nominations ................................................................ .

Second plenary meeting

1 2

4 5 7 7 7 8

1. Presidential address . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . .. . . . . . . . . . .. . . . . . . .. . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . .. . 11 2. Adoption ofthe agenda and allocation of items to the main committees.............................. 12 3. Announcements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . .. . . . . . . . . . . . . . . . .. ... .. . . .. . . . . . . . . . . . . . . . . . . .. .. .. . . .. . . . . .. . . . . . . . .. . 18 4. Reports of the Executive Board on its 1 06th and 1 07th sessions .. ............. .................... ....... 19 5. Report by the Director-General............................................................................................. 20 6. Invited speaker....................................................................................................................... 30

Third plenary meeting

Report by the Director-General (continued).......................................................................... 39

Fourth plenary meeting

1. 2.

First report of the Committee on Credentials ....................................................................... . Report by the Director-General (continued) ......................................................................... .

Fifth plenary meeting

74 74

Report by the Director-General (continued).......................................................................... 103

Special plenary meeting

Visit ofMr Kofi Annan, Secretary-General of the United Nations....................................... 122

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Page

Sixth plenary meeting

Awards.................................................................................................................................. 127 Presentation of the Leon Bernard Foundation Prize........................................................ 127 Presentation of the Jacques Parisot Foundation Medal.................................................... 128 Presentation of the Ihsan Dogramaci Family Health Foundation Prize........................... 130 Presentation of the Sasakawa Health Prize...................................................................... 131 Presentation of the United Arab Emirates Health Foundation Prize............................... 134 Francesco Pocchiari Fellowship...................................................................................... 138

Seventh plenary meeting

1. Executive Board: election..................................................................................................... 140 2. First report of Committee A.................................................................................................. 141 3. Second report of Committee A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141

Eighth plenary meeting

1. Second report of the Committee on Credentials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 2 2. Reports ofthe main committees........................................................................................... 142

Ninth plenary meeting

1. Reports of the main committees (continued) .. .. ... .. . .. ......... .. .. .. .. . ..... ... .. ... ...... .. ...... .... ... ... .. ... 144 2. Selection of the country in which the Fifty-fifth World Health Assembly will be held....... 14 7 3. Closure of the session........................................................................................................... 147

MEMBERSHIP OF THE HEALTH ASSEMBLY

List of delegates and other participants........................................................................................... 15 5 Representatives ofthe Executive Board.......................................................................................... 231

Indexes (names of speakers; countries and organizations)............................................................. 233

- Vlll -

TABLE DES MATIERES

Pages

Avant-propos..................................................................................................................................... 111

COMPTES RENDUS IN EXTENSO DES SEANCES PLENIERES

Premiere seance pleniere

1. 2. 3. 4. 5. 6. 7. 8.

Ouverture de la session .......................................................................................................... . Allocution du representant du Secretaire general de !'Organisation des Nations Unies ....... . Allocution du representant du Conseil d'Etat de la Republique et Canton de Geneve ......... . Allocution du President de la Cinquante-Troisieme Assemblee mondiale de la Sante ......... . Constitution de la Commission de Verification des Pouvoirs ............................................... . Election de la Commission des Designations ........................................................................ . Premier rapport de la Commission des Designations ............................................................ . Deuxieme rapport de la Commission des Designations ........................................................ .

Deuxieme seance pleniere

1. 2. 3. 4. 5. 6.

Discours du President del' Assemblee ................................................................................... . Adoption de l'ordre dujour et repartition des points entre les commissions principales ...... . Communications .................................................................................................................... . Rapports du Conseil executif sur ses cent sixieme et cent septieme sessions ....................... . Rapport du Directeur general ................................................................................................. . Intervenants invites ................................................................................................................ .

Troisieme seance pleniere

2 4 5 7 7 7 8

11 12 18 19 20 30

Rapport du Directeur general (suite)...................................................................................... 39

Quatrieme seance pleniere

1. 2.

Premier rapport de la Commission de Verification des Pouvoirs .......................................... . Rapport du Directeur general (suite) ..................................................................................... .

Cinquieme seance pleniere

74 74

Rapport du Directeur general (suite) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 03

Seance pleniere speciale

Visite de M. Kofi Annan, Secretaire general de !'Organisation des Nations Unies............... 122

- ix-

Pages

Sixieme seance pleniere

Distinctions............................................................................................................................. 127 Remise du Prix de la Fondation Leon Bernard............................................................. 127 Remise de la Medaille de la Fondation Jacques Parisot ............................................... 128 Remise du Prix de la Fondation Ihsan Dogramaci pour la Sante de la Famille............ 130 Remise du Prix Sasakawa pour la Sante............... .. . . . . .. . .. . . . . . . . . . .. .. . . . . . . . . . . . . . . . . . . . .. . . . . . . . .. . . 131 Remise du Prix de la Fondation des Emirats arabes unis pour la Sante ....................... 134 Bourse Francesco Pocchiari.......................................................................................... 138

Septieme seance pleniere

1. 2. 3.

Conseil executif: election ...................................................................................................... . Premier rapport de la Commission A ..................................................................................... . Deuxieme rapport de la Commission A ................................................................................. .

Huitieme seance pleniere

140 141 141

1. Deuxieme rapport de la Commission de Verification des Pouvoirs ........ .......................... ..... 142 2. Rapports des commissions principales . .......... ...... ......... ..... ............................ .. .... ............. ..... 142

Neuvieme seance pleniere

1. Rapports des commissions principales (suite) ............. ... .. ... ... ... ... ...... .. ... ..... .. .. ........ .............. 144 2. Choix du pays ou se tiendra la Cinquante-Cinquieme Assembtee mondiale de la Sante .. ..... 14 7 3. Cl<)ture de la session............................................................................................................... 147

COMPOSITION DEL' ASSEMBLEE DE LA SANTE

Liste des delegues et autres participants ........................................................................................... 155 Representants du Conseil executif.................................................................................................... 231

Index (noms des orateurs; pays et organisations)............................................................................ 233

-X-

VERBATIM RECORDS OF PLENARY MEETINGS

COMPTES RENDUS IN EXTENSO DES SEANCES PLENIERES

FIRST PLENARY MEETING

Monday, 14 May 2001, at 10:00

President: Dr L. AMATHILA (Namibia) later: Dr HONG Sun Huot (Cambodia)

PREMIERE SEANCE PLENIERE

Lundi 14 mai 2001, 10 heures

President: Dr L. AMA THILA (Namibie) puis: Dr HONG Sun Huot (Cambodge)

1. OPENING OF mE SESSION OUVERTURE DE LA SESSION

The PRESIDENT:

A54NR/1 page I

The Assembly is called to order. Distinguished delegates, ladies and gentlemen, as President of the Fifty-third World Health Assembly, I have the honour to open the Fifty-fourth World Health Assembly.

I now have pleasure in welcoming on behalf of the Assembly and the World Health Organization, our special guests: Ms Danuta HUhner, Executive Secretary, Economic Commission for Europe, United Nations, representing the Secretary-General of the United Nations; Mr Guy-Olivier Segond, Councillor of State, Head of the Department of Social Action and Health of the Republic and Canton of Geneva; Mr Jean-Luc Chopard, Head of Protocol of the Republic and Canton of Geneva; Mr Alain Vaissade, Mayor of the City of Geneva; Mr Bernard Paillard, President of the Municipal Council of the City of Geneva; Mr Franc;ois Nordmann, Ambassador, Permanent Representative of Switzerland to the International Organizations at Geneva and Permanent Observer to the United Nations; Miss Karen Lee, Councillor, Special Council to the Director-General of the World Intellectual Property Organization; Mr Jakob Kellenberger, President of the International Committee ofthe Red Cross; and Mr Alvaro Bermejo, representing the International Federation of Red Cross and Red Crescent Societies; the representatives of the United Nations specialized agencies; the representatives of the various United Nations bodies, and the delegates of Member States.

I also welcome the observer from a non-Member State, the observers from the Order of Malta, the International Committee of the Red Cross, the International Federation of Red Cross and Red

A54NR/1 page 2

Crescent Societies, and from Palestine; and the representatives of intergovernmental and nongovernmental organizations in official relations with WHO. I also welcome the representatives of the Executive Board.

2. ADDRESS BY THE REPRESENTATIVE OF THE SECRETARY-GENERAL OF THE UNITED NATIONS ALLOCUTION DU REPRESENT ANT DU SECRETAIRE-GENERAL DES NATIONS UNIES

The PRESIDENT:

It is now my honour to give the floor to Ms Hiibner, representing the Secretary-General of the United Nations.

Ms HUBNER (Executive Secretary of the Economic Commission for Europe, representing the Secretary-General of the United Nations):

Madam President, Madam Director-General, Excellencies, ladies and gentlemen, it is a great pleasure and honour for me to address this distinguished Assembly of the World Health Organization and to convey to you the good wishes of the Secretary-General, Mr Kofi Annan, for the success in your deliberations.

At the dawn of the twenty-first century, the world has seen a transformation in human health unmatched in history, especially during the past decade, which has been a time of significant change. A number of communicable diseases have been eradicated or brought under control. Life expectancy has been considerably increased and quality of life greatly improved for a large number of people. However, it is saddening to note that more than one thousand million people have been excluded from the benefits of economic development and scientific advances. They continue to suffer from diseases where the tools for their control and effective treatment are available, but are neither accessible nor affordable to them.

For humankind, there is a long way to go to attain the goal of health for all. The health situation in many parts of the world is cause for concern. The globalization of infectious diseases is such that an outbreak in one country is potentially a concern for the whole world. This is due to increased population movement, growth in international trade and biological products, changes in methods of food processing, social and env~mnmental changes. New diseases, such as AIDS and Ebola are emerging, while some such as malaria or tuberculosis, are re-emerging with a vengeance. In fact we increasingly see forms of tuberculosis that resist to all but a combination of very expensive drugs.

Since the end of the cold war, the international community has been facing major challenges. It is important to understand that various elements that contribute to sustainable peace and security must be addressed in a comprehensive way. The concept of human security has been widened to include health, and, in particular, such issues as HIV/AIDS. Good health is a key component of human security and the basis for human development. Never before has a health issue, namely HIV/AIDS in Africa, been discussed by the Security Council of the United Nations. Health has been a central theme of the special session ofthe United Nations General Assembly on Social Development and then at the Millennium Summit. Heads of State have been calling for action to improve health outcome, to contain the global public health threat of emerging infectious diseases, epidemics and drug-resistant infectious agents, and so to contribute to human and national security.

Significant in this respect is WHO's collaboration with UNAIDS and its cosponsors, as well as with the United Nations Secretariat, in preparation for the special session of the United Nations General Assembly on HIV I AIDS to be held in June 2001. WHO has contributed by undertaking to explore new options for people's access to better care, including access to antiretroviral medication. Efforts were made to encourage effective health system action to prevent infection, reduce vulnerability and ensure that infected people can have the appropriate support they need. For the

A54NR/1 page 3

United Nations part, the Secretary-General addressing the African summit on HIV/AIDS on 26 April this year, proposed the creation of a global fund, dedicated to the battle against HIV I AIDS and other infectious diseases. This fund must be structured in such a way as to ensure that it responds to the needs of the affected countries and people, and it must be able to count on the advice of the best experts in the world.

At present, the Third United Nations Conference on Least Developed Countries is taking place in Brussels. The main objective of the Conference is to consider the formulation and adoption of appropriate national and international policies for sustainable development and the progressive integration ofthese countries into the world economy. As a contribution to the conference WHO will organize a meeting related to health service delivery. The deliberations reflect the range of health inputs to development so as to provide a useful mechanism to reach interagency agreement on future activities aimed at strengthening the health dimensions of policies and programmes in least developed countries.

In this spirit, let me draw your attention to the 1.5 billion people who live in extreme poverty, perpetuated by ill health. Dreadful diseases are compounded by poverty and they lead to poverty. Poverty and its causes need to be seriously addressed in order to reduce effectively the burden of illness. At the same time, improving people's health also means enabling them to provide for their own and their families' basic needs, as well as for their children's education, thus breaking the vicious circle of poverty. It is significant that the World Summit for Social Development (Copenhagen, 1995) preferred the word "eradication" to "alleviation" because it regarded the prevalence and growth of poverty as totally "unacceptable" and wanted the international community to make an effort to erase this scourge by attacking its root causes, and not just by providing relief to those who live in poverty.

To move closer to the goal of health for all, WHO needs new and enlarged partnerships for health based on equity, solidarity and respect. This applies to a considerable increase in resources for health, particularly within poor countries. In this context, I cannot but indicate a resolution on global partnerships, approved by the fifty-fifth session of the United Nations General Assembly, which reaffirms the central role of the United Nations system in promoting partnerships in the context of globalization. It stresses the need for Member States to further discuss cooperation with the private sector and other actors.

Today, ministers of health in many countries are increasingly working with the private sector, especially the private not-for-profit sector, in order to build up capacity for service provision and to improve access to care. To maximize the contribution of various health-care providers key capacities need to be developed and strengthened. Governments should have the capacity to articulate a clear policy for working with the non-public sector in order to undertake stewardship of the health sector, including negotiation and agreement on roles and responsibilities, enforcement of agreed terms, and evaluation of effectiveness. Real global and equitable partnerships would come about if pharmaceutical companies were to develop cures for diseases that mainly affect poor citizens in the developing world, even though there would be less profit for them.

What appears commendable in WHO's activities is its role in humanitarian response. Taking into account that in today's wars, 95% of the victims are civilians, because the difference between soldiers and civilians is disappearing, relief measures cannot be overestimated. Population displacement, water and food insecurity, and the collapse of basic health services compound the severe public health consequences of armed conflicts, and enforce WHO intervention in complex emergency situations.

Against this background, I am pleased to recognize that Dr Brundtland, Director-General of WHO, and her dedicated staff have given the highest priority to saving numerous lives during humanitarian relief in Kosovo, Mozambique, East Timor, Turkey. Health workers and their ministers have found that a focus on health in complex emergencies and during conflict can help bring together communities that are divided by conflict, serving as a bridge for peace and reconciliation.

The challenge for the international community today is to make sure that people, especially in developing countries, benefit from modem science and technology in coping with a range of complex emergency situations. There is a need to help the world move forward from "digital divide" to "digital bridge". The use of modem technologies is considered as a part of the new initiative that the Secretary-General of the United Nations announced in his Millennium Report. In particular, he

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stressed that communications satellites would be useful for the Health InterNetwork to establish 10 000 on-line health information centres at hospitals and clinics in the developing world.

Looking ahead, we must never lose sight of one immediate conclusion: that WHO continues to operate in an increasingly complex environment. The health agenda before the Organization is considerably heavy and requires allocation of substantial financial, logistic and human resources, which are commensurable with its magnitude. It is encouraging to note that WHO tries to redouble its efforts to cope with major challenges. Bearing this in mind, I think we should express our gratitude to the Director-General for her enthusiasm and initiative to put forward the WHO corporate strategy aimed at reducing excess mortality and disability, developing national health systems, and putting health at the centre of economic and development policy. Let this Assembly assist the health community in translating international commitments into practical actions. I thank you for your kind attention.

The PRESIDENT:

Thank you, Ms Huhner.

3. ADDRESS BY THE REPRESENTATIVE OF THE CONSEIL D'ETAT OF THE REPUBLIC AND CANTON OF GENEVA ALLOCUTION DU REPRESENTANT DU CONSEIL D'ETAT DE LA REPUBLIQUE ET CANTON DE GENEVE

The PRESIDENT:

I now give the floor to Mr Guy-Olivier Segond, Councillor of State, Department of Social Action and Health of the Republic and Canton of Geneva.

M. SEGOND (representant du Conseil d'Etat de la Republique et Canton de Geneve):

Madame la Presidente, Madame la Directrice generale, Mesdames et Messieurs les delegues, Excellences, Mesdames et Messieurs, a l'occasion de l'ouverture de la Cinquante-Quatrieme Assemblee mondiale de la Sante, j'ai le plaisir et l'honneur de vous souhaiter, au nom des autorites suisses et des autorites genevoises, representees par M. Alain Vaissade, Maire de Geneve, la bienvenue dans notre ville et dans notre pays.

Au cours du :xxe siecle, depuis la fondation de l'ONU et de l'OMS, le monde a bien change politiquement, economiquement et socialement. Apres !'effort de reconstruction qui a suivi la Seconde Guerre mondiale, apres les luttes de liberation nationale et apres l'independance de nombreux nouveaux Etats, la rivalite Est-Ouest a ete progressivement remplacee par la dynamique Nord-Sud. La globalisation de tous les problemes a bouleverse le cours ordinaire des choses et, grace au prodigieux developpement des nouvelles technologies de la communication, le monde est devenu un.

Chacun le sait et chacun le voit, ces dernieres annees, de formidables forces de changement sont nees. Les attitudes politiques et culturelles a l'egard de l'Etat se sont profondement modifiees. D'importants problemes demographiques et sociaux lies aux migrations, au vieillissement et a l'exclusion se sont developpes et, partout dans le monde, il y a des mouvements amples et puissants en faveur d'une reforme des systemes de sante.

Au cours du XXe siecle, I'OMS a pris sa part de ces grands changements mondiaux, notamment en conduisant le passage d'un systeme de sante centralise privilegiant la pathologie urbaine a une pratique communautaire de soins de sante primaires. Les resultats sont la : les taux de mortalite infantile ont baisse dans la piu part des pays, I' esperance de vie a la naissance a augmente regulierement et la sante de la plus grande partie de la population mondiale s'est amelioree durant les 50 dernieres annees. C'est clairement un veritable succes.

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Pourtant, si des progres remarquables ont ete accomplis sur le plan de la sante physique, il n'en est malheureusement pas de meme sur le plan de la sante mentale et, aujourd'hui, au debut du xxr siecle, les problemes de sante mentale representent une des plus importantes causes de maladie et d'incapacite. Ces problemes, souvent aggraves par les guerres, les deplacements de population, les violations des droits fondamentaux, !'exclusion sociale ou la pauvrete, touchent environ 400 millions d'habitants de la planete. Ces 400 millions de personnes souffrent de troubles mentaux, de troubles neurologiques ou de troubles psychosociaux lies a l'alcoolisme ou a la toxicomanie. Elles souffrent dans le silence et dans la solitude et, au-dela de leur souffrance, au-dela de leur solitude, il y a le manque de soins, les prejuges, la honte, I' exclusion et, trop souvent, la mort choisie.

Pourtant, nous avons les connaissances et les moyens d'aider ces millions de personnes a moins souffrir en mettant sur un pied d'egalite sante physique et sante mentale, comme le rappelle d'ailleurs la Constitution de l'OMS. C'est pourquoi le Rapport sur la sante dans le monde, 2001 est consacre a la sante mentale et c'est pourquoi la sante mentale, qui est inscrite a l'ordre du jour des tables rondes ministerielles, occupera une part importante des debats de cette Cinquante-Quatrieme Assemblee mondiale de la Sante.

Un dernier mot pour conclure. Je suis personnellement convaincu que l'OMS peut -et doit­ rappeler aux chefs d'Etat et aux chefs de gouvernement qu'ils soot eux-memes des ministres de la sante. En accordant plus de moyens aux politiques de sante, en mettant sur un pied d'egalite sante physique et sante mentale, ils obtiendront une amelioration de la qualite de la vie des populations et ils constateront une amelioration de la productivite, ce qui permettra de s'attaquer a l'une des causes fondamentales de la pauvrete.

Ainsi, par un plaidoyer ferme et efficace a l'echelle mondiale, l'OMS, sous la direction determinee du Dr Gro Harlem Brundtland, atteindra au debut du XXIe siecle l'objectif d'une meilleure sante, physique et mentale, pour tous entrainant un vrai changement de la qualite de la vie des habitants du monde entier. Je vous remercie.

The PRESIDENT:

Thank you, Mr Segond.

4. ADDRESS BY THE PRESIDENT OF THE FIFTY-THIRD WORLD HEALTH ASSEMBLY ALLOCUTION DU PRESIDENT DE LA CINQUANTE-TROISIEME ASSEMBLEE MONDIALE DE LA SANTE

The PRESIDENT:

Madam Director-General, Excellencies, distinguished delegates, ladies and gentlemen, it is my distinct honour to address the Fifty-fourth Health Assembly. I was privileged to serve as President of the Fifty-third World Health Assembly. This is an honour to my country, Namibia, and to Africa as a whole. I am leaving the mantle of the presidency of the Health Assembly. I have the conviction that the trust you bestowed in me has not been misplaced.

As in previous Health Assemblies, we are called upon to marshal our collective wisdom to find appropriate solutions to the present health problems. We all know that some key determinants of health problems lie outside the health sector. The socioeconomic situation in the world today is not better than in previous years. There are pockets of war and civil unrest in many parts of the world which result in injury and death. Wars create refugees with a resultant disintegration of social structure and the emergence of preventable diseases, especially HIV I AIDS, tuberculosis and diarrhoea! diseases. The disproportionate distribution of wealth has created poverty which in turn results in preventable diseases, as poor people resort to risky survival strategies. The abundance of ignorance results in disempowerment of individuals and undermines their basic human rights.

A54NR/1 page 6

During the last Health Assembly, we examined modalities for improving the performance of health systems. It is a reality that access to basic health care remained a dream to the majority of inhabitants of our planet. This takes many forms: absence of health infrastructure, inaccessibility of essential drugs, or even unaffordability of health services.

This year, the Health Assembly's attention is drawn to a very important aspect of mental health. This was also the theme of this year's World Health Day. I have also noted with satisfaction that mental health was chosen as the theme for the round tables. Distinguished delegates, mental disorders are a major health problem in the world. It is now known from scientific evidence in different parts of the world that between 2% to 3% of any population group at any given time suffers from serious mental illnesses or disorders. Common but less serious mental illnesses occur in 20% to 30% of the general population. Individuals who are depressed and in some instances with suicidal tendencies make up to 3% ofthe general population. Some of the very serious mental illnesses affect individuals during adolescence and tend to be chronic with poor prognoses. Such individuals are unable to work and support themselves, thus becoming a liability to the family and to the community. Socioeconomic conditions, lack of education and job opportunities and alcohol and substance abuse are some of the factors that serve as catalysts for mental illnesses.

This Health Assembly will also offer us an opportunity to consider the scourge of HIV I AIDS, taking full cognizance of appropriate preventive measures and those activities to mitigate its impact. HIV I AIDS has a direct impact on demographic structure, human resource development and on the economy; however the most significant effect of AIDS may be at the household level; loss of income, compounded by substantial medical expenses can deplete family assets and accentuate poverty. The breakdown of family structure may have serious effect on how the children are taken care of, and the elderly may be burdened with bringing up children orphaned by the epidemic. Although we should focus our attention on prevention, we should not lose sight of mitigating the impact of AIDS on those affected; therefore, the issue of access to essential medicines and other pharmaceutical substances must remain high on our agenda. This is both a social responsibility and a moral issue. The world watched in horror when attempts by the Government of South Africa to make antiretroviral and other drugs available to its population were challenged by multinational pharmaceutical companies. The world stood firm in support of the Government of South Africa: the case is now over and governments can make antiretroviral drugs and others available to their respective populations.

I wish to thank national governments, civil societies, nongovernmental organizations and individuals for their unwavering support to the Government of South Africa. I congratulate the honourable Minister, Dr Manto Tshabalala-Msimang and, through her, the people and Government of South Africa for their steadfastness in the face of the strong multinational pharmaceutical giants' challenge. We all know that Africa has the heaviest burden of communicable diseases, including HIV I AIDS; but Africa has less than 10% of the resources allocated globally to fight these diseases; we are therefore appealing to all concerned to show solidarity. In conclusion I wish to place on record my appreciation for your support during my presidency. I wish to single out the Director-General and her staff as well as my colleagues in the Southern Africa Development Community.

The PRESIDENT:

I would now ask our distinguished guests to kindly remain seated while the Assembly deals with its first two items which should soon be completed.

A54NR/1 page 7

5. APPOINTMENT OF THE COMMITTEE ON CREDENTIALS CONSTITUTION DE LA COMMISSION DE VERIFICATION DES POUVOIRS

The PRESIDENT:

We shall now proceed with the Appointment of the Committee on Credentials. The Assembly is required to appoint a Committee on Credentials in accordance with Rule 23 of the Rules of Procedure of the Assembly. In conformity with this Rule, I propose for your approval the following 12 Member States: Austria, Bangladesh, Bosnia and Herzegovina, Liberia, Libyan Arab Jamahiriya, Luxembourg, Malaysia, Mozambique, Paraguay, Saint Kitts and Nevis, Syrian Arab Republic and Uganda.

Are there any objections? If there are no objections, I declare the Committee on Credentials, as proposed by me, appointed by the Assembly. Subject to the decision of the General Committee, and in conformity with resolution WHA20.2, this Committee will hold its first meeting on Tuesday, 15 May at 14:30.

6. ELECTION OF THE COMMITTEE ON NOMINATIONS ELECTION DE LA COMMISSION DES DESIGNATIONS

The PRESIDENT:

We shall now proceed with the Election of the Committee on Nominations. This item is governed by Rule 24 of the Rules of Procedure of the Assembly. In accordance with this Rule, a list consisting of 24 Member States and the President ex officio has been drawn up, which I shall submit to the Assembly for its consideration. May I explain that, in compiling this list, the following distribution by Region has been applied: Africa: five Members; Americas: five Members; Eastern Mediterranean: three Members; Europe: six Members; South-East Asia: two Members; Western Pacific: three Members. I therefore propose to you the following Member States: Argentina, Belize, Chad, China, Costa Rica, Croatia, Democratic People's Republic of Korea, Ecuador, Eritrea, France, Gambia, Guinea, Israel, Jordan, Malta, Nepal, Nigeria, Papua New Guinea, Qatar, Russian Federation, Sudan, United Kingdom of Great Britain and Northern Ireland, Vanuatu, Venezuela (ex officio: Namibia).

Are there any observations? In the absence of observations, I declare the Committee on Nominations elected. As you know, Rule 25 ofthe Rules of Procedure, which defines the mandate of the Committee on Nominations, also states that "the proposals of the Committee on Nominations shall be forthwith communicated to the Health Assembly".

I will now suspend the meeting so that the Committee on Nominations may meet in Room VII. As soon as the Committee on Nominations has completed its deliberations, we will resume in plenary. This is expected to take approximately half an hour.

Before I suspend the meeting, I wish to thank our distinguished guests for having honoured us with their presence and I would ask all delegates to remain in the hall while the Nominations Committee meets.

7. FIRST REPORT OF THE COMMITTEE ON NOMINATIONS PREMIER RAPPORT DE LA COMMISSION DES DESIGNATIONS

The PRESIDENT:

We will now consider the first report of the Committee on Nominations. I shall read the report which will be made available this afternoon.

The Committee on Nominations, consisting of delegates of the following Member States: Argentina, Belize, Chad, China, Costa Rica, Croatia, Democratic People's Republic of Korea,

A54NR/1 page 8

Ecuador, Eritrea, France, Gambia, Guinea, Israel, Jordan, Malta, Nepal, Nigeria, Papua New Guinea, Qatar, Russian Federation, Sudan, United Kingdom of Great Britain and Northern Ireland, Vanuatu, Venezuela and Dr L. Amathila, Namibia (ex-officio), met on 14 May 2001.

In accordance with Rule 25 of the Rules of Procedure of the Health Assembly and respecting the practice of regional rotation that the Assembly has followed for many years in this regard, the Committee decided to propose to the Assembly the nomination of Dr Hong Sun Huot (Cambodia) for the Office of President ofthe Fifty-fourth World Health Assembly.

Are there any observations?

Election of the President Election du President de I' Assemblee

The PRESIDENT:

In the absence of any observations, and as it appears that there are no other proposals, it will not be necessary to proceed to a vote since only one candidate has been put forward. In accordance with Rule 80 of the Rules of Procedure, I therefore suggest that the Assembly should approve the nomination submitted by the Committee and elect its President by acclamation.

(Applause/Applaudissements)

Dr Hong Sun Huot is thereby elected President of the Fifty-fourth World Health Assembly and I invite him to take his seat on the rostrum.

Dr Hong Sun Huot (Cambodia) took the presidential chair. Le Dr Hong Sun Huot (Cambodge) prend place au fauteuil presidentiel.

Le PRESIDENT :

Excellences, Mesdames et Messieurs les Ambassadeurs et delegues, Madame le Directeur general, je tiens a remercier l'auguste Assemblee pour la confiance qu'elle vient de me temoigner en m'elisant a la presidence de la Cinquante-Quatrieme Assemblee mondiale de la Sante. Je saisis cette occasion pour exprimer mes remerciements a mon predecesseur, le Dr Libertine Amathila, pour la contribution qu'elle a apportee a la derniere Assemb1ee de la Sante. Je prononcerai le discours habituel plus tard dans la journee et no us allons maintenant poursuivre nos travaux.

8. SECOND REPORT OF THE COMMITTEE ON NOMINATIONS DEUXIEME RAPPORT DE LA COMMISSION DES DESIGNATIONS

Le PRESIDENT :

J'invite maintenant l' Assemblee a examiner le deuxieme rapport de la Commission des Designations. Je donne lecture de ce rapport, qui vous sera distribue cet apres-midi.

Au cours de sa premiere seance, tenue le 14 mai 200 I, la Commission des Designations a decide de proposer a 1 'Assemblee de la Sante, conformement a l' article 25 du Reglement interieur de 1' Assemblee, les designations suivantes :

Vice-Presidents de 1' Assemblee : M. P. J. E. Tapsoba (Burkina Faso), Mme M. Argiiello (Nicaragua), Dr A. M. Kasi (Pakistan), Dr I. B. Zelenkevich (Belarus), M. Ri Tcheul (Republique populaire democratique de Coree ).

Commission A : President- Professeur S. K. Ongeri (Kenya). Commission B :President- M. D. A. Gunnarsson (lslande).

A54NR/1 page9

En ce qui conceme les postes de membres du Bureau a pourvoir par voie d'election, conformement a I' article 31 du Reglement interieur de I' Assemblee, la Commission a decide de proposer Ies delegues des 17 pays suivants : Bahrein, Bhoutan, Bolivie, Chine, Cuba, Dominique, Etats-Unis d' Amerique, Federation de Russie, France, Guinee-Bissau, Iran (Republique islamique d'), Japon, Mali, Niger, Republique democratique du Congo, Royaume-Uni de Grande-Bretagne et d'Irlande du Nord, Suede.

Election of the five Vice-Presidents Election des cinq vice-presidents de I' Assemblee

Le PRESIDENT :

J'invite I' Assemblee a se prononcer successivement sur les designations proposees. En !'absence d'observations, je propose a I' Assemblee de declarer les cinq vice-presidents elus

par acclamation.

(Applause/Applaudissements)

Je vais maintenant determiner par tirage au sort dans quel ordre les Vice-Presidents seront eventuellement appeles, entre les sessions, a remplacer le President empeche. Les noms des cinq Vice-Presidents ont ete ecrits sur cinq feuilles distinctes que je vais tirer au sort. Les Vice-Presidents assumeront la presidence dans l'ordre suivant: Dr A. M. Kasi (Pakistan), Mme M. Argiiello (Nicaragua), M. P. J. E. Tapsoba (Burkina Faso), Dr I. B. Zelenkevich (Belarus), M. Ri Tcheul (Republique populaire democratique de Coree). Je prie les Vice-Presidents de bien vouloir monter a la tribune pour occuper les places qui leur sont reservees.

Election of the Chairmen of the main committees Election des presidents des commissions principales

Le PRESIDENT :

Nous passons maintenant a I' election du President de la Commission A. Le Professeur S. K. Ongeri (Kenya) est propose. Y a-t-il des observations? En !'absence d'observations, j'invite I' Assemblee a declarer le Professeur S. K. Ongeri (Kenya) elu par acclamation President de la Commission A.

(Applause/Applaudissements)

Nous devons maintenant elire le President de la Commission B. M. D. A. Gunnarsson (Islande) est propose. Y a-t-il des observations? En l'absence d'objections, j'invite l'Assemblee a declarer M. D. A. Gunnarsson (lslande) elu par acclamation President de la Commission B.

(Applause/Applaudissements)

Establishment of the General Committee Constitution du Bureau de I' Assemblee

Le PRESIDENT :

Nous en arrivons a la constitution du Bureau de l' Assemblee. Conformement a I' article 31 du Reglement interieur, la Commission des Designations a propose les noms de 17 pays dont les delegues, avec ceux qui viennent d' etre elus, constitueront le Bureau de I' Assemblee. Ces propositions tiennent compte d'une repartition geographique equitable du Bureau de 1' Assemblee. Les pays proposes sont les suivants : Bahrein, Bhoutan, Bolivie, Chine, Cuba, Dominique, Etats-Unis

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d' Amerique, Federation de Russie, France, Guinee-Bissau, Iran (Republique islamique d'), Japon, Mali, Niger, Republique democratique du Congo, Royaume-Uni de Grande-Bretagne et d'Irlande du Nord, Suede. Y a-t-il des observations ? Je constate qu'il n'y en a aucune et je declare done elus ces 17 pays.

Les membres du Bureau sont le President et les Vice-Presidents de 1' Assemblee, les Presidents des commissions principales et les delegues des 17 pays que vous venez d'elire.

Avant d'ajoumer cette seance pleniere, je voudrais rappeler qu'une photographie de tous les ministres de la sante et chefs de delegations des Etats Membres sera prise devant la Porte 16 immediatement apres cette seance. Apres la photographie, les membres du Bureau sont pries de se rendre a la Salle VII ou le Bureau tiendra sa premiere seance aux environs de 11 h 30. Des sandwiches seront servis dans le salon des delegues, a cote de la Salle VII, a !'intention des participants du Bureau des la levee de la seance de celui-ci. Comme indique dans le Journal, une reunion d'information technique sur les « menaces pour la securite sanitaire mondiale » aura lieu a 13 heures dans la Salle XIX. La prochaine seance pleniere aura lieu cet apres-midi a 14 h 30. La seance est levee.

The meeting rose at 11:40. La seance est levee a llh40.

SECOND PLENARY MEETING

Monday, 14 May 2001, at 14:30

President: Dr HONG Sun Huot (Cambodia)

DEUXIEME SEANCE PLENIERE

Lundi 14 mai 2001, 14h30

President: Dr HONG Sun Huot (Cambodge)

PRESIDENTIAL ADDRESS DISCOURS DU PRESIDENT DE L' ASSEMBLEE

Le PRESIDENT :

A54NR/2 page 11

Excellences, Mesdames et Messieurs les Ministres et Ambassadeurs, distingues delegues, Madame le Directeur general, Mesdames et Messieurs les representants des organisations internationales, distingues invites, Mesdames et Messieurs, j'ai le grand plaisir, en ma qualite de President, de vous souhaiter la bienvenue a cette Cinquante-Quatrieme Assemblee mondiale de la Sante.

Je souhaiterais commencer en vous remerciant de m'avoir elu a la presidence. Cette election constitue un grand honneur et un privilege pour mon pays, le Cambodge, ainsi que pour la Region du Pacifique occidental, dont les differents Etats Membres ont beaucoup contribue a l'oeuvre de I' Assemblee au fil des annees.

Le Cambodge a entretenu depuis longtemps d'excellentes relations avec l'OMS et je suis persuade qu'elles resteront excellentes. Apres une longue periode de contlit, notre pays a entrepris la tache enorme de la reconstruction de son systeme de sante. Avec l'appui et l'aide de l'OMS, nous avons pu reformer nos services de sante publique, reduire la charge de morbidite due au paludisme et a la tuberculose, endiguer la propagation du VIH et, enfin, eradiquer la poliomyelite. 11 nous reste encore beaucoup a faire, mais, avec le soutien de l'OMS et des autres partenaires du developpement, nous faisons des progres. Nous sommes profondement reconnaissants de l'appui qui nous est apporte.

L'OMS a subi de nombreuses transformations depuis !'election du Dr Gro Harlem Brundtland au poste de Directeur general. Les realisations ont ete nombreuses, surtout dans la lutte contre la pauvrete. Nous savons que la maladie fait partie du cercle vicieux de la pauvrete. La maladie engendre la pauvrete et la pauvrete engendre la maladie. L'oeuvre de l'OMS dans la lutte contre la maladie, surtout dans le domaine du VIH/SIDA, du paludisme et de la tuberculose, est etroitement liee a la reduction de la pauvrete. Dans de nombreuses parties du monde, le VIH/SIDA a ete une cause majeure de pauvrete depuis bien des annees. Au Cambodge, par exemple, on estime a 3,2% la prevalence du VIH dans le groupe d'age de 15 a 49 ans.

Par ailleurs, on reconnalt de plus en plus la perte de la qualite de vie due aux troubles mentaux. L'incapacite mentale est un probleme mondial, surtout pour un pays comme le mien, qui est en train de se relever apres des periodes de guerre et de troubles. Le suicide, souvent associe aux troubles mentaux, est egalement un probleme de sante majeur dans de nombreux pays de notre Region. En consacrant la Journee mondiale de la Sante a la sante mentale, l'OMS a contribue a faire en sorte que

A54NR/2 page 12

la sante mentale figure en meilleure place dans les programmes des responsables de la sante. 11 est judicieux d'avoir choisi la sante mentale comme theme de la Joumee mondiale de la Sante et du Rapport sur la sante dans le monde, 2001, etje me felicite de cette decision.

Distingues delegues, chers collegues, Mesdames et Messieurs, permettez-moi de vous rappeler les engagements que nous avons acceptes en adherant a l'OMS. Notre Constitution stipule que «la possession du meilleur etat de sante qu'il est capable d'atteindre constitue l'un des droits fondamentaux de tout etre humain, quelles que soient sa race, sa religion, ses opinions politiques, sa condition economique ou sociale ». Si nous sommes ici aujourd'hui, c'est pour travailler ensemble, pour defendre et maintenir le droit de tous les peuples a la sante. Les delegues a 1' Assemblee de la Sante ont maintenant une meilleure occasion de contribuer aux decisions sur le role de l'OMS dans la lutte contre la maladie et la promotion de la sante. Nous pouvons desormais vraiment reflechir a la contribution que l'OMS peut apporter sur chaque point inscrit a l'ordre du jour. Je vous demande instamment de saisir pleinement cette occasion et de ne pas considerer votre participation a 1' Assemblee comme une activite parmi d'autres. L'OMS nous appartient. Cette Assemblee de la Sante constitue notre chance de changer le cours des choses.

L'ordre du jour de l'Assemblee est bien charge cette annee. Vous serez notamment pries de parvenir a un accord sur le montant des fonds a allouer a chaque domaine d'activite dans le projet de budget programme 2002-2003. Le Directeur general estime que l'action de l'OMS doit etre ciblee sur les pays et que c' est done a no us qu' il appartient de veiller a ce que le budget programme permette a tousles Etats Membres de l'OMS d'atteindre le but fixe en matiere de sante.

Vous serez egalement pries d 'apporter une contribution significative sur des questions techniques. Je vous demande de faire une utilisation judicieuse du temps de 1' Assemblee de la Sante. Soyez brefs dans vos interventions et ne vous ecartez pas du sujet, pour que nous puissions utiliser le temps dont nous disposons de maniere efficace et pour que 1' Assemblee puisse terminer ses travaux dans les delais prevus.

Enfin, je tiens a vous remercier encore de m' avoir elu a la presidence. Je suis profondement honore et resolu a faire en sorte que nous puissions tous quitter cette Assemblee de la Sante en etant fiers des contributions que nous aurons apportees a la sante mondiale. Merci beaucoup.

2. ADOPTION OF THE AGENDA AND ALLOCATION OF ITEMS TO THE MAIN COMMITTEES ADOPTION DE L'ORDRE DU JOUR ET REP ARTITION DES POINTS ENTRE LES COMMISSIONS PRINCIP ALES

Le PRESIDENT :

Le premier point a examiner cet apres-midi est le point 1.4, Adoption de l'ordre du jour et repartition des points entre les commissions principales, qui a ete examine par le Bureau a sa premiere seance ce matin.

Le Bureau a examine l'ordre dujour provisoire de la Cinquante-Quatrieme Assemblee mondiale de la Sante (document A54/1), tel qu'il a ete etabli par le Conseil executif et envoye a tous les Etats Membres.

Avant de passer aux propositions d'inscrire des points supplementaires a l'ordre du jour, je voudrais d'abord traiter l'ordre dujour provisoire tel qu'il figure dans le document A54/1. Le Bureau a recommande le changement suivant a l'ordre du jour provisoire contenu dans ce document: suppression du point 5, Admission de nouveaux Membres et Membres associes [s'il y a lieu], etant donne qu'aucune nouvelle demande n'a ete reyue.

L' Assemblee approuve-t-elle cette recommandation? Je ne vois aucune objection. 11 en est ainsi decide.

Inclusion of supplementary items on the provisional agenda Inscription de points supph~mentaires a l'ordre du jour provisoire

A54NR/2 page 13

Le Bureau a egalement envisage I' inscription de deux points supplementaires a I' ordre du jour, pour lesquels le Directeur general a re~u des propositions.

Une proposition visait a inscrire un point supplementaire a l'ordre du jour intitule «Invitation a la Republique de Chine (Taiwan) a participer a 1' Assemblee mondiale de la Sante en qualite d'observateur ». Le Bureau a adopte la meme position que 1' Assemblee l'annee demiere lorsque la meme proposition lui a ete soumise et a recommande de ne pas inscrire ce point a l'ordre dujour.

Lorsque les Assemblees precedentes ont aborde la question de cette proposition, la parole a ete donnee a deux orateurs en faveur de I' inscription du point a l'ordre du jour et a deux orateurs contre !'inscription du point. Comme 1' Assemblee a tres peu de temps, je voudrais proposer que nous suivions cette pratique et que nous reglions la question aussi rapidement que possible. Je voudrais done donner la parole a El Salvador.

El Sr. LAGOS PIZZATI (El Salvador):

Muchas gracias, sefior Presidente: Permitame en primer lugar felicitarle efusivamente a usted y a Ios demas miembros de la Mesa por su elecci6n para dirigir nuestros trabajos. La delegaci6n de El Salvador desea manifestar el firme apoyo de nuestro Gobiemo a la participaci6n de la Republica de China (Taiwan), en calidad de observador, en el principal 6rgano rector de la Organizaci6n Mundial de la Salud. No podemos negar al pueblo taiwanes el derecho a estar representado y participar en las actividades de esta Asamblea Mundial. Como Miembro fundador de la OMS, Taiwan particip6 como Miembro plena en programas de actividades de la OMS por 24 afios e hizo grandes aportaciones a la realizaci6n de Ios objetivos de la Organizaci6n. La experiencia de haber erradicado con exito muchas enfermedades contagiosas, junta a Ios recursos humanos y financieros de Taiwan, permiten tanto al pueblo como al Gobiemo dedicarse a la asistencia medica y ayuda humanitaria en el extranjero. Sin embargo, desde 1972 se le ha negado el derecho a Taiwan a tomar parte en ningun foro o taller de trabajo organizado por la OMS sabre las ultimas tecnologias de diagn6stico, monitoreo y control de enfermedades. A las autoridades de salud de Taiwan incluso se les ha negado el derecho de mantener contacto con la OMS e incluso coordinarse con esta Organizaci6n en casos de emergencia que involucran enfermedades contagiosas. La comunidad intemacional ya apoy6 la participaci6n de Taiwan en el Banco Asiatico de Desarrollo y en el Foro de Cooperaci6n Econ6mica de Asia y el Pacifica (APEC) estando ademas, en principio, de acuerdo con la admisi6n de Taiwan en la OMC. Asimismo, por su parte, la OMS ha sabido responder a diferentes realidades politicas otorgando la condici6n de Observador Permanente a la Santa Sede, a Palestina, a la Orden Soberana Militar de Malta y al Comite Intemacional de la Cruz Roja.

Sefior Presidente: Queremos dejar claro que nuestra posici6n se basa en principios de universalidad contenidos en la Carta de las Naciones Unidas y en Ios instrumentos que componen la Carta Intemacional de Derechos Humanos y que de ninguna manera debe interpretarse como una intervenci6n en Ios asuntos intemos de un Estado o como una acci6n para dividir a un Estado soberano u obstaculizar su reunificaci6n, ya que la participaci6n de la Republica de China (Taiwan) en la Asamblea Mundial de la Salud no seria un obstaculo para la futura soluci6n pacifica de las diferencias entre ambas partes del estrecho de Taiwan. Conceder la condici6n de Observador en la Asamblea Mundial de la Salud a Taiwan demostraria unicamente que la OMS esta dispuesta a escuchar a Ios 23 millones de taiwaneses y le permitiria incluir a Taiwan en el sistema de salud global sin que esto debiera poner en peligro el proceso de dialogo entre Taiwan y la Republica Popular de China. Convencidos de la valiosa contribuci6n que Taiwan puede y desea hacer y considerando que la salud y el bienestar deben prevalecer, compartimos la aspiraci6n del pueblo de Taiwan a estar representado en la Asamblea Mundial que establece y supervisa el marco global para el control de enfermedades y la promoci6n de la salud para todos, sin exclusiones. Muchas gracias, sefior Presidente.

A54NR/2 page 14

Le PRESIDENT :

Je voudrais maintenant donner la parole a la Chine.

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Le PRESIDENT :

Je voudrais maintenant donner la parole au Swaziland.

A54NR/2 page 16

Dr KUNENE (Swaziland):

Mr President, Madam Director-General, honourable Ministers, distinguished delegates, let me first of all on behalf of my delegation congratulate the President and the General Committee on their election to such important offices at this Health Assembly.

The delegation of the Kingdom of Swaziland would like to associate itself with the delegation of El Salvador in expressing deep concern as regards the General Committee's decision not to recommend inclusion on the agenda of the item inviting the Republic of China (Taiwan) to participate in the World Health Assembly as an observer. Swaziland is fully convinced that the World Health Organization is an organization dedicated to the noblest humanitarian purpose of promoting and protecting the health of people all over the world. And it is our belief that health is a human right for all, including over 23 million people in the Republic of China (Taiwan). We know epidemics and disasters indeed do not exempt anyone. The participation of the Republic of China (Taiwan) in WHO would benefit many Member States of this esteemed Organization, as well as the cause of international cooperation in public health. For the past four years, our delegation has had various reasons against the participation of the Republic of China (Taiwan) as an observer in WHO, including the statement just made by the honourable delegate of the People's Republic of China. However, those reasons are purely political. The allegation that the participation of the Republic of China (Taiwan) in WHO is aimed at creating two Chinas, or one China and one Taiwan, in WHO is totally groundless. We shall recall that indeed both United Nations General Assembly Resolution 2758 (XXVI) and World Health Assembly resolution WHA25 .1 were products of the 1970s which dealt with the question of China's representation in the United Nations system. As has been mentioned by the delegate of El Salvador, WHO has been able to accommodate different political realities by granting observer status to the Holy See, Palestine and others. Granting the Republic of China (Taiwan) observer status does not engender any dispute over sovereignty and is not about China's representation, nor will it challenge the present status of the People's Republic in international organizations such as WHO. It would demonstrate that this Organization of ours is indeed willing to listen to the voice of the 23 million people of the Republic of China (Taiwan) and to include those unrepresented people in this august Health Assembly. The disagreement between the People's Republic of China and the Republic of China (Taiwan) is a matter that my delegation believes can be resolved by the people on both sides of the Taiwan Straits and is an issue which is not a matter for this Health Assembly to decide. However, the continued exclusion of the Republic of China (Taiwan) from WHO does constitute a discrimination against those 23 million people, while the primary purpose of our great Organization is to -ensure the participation of all in our work, so as to realize our objectives. The delegation of Swaziland recognizes the Republic of China (Taiwan) as a sovereign state and the Government in Taiwan as the highest and sole legitimate authority governing all health issues in the country.

As I end, I would like to point out that the Republic of China (Taiwan) is only seeking observer status in order to ensure that there is no possibility of political conflict. Our delegation believes that granting observer status is the modus vivendi that can allow WHO to include the Republic of China (Taiwan) in the global health system, while not jeopardizing the peace process between the Republic of China (Taiwan) and the People's Republic of China. Therefore, we would like to urge our colleagues from the People's Republic of China and other delegations to take a positive and proper perspective on this issue by supporting the observer status of the Republic of China (Taiwan) in WHO. Diseases know no boundaries. Allow me to quote what Dr Brock Chisholm of Canada, who later became the first Director-General of this Organization, said during the International Health Conference in 1946 regarding the question of universality. I quote: "This is not at all an altruistic gesture but a simple matter of enlightened self-interest. We cannot afford to have gaps in the fence against disease; and any country, no matter what its political attitudes or affiliations are, can be a serious detriment to the effectiveness of the World Health Organization if it is left outside. It is important that health should be regarded as a world-wide question quite independent of political attitudes in any country in the world." Our delegation therefore deeply regrets that the General Committee did not recommend the inclusion of the participation of the Republic of China (Taiwan) in WHO as part of the amended agenda.

Le PRESIDENT :

Je voudrais maintenant donner la parole au Pakistan.

Dr KASI (Pakistan):

A54NR/2 page 17

Once again this year the Health Assembly has been obliged to divert its attention from the health concerns of billions of people around the globe in order to discuss a political question. The attempt year after year to bring the issue of whether Taiwan should be given observer status by WHO regrettably politicizes the work of the Organization and diverts the attention of the Health Assembly from its core function of furthering the objective of the Organization which, as defined in Article I, is to ensure the attainment by all peoples of the highest possible level of health. The proposal before us should be rejected by the Health Assembly without further discussion for the following reasons. Firstly, the Health Assembly is committed to discussing health issues, not political issues. Secondly, the Health Assembly cannot take any decision that impinges on the unity and integrity of a Member State. In 1971 the United Nations General Assembly, while restoring all the rights of the People's Republic of China in the United Nations, recognized the Government ofthe People's Republic as the legitimate representative of the Chinese people by expelling Taiwan from the United Nations. The international community has closed the chapter regarding Taiwan's status. Taiwan is a province of the People's Republic of China as recognized by international law and the relevant United Nations resolutions. A province or a part of a Member State cannot seek separate status in any intergovernmental organization. Thirdly, if the people of Taiwan are to benefit from the work and programmes of WHO, they could do so as soon as Taiwan's reunification with the People's Republic of China has been realized. This is the goal which the international community is committed to promoting. The Health Assembly cannot take a contrary position. Fourthly, the politically motivated nature of this proposal is also clear from the fact that it is brought before the Health Assembly year after year, despite its repeated rejection by an overwhelming majority of the Member States of the Health Assembly. Fifthly, this politically motivated proposal to give Taiwan separate status in WHO will constitute a dangerous precedent internationally if it is accepted. In future, any segment of any sovereign State seeking secession or separation could seek to promote its political objectives through such a move. Acceptance of this proposal therefore threatens the unity and territorial integrity of every Member State of the United Nations and the Health Assembly, including those States which have for well known reasons moved the proposal. We agree with the recommendations of the General Committee to reject the proposal. In view of the reasons I have cited, let us call upon the Health Assembly also to reject the proposal. Thank you.

Le PRESIDENT :

Maintenant que nous avons entendu quatre interventions sur cette question, puis-je supposer que l' Assemblee accepte la recommandation du Bureau de ne pas inscrire un point supplementaire a l'ordre dujour sur cette question?

Je ne vois pas d'objection, la recommandation est done approuvee. La deuxieme proposition examinee par le Bureau consiste a inscrire un point supplementaire a

l'ordre du jour intitule « Fonctionnement efficace des organes directeurs de l'OMS ». Le Bureau a decide de recommander !'inscription de ce point supplementaire a l'ordre dujour.

L' Assemblee approuve-t-elle cette recommandation? Je ne vois aucune objection, et la recommandation est done approuvee. Puis-je considerer que I' Assemblee decide d' adopter I' ordre du jour proviso ire ainsi modi fie ? 11 en est ainsi decide. Le document A54/l Rev.l incorporant ces changements sera distribue demain matin.

A54NR/2 page 18

Allocation of items to the main committees Repartition des points de l'ordre du jour entre les commissions principales

Le Conseil executif a etabli 1' ordre du jour proviso ire de 1 'Assemblee en indiquant la repartition des points qu' il proposait entre les Commissions A et B, sur la base du mandat de chacune des commissiOns.

Le Bureau a recommande que les points figurant a l'ordre du jour de la pleniere ainsi modifie, qui n'ont pas encore ete attribues, soient traites en pleniere. En ce qui conceme le point 10 de l'ordre du jour proviso ire, Tables rondes, le Bureau a fait les propositions suivantes :

Mardi matin, se tiendront parallelement quatre tables rondes sur la sante mentale. Chacune des tables rondes sera consideree comme une commission distincte a composition limitee. La participation a celles-ci sera done limitee aux ministres de la sante ou aux delegues designes pour les representer a l' Assemblee qui se sont inscrits aupres du secretariat. La liste des participants a chacune des tables rondes est publiee dans le Journal. Comme je l'ai deja dit, seuls ces participants seront consideres comme membres des tables rondes. Tous les autres delegues et observateurs a l' Assemblee de la Sante, y compris les membres de la delegation du ministre de la sante participant a la table ronde, y assisteront en qualite d' observateurs. Par consequent, seuls les participants - c'est-a-dire les ministres de la sante, ou les personnes designees par eux, qui sont membres de chacune des tables rondes - seront autorises a prendre la parole, et cela afin de permettre un veritable debat entre tous les participants. Le but des tables rondes etant de permettre a chacun de tirer parti d'un echange de vues entre les participants et non necessairement de parvenir a un accord dans tous les cas, les tables rondes n'auront pas pour mandat d'adopter des resolutions, mais seulement de soumettre un resume de leurs discussions a la pleniere. Le Bureau a propose de designer comme Presidents des quatre tables rondes les Ministres de la

Sante suivants presents a l' Assemblee: M. Phillip Goddard (Barbade), M. Lyonpo Sangay Ngedup (Bhoutan), Mme Annette King (Nouvelle-Zelande) et le Professeur M. Eyad Chatty (Republique arabe syrienne).

Le Bureau a egalement decide que l'un de ces Presidents serait charge de resumer oralement en pleniere les discussions ayant eu lieu entre les participants.

L'Assembtee venant d'approuver }'inscription d'un point supplementaire a l'ordre du jour, « Fonctionnement efficace des organes directeurs de l'OMS », il est propose de le faire examiner par la Commission B.

11 est entendu qu'il sera peut-etre necessaire ulterieurement de transferer certains points d'une commission a l'autre, suivant la charge de travail de chacune des commissions.

L' Assemblee approuve-t-elle ces propositions? Je ne vois pas d'objection. 11 en est ainsi decide.

3. ANNOUNCEMENTS COMMUNICATIONS

Le PRESIDENT :

Je voudrais maintenant faire une annonce importante concemant l'election annuelle de Membres habilites a designer une personne pour faire partie du Conseil executif.

L'article 101 du Reglement interieur de 1'Assemblee de la Sante, te1 qu'amende par la resolution WHA50.18, stipule ce qui suit.

Au debut de chaque session ordinaire de l' Assemblee de la Sante, le President invite les Membres desireux de faire des suggestions concemant l'election annuelle des Membres habilites a designer une personne devant faire partie du Conseil a adresser leurs suggestions au Bureau de 1' Assemblee. Ces suggestions doivent parvenir au President du Bureau de

A54NR/2 page 19

1' Assembh!e au plus tard vingt-quatre heures apres que le President, en application du present article, aura fait cette annonce. J'invite done les delegues souhaitant formuler des suggestions concemant cette election a les

soumettre a 1' Assistante du Secretaire de 1' Assemblee au plus tard mardi apres-midi, 15 mai, a 16 heures, afin de permettre au Bureau de se reunir pour etablir ses recommandations a l'Assemblee concemant cette election.

Le programme de travail du mardi 15 mai sera le suivant : le matin a 9 heures, les tables rondes se reuniront pour l' echange de vues sur le theme de la sante mentale. La troisieme seance pleniere, qui doit avoir lieu a 14 h 30, poursuivra le debat general sur le point 3, tandis que la Commission A et la Commission de Verification des Pouvoirs tiendront leur premiere seance. Le mercredi 16 mai, la pleniere se reunira a 9 heures pour examiner le rapport de la Commission de Verification des Pouvoirs et poursuivra le debat general sur le point 3, et la Commission A tiendra sa deuxieme seance. L'apres­ midi, la pleniere reprendra a 14 h 30 avec le debat general, parallelement a la troisieme seance de la Commission A. Si le debat sur le point 3 est termine mercredi au moment oil la seance est levee, la Commission B tiendra sa premiere seance.

Je voudrais aussi faire une annonce speciale. S. E. M. Kofi Annan, Secretaire general de l'ONU, sera a Geneve jeudi et prendra la parole devant l' Assemblee. 11 y aura done une seance pleniere speciale jeudi a 11 h 30, quand le Secretaire general prononcera un discours a 1' Assemblee.

Concemant la liste des orateurs pour le debat sur le point 3, afin de faciliter la discussion, je voudrais proposer, comme le veut la procedure qui a ete suivie precedemment, que l'ordre de la liste des orateurs soit rigoureusement respecte et que les nouvelles inscriptions soient prises dans 1 'ordre dans lequel elles arrivent. Ces inscriptions devront etre remises au bureau de 1' Assistante du Secretaire de 1' Assemblee ou en seance pleniere au fonctionnaire responsable de la liste des orateurs a la tribune. Je propose que la liste des intervenants soit close demain mardi a midi.

J'aimerais rappeler aux quelques delegues qui n'ont pas encore presente officiellement leurs pouvoirs de les remettre au secretariat de la Commission de Verification des Pouvoirs, bureau A.667 dans ce batiment, avant 11 heures demain matin.

4. REPORTS OF THE EXECUTIVE BOARD ON ITS 106TH AND 107TH SESSIONS RAPPORTS DU CONSEIL EXECUTIF SUR SES CENT SIXIEME ET CENT SEPTIEME SESSIONS

Le PRESIDENT :

Nous allons maintenant passer au point 2, Rapports du Conseil executif sur ses cent sixieme et cent septieme sessions. Avant de donner la parole au representant du Conseil executif, j'aimerais expliquer brievement le role des representants du Conseil executif a 1' Assemblee de la Sante et celui du Conseillui-meme, afin de lever tout doute qui pourrait subsister dans l'esprit de certains delegues a ce sujet.

Le Conseil executif a un role important a jouer dans les affaires de 1' Assemblee de la Sante, ce qui est tout a fait conforme a la Constitution de l'OMS, selon laquelle le Conseil doit appliquer les decisions et les directives de 1' Assemblee de la Sante, agir en tant qu'organe executif de 1' Assemblee, et conseiller 1' Assemblee sur les questions qui lui sont soumises. Le Conseil est egalement appele a soumettre des propositions de sa propre initiative.

Le Conseil nomme done quatre membres pour le representer a 1' Assemblee de la Sante. Le role des representants du Conseil executif consiste a faire connaitre a 1' Assemblee, au nom du Conseil, les principales questions soulevees au cours du debat et la teneur des discussions qui ont eu lieu au Conseil lors de 1' exam en des points qui doivent etre portes a 1' attention de 1 'Assemblee, en expliquant les raisons et la nature de toute recommandation du Conseil appelant un examen par 1' Assemblee. Au cours du debat a 1' Assemblee sur ces points, les representants du Conseil sont egalement censes repondre a toute question soulevee s'ils estiment necessaire d'apporter un eclaircissement sur la position adoptee par le Conseil. Les declarations des representants du Conseil executif, qui

A54NR/2 page 20

s' expriment en tant que membres du Conseil des ignes pour presenter son point de vue, sont done a distinguer des declarations des delegues exprimant le point de vue de leur gouvemement.

J'ai maintenant le plaisir de donner la parole au representant du Conseil executif, le Dr J. Jimenez de la Jara, President du Conseil. El Dr. JIMENEZ DE LA JARA (Presidente del Consejo Ejecutivo ):

Senor Presidente, senora Directora General, distinguidos delegados, excelentisimos senores, senoras y senores, en nombre de Ios otros miembros del Consejo Ejecutivo y en el mio propio deseo felicitar a usted, senor Presidente, y a Ios Vicepresidentes, por su elecci6n, y asegurarle el pleno apoyo del Consejo. Ha sido para mi un honor presidir el Consejo durante un ano de intensa labor e importantes avances y en el desempeno de esa funci6n representar a la Organizaci6n en diversas ocasiones.

Con arreglo a la Constituci6n de la Organizaci6n Mundial de la Salud, el Consejo Ejecutivo es un 6rgano deliberante integrado por 32 personas, designadas por igual numero de Miembros teniendo en cuenta una distribuci6n geognifica equitativa. La funci6n basica del Consejo consiste en ejercer, en nombre y representaci6n de toda la Asamblea de la Salud, las funciones delegadas por esta, es decir, por ustedes, Ios Estados Miembros.

Mas concretamente, y tal como ha sido referido por el Presidente, las principales funciones del Consejo Ejecutivo son las siguientes:

a) dar efecto alas decisiones y alas politicas de la Asamblea de la Salud; b) actuar como 6rgano ejecutivo de la Asamblea de la Salud; c) desempenar toda otra funci6n que la Asamblea de la Salud le encomiende; d) asesorar a la Asamblea de la Salud en Ios asuntos que esta le encomiende; e) asesorar y presentar propuestas a la Asamblea de la Salud por iniciativa propia; .f) preparar el programa de las sesiones de la Asamblea de la Salud.

Le PRESIDENT :

Merci, Docteur Jimenez, pour votre excellent rapport. J'aimerais saisir cette occasion pour rendre hommage au travail du Conseil executif, et en particulier pour adresser nos chaleureux remerciements aux membres sortants qui ont tres activement contribue aux travaux du Conseil.

5. REPORT BY THE DIRECTOR-GENERAL RAPPORT DU DIRECTEUR GENERAL

Je donne maintenant la parole au Dr Gro Harlem Brundtland, Directeur general, qui va nous presenter, au titre du point 3 de l'ordre du jour, son rapport sur l'activite de l'OMS. Docteur Brundtland, vous avez la parole.

The DIRECTOR-GENERAL:

Mr President, honourable delegates, this is a year of hope. People's health is the subject of intense public debate. Healthy lives are now a core goal of development. Health features in newspaper editorials, summit meetings, popular assemblies and parliamentary debates. New resources have been promised, and are starting to appear. New partnerships are bringing vital support to country action. WHO staff are working even harder. The contribution of civil society is vital and welcome. We seek ways to build on it. The involvement of the private sector evolves, with exciting new milestones: access to new medicines at lower prices. New drugs for sleeping sickness, and new vaccines. Combination antimalarials. The price of treating people with HIV is coming down. We are gaining speed. The move towards wider access to life-saving health care is now unstoppable. So, at the start of this Fifty-fourth World Health Assembly, we have new reason to be optimistic. We are working together with renewed energy. A renewed will to act. A determination to walk down unexplored paths

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to get results. The demands for effective action are ever more intense. Our fundamental challenge is to respond to the billions of people whose potential is so cruelly extinguished by avoidable ill-health. How can we best convert this new energy, interest and commitment into equitable health outcomes, or pursue our collective commitment to achieve results? This Health Assembly is an opportunity to share experiences. To define new steps, and to rally to the cause. We all know that good health is vital for economic and social development. There is increasing recognition by key decision-makers, in government, in the private sector and in civil society, that healthy individuals, communities and societies are crucial for the future well-being of nations and of our planet. The health of a society is seen as one of the first prerequisites for the development of its people. There has been a real change in development thinking. There is a new realization about the state of the world's health. Fifty years after the link between tobacco and ill-health was demonstrated, decision-makers at last understand the real global threat of tobacco. Not only in wealthy nations, but among poor people everywhere. The threat is greatest for the new generation in developing nations. Tobacco will cause more of them to die than any other single reason and health systems will not be able to afford the long and expensive care in its wake. After 30 years of making the case, the dire social and economic consequences of diseases such as malaria and tuberculosis in the poorest communities are being understood at the highest levels of decision-making everywhere. After 15 years of analysis, prediction and intense advocacy, the extreme damage caused by HIV has become apparent to all. And, at last, the world is waking up to the enormous burden of mental illness and neurological disorders: by applying the knowledge available today we can reduce the stigma, improve the quality of life for millions of people and help them increase their productivity. The challenge, now, is to respond to this growing public perception of a deep health divide: the gap between those who enjoy good health, and feel that they can control their destiny, and the millions more whose lives are undermined by serious illness. When speaking in public, on the radio or television, through the web, or in parliament, decision-makers increasingly acknowledge concerns about the current health situation for many of their people. They know that solutions exist. That interventions are available. That strategies to improve the situation are known. They also know how best to implement them. But they recognize that much more must be done if the divide is to be bridged. They seek the commitment and resources to make this happen. We are here at a time of unprecedented opportunity for global health. We must act now. This window of opportunity may close at any time. We cannot wait another decade while HIV/AIDS affects more and more of the people from Africa, China, Eastern Europe, India and the Russian Federation. If we do not act now, drug-resistant tuberculosis will have become far more widespread, requiring costly treatment that is difficult to provide. Malaria treatments will have lost their potency due to the increase of drug­ resistant strains.

During the last three years, we have concentrated on sharpening WHO's strategies and contribution to health and well-being. As I took up this position in July 1998, I said that the global health agenda is too big for any one entity. To work effectively, we need to pull together. Since then, we have reached out to different parts of government, civil society, professional associations, the research community, foundations and bilateral agencies, encouraging intensive and focused partnerships. Improving access to vaccines and immunization; rolling back malaria; stopping tuberculosis; helping to reduce HIV infection; accelerating access to treatment for AIDS; tackling epilepsy and mental ill-health; eradicating poliomyelitis; eliminating leprosy and guinea worm; improving child and adolescent health; making pregnancy safer; reducing injuries; improving food safety; developing effective health systems. It is all done in partnerships. Within any partnership WHO retains its core values and its integrity. The goals are always the same: to improve health outcomes and promote health equity. Partnerships have greatly advanced our reach and ability to make a difference. Two years ago, when I introduced WHO's budget for the current biennium, I committed WHO to work differently. Selecting priorities, and reducing the emphasis on, or even closing, non-priority programmes. Concentrating resources on the priorities, and cutting back on administration, improving our capacity to work together strategically, at country as well as at global level, and increasing our income to enable us to do this. We developed a corporate strategy and prepared a strategic programme budget. The next stage is to intensifY country action, within the context of country cooperation strategies, in ways that reflect the needs and intentions of Member States and agreed global priorities for health action. All our staff worked hard to increase efficiency and focus their work to make sure

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that WHO adds the greatest possible value to investments in world health, and wherever they are made. Our efforts have been recognized: voluntary contributions to WHO's work increased by 40% in 2000. We still have to invest more in our information technology, so that we can track income and expenditure in real time, and demonstrate a clear link between funds provided and results achieved. This will become easier in the next biennium as we move to programming by areas of work, across the whole Organization. We have to accept the reality of voluntary funding. Often funds are provided on a year-by-year basis, and are tightly earmarked. Because continuation of such funding cannot always be guaranteed, we are often reliant on short-term staff, and this creates challenges for human resource policies. The use of all resources within areas of work, across the Organization, will, for the first time, be reviewed at the remodelled Meeting oflnterested Parties that will take place in June each year.

Last week, I appointed a new Executive Director for WHO's General Management, someone who has extensive experience in handling the complex challenges of administration in a United Nations system under reform. I have also decided to upgrade the post of Human Resources Director to a Cabinet position. The person selected will help to take forward human resource reform and be responsible for an enhanced programme of staff development, as well as the important task of relating to the energetic and constructive staff associations throughout the Organization. In 1998, our review of WHO's administrative systems suggested that financial and personnel management functions should be streamlined and standardized while, at the same time, brought closer to the technical programmes in the regions and Geneva. Management support units were created in each of the Geneva clusters. This innovation has been appreciated by the programmes, and has proved, overall, to be effective. However, internal audit has highlighted the need for further standardization of procedures, and we are now implementing such changes. During the past year, the Regional Directors and I have strengthened the ability of all parts of the Organization to work as one. In March, I called the second meeting of WHO Representatives here in Geneva. We agreed that the time had come to focus on strengthening the capacity and contribution of our country teams. Regional offices have reviewed their capacity to support country programmes, and have established new intercountry programmes. The newly­ constituted Global Programme Management Group - which includes directors of programme management from each region - will take this work forward, together with the Regional Directors.

A major item on this year's Health Assembly will be the review of the proposed programme budget. It is a key instrument in the reform process towards one WHO, and one which will serve as the underpinning for WHO's strategy and our plans for the next biennium. The preparation of this budget is significantly different in several ways: firstly, it has been prepared in a truly collaborative spirit between the regional offices and Geneva; secondly, it applies principles of results-based budgeting through the identification of expected results and performance indicators for all the Organization's strategic areas; and thirdly, it has for the first time been reviewed in its entirety by the regional committees before being transmitted to the Executive Board. Over the last three years we have attempted to increase the effectiveness and efficiency of WHO's work with a declining regular budget. We have made extensive savings, and redirected resources to priority programmes. The demands on the regular budget - for our administration, our core programmes, our normative functions and our country programmes - are intense. This year we invite the Health Assembly to take account of the net increases in our costs and consider a 1.9% increase in the regular budget for the 2002-2003 biennium - equalling US$ 16 million. We also anticipate an amount of US$ 10 million from miscellaneous income that I believe is required for selected priorities, linked to the ongoing reform process in the Organization. One example is the investment required in strengthening the capacity and contribution of our country teams. There are also unexpected demands being made on the Organization. For example, during the last year we have been asked by Member States to do more to assess the possible health impact of the use of depleted uranium in munitions. We appealed for extrabudgetary resources to undertake essential field work and support research - particularly in the Balkans and the Gulf States. The response - from France and Switzerland - has been much appreciated but is far below the cost of doing this work. We hope that it will increase in coming months.

Three years ago, I pointed to the need for an increased focus on ensuring a strong evidence base for world health action. The initial focus was on identifying and quantifying the various reasons why healthy life years are lost in different countries, establishing which interventions are effective in different settings, and standardizing means through which guidelines are developed and disseminated.

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During the last two years we have followed similar principles in developing methods for analysing and comparing the performance of health systems worldwide. We set out desirable goals and functions for national health systems. We went on to develop a group of indicators for measuring health system performance, and to make quantitative assessments for all the world's health systems performance. The results were expressed as indices in the annex to The world health report 2000. There has been considerable public debate about both the methods used and results obtained. At the 1 07th session of the Executive Board in January, I indicated that WHO would encourage a wider examination of the issues. The Executive Board addressed such an approach through a resolution. I have now established a group to advise me on this important work. It will be led by Dr Mahmoud Fathalla of Egypt, the Chair of the Advisory Committee on Health Research.

The Regional Directors and I have moved ahead with plans for regional and international consultations which will enable WHO to receive and reflect on a wide range of views about optimum means for assessing health systems performance. The consultations are taking place between May and July this year. I am also establishing an expert team to peer-review health systems performance methodology, following the technical consultation process.

I expect that the technical consultations and peer reviews will enable us to update the methodology and data sources relevant to the performance of health systems, leading to a plan for further research. It will also enable us to develop the framework and relevant indicators for performance assessment, and improve data quality, as identified by the Executive Board resolution. The modifications will serve as the basis for the next report on the performance of the world's health systems in October 2002.

Another important innovation during the last three years has been the process through which governments are negotiating a framework convention on tobacco control. The second round of the negotiation process was completed earlier this month under the excellent stewardship of Ambassador Celso Amorim. His first draft was discussed at length. This is the normal negotiating process that will go forward to the next session in November. I am confident that we will end up with a strong and effective convention - one that can help countries confront the threat of tobacco to their people. As we move forward, we must keep the alternative firmly in mind: millions of needless and preventable deaths around the world ea