Всемирная организация здравоохранения (ВОЗ / WHO) · Governing Bodies documents

Executive Board 108th session, Geneva, 23 May 2001: resolutions and decisions, annex, summary records

31 декабря 2001 г. Всемирная организация здравоохранения

Полный текст размещён на сайте публикующей организации. lawenc.com индексирует метаданные и ведёт на официальный источник.

Полный текст

EB 108/200 1/REC/1

WORLD HEALTH ORGANIZATION

EXECUTIVE BOARD 108TH SESSION GENEVA, 23 MAY 2001

RESOLUTION AND DECISIONS ANNEX SUMMARY RECORDS

GENEVA 2001

EB 108/200 1/REC/1

WORLD HEALTH ORGANIZATION

EXECUTIVE BOARD 108TH SESSION GENEVA, 23 MAY 2001

RESOLUTION AND DECISIONS ANNEX SUMlVIARY RECORDS

GENEVA 2001

ABBREVIATIONS

Abbreviations used in WHO documentation include the following: ACC ACHR ASEAN CIOMS Administrative Committee on Coordination Advisory Committee on Health Research Association of South-East Asian Nations Council for International Organizations of Medical Sciences Food and Agriculture Organization ofthe United Nations - International Atomic Energy Agency International Agency for Research on Cancer International Civil Aviation Organization International Fund for Agricultural Development International Labour Organization (Office) International Monetary Fund International Maritime Organization International Telecommunication Union Organization of African Unity Organisation for Economic Co-operation and Development PAHO Pan American Health Organization UN AIDS Joint United Nations Programme on HIV/AIDS UNCTAD- United Nations Conference on Trade and Development United Nations International Drug UNDCP Control Programme UNDP United Nations Development Programme UNEP United Nations Environment Programme UNESCO - United Nations Educational, Scientific and Cultural Organization United Nations Population Fund UNFPA Office of the United Nations High UNHCR Commissioner for Refugees United Nations Children's Fund UNICEF United Nations Industrial UN IDO Development Organization United Nations Relief and Works UNRWA Agency for Palestine Refugees in the Near East WFP World Food Programme World Intellectual Property WIPO Organization World Meteorological WMO Organization WTO World Trade Organization

FAO

IAEA IARC ICAO IFAD ILO IMF IMO ITU OAU OECD

The designations employed and the presentation of the material in this volume do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Where the designation "country or area" appears in the headings of tables, it covers countries, territories, cities or areas.

- 11 -

EB 108/200 1/REC/1

EXECUTIVE BOARD 108th SESSION Geneva, 23 May 2001 RESOLUTIONS AND DECISIONS ANNEX

CORRIGENDUM

Page 12: Please note that under the entry for Cote d'lvoire, the affiliation of M. Weya should read "Mission permanente". In the entry for the Democratic People's Republic of Korea, the affiliation for Dr Kim Won Ho is the Ministry of Public Health. In the entry under Egypt for the Adviser to the Minister of Health and Population, the name should read Dr EL SHAFIE. Page 13: Please note that, under Italy, the affiliation for Mr Majori should read Laboratory of Parasitology. Page 14: Please note that Mr Ket Sein is the Minister of Health for Myanmar and the name of that country's Deputy Permanent Representative in Geneva is Mr Tin Maung Aye. Page 16: In the List of Members and other participants, to the section on MEMBER STATES NOT REPRESENTED ON THE EXECUTIVE BOARD, please add the following entries:

ECUADOR Sr. J. C. Castril16n Segundo Secretario Misi6n Permanente Ginebra

FRANCE M. F. Saint-Paul Representant permanent adjoint Geneve Mme F. Auer Premier Secn!taire Mission permanente Geneve Mme R. Lefait-Robin Delegation aux Affaires europeennes et intemationales Ministere de l'Emploi et de la Solidarite Paris

EB 108/200 1/REC/1 page 2

In the entry under United States of America, the title of Ms Blackwood should read Director ofHealth Programs. Page 17: To the section on REPRESENTATIVES OF THE UNITED NATIONS AND RELATED ORGANIZATIONS, please add to the list under United Nations: Ms M. Moulin-Acevedo Office for the Coordination of Humanitarian Affairs Geneva Page 18: In the entry for the Organization of African Unity in the section on REPRESENTATIVES OF OTHER INTERGOVERNMENTAL ORGANIZATIONS, the affiliation for Mr Mensa-Bonsu should read Minister Counsellor.

PREFACE

The 108th session of the Executive Board was held at WHO headquarters, Geneva, on 23 May 2001. The Fifty-fourth World Health Assembly elected 12 Member States to be entitled to designate a person to serve on the Executive Board 1 in place of those whose term of office had expired, giving the following new composition of the Board:

Designating country

Unexpired term of office 2

Designating country

Unexpired term of office 2

Belgium .............................. . Brazil .................................. . Chad .................................... . Colombia ........................... .. Comoros ............................. . Congo ................................. . Cote d'Ivoire ....................... . Cuba .................................... . Democratic People's Republic ofKorea ......... . Egypt. .................................. . Equatorial Guinea ............... . Eritrea ................................. . Ethiopia .............................. . Grenada ............................... . Guatemala ........................... . India .................................... . Iran (Islamic Republic of) .. .

1 year 2 years 1 year 3 years 1 year 1 year 1 year 3 years 2 years 3 years 2 years 3 years 3 years 3 years 1 year 1 year 2 years

Italy ..................................... . Japan ................................... . Jordan .................................. . Kazakhstan .......................... . Lebanon .............................. . Lithuania ............................. . Myanmar ............................. . Philippines .......................... . Republic of Korea ............... . Saudi Arabia ....................... . Sweden ................................ . Switzerland ......................... . United Kingdom of Great Britain and Northern Ireland ............................ . Vanuatu ............................... . Venezuela ............................ .

2 years 2 years 2 years 3 years 1 year 2 years 3 years 3 years 3 years 3 years 2 years 1 year

3 years 1 year 2 years

Details regarding members designated by the above Member States will be found in the list of members and other participants.

By decision WHA54(8). The retiring members were those designated by Bangladesh, Cape Verde, Central African Republic, Chile, China, France, Lao People's Democratic Republic, Qatar, Russian Federation, Trinidad and Tobago, United States of America, and Yemen. 2

At the time of the closure of the Fifty-fourth World Health Assembly. - Ill -

CONTENTS

Page Preface............................................................................................................................................. Agenda............................................................................................................................................. List of documents ... . .. .. .. .. . .. .. . .. . .. . . .. .. . .. . ..... ... .. .. ... . ... . ... .. .. .. .. . .. .. . .. . ... .. . ... .. .. .. ... .. ... .... . .... ... ... .. .. ... .. . ... 111

vu IX

PART I RESOLUTION AND DECISIONS

Resolution EB108.Rl Confirmation of amendments to the Staff Rules ............................................ .. 3

Decisions EB108(1) Membership of the Programme Development Committee of the Executive Board .............................................................................................. . Membership ofthe Administration, Budget and Finance Committee of the Executive Board ............................................................................................... . Membership of the Audit Committee of the Executive Board ........................ . Membership of the Executive Board's Standing Committee on Nongovemmental Organizations ..................................................................... . Membership of the Leon Bemard Foundation Committee ............................. .. Membership of the Jacques Parisot Foundation Fellowship Committee .......... Membership of the Sasakawa Health Prize Selection Panel... ......................... . Membership of the United Arab Emirates Health Foundation Selection Panel ................................................................................................................ . Appointment of representatives of the Executive Board at the Fifty-fifth World Health Assembly .................................................................................. .

EB108(2)

EB108(3) EB108(4)

4 4

EB108(5) EBI08(6) EBI08(7) EB108(8)

5 5

EB108(9)

-v-

Page

EB108(10) EB 108( 11)

Date, place and duration of the 109th session of the Executive Board ............ . Place, date and duration of the Fifty-fifth World Health Assembly ................ .

6 6

ANNEX Amendments to the Staff Rules .. .. .... .. .. .... ....... ... .... .. ... .... .. .... ...... .. ......... .. .... ... ... .... .... ... .... ... .. .. .. .. .. . 7

PART 11 SUMMARY RECORDS

List of members and other participants............................................................................................ Committees and working groups .. ... ... .. .... ... .. ..... .... .. .... ... .... .. ..... ........ .. ........ ... .... .. .. ... ... .. .. ... .. .. .. .. .. . Summary records: First meeting.......................................................................................................................... Second meeting ......................................................................-................................................

11 21

23 34

-VI-

AGENDA 1

I. 2. 3. 4.

Opening of the session and adoption of the agenda Election of Chairman, Vice-Chairmen and Rapporteurs Outcome of the Fifty-fourth World Health Assembly Technical and health matters • Intensifying the response to the conditions associated with poverty

Staffing matters • Statement by the representative of the WHO staff associations on matters concerning personnel policy and conditions of service • Confirmation of amendments to the Staff Rules

Management and financial matters • Committees ofthe Executive Board: membership • Governing bodies: future sessions

Matters for information • Report on meetings of expert committees and study groups • Food safety

Closure of the session

As adopted by the Board at its first meeting.

-VII -

LIST OF DOCUMENTS

EB10811 EB108/2 EB108/3

Agenda' Outcome ofthe Fifty-fourth World Health Assembly Intensifying the response to the conditions associated with poverty: next steps in scaling up Committees of the Executive Board: membership Governing bodies: future sessions Report on meetings of expert committees and study groups Food safety Confirmation of amendments to the Staff Rules2

EB 108/4 and Add.1 EB108/5 EB108/6 EB108/7 EB108/8

Information documents EB 108/INF .DOC./1 and Corr.1 EB 108/INF .DOC./2 Statement by the representative of the WHO staff associations on matters concerning personnel policy and conditions of service Revised procedures for updating the WHO Model List of Essential Drugs: a summary of proposals and process

1 2

See page vii. See Annex, page 7.

-IX-

PART I RESOLUTION AND DECISIONS ANNEX

RESOLUTION EB108.Rl Confirmation of amendments to the Staff Rules 1

The Executive Board CONFIRMS, in accordance with Staff Regulation 12.2/ the amendments to the Staff Rules that have been made by the Director-General with effect from 1 June 2001 in respect of standards of conduct and, with effect from the school year in progress on 1 January 2001, in respect of education grant entitlements. (Second meeting, 23 May 2001)

DECISIONS EB108(1) Membership of the Programme Development Committee of the Executive Board

The Executive Board appointed Dr C. Dotres Martinez (Cuba), Dr G. Azene (Ethiopia), Dr B. Sadrizadeh (Islamic Republic of Iran), Vice-Chairman of the Board, member ex officio, Mr Ket Sein (Myanmar), Dr A.G. Romualdez (Philippines) and Dr Y.Y. Al-Mazrou (Saudi Arabia) as members of its Programme Development Committee, for a period of two years, in addition to Ms K. Wigzell (Sweden), already member of the Committee. It was understood that if any member of the Committee was unable to attend, his or her successor or the alternate member of the Board designated by the Government concerned, in accordance with Rule 2 of the Rules of Procedure, would participate in the work of the Committee. (Second meeting, 23 May 2001)

EB108(2)

Membership of the Administration, Budget and Finance Committee of the Executive Board

The Executive Board appointed Dr S. Abia Nseng (Equatorial Guinea), Mr J.A. Chowdhury (India), Vice-Chairman of the Board, member ex officio, and Professor L. Donaldson (United Kingdom of Great Britain and Northern Ireland) as members of its Administration, Budget and Finance Committee for a period of two years, in addition to Dr Kim Won Ho (Democratic People's Republic of Korea), Dr R. Cabrera Marquez (Guatemala), Dr H. Shinozaki (Japan) and Dr K. Karam

1 2

See Annex.

WHO Basic Documents, 43rd ed., 200 I.

-3-

EXECUTIVE BOARD, 108TH SESSION

(Lebanon), already members of the Committee. It was understood that if any member of the Committee was unable to attend, his or her successor or the alternate member of the Board designated by the Government concerned, in accordance with Rule 2 of the Rules of Procedure, would participate in the work of the Committee. (Second meeting, 23 May 2001)

EB108(3)

Membership of the Audit Committee of the Executive Board

The Executive Board appointed Dr I. Sallam (Egypt), Dr Y.-J. Om (Republic of Korea), Ms A.-C. Filipsson (Sweden) (alternate to Ms K. Wigzell) and Professor T. Zeltner (Switzerland), Vice-Chairman of the Board, member ex officio, as members of the Audit Committee, in addition to Mr P.H. Kengouya (Congo) (alternate to Dr D. Bodzongo) and Mr G.R. Patwardhan (India) (alternate to Mr J.A. Chowdhury). The Board authorized the Chairman to appoint a member to the Committee from among the members or alternates of the Board designated by Colombia, on the basis of a curriculum vitae to be submitted. (Second meeting, 23 May 2001)

EB108(4)

Membership of the Executive Board's Standing Committee on N ongovernmental Organizations

The Executive Board appointed Dr Z. Alemu (Eritrea) and Mr Ket Sein (Myanmar) as members of its Standing Committee on Non governmental Organizations for the duration of their term of office on the Executive Board, in addition to Dr B. Sadrizadeh (Islamic Republic oflran), Dr M. Di Gennaro (Italy) and Dr M. Urbaneja-Durant (Venezuela), already members of the Committee. It was understood that if any member of the Committee was unable to attend, his or her successor or the alternate member of the Board designated by the Government concerned, in accordance with Rule 2 of the Rules of Procedure, would participate in the work of the Committee. (Second meeting, 23 May 200 I)

EB108(5)

Membership of the Leon Bernard Foundation Committee

The Executive Board, in accordance with the Statutes of the Leon Bernard Foundation, appointed Professor V.J. Grabauskas (Lithuania) as a member of the Leon Bernard Foundation Committee for the duration of his term of office on the Executive Board, in addition to the Chairman and Vice-Chairmen of the Board, members ex officio. It was understood that if Professor Grabauskas was unable to attend, his successor or the alternate member of the Board designated by the Government concerned, in· accordance with Rule 2 of the Rules of Procedure, would participate in the work of the Committee. (Second meeting, 23 May 2001)

RESOLUTION AND DECISIONS

EB108(6)

Membership of the Jacques Parisot Foundation Fellowship Committee

The Executive Board, in accordance with the Implementing Regulations of the Jacques Pari sot Foundation, appointed Or Y.-J. Om (Republic of Korea) as a member of the Jacques Parisot Foundation Fellowship Committee for the duration of his term of office on the Executive Board, in addition to the Chairman and Vice-Chairmen of the Board, members ex officio. It was understood that if Or Om was unable to attend, his successor or the alternate member of the Board designated by the Government concerned, in accordance with Rule 2 of the Rules of Procedure, would participate in the work of the Committee. (Second meeting, 23 May 200 1)

EB108(7)

Membership of the Sasakawa Health Prize Selection Panel

The Executive Board, in accordance with the Statutes of the Sasakawa Health Prize, appointed Or A.G. Romualdez (Philippines) as a member of the Sasakawa Health Prize Selection Panel, in addition to the Chairman of the Board and a representative of the founder, members ex officio. It was understood that if Or Romualdez was unable to attend, his successor or the alternate member of the Board designated by the Government concerned, in accordance with Rule 2 of the Rules of Procedure, would participate in the work of the Panel. (Second meeting, 23 May 2001)

EB108(8)

Membership of the United Arab Emirates Health Foundation Selection Panel

The Executive Board, in accordance with the Statutes of the United Arab Emirates Health Foundation, appointed Or Y.Y. Al-Mazrou (Saudi Arabia) as a member of the United Arab Emirates Health Foundation Selection Panel, in addition to the Chairman of the Board and a representative of the founder, members ex officio. It was understood that if Or Al-Mazrou was unable to attend, his successor or the alternate member of the Board designated by the Government concerned, m accordance with Rule 2 of the Rules of Procedure, would participate in the work of the Panel. (Second meeting, 23 May 2001)

EB108(9)

Appointment of representatives of the Executive Board at the Fifty-fifth World Health Assembly

The Executive Board, in accordance with paragraph 1 of resolution EB59.R7, appointed its Chairman, Mrs M. Abel (Vanuatu), ex officio, and Mr J.A. Chowdhury (India), Or K. Karam (Lebanon) and Ms K. Wigzell (Sweden) to represent the Board at the Fifty-fifth World Health Assembly. (Second meeting, 23 May 2001)

EXECUTIVE BOARD, 108TH SESSION

EB108(10)

Date, place and duration of the 109th session of the Executive Board

The Executive Board decided that its 109th session should be convened on Monday, 14 January 2002, at WHO headquarters, Geneva, and should close no later than Monday, 21 January 2002. (Second meeting, 23 May 2001)

EB108(11)

Place, date and duration of the Fifty-fifth World Health Assembly

The Executive Board decided that the Fifty-fifth World Health Assembly should be held at the Palais des Nations, Geneva, opening on Monday, 13 May 2002, and that it should close no later than Saturday, 18 May 2002. (Second meeting, 23 May 2001)

ANNEX

Amendments to the Staff Rules 1 Report by the Secretariat [EB108/8, Annex- 9 May 2001] 110. STANDARDS OF CONDUCT FOR STAFF MEMBERS

110.7

The Director-General shall decide on the compatibility of any interests declared by staff members with Article I of the Staff Regulations, and on any action to be taken under this Rule: 110.7.1 A staff member who has, or whose spouse or dependent children have, any interest in (including association with) any entity with which the staff member may be required, directly or indirectly, to have official dealings on behalf of the Organization, or which has a commercial interest in the work of WHO, or a common area of activity with WHO, shall report the interest to the DirectorGeneral. As determined by the Director-General, staff members in designated employment categories shall be required, upon appointment and at prescribed intervals, to file in respect of themselves, their spouses and dependent children, a declaration in a prescribed form disclosing designated types of interests.

110.7.2

350.

EDUCATION GRANT

350.1

.... For staff members at certain designated official stations, the amount ofthe grant in respect of primary and secondary education shall be increased by an additional amount corresponding to 100% of boarding costs up to US$ 5060 per child per year or, for expenses incurred in certain local currencies as determined by the Director-General on the basis of procedures agreed among the international organizations concerned, an amount established in those currencies.

350.2.2

the cost of full-time attendance at an educational institution outside the country or area of the official station, including the cost of board if provided by the institution. Where board is not provided by the institution, a flat amount is paid in lieu. The

See resolution EB I 08.R I.

-7-

EXECUTIVE BOARD, 108TH SESSION

flat amount per child per year shall be US$ 3373 or, for expenses incurred in certain currencies as determined by the Director-General on the basis of procedures agreed among the international organizations concerned, an amount established in those currencies. For staff members at certain designated official stations the flat amount in respect of primary and secondary education is US$ 5060, or for expenses incurred in certain currencies as determined by the Director-General on the basis of procedures agreed among the international organizations concerned, an amount established in those currencies.

PART 11 SUMMARY RECORDS

LIST OF MEMBERS AND OTHER PARTICIPANTS

MEMBERS, ALTERNATES AND ADVISERS VANUATU Mrs M. ABEL, Director of Public Health, Ministry of Health, Port Vila (Chairman)

BELGIUM Or G. THIERS, Directeur, Institut scientifique de la Sante publique- Louis Pasteur, Bruxelles Alternates M. J.-M. NOIRFALISSE, Ambassadeur, Representant permanent, Geneve Mme J. ZIKMUNDOVA, Attachee, Mission permanente, Geneve M. P. NAYER, Delegue, Communaute fran<;aise de Belgique et de la Region wallonne, Geneve

BRAZIL Professor J. YUNES, Professor, Public Health Faculty, University of Sao Paulo, Sao Paulo Alternates Mr R. OLIV A, Director, National Agency of Sanitary Vigilance, Ministry of Health, Brasilia Ms M. MOSLER PARADA TOSCANO, Head ofthe Multilateral Sector, International Affairs Department, Ministry of Health, Brasilia Mr F. COSTI SANTAROSA, Second Secretary, Permanent Mission, Geneva

CHAD Or M.E. MBAIONG, Directeur general adjoint, Ministere de la Sante publique, N'Djamena

COLOMBIA Or J. BOSHELL, Director General, Instituto Nacional de Salud, Santafe de Bogota Alternate Sra. F.E. BENAVIDES COTES, Ministro Plenipotenciario, Misi6n Permanente, Ginebra

COMOROS Or A. MSA MLIV A, Directeur general de la Sante, Ministere de la Sante publique et de la Population, Moroni

- 11 -

EXECUTIVE BOARD, 108TH SESSION

CONGO

Dr D. BODZONGO, Directeur general de la Sante, Ministere de la Sante, de la Solidarite et de l 'Action humanitaire, Brazzaville (Rapporteur)

COTE D'IVOIRE

Professeur R. ABOUO N'DORI, Ministre de la Sante publique, Abidjan Alternates M. C. BEKE DASSYS, Ambassadeur, Representant permanent, Geneve Dr F.B. TOURE, Secretariat technique permanent du Plan national de Developpement du Secteur sanitaire, Abidjan M. J.K. WEYA, Premier Conseiller, Mission permanent, Geneve Dr F. KOUNANDY, Directeur, Inspection de la Medecine du Travail, Abidjan

CUBA

Dr A. GONZALEZ FERNANDEZ, Jefe, Departamento de Organismos Intemacionales, Ministerio de Salud Publica, La Habana (alternate to Dr C. Dotres Martinez)

DEMOCRATIC PEOPLE'S REPUBLIC OF KOREA

Dr KIM Won Ho, Policy Adviser, Ministry of Health, Pyongyang Alternates Mr RI Si Hong, Deputy Director-General, Department oflntemational Organizations, Ministry ofForeign Affairs, Pyongyang Mr JANG Chun Sik, Counsellor, Permanent Mission, Geneva

EGYPT

Dr I. SALLAM, Minister of Health and Population, Cairo Alternates Mrs F. ABOULNAGA, Ambassador, Permanent Representative, Geneva Mr H. SELIM-LABIB, First Secretary, Permanent Mission, Geneva Advisers Dr W. ANWAR, Director, Technical Support Office, Ministry of Health and Population, Cairo Dr H. AB DEL FA TT AH, Ministry of Health and Population, Cairo Dr M. El SHAFIE, Adviser to the Minister of Health and Population, Cairo Dr N. EL SAIED, Director, AIDS Control Programme, Ministry of Health and Population, Cairo

EQUATORIAL GUINEA

Dr S. ABIA NSENG, Director General de Salud Publica y Planificaci6n, Malabo

MEMBERS AND OTHER PARTICIPANTS

ERITREA

Dr Z. ALEMU, Director, Primary Health Care Division, Ministry of Health, Asmara

ETHIOPIA

Dr G. AZENE, Head, Department of Planning and Programming, Ministry of Health, Addis Ababa

GRENADA

Dr C. MODESTE-CURWEN, Minister of Health, St. George's (Rapporteur)

GUATEMALA

Dr R. CABRERA MARQUEZ, Viceministro de Salud Publica y Asistencia Social, Ciudad de Guatemala Alternates Sr. A. ARENALES FORNO, Embajador, Representante Permanente, Ginebra Sr. I. ESPINOZA FARF AN, Ministro Consejero, Misi6n Permanente, Ginebra Srta. S. HOCHSTETTER, Segundo Secretario, Misi6n Permanente, Ginebra

INDIA

Mr J.A. CHOWDHURY, Secretary, Health and Family Welfare, New Delhi (Vice-Chairman)

IRAN (ISLAMIC REPUBLIC OF)

Dr B. SADRIZADEH, Senior Adviser, Ministry of Health and Medical Education, Teheran (Vice-Chairman)

ITALY

Dr F. CICOGNA, Department of the International Relations, Ministry of Health, Rome (alternate to Dr M. Di Gennaro) Alternates Mr G. MAJORI, Director, Laboratory ofParisitology, Ministry of Health, Rome Mrs N. QUINT A V ALLE, Counsellor, Permanent Mission, Geneva

JAPAN

Dr H. ENDO, Director, International Cooperation Office, International Affairs Division, Minister's Secretariat, Ministry of Health, Labour and Welfare, Tokyo (alternate to Dr H. Shinozaki) Alternate Mr M. W AT ANABE, Counsellor, Permanent Mission, Geneva

EXECUTIVE BOARD, 108TH SESSION

Advisers Dr M. SAKOI, Deputy Director, International Affairs Division, Minister's Secretariat, Ministry of Health, Labour and Welfare, Tokyo Mr A. YOKOMAKU, First Secretary, Permanent Mission, Geneva Dr T. ENAMI, Technical Officer, Medical Economics Division, Health Insurance Bureau, Ministry of Health, Labour and Welfare, Tokyo

JORDAN Dr S. AL KHARABSEH, Director-General, Primary Health Care, Ministry of Health, Amman (alternate to Dr T.S. Suheimat) Alternate Mr M. QASEM, Head of International Health, Ministry of Health, Amman

KAZAKHSTAN Mr N. DANENOV, Ambassador, Permanent Representative, Geneva (alternate to Professor M. Kulzhanov) Alternate Mr A. AKHMETOV, Counsellor, Permanent Mission, Geneva

LEBANON Dr K. KARAM, Minister of Tourism, Beirut

LITHUANIA Professor V.J. GRABAUSKAS, Rector, Kaunas Medical Institute, Kaunas

MYANMAR Mr KET Se in, Ministry of Health, Y angon Alternates Mr MY A Than, Ambassador, Permanent Representative, Geneva Professor MAUNG Maung Wint, Director-General, Department of Medical Sciences, Yangon Dr KYI Soe, Director-General, Department of Health Planning, Yangon Mr TIN Muaung Aye, Deputy Permanent Representative, Geneva Advisers Dr HLA Pe, Deputy Director-General, Department of Health, Y angon Dr PE Thet Tun, Chief, International Health Division, Ministry of Health, Yangon Mrs A YE Aye Mu, Counsellor, Permanent Mission, Geneva Mrs El Ei Tin, Second Secretary, Permanent Mission, Geneva

PHILIPPINES Dr A.G. ROMUALDEZ, Consultant, Department of Health, Manila

MEMBERS AND OTHER PARTICIPANTS

REPUBLIC OF KOREA Dr Y.-J. OM, Special Adviser to the Minister of Health and Welfare, Seoul Alternates Mr C.-J. MOON, Counsellor, Permanent Mission, Geneva Mr M.-B. JEON, Director, International Cooperation Division, Ministry of Health and Welfare, Seoul Mr K.-1. CHO, Administration Officer, International Cooperation Division, Ministry of Health and Welfare, Seoul Dr Y.-S. SHIN, Professor, Seoul National University, Seoul

SAUDI ARABIA Dr Y.Y. AL-MAZROU, Assistant Deputy Minister for Preventive Medicine, Ministry of Health, Riyadh

SWEDEN Ms A.-C. FILIPSSON, Director, Ministry of Health and Social Welfare, Stockholm (alternate to Ms K. Wigzell) Mr J. MOLANDER, Ambassador, Permanent Representative, Geneva Dr A. MOLIN, Senior Programme Officer, Swedish International Development Authority, Stockholm Ms P. STAV AS, First Secretary, Permanent Mission, Geneva Ms B. SCHMIDT, Administrative Director, National Board of Health and Welfare, Stockholm

SWITZERLAND Professeur T. ZELTNER, Directeur de I' Office federal de la Sante publique, Berne (Vice-Chairman) Alternates Dr R. DURLER, Chef, par interim, Section des Affaires internationales, Office federal de la Sante publique, Departement federal de l'Interieur, Berne Dr M. BERGER, Conseiller special (Sante publique et Developpement), Mission permanente, Geneve M. R. VONOVIER, Deuxieme Secretaire, Mission permanente, Geneve M. F. TSCHIRKY, Chef de l'Etat-major, Office federal de la Sante publique, Berne

UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND Professor L. DONALDSON, Chief Medical Officer, Department of Health, London Alternates Mr S. FULLER, Ambassador, Permanent Representative, Geneva Mr G. WARRINGTON, First Secretary, Permanent Mission, Geneva Dr W. THORNE, Department of Health, London Mrs S. MCRORY, Legal Adviser, Permanent Mission, Geneva Mr J. BRADLEY, Second Secretary, Permanent Mission, Geneva Miss S. COTTON, Attache, Permanent Mission, Geneva

EXECUTIVE BOARD, 108TH SESSION

VENEZUELA

Ora. L. LOPEZ, Viceministra de Salud y Desarrollo Social, Caracas (alternate to Dr M. Urbaneja-Durant) Alternate Sr. M. HERNANDEZ, Consejero, Misi6n Permanente, Ginebra

MEMBER STATES NOT REPRESENTED ON THE EXECUTIVE BOARD 1 CANADA

Dr J. LARIVIERE, Senior Medical Adviser, International Affairs Directorate, Health Canada, Ottawa Mr D. MACPHEE, Counsellor, Permanent Mission, Geneva

GUINEA

M. A.I.S. BALDE, Comptable, Conakry M. M. DIA YE, Technicien, Conakry M. M. N'F A KABA, Technicien, Conakry

MADAGASCAR

Mme Y. P ASEA, Conseiller, Mission permanente, Geneve

MOROCCO

M. A. ALLOUCH, Premier Secretaire (Institutions, specialisees), Mission permanente, Geneve

RUSSIAN FEDERATION

Mr P.G. CHERNIKOV, Counsellor, Permanent Mission, Geneva Mr N.N. FETISOV, Permanent Mission, Geneva

SLOVAK REPUBLIC

Mrs J. BARTOSIEWICZOV A, Counsellor, Permanent Mission, Geneva

UNITED STATES OF AMERICA

Ms A. BLACKWOOD, Director of Health Programmes, Bureau oflnternational Organization Affairs, Department of State, Washington, D.C.

Attending by virtue of Rule 3 of the Rules of Procedure of the Executive Board.

MEMBERS AND OTHER PARTICIPANTS

Mr D. HOHMAN, Senior Departmental Adviser for International Health and Human Services Initiatives, Office of International Affairs, Department of Health and Human Services, Washington, D.C. Mrs L.A. VOGEL, Health Attache, Permanent Mission, Geneva

ZAMBIA Ms A. KAZHINGU, Second Secretary, Permanent Mission, Geneva

ZIMBABWE Dr T.J. STAMPS, Minister ofHealth and Child Welfare, Harare Mr B.G. GHIDY AUSIKU, Ambassador, Permanent Representative, Geneva Mrs B. MUTETWA, Deputy Permanent Representative, Geneva Dr DHLAKAMA, Director, Technical Support, Harare Mrs M. SIBANDA, Director, Finance, Harare Mrs MADZIMA, Nutrition Intervention Officer, Harare Mr B. MUGARISANWA, Counsellor, Permanent Mission, Geneva

REPRESENTATIVES OF THE UNITED NATIONS AND RELATED ORGANIZATIONS United Nations MrS. KUY AMA, Chairman, Joint Inspection Unit, Geneva Mr A. DUQUE GONZALEZ, Vice-Chairman, Joint Inspection Unit, Geneva Mr I. GORIT A, Inspector, Joint Inspection Unit, Geneva Mr H.L. HERNANDEZ, Inspector, Joint Inspection Unit, Geneva Mr W. MUNCH, Inspector, Joint Inspection Unit, Geneva Mr L.D. OUEDRAOGO, Inspector, Joint Inspection Unit, Geneva Mrs C. MOMAL-VANIAN, Research Officer, Joint Inspection Unit, Geneva

United Nations Environment Programme Mr J.B. WILLIS, Director, UNEP Chemicals MrS. MILAD, UNEP Chemicals Mr H. FADAEI, UNEP Chemicals

United Nations Population Fund Mr E. PALSTRA, Senior External Relations Officer, UNFPA Office, Geneva Ms R. ABI CHEB, Consultant, UNFP A Office, Geneva Mr M. SEIJSENER. Consultant, UNFPA Office, Geneva

United Nations Relief and Works Agency for Palestine Refugees in the Near East United Nations Conference on Trade and Development Mr R. URANGA, Senior Economic Affairs Officer, Division for Services Infrastructure for Development and Trade Efficiency Dr F. MOUSSA, Director of Health

EXECUTIVE BOARD, I 08TH SESSION

SPECIALIZED AGENCIES International Labour Organization Ms S. PARKER, InFocus Programme on Skills, Knowledge and Employability Mr E. DA VYDOV, Bureau for External Relations and Partnerships Ms J. LAPORTE, Bureau for External Relations and Partnerships

United Nations Educational, Scientific and Cultural Organization Ms K. HOLST, Officer-in-Charge, UNESCO Liaison Office, Geneva

World Intellectual Property Organization Mile K. LEE, Conseiller, Bureau du Conseiller special

Food and Agriculture Organization of the United Nations MrT.N. MASUKU, Director, FAO Liaison Office with the United Nations, Geneva

United Nations Industrial Development Organization Ms E. MERZ, Liaison Office, UNIDO Office at Geneva

REPRESENTATIVES OF OTHER INTERGOVERNMENTAL ORGANIZATIONS Organization of African Unity Mrs S.A. KALINDE, Permanent Observer, Geneva Mr 1.0. MENSA-BONSU, Ministery Counsellor, Geneva Mr. R.I. AL-MOUSA Dr H.A. GADALLA, Medical Consultant

Organizaiton of the Islamic Conference Mr A.T. HANE, Ambassador, Permanent Observer, Geneva

Health Ministers' Council for Gulf Cooperation Council States Dr T.A. KHOJA, Executive Director

REPRESENTATIVES OF NONGOVERNMENTAL ORGANIZATIONS IN OFFICIAL RELATIONS WITH WHO Inter-African Committee on Traditional Practices affecting the Health of Women and Children Mme Mme Mme Mme B. RAS-WORK M. GREUTER R. BONNER B. VON DER WElD

International Commission on Occupational Health Professor P. WESTERHOLM

International Confederation of Midwives MsR. BRAUEN MsJ. BONNET Ms P. TEN HOOPE-BENDER

International College of Surgeons Professor P.B. HAHNLOSER

MEMBERS AND OTHER PARTICIPANTS

International Council of Nurses Dr J.A. OULTON Dr T. GHEBREHIWET MsA. OSWALD

Ms T. ALVES Mr G. FERREIRA

International Society of Doctors for the Environment Dr G. SILBERSCHMIDT

International Council of Women Mrs P. HERZOG

International Society of Surgery Professor S.W.A. GUNN

International Epidemiological Association Dr R. SARACCI

International Special Dietary Foods Industries Dr A. BRONNER Mr M. DE SKOWRONSKI

International Federation of Gynecology and Obstetrics Professor A. CAMP ANA

International Federation of Medical Students Associations Mr S. SAPKOTA MsJ.MOORE

International Union against Sexually Transmitted Infections DrG.M. ANTAL

World Association of Girl Guides and Girl Scounts Ms L. SCHURCH Ms S. SCHAFFSTEIN Ms P. D'HUEPPE

International Federation of Pharmaceutical Manufacturers Associations DrH.E. BALE Dr E. NOEHRENBERG DrD. WEBBER Ms S. DOUCET Ms P. GOLDSCHMID

World Federation for Mental Health Dr S. FLACHE

International Federation of Surgical Colleges Professor S.W. GUNN

World Federation ofHemophilia Mrs L. ROBILLARD

World Medical Association International League of Dermatological Societies Professor J.-H. SAURAT DrD. HUMAN DrR. SMOAK Dr J. APPLEY ARD Mr J. STRACHAN MrN.DUNCAN

International Life Sciences Institute Dr S. HARRIS

World Vision International DrE.RAM

International Pharmaceutical Federation Mr P. KIELGAST MrT. HOEK

I I

COMMITTEES AND WORKING GROUPS 1

Programme Development Committee

Dr C. Dotres Martinez (Cuba), Dr G. Azene (Ethiopia), Dr B. Sadrizadeh (Islamic Republic oflran), Vice-Chairman of the Board, member ex officio, Mr Ket Sein (Myanmar), Dr A.G. Romualdez (Philippines), Dr Y.Y. Al-Mazrou (Saudi Arabia), Ms K. Wigzell (Sweden)

Administration, Budget and Finance Committee

Dr Kim Won Ho (Democratic People's Republic of Korea), Dr S. Abia Nseng (Equatorial Guinea), Dr R. Cabrera Marquez (Guatemala), Mr J.A. Chowdhury (India), Dr H. Shinozaki (Japan), Dr K. Karam (Lebanon), Professor L. Donaldson (United Kingdom of Great Britain and Northern Ireland)

Fifteenth meeting, 11 May 2001: Professor T. Zeltner (Switzerland, Chairman), Dr G. Thiers (Belgium), Dr A. Msa Mliva (Comoros), Dr Kim Won Ho (Democratic People's Republic of Korea), Mr 0. Tasaka (Japan, alternate to Dr H. Shinozaki)

Audit Committee

Mr P.H. Kengouya (Congo, alternate to Dr D. Bodzongo), Dr I. Sallam (Egypt), Mr G.R. Patwardhan (India, alternate to Mr J.A. Chowdhury), Dr Y.-J. Om (Republic of Korea), Ms A.-C. Filipsson (Sweden, alternate toMs K. Wigzell), Professor T. Zeltner (Switzerland). The member appointed from among the members or alternates of the Board designated by Colombia remained to be determined.

Fourth meeting, 10-11 May 2001: Mr G.R. Patwardhan (India, Chairman, alternate to Mr J.A. Chowdhury), Mr Luo Meifu (China, alternate to Mr Liu Peilong), Mr P.H. Kengouya (Congo, alternate to Dr D. Bodzongo), Mr V.A. Vislykh (Russian Federation, alternate to Professor Y.L. Shevtchenko ), Dr N.N. Al-Aji (Yemen, alternate to Dr A.O. Al-Sallami)

Standing Committee on Nongovernmental Organizations

Dr Z. Alemu (Eritrea), Dr B. Sadrizadeh (Islamic Republic of Iran), Dr M. Di Gennaro (Italy), Mr Ket Sein (Myanmar), Dr M. Urbaneja-Durant (Venezuela)

Meeting of23 May 2001: Dr B. Sadrizadeh (Islamic Republic oflran, Chairman), Dr Z. Alemu (Eritrea), Dr M. Di Gennaro (Italy), Mr Ket Sein (Myanmar), Dr L. L6pez (Venezuela, alternate to Dr M. Urbaneja-Durant) Showing their current membership and listing the names of those who attended meetings held since the previous session of the Board. 1

- 21 -

EXECUTIVE BOARD, 108th SESSION

Leon Bernard Foundation Committee

The Chairman and Vice-Chairmen of the Executive Board, members ex officio, and Professor V.J. Grabauskas (Lithuania)

Jacques Parisot Foundation Fellowship Committee

The Chairman and Vice-Chairmen of the Executive Board, members ex officio, and Or Y.-J. Om (Republic of Korea)

Sasakawa Health Prize Selection Panel

The Chairman of the Executive Board, a representative of the founder, and Or A.G. Romualdez (Philippines)

United Arab Emirates Health Foundation Selection Panel

The Chairman of the Executive Board and a representative of the founder, members ex officio, and Dr Y.Y. Al-Mazrou (Saudi Arabia)

SUMMARY RECORDS

FIRST MEETING Wednesday, 23 May 2001, at 9:40 Chairman: Or J. JIMENEZ DE LA JARA (Chile) later: Mrs M. ABEL (Vanuatu)

OPENING OF THE SESSION AND ADOPTION OF THE AGENDA: Item 1 of the Provisional Agenda (Document EB 10811)

The CHAIRMAN declared open the 108th session of the Executive Board. He described his term as Chairman a rewarding experience and he thanked the Director-General, the members of the Executive Board, the Secretariat and the Regional Director of the Americas and his team for their invaluable support. He drew attention to the new Handbook for members which had just been issued and which was intended to help Board members in clarifying methods of work and ways of dealing with different issues. He proposed that the provisional agenda be amended as follows: since the Board would be discussing the second sub-item of item 5, Confirmation of amendments to the Staff Rules, "[if any]" should be deleted; and the first sub-item of item 6, Reports of the Joint Inspection Unit [if any], should be deleted since the reports would be submitted to the Board at its 109th session. The agenda, as amended, was adopted. 1

ELECTION OF CHAIRMAN, VICE-CHAIRMEN AND RAPPORTEURS: Item 2 of the Agenda The CHAIRMAN invited nominations for the office of Chairman.

Or ENDO (Japan) proposed Mrs M. Abel (Vanuatu), the nomination being seconded by Or ROMUALDEZ (Philippines). Mrs M. Abel was elected Chairman. The DIRECTOR-GENERAL thanked Dr Jimenez de la Jara, the outgoing Chairman, for his hard work and dedication. He had been instrumental in building consensus among Board members on a number of difficult issues, in assisting new Board members, and in fostering more frequent contact between members between sessions. The Director-General presented Dr Jimenez de la Jara with a gavel. Mrs Abel took the chair.

See page vii.

-23-

EXECUTIVE BOARD, 108TH SESSION

The CHAIRMAN thanked the Board for the honour it had done her, her country and the Western Pacific Region by electing her to her post. She looked forward to presiding over the Board's future deliberations in the knowledge that she would be able to rely on the assistance and support of its members. She invited nominations for the three Vice-Chairmen. Ms FILIPSSON (Sweden) proposed Professor T. Zeltner (Switzerland), the nomination being seconded by Professor GRABAUSKAS (Lithuania). Dr SALLAM (Egypt) proposed Dr B. Sadrizadeh (Islamic Republic of Iran), the nomination being seconded by Dr THIERS (Belgium). Mr KET Sein (Myanmar) proposed Mr J.A. Chowdhury (India), the nomination being seconded by Dr KIM Won Ho (Democratic People's Republic of Korea).

Mr J.A. Chowdhury (India), Dr B. Sadrizadeh (Islamic Republic of Iran) and Professor T. Zeltner (Switzerland) were elected Vice-Chairmen. The CHAIRMAN noted that, under Rule 15 of the Rules of Procedure of the Executive Board, if the Chairman was unable to act between sessions, one of the Vice-Chairmen should act in her place, and that the order in which the Vice-Chairmen would be requested to serve should be determined by lot at the session at which the election had taken place. It was determined by lot that the Vice-Chairmen should serve in the following order: Mr Chowdhury (India), Dr Sadrizadeh (Islamic Republic of Iran) and Professor Zeltner (Switzerland).

The CHAIRMAN invited nominations for the offices of English-speaking and French-speaking Rapporteurs. Dr GONZALEZ FERNANDEZ (Cuba) proposed Dr C. Modeste-Curwen (Grenada). Dr MBAIONG (Chad) proposed Dr D. Bodzongo (Congo).

Dr C. Modeste-Curwen (Grenada) and Dr D. Bodzongo (Congo) were elected Englishspeaking and French-speaking Rapporteurs, respectively.

OUTCOME OF THE FIFTY-FOURTH WORLD HEALTH ASSEMBLY: Item 3 of the Agenda (Document EB 108/2)

The CHAIRMAN reminded members that the Board had been represented at the Fifty-fourth World Health Assembly by Dr Bodzongo, Dr Jimenez de la Jara, Dr Thiers and herself. She invited Dr Jimenez de la Jara to deliver a report on their behalf. Dr JIMENEZ DE LA JARA (Chile), representative of the Executive Board at the Fifty-fourth World Health Assembly, introduced the report on the outcome of the Health Assembly. The agenda had been heavy, with complex and potentially controversial items, some touching on economic interests as well as health concerns, and others, such as the use of depleted uranium, having been given greater prominence by recent and intense media coverage. Yet, despite the complexity of the issues,

SUMMARY RECORDS: FIRST MEETING

the meetings had been conducted in an outstanding spirit of collaboration and cooperation, and the Health Assembly had adopted 22 resolutions. The opening day of the Health Assembly had proved outstanding. The contributions of the two women selected to express WHO's concerns, one representing people with HIV/AIDS and the other speaking on mental illness, had shown that WHO was not just a bureaucratic organization, dealing solely with political, policy or financial matters, but truly represented the genuine concerns of human beings, with their sufferings and daily problems. He welcomed the consensus reached on the vexed question of the scale of assessments, noting that any increase had a major impact on Member States. At the request of the Health Assembly, the Board would need to undertake a review of its management methods, not because it was poorly managed, but in order to see how it might be made much more effective, participatory and open to the concerns of Member countries, as well as more representative of present-day concerns. Ms FILIPSSON (Sweden), recalling the discussion on the working methods of the Executive Board at the Health Assembly, expressed the view that the working methods of the Health Assembly should also be analysed. The Fifty-fourth World Health Assembly had been efficient and successful in terms of the problems solved by consensus. However, delegates had worked under stress, frequently against the clock, with little time for constructive discussions on measures to meet the challenges taken up in the draft resolutions. The responses had to some extent been reactive and even, in some instances, restricted to damage limitation, not because of lack of will to take bolder steps, but owing to insufficient time for preparation and consultation with experts and governments. Moreover small delegations had found it difficult to handle the many concurrent processes. The decision-making process during the Health Assembly must be transparent and interactive and working methods must allow delegates the opportunity to contribute their views and proposals. She therefore suggested that new resolutions and substantive amendments to resolutions recommended by the Board should be available to all delegations from the start of the Health Assembly or earlier. There should also be a review of the timing and scheduling of the Health Assembly, including its working and drafting groups. Professor DONALDSON (United Kingdom of Great Britain and Northern Ireland), referring to paragraph 8 of the report before the Board, said that improving the quality of health care was important in strengthening health systems, and was increasingly becoming a priority in most health systems. Recent research had shown that as many as 10% of hospital admissions might result in an adverse event or avoidable error and that 25% of such adverse events worldwide might be due to medication errors alone. By comparison with the aviation industry, for example, health care had accorded a relatively low priority to safety, partly because there was no systematic way of collecting information on errors or learning from them. International collaboration in that area could make a considerable impact, and he therefore proposed that the Executive Board should take the initiative and, at a future session, discuss health care quality and patient safety, with a view to improving health care systems around the world. Professor GRABAUSKAS (Lithuania), referring to paragraph 7 of the report, said that the Baltic countries welcomed the attention paid at the Health Assembly to health problems caused by noncommunicable diseases. The discussions on health promotion and on the framework convention on tobacco control had clearly demonstrated the interest of most Member States in supporting the activities proposed by the Director-General in those programme areas. Professor YUNES (Brazil), pointing out that second-hand smoke caused a variety of illnesses, observed that smoking and the use of tobacco products was still permitted in workplaces and public areas owned, operated or controlled by the United Nations system. He therefore called on the Director-General to urge the Secretary-General of the United Nations to take measures to ensure that, during the Health Assembly, the United Nations building in Geneva was smoke-free in all its facilities;

EXECUTIVE BOARD, 108TH SESSION

that all United Nations buildings and United Nations-sponsored meetings were smoke-free; that a ban was enforced on the use of all kinds of tobacco products in all buildings within the United Nations system; that all United Nations buildings with shops banned the sale of all tobacco products; and that United Nations diplomats would not be supplied with duty-free tobacco products. He asked to be informed about progress in that area at the Board's next session. He stressed the need to follow closely developments in the area of indicators and methods for assessing health system performance. He expressed his satisfaction with the measures adopted by the Director-General, namely the establishment of an advisory group and the initiation of a process of regional consultations, and the expected constitution of the peer review group in October 2001. He proposed that the topic be added to the agenda for the 109th session of the Executive Board in January 2002, so that the Board could review progress. Dr SADRIZADEH (Islamic Republic of Iran) welcomed the initiative aimed at strengthening health services, an area that should continue to receive high priority. WHO should emphasize the quality of such services. As a global leader in the field, the Organization should promote greater political commitment to health system development at national level, as well as to strengthening capacity-building, transfer of technology and the mobilization of resources. WHO should also continue to encourage countries to integrate health programmes into their primary health care services. Dr SALLAM (Egypt), while agreeing with Professor Donaldson on the importance of the quality of health systems, pointed out that some countries still had no proper health system at all and thus urgently required international support. Serious consideration should be given to the establishment of a minimum acceptable standard of health system. It was also important to tailor health services to deal with country-specific problems, and in that context south-to-south cooperation might be valuable. Turning to financial issues, he said that the crucial question was how to encourage countries to invest in health, an issue which had to be discussed globally, within WHO and other organizations. Health care was not a commercial enterprise that could attract investment, and further incentives were required to persuade countries to give it greater prominence. The World Bank inter alia could play a valuable role in that regard. He expressed appreciation for the mixed funding that had been offered to his country by the Swiss Government, on the basis of 50% grant, 50% loan, which constituted a good example for possible future cooperation projects with western countries. Such mixed loans ought to be earmarked primarily for the health sector, particularly given the significance of ill-health as a major cause of poverty. Dr KIM Won Ho (Democratic People's Republic of Korea) welcomed the successful outcome of the Health Assembly, in particular the agreement reached on the scale of assessments and the active intervention of the Director-General. He also expressed appreciation for the successful ministerial round tables on mental health. He favoured holding further round-table discussions in coming years. He also called for straightforward, readable documents to be sent in good time to Member States, in order to improve the efficiency of the Health Assembly. Professor ZELTNER (Switzerland) welcomed the choice of mental health as the subject for the round-table discussions, but expressed doubts that the hopes placed in the round tables when they had started three years earlier had been fulfilled. The Board should consider, perhaps at its next retreat, how the format might be modified so as to encourage health ministers to debate rather than recite statements. Ministers should also be encouraged to participate actively in the Health Assembly. Switzerland was grateful to Pakistan for having brought the important matter of the reform of the Executive Board to the attention of the Health Assembly, an action that had led to adoption of resolution WHA54.22. Since virtually all Member States were interested in the process of reform, the establishment of an open-ended intergovernmental working group was undoubtedly the right approach. In order to assist the working group in its task, he suggested that the Director-General, with

SUMMARY RECORDS: FIRST MEETING

external assistance if necessary, should prepare an information paper presenting the strengths and weaknesses of the current working methods and a number of options for improvement. He said that he would appreciate hearing the views of the Director-General on the reform process. Or AL-MAZROU (Saudi Arabia), endorsing the comments by Professor Donaldson, observed that the need to ensure quality was a major challenge to health systems. The issue required further discussion, and WHO should assist Member States to define their priorities in that regard. Ultimately, it was a matter of making optimal use of the resources available and avoiding any gaps in the provision of health services, particularly at secondary and tertiary levels. Or OM (Republic of Korea) welcomed WHO's focus on national health policies and systems, and the restructuring of responsibilities at headquarters. Member States would undoubtedly encounter difficulties in undertaking health reforms. WHO should give special attention to health insurance and should seek to develop a close relationship with public health insurance agencies, including financing organizations. Or KARAM (Lebanon) endorsed the comments of previous speakers concerning the quality of health services. WHO's initiative on the assessment of health systems performance should lead to an improvement in the quality of health care worldwide. He supported the proposal by Professor Yunes for reinforcing WHO's Tobacco Free Initiative. Or CICOGNA (Italy) expressed his satisfaction with the adoption of resolution WHA54.2 on infant and young child nutrition by consensus, as well as with the entire process that had led to its adoption. Resolution WHA54.19 on schistosomiasis and soil-transmitted helminth infections, neglected but severe and widespread diseases, was also very welcome. It had clear objectives and a clear underlying strategy, and could serve as a good model for other resolutions. He shared the views expressed by Professor Donaldson, and supported the suggestion that the Board should discuss quality of care as part of strengthening health systems. He endorsed the views expressed by Ms Filipsson regarding the need to review the methods of work of both the Health Assembly and the Board in order to improve effectiveness, efficiency and transparency. The roundtable debate on mental health had been interesting and, in his view, fruitful. Mental health remained a major priority, and he commended the way in which World Health Day and the round tables had been prepared, organized and conducted. Dr THIERS (Belgium) agreed with the comment by Ms Filipsson on the methods of work of the Health Assembly. Recalling his own previous criticisms, he pointed to the contrast between the bureaucratic working methods of the Executive Board and health conditions in the field worldwide. There had long been an awareness in Belgium of the danger that overemphasis on vertical approaches obscured the overall vision of the functioning of health services. That was the reason behind the amendments Belgium had proposed at the Health Assembly to the draft resolution on schistosomiasis. Furthermore, the Institute ofTropical Medicine of Antwerp was planning a high-level meeting during Belgium's forthcoming presidency of the European Union to explain that no public health problem could be tackled squarely in the absence of proper health services. Not even the free availability of drugs would be sufficient to ensure progress in tackling the HIV/AIDS problem without good health service delivery. As Professor Donaldson had said, it was important to consider the quality of health services. Over the previous 15 years, Belgium had built up experience in evaluating the quality of health services, in hospitals and in general practice. Supporting the plea by Professor Yunes for a tobacco-free United Nations, he called upon the Director-General to take an initiative on the sale of tobacco products in international organizations. It should be possible to achieve a total smoking ban in United Nations premises within a few years.

EXECUTIVE BOARD, 108TH SESSION

Dr LOPEZ (Venezuela) said that the resolution on strengthening health systems was important to Venezuela. She emphasized the need for well functioning information systems based on sound indicators, which were vital to ensure appropriate public health policy development that would have a long-term impact on the performance of health systems and raise the quality of health care services. She supported previous comments regarding the need to improve participation in the preparation of Health Assembly resolutions. There was not always enough time to discuss fully resolutions of great importance, which were then difficult to implement. She welcomed the DirectorGeneral's suggestion for the more active promotion of regional meetings of health ministers. Dr BODZONGO (Congo) said that while, like previous speakers, he recognized the success of the Fifty-fourth World Health Assembly, it had proved difficult to debate the many important health matters on the agenda in sufficient detail within the allotted time. The fact that the Board was discussing health promotion extensively at its current session was evidence in itself that the debate at the Health Assembly had been incomplete. It was up to the Board, when considering the agenda for the Health Assembly, to set priorities so as to enable effective discussion of specific health issues. Noting with regret that many heads of delegation, often ministers of health, left before the end and in some cases soon after the beginning of the Health Assembly, he urged that everything possible be done to encourage those in overall charge of health policy in their countries to stay as long as possible, perhaps by holding round tables on more than one occasion during the Health Assembly. Dr AZENE (Ethiopia), referring to paragraph 8 of the report, welcomed the prominence given to the strengthening of health systems. The serious challenge for many developing countries was to expand the availability of basic health services and, at the same time, to improve and maintain the quality of health care, which currently varied widely between countries. WHO should take the lead in supporting countries to determine the appropriate level of health services and carry out monitoring and evaluation. Since infectious disease outbreaks were a serious problem for many developing countries, rapid response systems should be set up, not only as part of global eradication initiatives but for other devastating diseases, such as malaria and meningitis, as well. Dr ROMUALDEZ (Philippines) agreed with Dr Sadrizadeh that a strong political commitment was needed in order to strengthen health systems. Radical change in the health systems of many poor countries was needed to improve quality and particularly equity. Strengthening of health systems was also linked to other matters discussed at the Health Assembly. For example, under WHO's new medicines strategy commercial interests sometimes clashed with health concerns and difficult political choices had to be made. Conflicts of political interest would arise in other areas, too, and they should be dealt with sensitively if there were to be true health system reform. Dr ENDO (Japan) welcomed moves to consider reform of the Executive Board. Having noted the comments of Italy and Sweden on efficient functioning of the Health Assembly, he suggested that it would also be necessary to review the relationship between proceedings in the Health Assembly and those in the Board and the Regional Committees, so as to avoid repetition of discussions and to find ways of better reflecting Regional Committee discussions in the Board. Dr BOSHELL (Colombia), referring to paragraph 13 of the report, suggested that the Board needed further information if it was to do justice to discussion of the scale of assessments for the biennium 2002-2003. While he welcomed the action taken on schistosomiasis, he regretted that other vector-borne diseases, such as dengue, dengue haemorrhagic fever and yellow fever, which were high-priority public health concerns for tropical countries, had not been touched upon. Those conditions should be taken up in the Board and at the next Health Assembly.

SUMMARY RECORDS: FIRST MEETING

Dr ASAMOA-BAAH (Executive Director), replying to Professor Zeltner, said that a paper on reform, examining procedures adopted in similar institutions and setting forth options, would be submitted to the Executive Board. The topic could perhaps be considered at the forthcoming Executive Board retreat and included as a substantive item on the agenda of the 109th session of the Board. It was hoped that the open-ended intergovernmental working group would be established at that session of the Board, so that it might present a report to the Health Assembly in May 2002. The CHAIRMAN said that she took it that the Board wished to take note of the report. It was so agreed.

TECHNICAL AND HEALTH MATTERS: Item 4 ofthe Agenda

Intensifying the response to the conditions associated with poverty (Documents EB 108/3 and EB 108/INF .DOC./2) The DIRECTOR-GENERAL said that, although public health professionals had long known of and discussed the close links between health, the economy and development, widespread recognition of those links and the potential impact of scaled-up health actions was a relatively recent phenomenon. The presence of the United Nations Secretary-General at the Fifty-fourth World Health Assembly was evidence that momentum was gathering and that health was being assigned a higher priority in the political agenda. Heads of State of developing countries were realizing - on the basis of evidence from the Commission on Macroeconomics and Health, the World Bank, and elsewhere- that good health was a prerequisite for development, and that, without good health, poor communities could not take full advantage of development opportunities. It was also being increasingly acknowledged that illness precipitated and aggravated poverty, undermined the well-being of whole communities and the economic development of nations, and reduced opportunities for earning and learning. In Africa, where many of the problems were greatest, ill-health encouraged two-speed development in the global economy and made poorer communities worse off year by year. The Commission on Macroeconomics and Health had underlined the impact of communicable diseases such as AIDS, malaria and tuberculosis, as well as maternal ill-health, and conditions of childhood, on development. It had recognized the importance of tobacco-related morbidity, noncommunicable diseases and injuries, and the impact of human trypanosomiasis and onchocerciasis in certain regions. Recognition of the extraordinary contribution of ill-health to underdevelopment had led to calls for investment in health, not only as an end in itself but also as a contribution to human development and security. That meant investing in health systems, ensuring that essential benefits were available to people in need, providing the necessary commodities and effective services at the lowest possible price, and securing additional resources to scale up effective action. WHO had for years been encouraging political leaders to give more emphasis to investing in health. The fruits of that effort were being seen much more clearly, with different countries taking the lead in different forums. For example, there had been a greater focus on health at the recent Millennium Summit, in the Japanese Government's preparations for the G8 Okinawa Summit, and in efforts by the Government of Nigeria and OAU on malaria in 2000 and HIV/AIDS in 2001, among many others. Against the background of the G8 commitment to mobilize additional resources for health, particularly for HIV, malaria and tuberculosis in the first instance, she had launched an internal discussion to examine how WHO could contribute to a massive effort to increase the effectiveness of investing in health. She was looking at how WHO should prepare itself to respond effectively to the

EXECUTIVE BOARD, 108TH SESSION

new situation of increased funding available to countries in need. What was the best preparation, and what was the best response? Those were questions for WHO, countries, and the international community. Or NABARRO (Executive Director) outlined steps taken in that respect to support countries in scaling up action to tackle conditions most associated with poverty. The European Commission had put forward plans to intensify its own action for health, particularly with reference to infectious diseases, and in September 2000 had hosted a round table of European Union Member States, with senior representatives of many developing countries, the private sector and nongovernmental organizations, to consider how it could assist. The possibility had also been raised that prominence should be given to differential pricing of medicines to ensure that they were available at lower prices in poor countries. Similar issues had been raised at a consultation with advocacy groups in Winterthur, Switzerland, in October 2000. The Board had been briefed on those issues and an intensive dialogue had begun in the United Nations system. The Japanese Government had hosted a further conference in Okinawa and the United Nations had issued a report illustrating successes in scaling up at country level. The emphasis was on not only disease control but also building up and securing health systems so that they could help people to confront priority diseases, responding to the situation at country level. There was also increased public emphasis on intellectual property issues, and access to generic medicine, which had received further impetus following the recent court case in South Africa and the dispute between at least two Member States before WTO. High-profile campaigns had been started, particularly by Medecins sans frontieres and OXFAM, while media attention was increasing. WHO and WTO had recently initiated in Norway a broad discussion on the issue of differential pricing and financing of essential drugs and of improving access to medicines at lower prices. WHO had developed a framework for action, the essential elements of which were set forth in document EB 108/3. Among those the chief was additional resources from external sources, as additional annual spending for health action in developing countries and poor communities could reach at least US$ 10 000 million. Although some funds could be obtained by redistributing national resources, the majority had to come from external resources. A new funding mechanism was therefore needed. Proposals were taking shape for a global AIDS and health fund, which would focus in the first instance on HIV, malaria and tuberculosis, with a strong emphasis .on health systems development. The degree to which the fund would support better access to antiretroviral therapy was being discussed in various forums. About 100 health ministers had met the Secretary-General of the United Nations during the recent Health Assembly, endorsed his call for the new fund, and put forward points on how it should be taken forward. Further discussions had been held among diplomatic representatives in New York and with civil society, within the context of the preparations for the United Nations General Assembly special session on HIV/AIDS. Consensus was building on the mode of operation of the fund: the emphasis was on country-level action, taking existing strategies and initiatives on funding, linked as far as possible, to performance and achievement. The fund would be international, involving the United Nations but not owned by the United Nations. The preferred form of governance might involve a small board, reflecting interests of developing countries, developed donor countries, foundations with some involvement of private groups, the United Nations and representation from civil society. An open consultation would be held in Geneva in June involving countries with members on the Executive Board, those with representatives on the Programme Coordinating Board of UN AIDS and donor countries. Its purpose would be to permit broad discussion of the scope, purpose, architecture and process of the global fund, and of its links with the United Nations General Assembly special session on HIVI AIDS. Document EB108/INF.DOC./2 summarized the revised procedures for updating the WHO Model List of Essential Drugs. The increase in the political and public attention given to the access to drugs, and particularly to the expensive drugs required to treat the major infectious diseases had been

SUMMARY RECORDS: FIRST MEETING

accompanied by increased attention to the way in which the model list was updated and to the discussion, inter alia, as to whether antiretroviral medicines should be included in that list. The paper summarized the revision process and the major recommended changes in order to familiarize Board members with the procedures at the outset. A longer paper with greater detail would shortly be available to the Board and to Member States to ensure that the former in particular had an opportunity to comment on it before it was made available to a wider audience in July 2001. Any comments made by Board members and other Member States would be summarized and considered by the relevant expert committee before the proposals were returned to the Board at its 109th session in January 2002 for a more formal discussion. Or SALLAM (Egypt) emphasized that the provision of good health care was an important tool for combating poverty. The impurtance of establishing priorities in health agendas and tackling such issues as child and neonatal mortality should be advocated strongly by WHO. He commended WHO's initiative set out in document EB108/3. The United States' commitment of US$ 200 million for the global AIDS and health fund set an example that all countries should try to emulate. Egypt was unable to provide financial support of that nature, but could provide support at the technical level. As far as drugs were concerned, the WHO Model List of Essential Drugs and access to drugs were separate issues and should be treated as such. The model list was a technical matter requiring the endorsement of the technical committees. The question whether a drug was expensive or inexpensive was not relevant to the establishment of an essential drugs list. The two issues might best be considered by two different committees, the first acting as a technical support committee to consider the WHO Model List of Essential Drugs, and the second acting as a high level committee to study and discuss access and, later on, possibly to negotiate affordable prices. Or CABRERA MARQUEZ (Guatemala) noted with pleasure the intent in document EB108/3 for intensified action for at least 10 years, thereby making considerable headway likely against the diseases that had a disproportionate impact on the health of poor people. WHO should therefore promote cooperation, as referred to in paragraph 7 of that document, and place special emphasis on the access to lifesaving drugs, one of the components of the proposed framework of action which would improve the well-being of millions of poor people. Mr CHOWDHURY (India) commended the commitment in principle by international organizations and donors to pooling large funds for major disease control programmes. It would be particularly appropriate if WHO, as the international organization for promoting global health, was able to determine the norms, policies, guidelines and geographical focus of such funding. He drew attention to the disturbing imbalance between WHO's regular budget and extrabudgetary funds, remarked upon in several governing body forums. It was a matter of grave concern that less than 10% of the total budgetary funds of the Organization were allocated to the flagship programmes on malaria and tuberculosis, and that the Member countries of the South-East Asia Region, which represented 24% of the global population and carried a very high percentage of the global disease burden, had access to only 9% of the total extrabudgetary resources. WHO should use its influence with the governing bodies of the independent disease control programmes to remedy the inequality in access to such funds and ensure furtherance of global public health goals. The policies of those bodies should be based on the geographical spread of the disease burden in relation to population and disease prevalence levels. Moreover, disease control funds should not as a matter of policy be confined to therapeutic treatment. If disease control was to be sustained beyond any programme period, the basic public health infrastructure of many developing countries needed to be strengthened, for example by upgrading the physical assets of the public health system, capacitybuilding through improving the knowledge of the medical and paramedical personnel and addressing the deficiencies in the national public health infrastructure generally.

EXECUTIVE BOARD, 108TH SESSION

Or SAORIZAOEH (Islamic Republic oflran) said that, as poverty was both the cause and result of illness, investments in health system development and disease control programmes were crucial to socioeconomic development. He fully supported the priority accorded by WHO to malaria, tuberculosis and HIV/AIOS. However, other emerging or re-emerging diseases should be accorded the importance they deserved. Among the noncommunicable diseases, malnutrition, disabilities resulting from accidents, mental illness and genetic disorders should also be considered in the context of diseases of poverty. The allocation of financial resources to capacity-building to intensify the response to the conditions associated with poverty was commendable. Ms FILIPSSON (Sweden), referring first to document EB 108/3, welcomed the increasing focus placed on the relationship between health and economic growth. Health was rightly seen as a core development issue and was higher on the political agenda than it had been for many years, largely owing to the efforts of WHO. She also welcomed the proposed global AIDS and health fund and said that Sweden looked forward to participating in the work to establish the fund in the coming months. As the fight against poverty formed the basis of Swedish development cooperation, it was gratifying to see that that issue was also high on the WHO agenda. Given its importance, however, it was unfortunate that the documents to be discussed by the Executive Board had only been made available on the day of the meeting. She therefore suggested that the response to the item should be placed on the agenda of the Executive Board's session in January 2002 and that the report to that session should focus on the ways in which global initiatives could be linked at the country level, including coordination within health systems in accordance with national priorities. As maternal and child health were important elements in the fight against poverty, emphasis should also be placed on reproductive health, safe motherhood and child health. Or OM (Republic of Korea) said that, in the context of the insufficiency of empirical evidence to demonstrate the extent to which medical, social and economic factors affected health, the proposed framework for action was important in providing another policy dimension to improve the general health conditions in Member States. WHO should therefore promote the initiative through intensive research into the relationship between disease control and the medical services as well as between health and other factors affecting health, such as economic growth and environmental factors, in collaboration with other United Nations bodies and Bretton Woods institutions such as the World Bank. Or CICOGNA (Italy) expressed particular appreciation for the work of the Commission on Macroeconomics and Health which had provided good evidence for the links between disease, health and development. He looked forward to receiving more conclusive reports and information from the Commission in the near future for use in other international forums. Referring in particular to paragraph 5 of document EB108/3, he emphasized the initiative of the Italian presidency of the G8 in establishing a global health fund aimed at bringing together all stakeholders and mobilizing fresh resources as a follow-up to the initiative of the Japanese presidency. Italy would draw the attention of the G8 countries and of the policy-makers of other countries, the private sector and public opinion to the need to find additional resources to combat diseases, particularly those associated with poverty, and to strengthen health systems. He agreed with the six components of the proposed framework for action, particularly the building up of health systems, social mobilization through local and international nongovernmental organizations and mechanisms for the rapid transfer of resources. All those elements constituted the fundamental pillars of the strategy of Italy's cooperation for development as demonstrated by its recent programme, jointly implemented with WHO, to combat HIV I AIDS in 10 African countries. Or ROMUALOEZ (Philippines) confirmed WHO's important role in generating international interest in health and its funding, especially for poor countries and poor communities within countries. The report contained in document EB108/3 emphasized WHO's role in defining a framework for

SUMMARY RECORDS: FIRST MEETING

health action that was acceptable to all countries. WHO also had an important role to play at country level by providing technical, material and moral support to the health sectors of the developing countries in their coordination and organizational difficulties with the many well-meaning partner agencies that sometimes appeared to be at variance with each other and with the objectives of the beneficiary country. He supported the comments by Dr Sallam that access to drugs and the WHO Model List of Essential Drugs should be dealt with as separate issues.

The meeting rose at 12:30.

SECOND MEETING Wednesday, 23 May 2001, at 14:10 Chairman: Mrs M. ABEL (Vanuatu)

TECHNICAL AND HEALTH MATTERS: Item 4 of the Agenda (continued)

Intensifying the response to the conditions associated with poverty (Documents EB 108/3 and EB108/INF.DOC./2) (continued) Professor GRABAUSKAS (Lithuania), observing that all health problems were poverty-related to a greater or lesser degree, fully supported the report by the Director-General and suggested that future such documents would benefit from reference to education as a social factor in reducing poverty and thus in alleviating the disease burden. Providing education to people would improve health globally for all countries irrespective of their economic level. In addition, he welcomed the DirectorGeneral's endeavours to mobilize resources for those Member States in need. Dr MBAIONG (Chad) noted with satisfaction the activities conducted by WHO to combat malaria, tuberculosis, HIVI AIDS, mental illness and other poverty-linked diseases. Success needed the strengthening of health systems, promotion of healthy lifestyles, improvement of health care, better access to drugs and health services in an equitable fashion and, particularly, good quality health care and staff. Of course, adequate financial resources were also needed to implement health policies but, without qualified human resources, it would be practically impossible to do so. In the interests of improving health, WHO should strengthen tobacco-control measures by seeking to have the consumption or sale of that commodity prohibited on United Nations premises, as suggested earlier by Professor Yunes, and should speed up negotiations on the framework convention on tobacco control. It should also encourage research to discover and make available vaccines and drugs to alleviate poverty-related diseases; intervene forcefully with the pertinent United Nations agencies to urge the reconsideration of intellectual property agreements so as to bring the patents on the manufacture of pharmaceuticals into the public domain, thereby promoting the production of drugs and vaccines for the treatment of poverty-related diseases at affordable prices; encourage training for health professionals in order to provide adequate health care; and make Member countries, especially developing ones, aware of the need to motivate health staff in order to reduce the migration of qualified personnel. Dr ENDO (Japan) said that the proposed new global AIDS and health fund would make a very important contribution to combating major infectious diseases. In view of the forthcoming United Nations General Assembly special session in June and the G8 Summit in July, his country was determined to continue to lead action against infectious diseases. Although the new fund would receive more attention, he would appreciate discussion on how new resources could be utilized and how existing cooperation mechanisms, as well as existing resources of other agencies, could complement each other and the new fund effectively. Dr AZENE (Ethiopia) praised the establishment of a new global AIDS and health fund as a noble initiative. All countries should contribute, including developing countries, however small their contribution, as they were likely to be the major beneficiaries, having the greatest need.

-34-

SUMMARY RECORDS: SECOND MEETING

Dr GONZALEZ FERNANDEZ (Cuba) applauded the report before the Board. It was precisely among the poor that the greatest health problems were concentrated, whether in relation to communicable or noncommunicable diseases, and poor people were often incapable of contributing to development owing precisely to poor health. A recent report had shown that only 10% of resources devoted to research were spent on health problems and that diseases such as malaria, tuberculosis and other communicable diseases received only 1% of such resources although they caused 40% of illness specifically suffered by the poorest people. He therefore urged that more research should be devoted to the causes and consequences of poverty. He considered, moreover, that the establishment of a fund to assist in alleviating the impact of AIDS on the most vulnerable people and the provision of antiretroviral treatment were important. His country could not contribute financially but could offer the services of 3000 doctors to work in the most isolated areas of Africa; there were already 800 Cuban doctors in nine African countries. He requested that the issue of poverty should be discussed again at the session of the Executive Board in January 2002 and that it should also be on the agenda of the Fifty-fifth World Health Assembly. Dr MSA MLIVA (Comoros) commended the Director-General's report. There was little doubt of the link between poverty and disease, at least in his country where malaria, filariasis, leprosy and diarrhoea! diseases were great scourges. While it was true that the incidence of HIV I AIDS was low in his country at 0.1 %, an impending epidemic was feared, and he asked WHO to request UNAIDS to regard the Comoros as a country at risk and give it a higher priority. It should benefit from the experience of other countries, especially since social and political unrest, exacerbated since 1997 by a separatist movement, made it difficult for the Government to provide the necessary resources to combat the disease. It had, however, established a national, multisectoral committee to fight AIDS, tuberculosis and sexually transmitted infections, composed of people from all social levels, along with representatives from United Nations bodies and nongovernmental organizations, which bore witness to its commitment to fight the pandemic. The diseases he had mentioned reduced his country's productive capacity considerably but also strained its scant financial resources owing to expenditure on drugs and other health care. In addition, tourism suffered. For all those reasons, he considered that the first priority should be to strengthen health systems. Professor ZELTNER (Switzerland) said that a structure was apparently being sought for the global AIDS and health fund that went beyond the United Nations system to include the private sector, and he endorsed that approach. However, he urged the Director-General to endeavour to maintain a strong position in the fund. On that point he agreed with the ministers of development and social affairs with whom he had held discussions and who felt that WHO should be the lead agency. Furthermore, many funds had been successfully set up in recent years and had obtained new resources from the public and private sectors. There had been less success, however, in making rational and efficient use of those resources and he therefore welcomed the idea that the resources of the new fund should be invested at the national level and incorporated into national programmes. WHO had the technical knowledge and structures to channel the money appropriately and it was his understanding that there was to be a preference, which he endorsed, for horizontal and comprehensive programmes for the development of sustainable health systems. Dr BODZONGO (Congo) expressed his concern that, although the intention ofthe report was to step up action against conditions associated with poverty, in fact it was chiefly AIDS, malaria and tuberculosis that were being targeted, whereas there were many diseases that had an adverse impact on development and thus led to poverty. There was a risk, therefore, of casting the net too wide and achieving very little. In fact, the expression "conditions associated with poverty" could be taken to refer to diseases that caused poverty or to those that resulted from poverty. It was necessary to define precisely which conditions were to be addressed so that the response could be closely targeted, and so that no important diseases were overlooked. The establishment of a fund for AIDS and health should not focus exclusively on AIDS to the neglect of other diseases.

EXECUTIVE BOARD 108TH SESSION

Or LOPEZ (Venezuela) welcomed the inclusion on WHO's agenda of the item that showed the Organization's interest in reducing social inequalities and their effects. In the same way that world priorities and possibilities had been reviewed in the document, she requested consideration of an agenda for regional priorities that took into account the health needs and problems of the various regions of the world. AIDS, malaria and tuberculosis had an important impact on society but, seen from a worldwide viewpoint, there were other important health problems such as mother and child mortality and dengue fever that should be addressed, particularly in the Region of the Americas. Both those conditions went beyond the strict field of health and were often related to educational, cultural and economic factors. Or AL-MAZROU (Saudi Arabia) commended the well-prepared and comprehensive text which covered many questions of crucial importance, particularly for developing countries, but said that it should not be forgotten that maternal and infant morbidity and mortality rates in developing countries were very high and had a long-term impact. He therefore thought that that topic should be considered more closely on an equal footing with other diseases referred to in the report. Or BOSHELL (Colombia) welcomed the report and endorsed the request of Or Gonzalez Fernandez that the topic should be discussed by both governing bodies. He expressed concern, however, that only three poverty-related diseases were named: they were undoubtedly important, but dengue and yellow fever were endemic and constituted a great threat in the Region of the Americas, particularly if an urban epidemic were to occur. He therefore suggested that the Board should include those two diseases in the topic under discussion. He had attended a meeting at WHO about violence and health and pointed out that violence was another factor associated with poverty, at least in his country, which caused enormous concern and said that it too should have a place in the Board's preoccupations. Professor YUNES (Brazil) endorsed the proposal that the issue of poverty and health should be brought before the Board again at its 109th session in January 2002. He supported the new fund, and considered that WHO should provide technical input as to the ways in which available resources should be utilized in order to attain the best possible outcome from a public health perspective. Prevention and infrastructure should be given as much weight as access to treatment. He agreed on the need to ensure a broad geographical scope in the use of the fund, which should also take account of the rates of prevalence of diseases in the various countries. Although it was desirable to adopt a technical approach to drawing up a list of essential drugs, there was little point in such a list if the majority of health systems could not have access to the drugs. Every effort should be made to make essential drugs affordable. The DIRECTOR-GENERAL thanked the members of the Board for their helpful comments and suggestions. Many speakers had endorsed WHO's efforts to focus on the development of health systems as an important mechanism for tackling disease. The work of WHO should not be seen in "all or nothing" terms, but should be focused on what was possible. In the case of malaria, there was an increasing awareness that efforts needed to be scaled up and that more funds must be found, and the situation was similar with regard to tuberculosis, where only a few had access to DOTS (directly observed treatment, short course), with the result that the disease was becoming an increasing burden worldwide. The AIDS epidemic, too, involved enormous numbers and was spreading to new countries. None of those diseases could be effectively tackled without a functioning health system. The fact that there were political leaders committed to scaling up the fight against such diseases was hugely important, and WHO must seize the opportunity offered. On the question of lead agency, there was need to ensure that WHO's comparative advantage, notably its outreach and its experience at country level, was fully utilized in the operation of the proposed fund. The Global Alliance on Vaccines and Immunization (GAVI) had made rational, effective use of added resources, and had shown that it was possible to secure a broad range of

SUMMARY RECORDS: SECOND MEETING

donations of private and public money at a higher level and to integrate them into efforts being made by developing countries themselves to strengthen their health systems. It should be possible to do the same with the new global fund. She was sure that WHO, thanks to its technical excellence, experience in development efforts, close links between country offices, regional offices and headquarters, and outreach to other agencies at global and country level would be able to meet the challenge of making the fund a success. In response to the point raised by Or Bodzongo, she said that the fund would not be limited to AIDS, but would encompass both infectious diseases and noncommunicable diseases such as tobaccorelated conditions and mental health. There was much support from major donor countries for a broader perspective. Or NABARRO (Executive Director) said the discussion had been most helpful. WHO had a major role to play at country level and would be working to strengthen its country teams. He agreed with Or Sallam that the technical aspects of the revision of the list of essential drugs had to be separated from the political aspects, such as improving access. However, maintaining that separation was difficult because there was considerable interplay between the two. It would seem that the process set out in document EB 108/INF .DOC./2 was acceptable, and WHO would proceed along those lines. Or SALLAM (Egypt) recalled that he had proposed that an expert committee of the Executive Board be set up to discuss the matter. Such a committee would have a two-fold remit: technical issues and the issue of accessibility. Or NABARRO (Executive Director) suggested that informal discussions among Executive Board members might be held on that proposal before any decision was taken. Or SUZUKI (Executive Director) pointed out that one expert committee already looked at the selection of essential drugs: its latest report was contained in document EB I 08/6. That committee reported to the Executive Board every time it made technical recommendations. With respect to the broader policy issue of accessibility, he drew attention to the resolution on WHO medicines strategy (resolution WHA54.11) adopted the previous day by the Health Assembly, which requested the Director-General to report progress on initiatives taken to expand access to essential drugs to the Fiftyfifth World Health Assembly. The matter would come before the Executive Board at its 109th session. Or SADRIZADEH (Islamic Republic of Iran) welcomed the Director-General's stated intention to give priority not only to the three major infectious diseases but also to other emerging or reemerging communicable and noncommunicable diseases. In many developing countries, cardiovascular disease and cancer had become the leading causes of death. WHO and Member States needed to address those problems and to tackle their underlying causes, including lifestyles and human behaviour. Health promotion had not been given the priority it deserved, and he asked that that situation be remedied. Or BODZONGO (Congo) said that he remained concerned, because the Board had never defined which conditions were associated with poverty and which would need to be precisely targeted, if action taken to deal with them was to be effective. The CHAIRMAN said that she took it that the Board noted the report contained in document EB108/3. It was so agreed.

EXECUTIVE BOARD 108TH SESSION

MANAGEMENT AND FINANCIAL MATTERS: Item 6 of the Agenda

Committees of the Executive Board: membership (Documents EB 108/4 and EB 108/4 Add.1) The CHAIRMAN drew the Board's attention to the report on membership of committees of the Board contained in document EB 108/4 and to the proposals for filling vacancies contained in document EB 108/4 Add.1.

Programme Development Committee Decision: The Executive Board appointed Dr C. Dotres Martfnez (Cuba), Dr G. Azene (Ethiopia), Dr B. Sadrizadeh (Islamic Republic of Iran), Vice-Chairman of the Board, member ex officio, Mr Ket Sein (Myanmar), Dr A.G. Romualdez (Philippines) and Dr Y.Y. Al-Mazrou (Saudi Arabia), as members of its Programme Development Committee, for a period of two years, in addition to Ms K. Wigzell (Sweden), already a member of the Committee. It was understood that if any member of the Committee was unable to attend, his or her successor or the alternate member of the Board designated by the Government concerned, in accordance with Rule 2 of the Rules of Procedure, would participate in the work of the Committee. 1 Administration, Budget and Finance Committee Decision: The Executive Board appointed Dr S. Abia Nseng (Equatorial Guinea), Mr J.A. Chowdhury (India), Vice-Chairman of the Board, member ex officio, and Professor L. Donaldson (United Kingdom of Great Britain and Northern Ireland) as members of its Administration, Budget and Finance Committee, for a period of two years, in addition to Dr Kim Won Ho (Democratic People's Republic of Korea), Dr R. Cabrera Marquez (Guatemala), Dr H. Shinozaki (Japan) and Dr K. Karam (Lebanon), already members of the Committee. It was understood that if any member of the Committee was unable to attend, his or her successor or the alternate member of the Board designated by the Government concerned, in accordance with Rule 2 of the Rules of Procedure, would participate in the work of the Committee. 2 Responding to a question from Dr AL KHARABSEH (Jordan), Mr AITKEN (Senior Policy Adviser) said that the choice of members was decided by means of consultation with the regions. Where the size of the Committee permitted, it would have one representative from each region.

Audit Committee Decision: The Executive Board appointed Dr I. Sallam (Egypt), Dr Y.-J. Om (Republic of Korea), Ms A.-C. Filipsson (Sweden) (alternate to Ms K. Wigzell) and Professor T. Zeltner (Switzerland), Vice-Chairman of the Board, member ex officio, as members of the Audit Committee, in addition to Mr P.H. Kengouya (Congo) (alternate to Dr D. Bodzongo) and Mr G.R. Patwardhan (India) (alternate to Mr J.A. Chowdhury), already members of the Committee. The Board authorized the Chairman to appoint a member to the Committee from among the members or alternates of the Board designated by Colombia, on the basis of a curriculum vitae to be submitted. 3

Decision EB I 08( I). Decision EB I 08(2). Decision EBI08(3).

2 3

SUMMARY RECORDS: SECOND MEETING

Standing Committee on Nongovernmental Organizations Decision: The Executive Board appointed Or Z. Alemu (Eritrea) and Mr Ket Sein (Myanmar) as members of the Standing Committee on Nongovernmental Organizations, in addition to Or B. Sadrizadeh (Islamic Republic of Iran), Or M. Di Gennaro (Italy) and Or M. UrbanejaDurant (Venezuela), already members of the Committee. It was understood that if any member appointed by the Board was unable to attend, his or her successor or the alternate member of the Board designated by the Government concerned, in accordance with Rule 2 of the Rules of Procedure, would participate in the work of the Panel. 1 WHOIUNICEFIUNFPA Coordinating Committee on Health At its third meeting in April 2001, the Committee had decided that its next meeting should be held in 2003. The vacancy on the Committee would therefore not need to be filled before May 2002. Leon Bernard Foundation Committee Decision: The Executive Board, in accordance with the Statutes of the Leon Bernard Foundation, appointed Professor V.J. Grabauskas (Lithuania) as member of the Leon Bernard Foundation Committee, in addition to the Chairman and Vice-Chairmen of the Executive Board, members ex officio. It was understood that if Professor Grabauskas was unable to attend, his successor or the alternate member of the Board designated by the Government concerned, in accordance with Rule 2 of the Rules of Procedure, would participate in the work of the Committee. 2 Jacques Parisot Foundation Fellowship Committee Decision: The Executive Board, in accordance with the Implementing Regulations of the Jacques Parisot Foundation, appointed Or Y.-J. Om (Republic of Korea) as a member of the Jacques Parisot Foundation Fellowship Committee for the duration of his term of office on the Executive Board, in addition to the Chairman and Vice-Chairmen of the Board, members ex officio. It was understood that if Or Om was unable to attend, his successor or the alternate member of the Board designated by the Government concerned, in accordance with Rule 2 of the Rules of Procedure, would participate in the work of the Committee. 3 Sasakawa Health Prize Selection Panel Decision: The Executive Board, in accordance with the Statutes of the Sasakawa Health Prize, appointed Or A.G. Romualdez (Philippines) as a member of the Sasakawa Health Prize Selection Panel, in addition to the Chairman of the Board and a representative of the founder, members ex officio. It was understood that if Or Romualdez was unable to attend, his successor or the alternate member of the Board designated by the Government concerned, in accordance 4 with Rule 2 of the Rules of Procedure, would participate in the work ofthe Panel.

1 2

Decision EB 108( 4). Decision EB108(5). Decision EB I 08(6). Decision EB I 08(7).

3 4

EXECUTIVE BOARD 108TH SESSION

United Arab Emirates Health Foundation Selection Panel Decision: The Executive Board, in accordance with the Statutes of the United Arab Emirates Health Foundation, appointed Dr Y.Y. Al-Mazrou (Saudi Arabia) as a member of the United Arab Emirates Health Foundation Selection Panel, in addition to the Chairman of the Board and a representative of the founder, members ex officio. It was understood that ifDr Al-Mazrou was unable to attend, his successor or the alternate member of the Board designated by the Government concerned, in accordance with Rule 2 of the Rules of Procedure, would participate in the work of the Panel. 1 Representatives of the Executive Board at the Fifty-fifth World Health Assembly Decision: The Executive Board, in accordance with paragraph 1 of resolution EB59.R7, appointed its Chairman, Mrs M. Abel (Vanuatu), ex officio, and Mr J.A. Chowdhury (India), Dr K. Karam (Lebanon) and Ms K. Wigzell (Sweden) to represent the Board at the Fifty-fifth World Health Assembly? The meeting was suspended at 15.10 and resumed at 15.35. Mr AITKEN (Senior Policy Adviser), responding to a request made by Dr SALLAM (Egypt), proposed that a group meeting open to all Board members should be held immediately before the forthcoming retreat. A meeting at that time on access to medicines and, if necessary, other essential commodities could help prepare for a full discussion by the Executive Board at its 109th session. Dr SALLAM (Egypt) accepted that proposal as a positive response. (For resumption of discussion see section 4.)

STAFFING MATTERS: Item 5 of the Agenda

Statement by the representative of the WHO staff associations on matters concerning personnel policy and conditions of service (Documents EB108/INF.DOC./l and Corr.l) Ms DWEGGAH (representative of the WHO staff associations) thanked the Director-General for her response to the statement of the staff associations, which was reproduced in document EB108/INF.DOC./1. She expressed their appreciation of the Director-General's willingness to make opportunities for regular meetings; the Global Staff/Management Council provided a forum for raising human resources issues. When the reform of human resources management had started two years earlier, consultants had been brought in, but their advice had been more or less ignored. A moratorium had been proposed on the hiring of temporary staff until the staffing situation had been resolved, but short-term staff were still being recruited in large numbers. She exemplified a serious inequity in relation to long-serving temporary staff: the absence of paid maternity leave. Although the administration had made a proposal that was a step in the right direction, the staff associations rejected anything less than WHO's international policy, which had been approved by Member States. All women at WHO, irrespective of short-term or fixed-term appointment, should have equal maternity-leave benefits. 1 2

Decision EB108(8). Decision EB 108(9).

SUMMARY RECORDS: SECOND MEETING

She recalled that, in January 2001, the Board had discussed various issues of human resources reform, including the precarious contractual conditions of long-serving temporary staff, consultation and negotiation of employment conditions through collective bargaining. In the latter context, the staff associations had raised the subject of the imminent transfer of the International Computing Centre, planned without consultation. That issue had been resolved, thanks to open discussion between staff and management, exemplifying what could be achieved through communication. Failure to communicate bred fear, which led to conflict, absenteeism, dysfunctional behaviour, high employee turnover and low productivity. Even though WHO had never been richer, a recent staff survey, supported by the increasing number of appeals and visits to internal and external counsellors, showed that morale and job satisfaction in-house were low and that staff were losing their sense of loyalty and feeling of ownership. They were becoming less optimistic about WHO's ability to fulfil its mandate, given the current levels of stress and dissatisfaction, which adversely affected the success of an organization, the loyalty of its staff and the level of production. Staff sought consistency, honesty, accountability and mutual respect at all levels of management. Frustration with the short-term/long-term staffing problem and more generally the way staff were treated was reflected by the large number of signatures (about two-thirds of all staff) collected in petitions at headquarters, the Regional Office for Europe and IARC. The problem was not unique to WHO, but was prevalent in all other organizations of the common system, including the World Bank. Morale, belief in a fair and capable management and productivity were highly interdependent. The staff associations had one simple message: "Do what is right by your staff and staff will do right by you". Dr MSA MLIVA (Comoros), recalling that at the Board's 107th session he had requested a statement outlining the demands of staff at all levels of WHO, noted that the statement made to the 108th session came from the headquarters staff association. He asked whether there was a staff association for all WHO staff, including those at the regional and country offices. Dr MBAIONG (Chad) noted with pleasure that the Director-General's response addressed the concerns expressed in the staff associations' statement. He asked whether the statement referred to the concerns of headquarters staff alone or of all WHO staff in the six regions. Dr CICOGNA (Italy) was concerned by the feeling of frustration revealed in the staff associations' statement. The results of the survey gave rise to questions about human resources management and reform. While certain points raised in the statement deserved particular attention, such as the problem of long-term/short-term staff, such matters were not the Board's first duty. He said that nevertheless he hoped that future statements made by the staff associations would reflect a change in feeling. Dr THIERS (Belgium), recalling that the staff associations' representative had said that the feeling was the same in all the international organizations, added that he had experienced it in most national institutions as well. The situation was often related to the fact that the world was changing and that all institutions had to adapt extremely quickly. Staff policy also had to be adapted. Staff found it difficult to accept change and were sometimes not given adequate information. Efforts had to be made to retrain them, and he understood that many people found that difficult. The Board should note the staff associations' statement but leave entire responsibility for the matter with the DirectorGeneral, who apparently had a regular dialogue with the staff, and encourage her to continue along those lines. Professor ZEL TNER (Switzerland) told the representative of the staff associations that her words had not fallen on deaf ears. She should convey to the staff that their work made a difference and was greatly appreciated. Staff faced two "burdens of work". First, they were experiencing a process of change at WHO, which gave rise to feelings of uncertainty. That process was coming to an end.

EXECUTIVE BOARD I 08TH SESSION

Secondly, the additional funds made available to WHO had resulted in a huge additional workload for staff; consideration should be given to that consequence with a view to improving staff performance. He trusted that in one or two years a more positive statement could be made by the representative of the staff associations. Dr SAMBA (Regional Director for Africa) related that, following the statement by the representative of the WHO staff associations during the Board's I 07th session, he had approached the staff representative outside the meeting room to tell him that his statement did not reflect the situation at the Regional Office for Africa. Specifically, the staff representative had referred in his statement to the management harassing members of the staff associations, while at the Regional Office the reverse was true: a small proportion of the staff association there (to which all staff members, including the Regional Director, belonged) had been harassing the management. He had therefore drawn the conclusion that the statement on behalf of the WHO staff associations had not been representative of the Organization as a whole. The staff representative had eventually apologized, saying that the next staff associations' statement would be more balanced. In that connection, he wondered to what extent the statement made by the representative of the staff associations at the current session applied to the regions and countries, all of them part of one WHO. Ms STEWARD-GOFFMAN (ad interim, Human resources services) said that the comments made by the representative of the staff associations had provided insight into the issues underlying working in a modern world and the demands placed on all parties concerned. The Director-General, with whom the responsibility for maintaining dialogue with staff rested, had doubtless taken note of them. In response to the query by Dr Msa Mliva, there was no umbrella staff association that represented the staff of WHO as a whole. Each regional office, as well as IARC and the Onchocerciasis Control Programme in West Africa (OCP), had its own staff association. It was not for the management, but the representative of the WHO staff associations, to clarify whether the statement in the document reflected the views of all the staff associations. The CHAIRMAN said she took it that the Board wished to note the statement of the representative of the WHO staff associations and the Director-General's written response. It was so agreed.

Confirmation of amendments to the Staff Rules (Document EB I 08/8) 1 The CHAIRMAN invited the Board to consider the draft resolution contained in the document.

The resolution was adopted?

See Annex. Resolution EBI08.Rl.

SUMMARY RECORDS: SECOND MEETING

MANAGEMENT AND FINANCIAL MATTERS: Item 6 of the Agenda (resumed from section 2)

Governing bodies: future sessions (Document EB I 08/5) The CHAIRMAN invited the Board to consider the draft decisions proposed in paragraph 5 of document EB 108/5. Date, place and duration ofthe 109th session of the Executive Board Decision: The Executive Board decided that its 109th session should be convened on Monday, 14 January 2002, at WHO headquarters, Geneva, and should close no later than Monday, 21 January 2002. 1 Place, date and duration of the Fifty-fifth World Health Assembly Decision: The Executive Board decided that the Fifty-fifth World Health Assembly should be held at the Palais des Nations, Geneva, opening on Monday, 13 May 2002, and that it should close no later than Saturday, 18 May 2002. 2

MATTERS FOR INFORMATION: Item 7 of the Agenda

Report on meetings of expert committees and study groups (Document EB 108/6) The CHAIRMAN noted that document EB 108/6 contained reports on five meetings of expert committees and one meeting of a study group. She invited the Board to consider them in turn. Dr AL-MAZROU (Saudi Arabia) inquired how frequently expert committees and study groups reported to the Executive Board, given that some of the meetings referred to in document EB 108/6 had taken place in 1999. Mr AITKEN (Senior Policy Adviser) said that reports of the meetings were submitted regularly to the Board. However, a certain amount of time was required for their processing and publication. Dr ENDO (Japan) said that, in view of the rapid pace of scientific progress, two years was too long for the Board to wait to consider such reports. There were various options for making information available, and he looked forward to improvements. Mr AITKEN (Senior Policy Adviser) confirmed that every effort would be made to speed up the process. Ms FILIPSSON (Sweden) referred to the recommendations of the WHO Expert Committee on the Use of Essential Drugs in connection with the revised procedures for updating the WHO Model List of Essential Drugs (document EB108/INF.DOC./2). Over the years the model list had proved to be an important tool in improving access to drugs. She welcomed the move towards an evidence-based selection of drugs on the list, not only to ensure selection of the most appropriate drugs, but also to 1 2

Decision EB108(10). Decision EB I 08( 11 ).

EXECUTIVE BOARD 108TH SESSION

strengthen objectivity, thereby dispelling any doubts of inappropriate commercial or political influence. She also expressed satisfaction at the closer links between the model list and WHO clinical guidelines as well as the establishment of core and complementary lists. Dr THIERS (Belgium) said that there was no mention in the report of the WHO Expert Committee on the Use of Essential Drugs of the ethical aspect of drug selection. That issue should be addressed in future discussions on the subject. Dr LOPEZ (Venezuela) welcomed the work done in recent years in connection with the Model List of Essential Drugs. It helped Member States to decide on priority areas of treatment. She requested the Expert Committee to take up the matter of antiretroviral drugs and their inclusion in the model list at its meeting in October 2001. Antiretroviral treatment was currently provided under the Venezuelan health care system, but represented a considerable financial burden. Dr THIERS (Belgium) commented that it was difficult for Belgium to take part in the work of the WHO Expert Committee on Vector Biology and Control owing to the shortage of expert toxicologists in the public sector. The same applied to the other highly technical groups whose reports were under consideration. Dr SALLAM (Egypt) said that information on pesticides was subject to frequent change. The latest recommendations sometimes called for the use of certain products to be banned, when in fact they were still widely applied. He therefore asked WHO to ensure that the information it published was up to date. The situation should be monitored closely from two angles: the availability of alternative pesticides; and pricing and accessibility for the developing world. It would be useful if such information could be posted on the WHO web site or distributed through the regional offices. Dr GONZALEZ FERNANDEZ (Cuba), noting that four of the six reports covered in document EB 108/6 related to meetings held in 1999, endorsed the remarks of previous speakers about the need to accelerate publication of reports. The subject of home-based and long-term care warranted more careful consideration by the Board. A new community-based approach to mental health had been proposed during the Health Assembly; the approach could be adopted with regard to other areas of health care too, including care of the elderly. There was a noticeable trend towards incorporating home-based care in health systems, alongside traditional hospital care. Given the need to strengthen health systems the pressing question was how exactly such care could be incorporated in treatment, rehabilitation and social welfare programmes. He proposed that the matter should be taken up in connection with the strengthening of health systems at the Board's next session. Professor GRABAUSKAS (Lithuania) stressed the importance of the recommendations of the WHO Study Group on Home-Based and Long-Term Care for his region, in particular that policies should be developed which included home-based long-term care as an integral part of national health and social systems as well as a need to encourage and respect creative community-based initiatives for long-term care. People suffering from chronic illnesses only saw specialists when they had a crisis. He requested that the concepts and main recommendations in the Study Group's report should be publicized as widely as possible. Dr LOPEZ (Venezuela) agreed on the need for the wide dissemination of the Study Group's recommendations. Plans to strengthen health systems should take account of the noticeable trend towards home-based care and, in that connection, capacity-building: health staff were not used to providing such care. Referring to the last part of paragraph 50, she stressed the need to focus on the gender aspect of the development of health systems worldwide.

SUMMARY RECORDS: SECOND MEETING

Dr BOSHELL (Colombia), referring to the report on the meeting of the WHO Expert Committee on the Control of Chagas Disease, said that he would provide updates on the Southern Cone, Andean and Central American initiatives to the Secretariat. The Expert Committee had clearly recommended that control and research activities should continue until the disease had been eliminated. In that connection, the nine Latin American countries participating in the Tenth Meeting of the Southern Cone Initiative, held in Montevideo in March 2001, had addressed a letter to the Director-General, but thus far there had been no reply. He would welcome some clarification in that regard. Furthermore, the Expert Committee had also recommended the promotion of the development of new drugs to avoid chronic cardiac lesions. Posaconazole had been successfully tested in animal models against Trypanosoma cruzi infection, and full data had been published as well as information on its use in humans against some mycoses. The previous year negotiations had begun with the pharmaceutical company concerned on the start of clinical trials of the drug on humans; however, the trials had been abandoned by the company. Countries participating in the Montevideo meeting had requested the Director-General to intercede in that connection to ensure that the drug could be tested on patients living in countries where Chagas disease was endemic. Once again there had been no reply. What was the reason for that? Lastly, in view of current budgetary constraints, he expressed concern that the Organization would be unable to find a suitably qualified successor for the adviser on Chagas disease control, who was due to retire from WHO. Dr CICOGNA (Italy) expressed satisfaction at the remarkable progress made in interrupting Chagas disease transmission. He shared the views and recommendations of the Expert Committee, particularly as regards the need for endemic countries to continue vector control and surveillance activities. He welcomed the various initiatives referred to in the report, which augured well for achieving the goal of eliminating transmission of the disease by the year 2010. Dr LOPEZ (Venezuela) endorsed the remarks made by Dr Boshell and Dr Cicogna. She particularly wanted to know the prospects for further support and continued action in relation to the measures already taken to interrupt the transmission of Chagas disease or improve its control. That support would be very important for consolidating the success achieved so far. Professor YUNES (Brazil) welcomed the Expert Committee's report, which acknowledged the progress achieved in the control of Chagas disease in the Region of the Americas, thanks to the technical cooperation of PAHO with Member States. The transmission of Chagas disease had been interrupted in a number of countries, and the available data indicated that both vectoral and blood transfusion-related transmission would soon be interrupted in other countries. The incidence of Chagas disease throughout Latin America had fallen substantially. The Expert Committee's report provided important technical guidelines for Chagas disease control programmes at country level. It was vital for countries to continue both vector control and surveillance, depending on the extent to which vectoral transmission had been interrupted. Endemic countries must improve quality control in their blood banks in order to detect the parasite in donated blood. He expressed his support for the goal set in resolution WHA51.14 that transmission of Chagas disease should be eliminated by 2010. Dr ALLEYNE (Regional Director for the Americas) said that Member States, with the support of WHO and PAHO, had quietly and persistently dedicated themselves to the elimination of Chagas disease. They should be proud of a remarkable public health achievement. Members had asked about the cooperation between the Regional Office and headquarters. There had been a single clear channel of communication between the two for many years. He said that he was unaware of the letters that had been mentioned. Recently, PAHO had been discussing with WHO how effective liaison at country level could be maintained during the current process of restructuring. He was confident that headquarters would remain as responsive to, and cooperative with, Member States as it had been in the past.

EXECUTIVE BOARD 108TH SESSION

Or HEYMANN (Executive Director) agreed that the campaign against Chagas disease had been a success for WHO, PAHO and Member States. He paid tribute to his colleague Or Moncayo, who would retire from WHO at the end of May 2001 after 22 years dedicated to the fight against Chagas disease. There had been two letters to WHO about the Chagas disease research programme, to which Or Boshell had referred. The first was a general letter requesting continued support for the fight against Chagas disease. The second had been more specific, requesting WHO to approach a pharmaceutical company that manufactured a potentially useful new azole drug. WHO was currently negotiating with the pharmaceutical company: research would continue into the safety of the drug in humans, since the relevant studies were not yet complete, and its effectiveness against Chagas disease. The letters would receive a reply when the negotiations were complete. Or MOREL (Special Programme of Research and Training in Tropical Diseases) said that negotiations were in progress with PAHO on the future course of research into the epidemiology and entomology of Chagas disease. Projects that required field research would be transferred to PAHO and the countries, while those concerned with drug development and strategic research would remain in Geneva. The successful fight against Chagas disease had been an immense public health victory, and WHO fully intended to continue its work in that field. The CHAIRMAN took it that the Board wished to thank the experts who had taken part in the meetings, to take note of the recommendations of the five expert committees and the study group, and to request follow up of their recommendations as appropriate. It was so agreed.

Food safety (Document EB 10817) Dr ENDO (Japan) welcomed the document on the global just been made available to the Board. He had not yet had time he hoped that the strategy would be finalized soon in order adequate and timely fashion. His Government would follow interest. WHO food safety strategy which had to read it thoroughly, but he said that to address an important issue in an the elaboration of the strategy with

Dr AL KHARABSEH (Jordan) suggested that the draft food safety strategy should include some reference to the obligations incurred by States that were members of WTO. For example, such States were called upon to simplify and speed up measures related to food monitoring, simplify laboratory investigations and adopt "risk-based systems" when monitoring their food industries. The division of foods into low-, medium- and high-risk categories might mean that food-monitoring procedures, laboratory investigations and inspection of foodstuffs entering the country became less stringent for some products, which would have implications for food safety. Or MODESTE-CURWEN (Grenada) welcomed WHO's recognition of food safety as a high-priority issue, in particular as Caribbean countries had not accorded it such a high priority in the past. One of the aims of the proposed food safety strategy was to promote interdisciplinary collaboration in food safety management (paragraph 8). That was relevant in Grenada, where the Ministry of Health was concerned with food safety, but most communications from international agencies were sent to the Ministry of Agriculture, and there was little liaison between the two ministries. The same situation existed in most Caribbean countries. A welcome initiative by PAHO had recently brought together the ministries of health and agriculture of the Member States of the Inter-American Meeting, at the Ministerial Level, on Animal Health (RIMSA). Their in-depth analysis of food safety issues had yielded positive results. She called upon WHO to promote an interdisciplinary approach among both Member States and international agencies.

SUMMARY RECORDS: SECOND MEETING

Mr CHOWDHURY (India) said that unsafe food was a major cause of the heavy burden of disease in many developing countries, because of, in part, a lack of awareness, but mainly the low level of existing technology for food production, storage and transport. The situation would not improve until the economic situation of developing countries improved. Measures to tighten up international food standards must take into account the pace of modernization of those technologies in the developing world. If developing countries were expected to adopt excessively stringent international food standards immediately, they would be considerably disadvantaged in international trade. If national standards were made equally stringent, domestic manufacturers would be unable to meet them. He wanted WHO to intercede on behalf of developing countries for a transitional period while they adapted to more stringent standards, for instance in the negotiations of the Codex Alimentarius Commission. WHO was the agency best placed to judge the level of food standards that might justifiably be applied in a particular country. WHO's role as a mediator on behalf of developing countries should be explicitly included in the food safety strategy. Food safety had been recognized as a major public health concern in India only relatively recently. His country would welcome technical assistance from WHO in such areas as the development of test protocols, standard-setting for laboratory infrastructure and training of technical personnel. Or SADRIZADEH (Islamic Republic of Iran) confirmed that the problem of unsafe food, which was exacerbated by globalization and rapid industrialization, had only recently become a priority for most developing countries. However, they did not have the facilities to guarantee food safety: many did not have acceptable food safety standards, and those that did had no capacity to implement them. He called upon WHO to provide countries with technical assistance in those areas. Professor YUNES (Brazil) said that food safety concerned all countries and emphasized its importance for his own country, which relied greatly on agriculture and food exports. On an international scale, there was the risk from microbiological contamination and the appearance or revival of zoonoses such as bovine spongiform encephalopathy and foot-and-mouth disease. New challenges were arising with the growing use of new technologies such as genetic engineering. He commended WHO for keeping the problem of food safety on its agenda, in view of its implications for both health and the economy, and expressed his appreciation of the regional meeting organized by PAHO in Sao Paulo, Brazil, in May 2001 between ministers of health and agriculture from the Region of the Americas. Professor DONALDSON (United Kingdom of Great Britain and Northern Ireland), welcoming WHO's initiatives on food safety, suggested that the proposed strategy would be strengthened by inclusion of a set of principles that would guide the Organization's approach. Those principles might include, for example, the importance of information for the consumer: not only labelling of food products, but also information for the public at times when particular food hazards were causing concern. Further, they should include a commitment to openness wherever possible and a commitment to independent and high-quality scientific assessment of risks arising from food. They should also include a statement of the extent to which actions related to particular food hazards should be based on a precautionary approach in cases where the scientific evidence for action was unclear. The draft strategy referred mainly to surveillance of food safety in humans. However, the modern approach was to integrate surveillance of human disease, veterinary surveillance and monitoring of environmental hazards. Dr THIERS (Belgium) said that the list of main points of the proposed food safety strategy (paragraph 8) should refer explicitly to laboratory services. WHO had not done enough to promote basic laboratory services in developing countries over the past 10 years, although an adequate laboratory infrastructure was essential to any food safety policy.

EXECUTIVE BOARD 108TH SESSION

Dr SCHLUNDT (Food safety) apologized for the late submission of the draft food safety strategy to members, but said that he had been eager to involve the Executive Board in its development as early as possible. The document would then go out to Member States and nongovemmental organizations for wider consultation. It was important to involve consumers in food safety issues, and indeed all interested parties, as soon as possible. Several members had commented on the importance of a risk-based approach. Others had called for a more interdisciplinary approach. WHO had increased its collaboration with FAO and the Codex Alimentarius Commission. WHO and FAO planned to establish a global food safety forum to promote the exchange of experiences between Member States. Members had stressed the importance of capacity-building. It had perhaps been the opinion in the past that the developed countries knew all the answers in the field of food safety, which had turned out not to be the case. It was important for developing countries to learn from the developed world's mistakes and adopt a risk-based strategy straight away. As far as trade was concerned, he said that he hoped that improving food safety at the national level would not only improve countries' own health status, but also promote their exports. WHO had paid considerable attention to the issue of microbiological contamination, and it would continue to concentrate on that issue and on biotechnology. WHO was also attempting to integrate surveillance of human diseases with that of animal diseases by means of cross-cluster activities. A joint meeting on bovine spongiform encephalopathy involving WHO, FAO and the International Office of Epizootics was due to take place in June 2001. The CHAIRMAN took it that the Board wished to note the report. It was so agreed.

CLOSURE OF THE SESSION: Item 8 of the Agenda After the customary exchange of courtesies, the CHAIRMAN declared the session closed.

The meeting rose at 17:00.

Основные сведения

Организация Всемирная организация здравоохранения (ВОЗ / WHO)

Тип документа Governing Bodies documents

Дата принятия 31 декабря 2001 г.

Источник Всемирная организация здравоохранения