EXECUTIVE BOARD - World Health Organization · - International Civil Aviation Organization ... Report of the Representatives of the Executive Board at the Fifth ... The list of attendances

OFFICIAL RECORDSOF THE

WORLD HEALTH ORGANIZATION

No. 46

EXECUTIVE BOARDELEVENTH SESSION

HELD IN GENEVA FROM 12 JANUARY TO 4 FEBRUARY 1953

RESOLUTIONS

REPORT OF THE EXECUTIVE BOARDINCLUDING THE

REPORT ON THE PROPOSED PROGRAMME AND BUDGET ESTIMATES FOR 1954

ANNEXES

WORLD HEALTH ORGANIZATIONPALAIS DES NATIONS

GENEVA

April 1953

ABBREVIATIONS

The following abbreviations are used in the Official Records of the World Health Organization:

ACCCIOMSECAFEECEECLAFAOICAOICITOILOITUOIHPPASBPASOTAATABTACUNESCOUNICEFUNKRAUNRWAPRNEWFUNA -WMO

- Administrative Committee on Co- ordination- Council for International Organizations of Medical Sciences- Economic Commission for Asia and the Far East- Economic Commission for Europe- Economic Commission for Latin America- Food and Agriculture Organization- International Civil Aviation Organization- Interim Commission of the International Trade Organization- International Labour Organisation (Office)- International Telecommunication Union-- Office International d'Hygiène Publique- Pan American Sanitary Bureau- Pan American Sanitary Organization- Technical Assistance Administration- Technical Assistance Board- Technical Assistance Committee- United Nations Educational, Scientific and Cultural Organization- United Nations. International Children's Emergency Fund- United Nations Korean Reconstruction Agency

United Nations Relief and Works Agency for Palestine Refugees in the Near EastWorld Federation of United Nations AssociationsWorld Meteorological Organization

PRINTED IN SWITZERLAND

NO TE

Part 1 of this volume contains the resolutions adopted by the Executive Board at itseleventh session. Part 2 contains the Board's comments and recommendations on theProposed Programme and Budget Estimates for 1954, together with its reports on theExpanded Programme of Technical Assistance, on the education and training programme,and on regionalization.

The minutes of the session have been deposited in mimeographed form with the depart -ments of health of Member Governments.

156 G rn

EXPLANATORY NOTE

In this volume the resolutions are reproduced in the serial order in which they wereadopted by the Executive Board. However, in order to facilitate the use of the volumein conjunction with the Handbook of Resolutions and Decisions (first edition), theyhave been grouped by title in the table of contents under the Handbook subject- headings.There has also been added, beneath each resolution, a reference to the section of theHandbook containing previous resolutions on the same subject.

Introduction

For Index to Resolutions, see page 261.

TABLE OF CONTENTS

PART 1 : RESOLUTIONS

PROGRAMME

Page

1

ANNUAL REPORTS

Annual Report of the Director- GeneralEB11.R44 Periodical Reports on Projects 17

COMMUNICABLE AND OTHER DISEASES

Bilharziasis (Schistosomiasis)EB11.R11 Expert Committee on Bilharziasis : First Report 4

Brucellosis and Other ZoonosesEB11.R12 Joint FAO /WHO Expert Committee on Brucellosis : Second Report 4

Hepatitis

EB11.R14 Expert Committee on Hepatitis : First Report 5

InfluenzaEB11.R13 Expert Committee on Influenza : First Report 5

Malaria and Insect ControlEB 11. R21 Toxic Hazards of Certain Insecticides and Similar Products 7

Smallpox

EB11.R58 World -Wide Campaign against Smallpox 31

TuberculosisEB11.R27 Tuberculosis Research Office, Copenhagen

Venereal Diseases and Other TreponematosesEB11.R15EB11.R10

Expert Committee on Venereal Infections and Treponematoses :International Anti -Venereal- Disease Commission of the Rhine

9

Fourth Report 5

4

Yellow FeverEB11.R23 Approval of Yellow -Fever Vaccine 7

DRUGS AND OTHER THERAPEUTIC SUBSTANCES

Biological StandardizationEB11.R17 Expert Committee on Biological Standardization : Sixth Report 6

International PharmacopoeiaEB11.R18 Expert Committee on the International Pharmacopoeia, Report on Eleventh

Session ; Sub -Committee on Non -Proprietary Names, Report on Fifth Session 6

-v

PageEDUCATION AND TRAINING

EB11.R53 Organizational Study on Education and Training Programme 22

EB11.R61 Maintenance and Travel Costs of National Candidates attending National TrainingCourses organized with the help of WHO 32

Education of Medical and Auxiliary PersonnelEB 11.R52 Expert Committee on Professional and Technical Education of Medical and Auxiliary

Personnel : Second Report 22

Fellowships

EB11.R64 Priorities in awarding Fellowships 34

EPIDEMI OLOGICAL SERVICES

Epidemiological IntelligenceEB11.R22 Recording and Transmission of Epidemiological Information 7

International Sanitary Conventions and RegulationsEB11.R20 Procedure for Examination of Reservations to the International Sanitary Regula-

tions (WHO Regulations No. 2) 6

EXPERT ADVISORY PANELS AND COMMITTEES

Establishment, General Programme and MeetingsEB11.R19 Appointments to Expert Advisory Panels and Committees 6

PUBLIC - HEALTH SERVICES

Public -Health Administration (Certain Aspects)EB11.R59 Dental Hygiene and Preventive Dentistry 31

Social and Occupational HealthEB11.R16 Joint ILO /WHO Committee on Occupational Health : Report on Second Session 5

PUBLICATIONS AND REFERENCE SERVICES

EB11.R42 Distribution and Sale of WHO Publications 16

PROGRAMME AND BUDGET

BUDGET ESTIMATES AND LEVELS OF EXPENDITURE

EB11.R36 Transfers between Sections of the 1953 Appropriation Resolution 14

EB11.R62 Proposed Programme and Budget Estimates for 1954 33

For 1952EB11.R35 Transfers between Sections of the 1952 Appropriation Resolution 13

PROCEDURE FOR EXAMINATION OF THE PROGRAMME AND BUDGET ESTIMATES

EB11.R65 Procedure for Consideration of the 1954 Programme and Budget Estimates bythe Sixth World Health Assembly 34

- VI -

TECHNICAL ASSISTANCE FOR ECONOMIC DEVELOPMENT OF UNDER-DEVELOPED COUNTRIES

Page

EB11.R57 WHO Participation in the United Nations Expanded Programme of TechnicalAssistance 24

EB 1 1.857.1 Legislative Responsibility for Review and Approval of the Technical AssistanceProgramme 25

EB I I .R57.2 Technical Assistance Programme : Administrative Structure and Costs 25

EB 1 1.857.3 Co- ordination of Assistance to Governments under the Technical AssistanceProgramme 25

EB 1 1.857.4 Financial Resources Available or expected to be Available for the Technical Assis-tance Programme in 1953 26

EB11.R57.5 Participation of Member States in Certain Costs incurred in the Operation ofTechnical Assistance Projects 28

EB11.R57.6 Criteria for the Development of Health Aspects of the Technical Assistance Pro-gramme 28

EB11.R57.7 Technical Assistance Programme : Conditions of Service for Experts 30

EB11.R57.8 Technical Assistance Programme : Central Administrative, Indirect Operationaland Project Costs 30

EB11.R57.9 Long- Term Planning and Continued Financing of the Technical Assistance Pro-gramme 31

WORLD HEALTH ASSEMBLY AND EXECUTIVE BOARD

WORLD HEALTH ASSEMBLY

EB11.R66 Provisional Agenda for the Sixth World Health Assembly 35

EB11.R68 Duration of Sessions of the Health Assembly 35

Rules of ProcedureEB11.R24 Amendments to Rules of Procedure of the World Health Assembly 7

Technical Discussions on Special SubjectsEB11.R67 Technical Discussions at Future Health Assemblies 35

Time, Place and Frequency of Health AssembliesEB11.R69 Frequency of Sessions of the Health Assembly 36

EXECUTIVE BOARD

Representation at the Health AssemblyEB11.R1 Representation of the Executive Board at the Sixth World Health Assembly 1

Rules of ProcedureEB11.R25 Amendment to Rules of Procedure of the Executive Board

Schedule of MeetingsEB11.R70 Date and Place of Twelfth Session of the Executive Board

Standing Committee on Administration and FinanceEB11.R2 Method of Work of the Executive Board

- VII -..

39

1

EB11.R9

EB11.R50

EB11.R71

REGIONAL QUESTIONSPage

Reports of Regional Committees 3

Organizational Study on Regionalization 19

Allocation of Resources as between Regions 39

GEOGRAPHICAL AREAS

Delineation of and Assignment to RegionsEB11.R51 Assignment to Regions 21

SPECIFIC REGIONS

AfricaEB11.R4

The AmericasEB11.R5

South -East AsiaEB11.R7

Appointment of Regional Director for Africa 2

Confirmation of Appointment of Regional Director for the Americas 2

Extension of Appointment of Regional Director for South -East Asia 3

Eastern MediterraneanEB11.R8

EBI1.R6

MEMBERSHIP

Regional Committee for the Eastern Mediterranean 3

Confirmation of Appointment of Regional Director for the Eastern Mediterranean 3

CONSTITUTIONAL AND LEGAL QUESTIONS

Associate MembersEB11.R26 Rights and Obligations of Associate Members in Regional Committees

PRIVILEGES AND IMMUNITIES

8

Privileges and Immunities in Host CountriesEB11.R3 Host Agreement with the Government of France 2

TRANSFER OF FUNCTIONS OR ASSETS TO WHO

Office International d'Hygiène PubliqueEB11.R38 Arrears of Contributions due in respect of the Office International d'Hygiène

Publique 15

FINANCIAL AND ADMINISTRATIVE QUESTIONSBUDGET AND FINANCE

Assessments and ContributionsEB11.R30

EB11.R31

EBI1.R34

Scale of Assessments 10

Collection of Contributions and Advances to the Working Capital Fund 11

Assessment of China 12

-- VIII ---

PageExternal Audit

EB11.R32 Examination of the Financial Report and the External Auditor's Report for 1951 11

EB11.R33 Ad Hoc Committee to examine the External Auditor's Report on the Accountsof the Organization for 1952 12

Field Projects : Government Participation in CostsEB11.R60 Local Costs to be borne by Governments 32

Special Funds and Other Sources of Additional IncomeEB11.R46 Gift to World Health Organization 18

EB11.R43 Publications Revolving Fund 17

EB11.R37 WHO Seals 14

ORGANIZATIONAL STRUCTURE AND ADMINISTRATIVE EFFICIENCY

EB11.R63 Suggestion for a Future Organizational Study 33

STAFF MATTERS

Director - General : Appointment and ContractEB11.R47 Procedure for Nomination of the Director - General 18

EB11.R48 Nomination for the Post of Director -General 19

EB11.R49 Contract of the Director -General 19

Headquarters : Location and Office AccommodationEB11.R56 Accommodation for Headquarters Office 23

Staff Regulations and RulesEB11.R39 Amendments to Staff Rules 15

Tax ReimbursementEB11.R45 Tax Reimbursement 18

CO- ORDINATION AND LIAISON

CO- OPERATION WITH THE UNITED NATIONS

GeneralEB 11.R55 Decisions of the United Nations General Assembly and of the Economic and Social

Council 23

EB11.R29 Representation of WHO at Meetings of Other Organizations 10

Co- ordination of Work on Special SubjectsEB11.R40 Development and Concentration of Efforts in the Social Field 15

Trusteeship Council and Committee on Information from Non - Self -Governing TerritoriesEB11.R41 Co- operation with the Committee of the United Nations General Assembly on

Information from Non -Self- Governing Territories 16

United Nations International Children's Emergency FundEB11.R28 Procedure for Joint Development of UNICEF /WHO Health Programmes 9

- IX -

Page

RELATIONS WITH NON -GOVERNMENTAL ORGANIZATIONS

Principles governing RelationshipEB11.R54 Relations with Non -Governmental Organizations 22

PART 2 : REPORT OF THE EXECUTIVE BOARD

I. Proposed Programme and Budget Estimates for 1954 41

II. WHO Participation in the United Nations Expanded Programme of Technical Assistance 95

III. Organizational Study on the Education and Training Programme 131

IV. Organizational Study on Regionalization 157

ANNEXES

1. List of Attendances 187

2. Officers of the Executive Board and Membership of its Committees and Working Parties . 190

3. Report of the Representatives of the Executive Board at the Fifth World Health Assembly 191

4. Host Agreement with the Government of France 192

5. Rights and Obligations of Associate Members 198

6. Report on the Tuberculosis Research Office, Copenhagen 202

7. Representation of the World Health Organization at Meetings of Other Organizations 216

8. Scale of Assessments 220

9. Scale of Assessments : Working Capital Fund 229

10. Transfers between Sections of the Appropriation Resolution for 1952 230

11. Amendments to Staff Rules 232

12. Report on Distribution and Sale of WHO Publications 233

13. Contract of the Director - General . . . . . . . . . . . . . . . . . . 246

14. Assignment to Regions 247

15. Relations with Non - Governmental Organizations 258

Index to Resolutions 261

INTRODUCTION

The eleventh session of the Executive Board was held in the Palais des Nations, Geneva, from 12 Januaryto 4 February 1953, under the chairmanship of Dr. M. Jafar, with Professor G. A. Canaperia andDr. H. B. Turbott as vice-chairmen.' Dr. S. Hayek and Dr. J. N. Togba were re- elected rapporteurs for thesession. The list of attendances will be found in Annex 1 and the membership of the committees and workingparties in Annex 2.

The method of work adopted by the Board for its eleventh session is indicated in resolution EB11.R2.For the review of the Director -General's Proposed Programme and Budget Estimates for 1954, the ExecutiveBoard, in accordance with resolution EB10.R21, established the whole Board as the Standing Committee onAdministration and Finance, and in that capacity held 11 meetings.

The Executive Board, in the course of 27 meetings, adopted the resolutions and the report contained inParts 1 and 2 of this volume.

PART 1

RESOLUTIONS

EB11.R1 Representation of the Executive Board at the Sixth World Health Assembly

The Executive Board

1. NOTES the report of the representatives of the Board at the Fifth World Health Assembly ; 2

2. DECIDES that the Board shall be officially represented at the Sixth World Health Assembly by ProfessorG. A. Canaperia and Dr. M. Jafar or Dr. W. A. Karunaratne (alternate to Dr. Jafar) ; and

3. REQUESTS the Director - General to make suitable arrangements for the presentation of the Board'sreport by its representatives at the Sixth World Health Assembly.

Handb. Res., 1st ed., 4.2.2 (First meeting, 12 January 1953)

EB11.R2 Method of Work of the Executive Board

The Executive Board,

In accordance with the decision as to its method of work which was taken at the tenth session(resolution EB10.R21),

DECIDES to discuss all items on the agenda of its eleventh session in plenary session and to appointworking parties to deal with particular aspects of problems only as and when these problems arise.

Handb. Res., 1st ed., 4.2.6 (First meeting, 12 January 1953)

1 Dr. Turbott was elected vice -chairman in place of Dr. A. H. Taba, who since the previous session of the Board had beenappointed Deputy Director for the Eastern Mediterranean.

2 Annex 3

2 EXECUTIVE BOARD, ELEVENTH SESSION

EB11.R3 Host Agreement with the Government of France


Having noted the proposed Host Agreement between the World Health Organization and the Govern-ment of France defining the privileges and immunities of the Organization and of its regional office inAfrica, signed on 23 July and 1 August 1952, and the exchange of notes relating thereto,'

TRANSMITS these texts to the Sixth World Health Assembly with a recommendation that they beapproved.

Handb. Res., 1st ed., 6.4.2 (Second meeting, 12 January 1953)

EB11.R4 Appointment of Regional Director for Africa


Having considered the recommendations of the Regional Committee for Africa and of the Director -General,

1. AUTHORIZES the Director -General

(1) to extend the appointment of Dr. F. Daubenton as Regional Director for Africa for a period ofone year from 1 February 1953, under the same terms and conditions as those of the previous appoint-ment ,(2) to appoint Dr. F. J. Cambournac to succeed Dr. Daubenton as Regional Director, and(3) to issue to him a contract for a period of five years, subject to the Staff Rules and Regulations,at a salary of $15,000 per annum, the effective date to be 1 February 1954 ;

2. AUTHORIZES the Director -General, in order to provide for an earlier appointment if this is possible,to appoint Dr. Cambournac for a temporary period of up to three months prior to the coming- into -forceof the five -year contract on conditions similar to those contained therein.

Handb. Res., 1st ed., 5.2.1 (Second meeting, 12 January 1953)

EB11.R5 Confirmation of Appointment of Regional Director for the Americas

Taking into consideration (1) that the XIIIth Pan American Sanitary Conference, serving as theRegional Committee for the Americas, recommended Dr. Fred L. Soper as Regional Director for theAmericas for the period 1 February 1951 to 31 January 1955, and (2) that at the seventh session of theExecutive Board (resolution EB7.R23) Dr. Soper was appointed Regional Director for the Americasfor a period of four years from 1 February 1951 ;

Noting that Dr. Soper will reach the age of 60 on 13 December 1953,


In accordance with Article 52 of the Constitution of WHO and in conformity with its Staff Rulesand Regulations,

CONFIRMS this appointment until 31 January 1955, as originally decided at the seventh session ofthe Board.

Handb. Res., 1st ed., 5.2.2.III (Second meeting, 12 January 1953)

3 Annex 4

RESOLUTIONS 3

EB11.R6 Confirmation of Appointment of Regional Director for the Eastern Mediterranean


In accordance with Article 52 of the Constitution of WHO and in conformity with its Staff Rulesand Regulations,

CONFIRMS the appointment of Dr. Aly Tewfik Shousha as Regional Director for the Eastern Mediter-ranean, under the same terms and conditions as those of the previous appointment, for the period 1 January1953 to 31 January 1953, and for a period of one year as from 1 February 1953, which periods are withinthe period of his original appointment made by the Executive Board at its third session.'

Handb. Res., 1st ed., 5.2.5.I1í (Second meeting, 12 January 1953)

EB11.R7 Extension of Appointment of Regional Director for South -East Asia


Having considered the recommendations of the Regional Committee for South -East Asia,

AUTHORIZES the Director - General to extend the appointment of Dr. Chandra Mani as RegionalDirector for South -East Asia from 15 December 1953 to 28 February 1958, under the same terms andconditions as those of his previous appointment.

Handb. Res., 1st ed., 5.2.3.I11 (Second meeting, 12 January 1953)

EB11.R8 Regional Committee for the Eastern Mediterranean


Having heard a statement made by the Regional Director for the Eastern Mediterranean to the effectthat, once again, for non- technical reasons, it has been impossible to convene a session of the RegionalCommittee in 1952,

1. EXPRESSES its regret at the prolongation of a situation prejudicial to the health interests of the Region ;

2. REQUESTS the Director -General

(1) to ask the Member States of the Region for their views on the position and for solutions whichthey may wish to suggest ;(2) to report on this subject to the Sixth World Health Assembly ;

3. RECOMMENDS that when this report is presented the Health Assembly consider any measure whichmight put an end to this situation.

Handb. Res., 1st ed., 5.2.5 (Fourth meeting, 13 January 1953)

EB11.R9 Reports of Regional Committees

The Executive Board

NOTES the reports on the 1952 sessions of the following WHO regional committees :

(1) Regional Committee for Africa, second session ;

(2) Regional Committee for the Americas, sixth meeting of the Directing Council of the Pan AmericanSanitary Organization and fourth meeting of the Regional Committee ;

' Off. Rec. World Hlth Org. 17, 16, para. 6.26 At its second meeting

EXECUTIVE BOARD, ELEVENTH SESSION

(3)

(4)

(5)

Regional Committee for Europe, second session ;

Regional Committee for South -East Asia, fifth session ; andRegional Committee for the Western Pacific, third session.

Handb. Res., 1st ed., 5 (Second meeting, 12 January 1953)

EB11.R10 International Anti -Venereal -Disease Commission of the Rhine

The Executive Board

1. NOTES the report of the International Anti -Venereal- Disease Commission of the Rhine on its secondsession ;

2. THANKS the members of the Commission and the Director - General for the work performed ;

3. NOTES the resolution of the Regional Committee for Europe requesting the Regional Director tostudy the desirability of establishing a health and social commission dealing with the wider problems ofhealth and welfare of Rhine River boatmen and their families, and to report to the Regional Committeeat its third session ;

4. TRANSFERS to the Regional Committee for Europe the provisions of the terms of reference of thisCommission (resolution EB7.24) in so far as they refer to the Executive Board.6

Handb. Res., 1st ed., 1.3.23.VIII (Sixth meeting, 14 January 1953)

EB11.R11 Expert Committee on Bilharziasis : First Report

The Executive Board

1. NOTES the first report of the Expert Committee on Bilharziasis ; 7

2. THANKS the members of the committee for their work ; and

3. AUTHORIZES publication of the report.


EB11.R12 Joint FAO /WHO Expert Committee on Brucellosis : Second Report

The Executive Board

1. NOTES the second report of the Joint FAO /WHO Expert Committee on Brucellosis ;



Handb. Res., 1st ed., 1.3.3.Ií (Fourth meeting, 13 January 1953)

8

6 See resolution EB7.R24, paras. (6) and (11).Published as World Hlth Org. techn. Rep. Ser. 1953, 65

8 Published as World Hlth Org. techn. Rep. Ser. 1953, 67

RESOLUTIONS 5

EB11.R13 Expert Committee on Influenza : First Report

The Executive Board

1. NOTES the first report of the Expert Committee on Influenza ; S




EB11.R14 Expert Committee on Hepatitis : First Report

The Executive Board

1. NOTES the first report of the Expert Committee on Hepatitis ;

2. THANKS the members of the committee for their..work ; and



10

EB11.R15 Expert Committee on Venereal Infections and Treponematoses : Fourth Report

The Executive Board

1. NOTES the fourth report of the Expert Committee on Venereal Infections and Treponematoses ; 11

2. THANKS the members of the committee for their work ;

3. DRAWS the attention of governments to relevant recommendations contained in the report, and

4. AUTHORIZES its publication.

Handb. Res., 1st ed., 1.3.23.I1 (Fifth meeting, 14 January 1953)

EB11.R16 Joint ILO /WHO Committee on Occupational Health : Report on Second Session

The Executive Board

1. NOTES the report of the Joint ILO /WHO Committee on Occupational Health on its second session ; 12

2. THANKS the members of the committee for their work ;

3. THANKS the International Labour Organisation for its excellent collaboration ;

4. NOTES that the Governing Body of ILO has reviewed the report favourably, and

5. AUTHORIZES its publication and distribution.

Handb. Res., 1st ed., 1.11.8 (Fifth meeting, 14 January 1953)

9 Published as World Hlth Org. techn. Rep. Ser. 1953, 6410 Published as World Hlth Org. techn. Rep. Ser. 1953, 6211 Published as World Hlth Org. techn. Rep. Ser. 1953, 6312 Published as World Hlth Org. techn. Rep. Ser. 1953, 66 (as the first report of the committee)


EB11.R17 Expert Committee on Biological Standardization : Sixth Report

The Executive Board

1. NOTES the sixth report of the Expert Committee on Biological Standardization ; 13



Handb. Res., 1st ed., 1.5.3.Ií (Fourth meeting, 13 January 1953)

EB11.R18 Expert Committee on the International Pharmacopoeia, Report on Eleventh Session, and Sub -Committee on Non -Proprietary Names, Report on Fifth Session

The Executive Board

1. NOTES the report of the Expert Committee on the International Pharmacopoeia on its eleventh session,and the report of the Sub - Committee on Non -Proprietary Names on its fifth session ; 14

2. THANKS the members of the committee and of the sub -committee for their work ; and

3. AUTHORIZES publication of these reports.


EB11.R19 Appointments to Expert Advisory Panels and Committees

The Executive Board

NOTES the report of the Director - General on appointments to expert advisory panels and committees.

Handb. Res., 1st ed., 1.8.1 (Sixth meeting, 14 January 1953)

EB11.R20 Procedure for Examination of Reservations to the International Sanitary Regulations (WHORegulations No. 2)


Recognizing that the precedents established at the Fifth World Health Assembly in the examinationof the reservations to the International Sanitary Regulations (WHO Regulations No. 2) submitted byMember States will serve as a guide for the consideration of those submitted in respect of their overseasand outlying territories ;

Considering that the more recent reservations do not contain, as far as can now be judged, anycomplex legal or technical problems,

1. DECIDES to refer communications from governments in respect of their overseas and outlying territoriesdirectly to the Sixth World Health Assembly ;

2. REQUESTS the Director -General to make the necessary arrangements.

Handb. Res., 1st ed., 1.7.2.I1 (Sixth meeting, 14 January 1953)

13 Published as World Hlth Org. techn. Rep. Ser. 1953, 6814 Published in World Hlth Org. techn. Rep. Ser. 1953, 69 (as the tenth and fourth reports respectively)

RESOLUTIONS 7

EB11.R21 Toxic Hazards of Certain Insecticides and Similar Products

The Executive Board

NOTES that a report concerning the toxic hazards to human beings and animals of certain insecticidesand similar products has been prepared, as requested by the Executive Board at its eighth session (resolutionEB8.R52), and will be published in the Monograph Series during the first quarter of 1953.

Handb. Res., 1st ed., 1.3.11.X (Sixth meeting, 14 January 1953)

EB11.R22 Recording and Transmission of Epidemiological Information

The Executive Board

1. NOTES the report of the Director - General on the recording and transmission of epidemiological infor-mation, and the measures taken to improve the collection, handling and distribution of this information,as described in this report ;

2. APPROVES the arrangements which are being made in this field ;

3. REQUESTS the Director - General to invite Member States to give their full support to the epidemiologicalservices provided by the Organization, inter alia by submitting to the Organization the returns requiredby the International Sanitary Regulations (WHO Regulations No. 2) and whenever possible other appro-priate epidemiological information ; and

4. REQUESTS the Director- General

(1) to continue to improve the epidemiological services which the Organization provides to nationalhealth administrations and other authorities along the lines indicated in the report, so far as may befinancially possible and, in particular,(2) to study the methods which, applied to the production and distribution of the Weekly Epidemio-logical Record, might reduce its cost without impairing its value to national quarantine services.

Handb. Res., 1st ed., 1.7.1

EB11.R23 Approval of Yellow -Fever Vaccine

The Executive Board

(Sixth meeting of the Board and fourth meeting of theStanding Committee on Administration and Finance,

14 and 28 January 1953)

ACCORDS full approval, for the issue of international certificates of vaccination, to the yellow -fevervaccine produced by the Wellcome Research Laboratories, Beckenham, Kent (United Kingdom).

Handb. Res., 1st ed., 1.3.24.íI (Sixth meeting, 14 January 1953)

EB11.R24 Amendments to Rules of Procedure of the World Health Assembly

The Executive Board

I. TRANSMITS to the Sixth World Health Assembly the following draft amendments to Rules 51 and 106of the Rules of Procedure of the Health Assembly, with a recommendation that they be adopted : 15

15 The rules referred to in this resolution are numbered as in the Handbook of Basic Documents, fifth edition, August 1952.Proposed additions are shown in italics and proposed deletions in square brackets.


Rule 51The reports of all committees established to consider items of the agenda shall, before being

submitted to a plenary meeting for final disposition, be referred to the General Committee, or to adrafting committee appointed by it, for co- ordinating and editing. Such reports, including draftresolutions, shall, after being examined by the General Committee, be circulated, in so far as practic-able, at least twenty -four hours in advance of the plenary meetings at which they are to be considered,unless the General Committee decides to refer the report or the draft for re- examination to the com-petent committee. Where such reports have been so circulated twenty four hours in advance, they shallnot normally be read aloud in the plenary meeting, unless the President decides otherwise.

Rule 106

The approval by the World Health Assembly of any request made by a Member or other authorityhaving responsibility for the international relations of a territory or group of territories on behalf ofsuch territory or group of territories shall be communicated immediately to the Government of theMember or other authority which has submitted the request. Such Government or other authorityshall give notice to the Director - General of acceptance on behalf of the Associate Member of associatemembership [on the conditions existing at the date of admission]. The territory or group of territoriesshall become an Associate Member from the date of the receipt of such notice.

II. Having considered the anomaly which exists in Rule 68 because of the provisions of Rule 66, whichmakes it possible for a roll -call vote to be taken even on a proposal to vote by secret ballot ;

Having discussed various possibilities for amending Rule 68,

REQUESTS the Director- General to submit for the consideration of the Health Assembly a study of thisquestion, taking into account the amendments to Rule 68 which he has suggested as well as the viewsexpressed by the members of the Executive Board at its eleventh session.

Handb. Res., 1st ed., 4.1.1.Ií (Seventh meeting, 15 January 1953)

EB11.R25 Amendment to Rules of Procedure of the Executive Board

The Executive Board

AMENDS Rule 25 of its Rules of Procedure by substituting the words " Any member " for " Anydelegate or representative of an Associate Member ".

Handb. Res., 1st ed., 4.2.4.íI (Eighth meeting, 15 January 1953)

EB11.R26 Rights and Obligations of Associate Members in Regional Committees

The Executive Board,Pursuant to the resolution (EB10.R5) on the rights and obligations of Associate Members, adopted

by the Board at its tenth session ; and

Having considered a report made by the Director - General on the results obtained from his communi-cation with Member States on this subject,'°

1. RECOMMENDS to the Sixth World Health Assembly that Associate Members should be given the rightto vote in the meetings of regional committees ; and, further,2. RECOMMENDS the adoption of the following resolution :

The Sixth World Health Assembly,Having considered a report of the Executive Board on the rights and obligations of Associate

Members ; and

16 Annex 5

RESOLUTIONS 9

Noting a recommendation of the Board that Associate Members should be given the right tovote in meetings of regional committees,1. RESOLVES to amend paragraph 3 (2) of resolution WHA2.103 of the Second World Health Assem-bly by deleting the phrase " with the exception that they will have no vote in plenary meetings of theRegional Committee, nor in sub -divisions dealing with finance or constitutional matters, " so thatthe paragraph now reads : " Associate Members shall have all rights and obligations in the regionalorganizations."

II. Believing that the Sixth World Health Assembly might wish to reconsider the scale of assessmentsfor Associate Members in the light of the foregoing action ; and

After reviewing the decisions taken on the scale of assessments for Associate Members by the SecondWorld Health Assembly, by the Executive Board at its fourth session, and by the Third World HealthAssembly,17

RECOMMENDS the adoption of the following resolution :

The Sixth World Health Assembly,Having decided to change the rights of Associate Members in regional committees,

1. CONSIDERS that this increase in rights should carry with it an increase in obligations ; and, therefore,

2. DECIDES that for 1954 and future years the assessment of all Associate Members should be estab-lished at four units.

Handb. Res., 1st ed., for paragraph I : 6.3.2.I ; (Eighth and ninth meetings, 15 and 16 January 1953)for paragraph II : 7.1.1.III

EB11.R27 Tuberculosis Research Office, Copenhagen


Having considered the report of the Tuberculosis Research Office, Copenhagen, regarding the workdone during the last two years,'$

1. TAKES NOTE of the wide and important work which it has accomplished in the field of BCG vaccina-tion during that period ;

2. CONGRATULATES the Director - General on the way in which investigations have been carried out ;

3. RECOMMENDS that the Tuberculosis Research Office enlarge the field of co- operation with other groupsat present interested in this special type of work ;

4. REQUESTS the Director -General to report to a future session of the Board on the results of thisco- operation.

Handb. Res., 1st ed., 1.3.20.VI (Tenth meeting, 16 January 1953)

EB11.R28 Procedure for Joint Development of UNICEF /WHO Health Programmes


Having been informed that the present arrangements for joint operating procedure and joint policy -forming machinery between UNICEF and WHO are working satisfactorily,

CONSIDERS that no change need be made.

Handb. Res., Ist ed., 8.1.5 (Tenth meeting, 16 January 1953)

17 Off. Rec. World Hltli Org. 21, 42 ; 22, 11 ; 28, 5318 Annex 6

r


EB11.R29 Representation of WHO at Meetings of Other Organizations


Having studied the report by the Director - General on representation of the World Health Organiza-tion at meetings of other organizations,19 which was called for by resolution WHA5.67 of the Fifth WorldHealth Assembly,

1. SUBMITS this report to the Sixth World Health Assembly ;

2. REQUESTS the Director - General, when considering invitations received :(1) to keep in mind the criteria outlined in this report ;(2) to comply, as far as possible, with the suggestions of the Advisory Committee on Administrativeand Budgetary Questions to the Economic and Social Council ; 20

(3) to ensure that representation is on the highest level possible ;and further

3. REQUESTS the Director - General to draw the attention of the United Nations to the desirability ofholding a reasonable number of its meetings in Europe, where the specialized agencies responsible forsocial activities are situated.

Handb. Res. 1st ed., 8.1.1.I1 (Tenth meeting, 16 January 1953)

EB11.R30 Scale of Assessments 21


Having considered the study and analysis presented by the Director - General on the scale ofassessments, as well as the proposal made by a member of the Executive Board on the assessments foradvances to the Working Capital Fund ; 22

Noting(1) that, although the assessments of Members of WHO have been made according to the criteriaused by the United Nations and in accordance with principles similar to those on which the contri-butions of Members of the United Nations are based, there are variations due to the adjustmentswhich have been made in the United Nations scale of assessments since the WHO scale was adoptedby the First World Health Assembly ;(2) that it is difficult to make direct comparison between the WHO and the United Nations scalesbecause of :

(a) the difference in the percentage paid by the largest contributor ;(b) the difference in membership ;(c) the application of the per capita provision of the WHO assessment resolutions, which, bylimiting the per capita contribution of any country to the per capita contribution of the Membermaking the highest contribution, provides for a reduction in the amount of the full assessmentof certain Members, and to this extent alters the basic assessment ;

(3) that in 1954 the assessment of the largest contributor to the United Nations will be reduced toone -third of the total assessments, thus making the United Nations scale for 1954 in this respect thesame as the present WHO scale ;(4) that it would be possible, in accordance with General Assembly resolution 311 B (IV) to submitthe WHO scale of assessments to the United Nations Committee on Contributions for its recom-mendations and advice,

19 Annex 720 See section 4 of Annex 7.21 See also resolution EB11.R34 below.22 Annexes 8 and 9

RESOLUTIONS 11

1. CONSIDERS that the proposal made regarding assessments for advances to the Working Capital Fundhas merit in that it would remove anomalies which have arisen in the advances to this Fund made by certainMembers ;

2. DECIDES, however, that the application of any such plan should be held in abeyance until a generalrevision of the scale of assessments has been made ;

3. RESOLVES to postpone until its first session in 1954 the review of the scale of assessments and assess-ments for advances to the Working Capital Fund, requested by the Fifth World Health Assembly (reso-lution WHA5.57), since at that time additional information will be available on which to base the review ;

4. REQUESTS the Director - General to ask the United Nations Committee on Contributions to review thepresent WHO scale of assessments and furnish such advice and recommendations as would, in the opinionof that committee, assist the Board in bringing this scale into line with the United Nations scale, takingall relevant factors into account ;

5. RECOMMENDS to the Sixth World Health Assembly the adoption of the following resolution :

The Sixth World Health Assembly,Having considered the report of the Executive Board on the review of the scale of assessments ;Realizing that the Board, in order to make the study requested by the Fifth World Health

Assembly, should have all available information at its disposal,1. CONCURS in the Board's decision that this study should be postponed until the first session of theBoard to be held in 1954 and that the matter should be submitted to the United Nations Committeeon Contributions for recommendations and advice ; and

2. REQUESTS the Executive Board to report to the Seventh World Health Assembly on this subject.

Handb. Res., 1st ed., 7.1.1.1 ; 7.1.7 (Ninth meeting, 16 January 1953)

EB11.R31 Collection of Contributions and Advances to the Working Capital Fund

The Executive Board

1. NOTES the situation with regard to the collection of contributions and advances to the Working CapitalFund, as on 31 December 1952 ; and

2. REQUESTS the Director - General to forward current information on this subject to the Sixth WorldHealth Assembly, as well as a report on any Members whose assessments for 1948, 1949, 1950 and 1951have not yet been paid, in accordance with resolution WHA5.13.

Handb. Res., 1st ed., 7.1.1.V ; 7.1.7 (Thirteenth meeting, 19 January 1953)

EB11.R32 Examination of the Financial Report and the External Auditor's Report for 1951


Noting resolution WHA5.35 and the request of the Fifth World Health Assembly that the Board atits eleventh session examine in detail the Director -General's Financial Report for 1951 and the Reportof the External Auditor ;

Having considered the various documents submitted on this subject,

1. NOTES with satisfaction the action which has been taken by the Director- General ; and

2. DECIDES that the Executive Board, at its first session to be held in each year, shall examine the Director -General's Financial Report and the Report of the External Auditor thereon for the financial year precedingthe year which has just elapsed.

Handb. Res., 1st ed., 7.1.2.I11 (Thirteenth meeting, 19 January 1953)


EB11.R33 Ad Hoc Committee to examine the External Auditor's Report on the Accounts of the Organizationfor 1952


Considering that there will not be a formal session of the Executive Board between the date of thereceipt of the Report of the External Auditor on the accounts of the Organization for the year 1952 andthat of the convening of the Sixth World Health Assembly ; and

Considering the requirement that the comments of the Board on this report must be submitted to theSixth World Health Assembly,

ESTABLISHES an ad hoc committee of the Executive Board, consisting of

(1) Dr. M. Jafar (or Dr. W. A. Karunaratne, alternate),(2) Professor G. A. Canaperia, and(3) Dr. Melville Mackenzie,

to meet on 4 May 1953 to consider the report of the External Auditor on the accounts of the Organizationfor the year 1952 and to submit to the Sixth World Health Assembly, on behalf of the Board, such commentsas it deems necessary.

Handb. Res., 1st ed., 7.1.2.I11 (Thirteenth meeting, 19 January 1953)

EB11.R34 Assessment of China 23


Considering the request of the Fifth World Health Assembly (resolution WHA5.56) that the ExecutiveBoard should study the communication from the Republic of China containing proposals on its financialcontributions to the World Health Organization, and submit a report thereon to the Sixth World HealthAssembly ;

Having examined the report of the Director - General on this matter ; 24

Considering the statement of the Third World Health Assembly (in resolution WHA3.90) " that theresumption by China of full participation in the work of the Organization will be welcomed " ;

Noting that the United Nations General Assembly, in establishing the 1953 scale of assessments, fixedthe assessment of China at nearly the same percentage as its present assessment in WHO ; and

Noting further that the amount proposed by the Republic of China represents a very small fractionof this current assessment,

1. BELIEVES nevertheless that a plan should be developed in order to enable China to resume active par-ticipation in the Organization ;

2. RECOGNIZES that there are two or more alternative methods of making an adjustment, either in thescale of assessments itself or by an arrangement to accept an extraordinary reduced payment as fullydischarging the annual assessment of China toward the annual budget of the Organization ;

3. REQUESTS the Director -General to provide for the Sixth World Health Assembly

(1) copies of all communications on this subject with the Republic of China ;(2) the various alternative methods of dealing with this matter ;

(3) any other relevant data ;

23 See also resolution EB11.R30 above.24 See Annex 8.

RESOLUTIONS 13


The Sixth World Health Assembly,

I. Having considered the report of the Executive Board on the communication from the Republicof China containing proposals which would enable China to resume active participation in theOrganization,

WELCOMES the return of China to active participation ;

II. Taking into account the present situation of the Republic of China, which makes it difficult forthat Government to fulfil at this time its total financial obligations to the World Health Organization,

1. RESOLVES :

(1) that for the purpose of establishing the scale of assessments for 1954 and future years theassessment of China shall remain at 720 units ;

(2) that an extraordinary reduced contribution from China for 1954 and future years in theamount equivalent to .... 25 units shall be accepted as fully discharging the assessment ofChina for each year ;

(3) that, notwithstanding the provisions of Financial Regulation 5.6, the payment by Chinaof this amount for 1954 and future years shall be credited to income for the year in which it wasassessed rather than to the arrears of earlier years ; and further

(4) that at such time as the condition of China improves, its assessment shall be reconsideredby the Executive Board and /or the Health Assembly ;

2. DECIDES :

(1) that the token payment of US $15,000, to be applied to the arrears due to the Organizationfor 1953 and prior years, shall be accepted ;

(2) that, notwithstanding the provisions of Financial Regulation 5.6, this payment shall becredited to the assessment of 1948 ; and

(3) that the balance of the arrears of China for the years prior to 1954 shall be subject to futurearrangements, when the financial condition of this country improves.

Handb. Res., 1st ed., 7.1.1.V ; (Thirteenth meeting, 19 January 1953)for paragraph 4(I) : 6.3.3

EB11.R35 Transfers between Sections of the 1952 Appropriation Resolution


Having noted the report of the Director- General 26 on transfers of credits between sections of the 1952Appropriation Resolution which, pursuant to the authorization given by the Executive Board at itstenth session (resolution EB10.R9), were previously concurred in by correspondence,

CONFIRMS its concurrence in these transfers.

Handb. Res., 1st ed., 2.1.3.íI1 (Fourteenth meeting, 20 January 1953)

25 Figure to be inserted by the Health Assembly, on the basis of the data to be submitted by the Director- General under para-graph 3 above

26 Annex 10


EB11.R36 Transfers between Sections of the 1953 Appropriation Resolution

The Executive Board

CONCURS in the transfers proposed by the Director -General between sections of the 1953 AppropriationResolution 27 as follows :

Appropriationsection

Purpose of appropriationAmount votedby Fifth World

Health Assembly

Transfersauthorized

Revisedappropriation

US $ US $ US $PART I : ORGANIZATIONAL MEETINGS

1. World Health Assembly 154,400 12,900 167,3002. Executive Board and its Committees . . . 77,680 8,270 85,9503. Regional Committees 34,750 8,650 43,400

Total - Part I 266,830 29,820 296,650- - -- - - -- - - --PART II : OPERATING PROGRAMME

4. Central Technical Services 1,563,866 (62,707) 1,501,1595. Advisory Services 4,285,141 104,520 4,389,6616. Regional Offices 1,052,371 53,224 1,105,5957. Expert Committees and Conferences . . . 184,178 - 184,178

Total - Part II 7,085,556 95,037 7,180,593

PART III : ADMINISTRATIVE SERVICES

8. Administrative Services 1,132,709 (124,857) 1,007,852

Total - Part III 1,132,709 (124,857) 1,007,852

Sub -Total - Parts I, II and III 8,485,095 - 8,485,095

PART IV : RESERVE

9. Undistributed Reserve 1,347,659 - 1,347,659

Total - Part IV 1,347,659 - 1,347,659

TOTAL - ALL PARTS 9,832,754 - 9,832,754

Handb. Res., 1st ed., 2.1 (Fourteenth meeting, 20 January 1953)

EB11.R37 WHO Seals

The Executive Board

1. NOTES the report of the Director -General on the sale of WHO seals and the status of the special fundfor seals established by the Fourth World Health Assembly (resolution WHA4.48) ;

27 Resolution WHA5.37

RES OLUTI ONS 15

2. DECIDES that the Board should periodically review the situation with regard to the sale of seals in orderto assess the value of the campaign ; and therefore

3. REQUESTS the Director - General to submit a progress report to the first session of the Board to be heldin each year.

Handb. Res., 1st ed., 7.1.6.IV (Fourteenth meeting, 20 January 1953)

EB11.R38 Arrears of Contributions due in respect of the Office International d'Hygiène Publique


Having considered the report of the Director - General regarding the arrears of contributions due inrespect of the Office International d'Hygiène Publique,

1. NOTES

(1) that the Director - General has notified the States concerned of the amounts due ; and

(2) that the replies received from certain States would require negotiations between the States andthe Organization in order to arrive at a settlement ;

2. RECOMMENDS that the Director - General be authorized to negotiate with these States in order to obtaina settlement ; and, therefore,


The Sixth World Health Assembly,Having considered the resolution of the Executive Board concerning the arrears of contributions

due in respect of the Office International d'Hygiène Publique,1. AUTHORIZES the Director - General to negotiate with the States concerned in order to arrive at asettlement of these debts as to both amount and currency of payment ;2. RESOLVES to delegate to the Executive Board full powers to approve the final settlement of thesedebts ; and

3. REQUESTS the Board to submit a report to the Seventh World Health Assembly.

Handb. Res., 1st ed., 6.5.2 (Fourteenth meeting, 20 January 1953)

EB11.R39 Amendments to the Staff Rules

The Executive Board

CONFIRMS the changes in the Staff Rules as reported by the Director-General.28

Handb. Res., 1st ed., 7.3.10.1I (Fourteenth meeting, 20 January 1953)

EB11.R40 Development and Concentration of Efforts in the Social Field

The Executive Board

1. NOTES resolution 434 A (XIV) of the Economic and Social Council on the development and concen-tration of the efforts in the social field of the United Nations and the specialized agencies and the preli-minary report on the world social situation to the Economic and Social Council, issued by the UnitedNations ; 29

28 See Annex 11.29 UN document E/CN.5/267


2. NOTES the report of the Director - General on co- operation with the agencies concerned in the prepara-tion of the programme of concerted practical action in this field, proposed in resolution 535 (VI) of theGeneral Assembly ;

3. REQUESTS the Director- General to communicate with Member governments, inviting their attentionto the resolution of the Economic and Social Council referred to above, and asking for their suggestionsand recommendations on the establishment of the proposed programme and on the report on the worldsocial situation ; and further

4. REQUESTS the Director - General to submit to the Sixth World Health Assembly the results of thesecommunications, and to make available to delegations at that Assembly copies of both the preliminaryreport on the world social situation and the programme of concerted practical action in the social field.

Handb. Res., 1st ed., 8.1.2 (Fifteenth meeting, 20 January 1953)

EB11.R41 Co- operation with the Committee of the United Nations General Assembly on Information fromNon -Self -Governing Territories

The Executive Board

NOTES with appreciation that the Director- General has co- operated with the Committee of the GeneralAssembly on Information from Non -Self- Governing Territories by providing advice on the health aspectsof social conditions in these territories.


EB11.R42 Distribution and Sale of WHO Publications


Having continued its study on the free distribution and sales of WHO publications as requested bythe Fifth World Health Assembly in resolution WHA5.24,

1. ENDORSES the general conclusions contained in the Director -General's report on the distribution andsale of WHO publications and the postulates contained in Appendix 3 to that report ; 3°

2. EXPRESSES satisfaction with the co- ordination which has developed with the United Nations and otherspecialized agencies in the study of problems of distribution and sale of publications, through the WorkingGroup on Publications of the Administrative Committee on Co- ordination and otherwise ;

3. REQUESTS the Director - General to continue to give attention, in consultation with the United Nationsand other specialized agencies, to the promotion of distribution as an essential element of the publishingprogramme and to report on progress made to a future session of the Executive Board ;

4. TRANSMITS the Director- General's report on the distribution and sale of WHO publications to theSixth World Health Assembly with the above comments.

Handb. Res., 1st ed., 1.12 (Fourteenth meeting, 20 January 1953)

80 Annex 12

RESOLUTIONS 17

EB11.R43 Publications Revolving Fund


Having considered a report of the Director - General on the status of the Publications Revolving Fundas at 31 December 1952 31 and a report on the distribution and sale of WHO publications ; 32 and

Noting resolution WHA5.23 of the Fifth World Health Assembly in which the Assembly authorizedcertain expenditures to be made from the Fund for the purpose of giving publicity to and improving thesale of WHO publications,

1. ENDORSES the measures already taken by the Director- General as well as those which he has recom-mended to implement the above resolution ;

2. AUTHORIZES the Director -General to appoint a distribution and sales officer, the cost of this post tobe a charge against the amount the Director - General was authorized by the Fifth World Health Assemblyto withdraw from the Publications Revolving Fund in 1953 to give publicity to WHO publications and toimprove their sales ;



Having considered a report of the Executive Board on the Publications Revolving Fund ;

Noting that the Board had considered a report of the Director - General on the distribution andsale of WHO publications ; and

Further noting that the Board endorses the measures taken as well as those recommended by theDirector - General to give publicity to and to improve the sale of WHO publications,

1. AUTHORIZES the Director - General to draw on the Publications Revolving Fund an amount notto exceed $10,000 in 1954 to be used to give publicity to WHO publications, to improve the sale ofsuch publications, and to defray the costs of the post of distribution and sales officer authorized bythe Executive Board ;

2. REQUESTS the Director - General and the Executive Board to continue to study the staff and financialimplications 'of measures necessary to secure effective distribution and sale of WHO publications ;

3. REQUESTS the Executive Board, at its first session in 1954, to review the status of the PublicationsRevolving Fund in order to determine the purpose for which any accumulated sums should be used.

Handb. Res., 1st ed., 7.1.6.II ; 1.12 (Fourteenth meeting, 20 January 1953)

EB11.R44 Periodical Reports on Projects


Having examined a statement of projects which was prepared by the Director- General in pursuanceof resolution EB9.R75,

1. REQUESTS the Director -General to continue issuing such statements periodically ;

2. LEAVES to his discretion the precise manner of publication and the frequency of issue of such statementsin the Chronicle of the World Health Organization ;

31 Appendix 2 to Annex 1232 See preceding resolution.


3. RECOMMENDS that the Director - General include in his Annual Report :

(1) a complete review of current activities of the year, classified by region, country, and major typeof activity ; and

(2) a list of projects completed during the period covered, with an appraisal of the results achieved.

Handb. Res., 1st ed. 1.2.1 ; (Fifteenth meeting, 20 January 1953)for paragraph 2 : 1.12.1.I1I

EB11.R45 Tax Reimbursement

The Executive Board

NOTES that no further progress has been reported by governments in exempting certain staffmembers from taxes on income received from the World Health Organization.

Handb. Res., 1st ed., 7.3.11 (Fourteenth meeting, 20 January 1953)

EB11.R46 Gift to the World Health Organization


Having been informed that the Organization has received a cash gift of US $100 from the Women'sSociety of Christian Service of the First Methodist Church, Moscow, Idaho (USA),

1. ACCEPTS the gift in accordance with the provisions of Article 57 of the Constitution ;

2. REQUESTS the Director -General, on behalf of WHO, to express to the donors gratitude for and appre-ciation of this gift.

Handb. Res., 1st ed., 7.1.6.I (Nineteenth meeting, 22 January 1953)

EB11.R47 Procedure for Nomination of the Director - General


Considering that its Rules of Procedure contain no precise directive for voting on the nomination ofthe Director - General,

DECIDES to vote on this nomination in the following manner :

(1) A list of candidates shall be established by secret ballot and the names presented in alphabeticalorder ;

(2) A series of secret ballots shall be taken. Each member of the Board shall write down the nameof a single candidate which he chooses from the list of candidates which has been established. Thename of the candidate who receives the least number of votes shall be eliminated at each balloting ;(3) When the number of candidates has been reduced to two there shall be as many ballots as arenecessary in order to secure a majority for either candidate. In the event of a tie between theremaining candidates after three votes, the whole procedure shall start again.

Handb. Res., 1st ed., 7.3.2 (Twenty- second meeting, 27 January 1953)

RESOLUTIONS 19

EB11.R48 Nomination for the Post of Director -General

The Executive Board

1. NOMINATES Dr. Marcolino Gomes Candau for the post of Director -General of the World HealthOrganization, in accordance with Article 31 of the Constitution ;

2. SUBMITS this nomination to the Sixth World Health Assembly.


EB11.R49 Contract of the Director -General

(The Executive Board, at a secret session on 27 January1953, and by a secret ballot, voted in favour of the nomi-nation of Dr. Marcolino Gomes Candau for the post ofDirector -General of the World Health Organization)

In accordance with the requirements of Rule 97 of the Rules of Procedure of the Health Assembly,The Executive Board

1. SUBMITS to the Sixth World Health Assembly the attached draft contract establishing the terms andconditions of appointment of the Director - General ; 33

2. RECOMMENDS to the Sixth World Health Assembly the adoption of the following resolution :The Sixth World Health Assembly,Pursuant to Article 31 of the WHO Constitution and Rule 98 of the Rules of Procedure of the

Health Assembly,1. APPROVES the attached contract establishing the terms and conditions of appointment, salary andother emoluments for the post of Director - General ; and,

Pursuant to Rule 100 of the Rules of Procedure of the Health Assembly,

2. AUTHORIZES the President of the Sixth World Health Assembly to sign this contract in the nameof the Organization ; and, further,3. AGREES with the recommendation of the Executive Board at its eleventh session that the newDirector - General should, if possible, enter upon his duties some weeks before the departure of theoutgoing Director - General ; and, consequently,4. AUTHORIZES the commencement of the salary and allowances of the new Director - General uponhis departure from his current place of residence for Geneva at any time after 15 June 1953, theexact date to be inserted in paragraph II (1) and (2) of the contract by arrangement with him.

Handb. Res., 1st ed., 7.3.2 (Twenty -first meeting, 26 January 1953)

EB11.R50 Organizational Study on Regionalization

The Executive Board,In conformity with the request of the Fifth Health Assembly (resolution WHA5.63) that the Board

should undertake, at its eleventh session, a study of regionalization ; andHaving made such an investigation,

1. SUBMITS it for the consideration of the Sixth World Health Assembly ; S4 and

2. RECOMMENDS to the Sixth World Health Assembly the adoption of the following resolution :The Sixth World Health Assembly

1. REAFFIRMS the principles which prompted the establishment of regionalization and finds that theyhave been justified in practice ;

33 Annex 1334 See page 157.


2. EXPRESSES its satisfaction with the development of the organizational structure and functioningof the regional offices ;

3. REQUESTS the Executive Board periodically to review and report on the progress and problems ofregionalization ;4. REQUESTS the Director -General to provide, through the staff at headquarters, guidance to theregional offices on specific programmes, assistance in long -term planning, and control and co- ordina-tion of regional programmes to ensure that they conform to the principles and policies establishedby the Health Assembly, the Executive Board and the Director - General ;

5. RECOMMENDS the interchange of staff of the Secretariat among regions and between headquartersand regions ;6. NOTES that variations in constitution, objectives and organization produce wide differences inthe nature and extent of decentralization in the United Nations, the World Health Organization andother specialized agencies, and that such differences often impede effective co- operation in fieldprogrammes ;7. REQUESTS the Director - General to bring this problem to the attention of the Secretary - Generalof the United Nations and provide the utmost co- operation of WHO in finding a solution ;8. EXPRESSES its belief that the undoubted advantages of regionalization can be fully achieved onlyby continued mutual confidence and co- operation among all those to whom the Constitution and theHealth Assembly have delegated responsibility and authority.

II. The Executive Board,

Noting that the geographical pattern of certain regions imposes heavy costs on some Member Statesand Associate Members in sending representatives to meetings of the regional committees,1. RESCINDS its previous decisions to the effect that the reimbursement of the transportation expenses ofrepresentatives of Member States attending the second and subsequent meetings of regional committeesshall not be authorized ; 36 and2. RECOMMENDS to the Sixth World Health Assembly the adoption of the following resolution :

The Sixth World Health Assembly,Having considered the report of the Executive Board on regionalization ;Noting that the heavy costs entailed in sending representatives to attend meetings of regional

committees tend to deter Member States and Associate Members from sending such representatives ;and

Considering that it is most important and desirable that all Member States and Associate Mem-bers be enabled to participate in such meetings,1. AUTHORIZES the reimbursement of each Member State and each Associate Member for the actualtravelling expenses of one representative to not more than one session a year of the regional committee,the maximum reimbursement to be restricted to the equivalent of first -class return accommodation byrecognized public transport via an approved route from the seat of the central administration of theMember State or Associate Member to the place of the meeting, and not to include the payment ofsubsistence, except where this is included as an integral part of the regular posted schedule for first -class accommodation for recognized public transport ;2. DECIDES that this authorization shall become effective in 1955 ;

3. REQUESTS the Director - General to include in his annual budget estimates, beginning with theyear 1955, appropriate provision under the appropriation section for regional committees to coversuch expenditures.

III. The Executive Board,

Considering the increased expenditure entailed by holding sessions of regional committees elsewherethan at regional headquarters,

35 Off. Rec. World HIM Org. 14, 26 ; 25, 22

RESOLUTIONS 21

RECOMMENDS to the Sixth World Health Assembly the adoption of the following resolution :

The Sixth World Health Assembly,Noting that the holding of sessions of regional committees at centres other than the regional

headquarters entails increased costs to the Organization ;

Considering the desirability of limiting such costs wherever possible,

1. INVITES the co- operation of regional committees to this end ; and

2. SUGGESTS that regional committees give consideration to the possibility of holding sessions atregional headquarters every alternate year.

Handb. Res., 1st ed., 5 ; 7.2 ; (Twenty -third meeting, 2 February 1953)for paragraph II : 7.1.5.111

EB11.R51 Assignment to Regions

The Executive Board,Having considered the results of the study made by the Director - General in pursuance of resolution

WHA5.43, on the rules and criteria to be adopted for determining the assignment of territories to thegeographical areas established in conformity with Article 44 of the Constitution ; 38

Considering that the Health Assembly itself should take a decision on this subject,

PROPOSES the following alternative draft resolutions 37 for the consideration of the Sixth World HealthAssembly :

First Alternative


Having examined the various criteria for the assignment of the territories of Members of theWorld Health Organization to regions within the World Health Organization and the opinions statedin this respect by Member States,

RESOLVES

(1) that in this matter, the wishes of the appropriate sovereign authority of the State orterritory concerned shall be paramount ;

(2) that such authorities, in stating their wishes, shall take into account :(a) geographical position ;(b) similarity of health problems ;(c) economic aspects ;(d) administrative considerations ;(e) relations between the various regions of WHO and regional arrangements made by otherinternational organizations.

Second Alternative

The Sixth World Health Assembly,Noting resolution WHA5.43 of the Fifth World Health Assembly requesting the Executive Board

to undertake a study of rules and criteria for determining the assignment of any territory to ageographical area ; and

Having examined the various rules and criteria for such assignments and the opinions stated inthis respect by Member States of WHO,

33 Annex 14S7 These draft resolutions received an equal number of votes when they were considered by the working party on this question

set up by the Board.


RESOLVES that the following criteria, in the order of priority given below, be considered in theassignment of any territory to any geographical area :

(1) the wishes of the appropriate sovereign authority of the State or territory concerned ;(2) geographical position ;(3) similarity of health problems ;(4) economic aspects ;(5) administrative considerations ;(6) relations between the various regions of WHO and regional arrangements made by otherinternational organizations.

Handb. Res., 1st ed., 5.1.1.I (Twenty -third meeting, 2 February 1953)

EB11.R52 Expert Committee on Professional and Technical Education of Medical and Auxiliary Personnel :Second Report

The Executive Board

1. NOTES the second report of the Expert Committee on Professional and Technical Education of Medicaland Auxiliary Personnel ; 38




EB11.R53 Organizational Study on Education and Training

(Twenty-fourth meeting, 2 February 1953)


In accordance with the request of the Fifth World Health Assembly that the Board should undertake,at its eleventh session, a study on the education and training programme (resolution WHA5.63) ;

Having made such a study,

1. SUBMITS it for the consideration of the Sixth World Health Assembly ; 39

2. REQUESTS the Director- General to prepare for the consideration of the Health Assembly, as an annexto the study, a résumé of the opinions on this subject expressed at the eleventh session of the ExecutiveBoard.40

Handb. Res., 1st ed., 1.6 ; 7.2 (Twenty -sixth meeting, 3 February 1953)

EB11.R54 Relations with Non -Governmental Organizations


Having examined the report of the Director - General on relations with non - governmental organi-zations ; and

Believing that this question presents aspects on which the Health Assembly alone is competent totake a decision,

38 Published as World Hlth Org. techn. Rep. Ser. 1953, 7039 See page 131.4o See page 153.

RESOLUTIONS 23

1. INVITES the Sixth World Health Assembly to consider the problem along with the annexed report onthe discussions at the eleventh session of the Executive Board ; 41 and

2. REQUESTS the Director - General to make available any further documentation which he considers wouldbe helpful to the Health Assembly in its deliberations.

Handb. Res., 1st ed., 8.3.1 (Twenty -third meeting, 2 February 1953)

EB11.R55 Decisions of the United Nations General Assembly and of the Economic and Social Council

The Executive Board

1. NOTES the report of the Director - General on the decisions taken by the General Assembly of theUnited Nations in the first part of its seventh session and by the Economic and Social Council at its four-teenth session on matters which concern the World Health Organization ;

2. NOTES, in particular, resolution 451 (XIV) of the Economic and Social Council on co- ordinationof the work of the United Nations and the specialized agencies and the statement on United Nationspriority programmes which appears in that resolution ;

3. RECALLS the resolutions on concentration of effort and resources which were adopted by the Boardat its seventh session (resolution EB7.R17) and by the Fourth World Health Assembly (resolutionWHA4.10) ;

4. EXPRESSES the opinion that the statement of the Economic and Social Council implies no modificationin the place allotted to health programmes in the work of the United Nations system and does not suggestany need to modify the policies or programme of WHO ;

5. FORWARDS this information to the Sixth World Health Assembly so that it may take it into accountwhen examining the programme of the Organization.


EB11.R56 Accommodation for Headquarters Office


Taking cognizance of the report of the Building Committee,42

1. APPROVES the proposal to have modernized at the expense of WHO one of the lifts serving the sectionof the building occupied by the Organization, this expense being charged to the Building Fund ;

2. NOTES with satisfaction that, in accordance with resolution WHA5.54 of the Fifth World HealthAssembly and by economies in the Organization's regular budget for 1952, it has been possible to find thenecessary amounts to finance the additional work and to meet the supplementary claims for payment ;

3. CONFIRMS the full powers conferred upon the Building Committee to act on behalf of the Board inconnexion with the final settlement of all questions relating to the extension of the Palais des Nations ; and

4. AUTHORIZES the Building Committee to submit to the Sixth World Health Assembly, on behalf of theBoard, the report requested by the Fifth World Health Assembly.

Handb. Res., 1st ed., 7.3.4.I1 (Twenty -third meeting, 2 February 1953)

41 Annex 1542 The final report of the Building Committee will be submitted to the Sixth World Health Assembly.


EB11.R57 WHO Participation in the United Nations Expanded Programme of Technical Assistance

Having considered a report on the participation of WHO in the United Nations Expanded Programmeof Technical Assistance for the Economic Development of Under -Developed Countries ;

Having considered the projects started, completed and now in operation as well as those planned,including the activities during the first and second financial periods and those planned for the fiscal year1953 ,

Considering the provisions of the several resolutions concerning this programme which have beenadopted by the United Nations General Assembly, the Economic and Social Council, the World HealthAssembly and the Executive Board ;

Considering the provisions of the Constitution of WHO and the articles therein establishing theOrganization's functions, particularly Article 2 (a) which provides that it shall " act as the directing andco- ordinating authority on international health work " ;

Considering that resolution 222 (IX) of the Economic and Social Council provides particularly that" the projects falling within the competence of participating organizations should be carried out by them,and the co- ordination of their work should be effected, with due regard to their constitutions and therelations established between them ", and that " the work undertaken by the participating organizationsunder the expanded Technical Assistance programme should be suitable for integration with their normalwork " ; 43

Considering that the agreement between the United Nations and WHO provides, in Article I, that" the United Nations recognizes the World Health Organization as the specialized agency responsible fortaking such action as may be appropriate under its Constitution for the accomplishment of the objectivesset forth therein " ;

Considering the inadequate financial resources which appear to be available for carrying out the acti-vities assisted by WHO during 1953 ;

Considering resolution WHA3.116, in which the Third World Health Assembly noted with interestand approval United Nations resolution 304 (IV) with particular reference to resolution 222 A (IX) (of15 August 1949) of the Economic and Social Council and the principles established by the Council entitled" Observations on and Guiding Principles of an Expanded Programme of Technical Assistance for EconomicDevelopment " ;

Considering the amendments to resolution 222 (IX) which have been made by the Economic andSocial Council by the adoption in July 1952 of its resolution 433 A (XIV) and which provide for areorganization of the Technical Assistance Board, including the appointment of an Executive Chairmanfor that Board ; 44

Considering that these amendments have not yet been examined by the Health Assembly,

The Executive Board

1. TRANSMITS to the Sixth World Health Assembly a report dealing with the several aspects of the presentstage of development of the United Nations Expanded Programme of Technical Assistance ; 46

2. DRAWS the attention of the Health Assembly to the resolutions dealing with each of the various aspectsof the Technical Assistance programme on which the Board took action 46 under the authority delegatedto it by the Fifth World Health Assembly (in resolution WHA5.61) ;

3. REQUESTS the Director- General to furnish to the Sixth World Health Assembly a supplementaryreport on any additional developments which may occur between the eleventh session of the ExecutiveBoard and the convening of the Health Assembly.

43 Annex I to the resolution, paragraphs 1 and 2 of the section on co- ordination of effort44 See Appendix 5 to the Board's report on Technical Assistance, page 115.46 See page 95.46 Resolutions EB11.R57.1 to R57.9 hereunder

RESOLUTIONS 25

EB11.R57.1 Legislative Responsibility for Review and Approval of the Technical Assistance Programme


While of the opinion that the appointment of an Executive Chairman of the Technical AssistanceBoard as a co- ordinator may be desirable ;

Considering the responsibility of WHO to act as the directing and co- ordinating authority on inter-national health work, in accordance with Article 2 (a) of the Constitution ;

Recognizing the inseparability of social, economic and health factors ;'97Considering that the Executive Board and the Health Assembly, in accordance with the wishes

expressed in the United Nations General Assembly, review and approve the programme to be financedfrom Technical Assistance funds, after the participating governments have examined the value of theprogrammes which they themselves have requested,

1. VIEWS WITH CONCERN the responsibility given to the Executive Chairman and the Technical AssistanceBoard by the Technical Assistance Committee, under which they are required to examine and approveprogramme proposals and projects submitted by WHO and to appraise the effectiveness of programmeswhich are technically the responsibility of the Organization ;

2. PROPOSES that, in accordance with resolution WHA4.23 concerning co- ordination of the TechnicalAssistance programme and resolution EB9.R50 of the Executive Board concerning co- ordination of jointprojects under the Expanded Programme of Technical Assistance, planning and co- ordination of countryprogrammes should be undertaken by the government concerned, whose responsibility it is to determinethe kind of assistance needed and the rate at which it can be absorbed in orderly development ;

3. URGES the Sixth World Health Assembly to consider this matter during its examination of the amend-ments made by the Economic and Social Council to its resolution 222 (IX) ; and, in the meantime,

4. REQUESTS the Director - General to communicate these views to the Technical Assistance Committeeof the Economic and Social Council and to the Technical Assistance Board.

EB11.R57.2 Technical Assistance Programme : Administrative Structure and Costs 48


Having considered the administrative structure resulting from the reorganization of the administrationof the Technical Assistance programme and the costs attendant on that structure,

1. REQUESTS the Director -General to present to the Technical Assistance Board its concern regarding thecomplicated administrative structure and the costs thereof, together with the suggestion of the ExecutiveBoard that every effort be made to simplify the structure and reduce the costs ; and further

2. REQUESTS the Director -General to continue to carry out the part of the programme for which WHOis responsible with the greatest economy possible in central administrative and indirect operational costs,so that any savings which may be realized on the amount ear -marked for WHO for these purposes maybe used for health projects.

EB11.R57.3 Co- ordination of Assistance to Governments under the Technical Assistance Programme


Considering the constitutional responsibility of the World Health Organization to establish andmaintain effective collaboration with governmental health administrations ;

47 Resolution WHA5.61, paragraph 6 (2)48 See also resolution EB11.R57.8 below.


Having noted the practice of appointing resident Technical Assistance representatives, responsiblefor co- ordinating assistance to the governments to which they are accredited under the ExpandedProgramme of Technical Assistance,

1. EXPRESSES THE OPINION that WHO is not in a position to interpose any indirect channels of communi-cation between the Organization and governmental health administrations, or to abrogate its constitutionalresponsibilities as the directing and co- ordinating authority on international health work ;

2. BELIEVES that in the present financial situation the practice of appointing resident Technical Assistancerepresentatives should be limited as far as possible ;

3. REQUESTS the Director - General to bring this view of the Executive Board to the attention of theTechnical Assistance Board ; and further

4. REQUESTS the Director -General to continue to co- operate with resident Technical Assistance repre-sentatives, taking into account the provisions of the Constitution of the World Health Organization.

EB11.R57.4 Financial Resources Available or expected to be Available for the Technical AssistanceProgramme in 1953


Having considered the serious financial situation which faces the Organization in effectively implement-ing the programme planned for 1953, and the various proposals for meeting the situation ;

Considering that the rapid development and increase of the Expanded Programme of TechnicalAssistance by WHO is the result of the urgent requests of the Economic and Social Council and itsTechnical Assistance Committee and the desires of individual governments contributing to this programme ;

Considering that the programme to be carried out by the World Health Organization in 1953 and tobe financed from both regular and Technical Assistance funds was endorsed by the Executive Board atits ninth session and approved by the Fifth World Health Assembly as an integrated whole, and consideringthat a large number of Technical Assistance projects included in that programme are ready for imple-mentation in accordance with formal signed agreements between the World Health Organization andgovernments, entered into with the concurrence of the Technical Assistance Board ;

Considering that the United Nations General Assembly at its seventh session established a goal inthe amount of twenty -five million dollars for this programme in 1953 ; 49

Considering that the preliminary estimates made in December 1952 by the Executive Chairman andthe Technical Assistance Board of resources available for 1953 represented a conservative estimate of theoutstanding amounts expected to be paid for the previous financial periods and the amounts to be pledgedand paid for the 1953 financial period ;

Considering the statement made by the Executive Chairman of the Technical Assistance Board tothe Executive Board wherein the Board was informed that resources could be expected to be availablein the amount of three or four million dollars in addition to the amounts of the preliminary estimates ofDecember 1952 ; 5°

Considering that, under the provision of resolution 222 (IX) of the Economic and Social Council," the work undertaken by the participating organizations under the expanded technical assistance pro-gramme should be suitable for integration with their normal work " and that therefore WHO has alwaysregarded this programme as an expansion of its normal functions of providing technical assistance ;

Considering that it is essential, in dealing with this financial crisis, to consider all possible resourcesavailable to WHO, including (1) the regular budget, (2) the funds available from the Technical Assistanceprogramme, (3) co- operative arrangements with UNICEF, (4) possible arrangements with other multi-

49 See Appendix 7 to the Board's report on Technical Assistance, page 117.s° See Appendix 1 to the Board's report on Technical Assistance, page 106.

RESOLUTIONS 27

lateral or bilateral programmes of technical assistance, and (5) the institution of campaigns to raise fundsby voluntary contributions ;

Considering that the Expanded Programme of Technical Assistance has already proved itself aneffective and valuable programme and that incalculable damage would result if any existing activitiesshould be discontinued or if certain projects far advanced toward the stage of actual implementation werenot allowed to go forward ;

Considering that the abandonment, curtailment or interruption of projects in operation or for whichdetailed plans have already been agreed between the requesting government and the participating organiza-tion, and which are far advanced toward implementation, would seriously hamper future relations betweenthe governments and organizations participating in the Expanded Programme of Technical Assistance ;

Considering that the Technical Assistance Conference is convened for 26 and 27 February 1953 andthat only at that time will more specific information be available as to the amount of new pledges to bemade for 1953 ; and that the next meeting of the Technical Assistance Board in March 1953 will, with itsExecutive Chairman, be reconsidering the entire financial position ; and

Considering that by resolution WHA5.61 of the Fifth World Health Assembly the Executive Boardwas authorized " to act on behalf of the World Health Assembly in connexion with any aspect of thisprogramme, including any necessary modification thereof, in order to adjust it to the amount of funds madeavailable ",

1. AUTHORIZES the Director -General :

(1) to continue all projects and activities at present in operation ;(2) to proceed with the implementation of those projects not yet started where plans have proceededto the point where staff has been employed, where supplies or equipment have been ordered, and /orwhere the government of the country concerned has proceeded with arrangements for the project tothe extent that funds already spent or set aside would be lost if the project did not go forward ;

2. REQUESTS the Director - General :

(1) to take into consideration all resources at present available under both the regular budget andTechnical Assistance funds ;(2) to defer starting new activities wherever and whenever possible in order to provide to themaximum extent for the financing of the activities which must continue and those which must bestarted as provided for in the preceding paragraph, provided that, to the extent that sufficient fundsbecome available, additional projects may be started ;(3) to give serious consideration to methods of ensuring that the financial stringency in TechnicalAssistance funds in 1953 does not interfere with the development of WHO assistance to any countrywhere assistance was planned to be financed only from Technical Assistance funds ;(4) to take all possible action to alleviate the financial deficiency by :

(a) continuing his negotiations with UNICEF to obtain such temporary financial assistance asit can provide during the 1953 financial period ;(b) taking steps to explore with other multilateral and bilateral sources and private foundationsthe possibility of some of the new projects being taken over for financing, either directly or on areimbursable basis ;

3. REQUESTS the Director -General to call the attention of the Technical Assistance Board and itsExecutive Chairman to the desirability of :

(1) making every possible effort to assure that all governments are made aware of the critical situa-tion which exists with regard to the inadequate financial resources available for the continuation andexpansion of this programme ;(2) requesting the participating organizations to arrange jointly to concentrate and co- ordinate theirefforts to obtain increased contributions from governments ; and(3) considering the possibility of a campaign to raise additional funds by an appeal to the generalpublic ;

4. RECOGNIZES that this financial position will have to be reviewed at the time of the Sixth World HealthAssembly in the light of developments which may occur by that time.


EB11.R57.5 Participation of Member States in Certain Costs incurred in the Operation of Technical AssistanceProjects


Recalling resolution WHA5.59 of the Fifth World Health Assembly concerning the participationof Member States in certain costs incurred in the operation of field projects, as well as earlier resolutionsof the Health Assembly and the Board on this subject,

1. REAFFIRMS that the present requirement that governments contribute to the costs of maintaining inthe country experts provided to them under the Expanded Programme of Technical Assistance createsgreat difficulties for receiving countries, in view of the other costs which governments must meet incarrying on projects for which international assistance is provided under the programme ;

2. RECOMMENDS strongly to the Technical Assistance Committee that it reconsider favourably the proposalof the Fifth World Health Assembly for the removal of the requirement that governments provide lodgingand travel per diem in the country in any form whatsoever ; and, in the meantime,

Cognizant of the decision of the Economic and Social Council at its fourteenth session with regardto this problem ;

Having studied the proposal of the Technical Assistance Board to the Technical Assistance Committeefor meeting local project costs ;

Considering that such contributions shall be considered as contributions to the Special Account ;

Noting that this plan will be implemented only in agreement with the country concerned,

3. BELIEVES that the proposal of the Technical Assistance Board for the establishment of a scheme forlump -sum contributions for local costs of experts 51 is preferable to the present system ;

4. BELIEVES that the part of the proposal related to fellowship costs is not desirable because of the sub-stantial expenses borne by governments in connexion with fellowships, including salaries, allowances,internal travel costs, and insurance ; that this part of the proposal is not compatible with paragraph 4of resolution No. 4 of the Technical Assistance Committee ; b2 and that it should therefore be omittedfrom the proposal ;

5. AGREES with the decision of the Technical Assistance Committee contained in paragraph 2 of reso-lution No. 4 that " requesting governments should not be required to provide the cost of lodging or travelper diem for experts in respect of such projects and programmes for the implementation of which extensivestaff and other facilities are provided by the requesting governments ; in all cases requesting governmentsshould undertake to secure suitable accommodation for the experts " ; 52

6. REQUESTS the Director - General to transmit the present resolution to the Technical Assistance Com-mittee of the Economic and Social Council, and to the Technical Assistance Board.

EB11.R57.6 Criteria for the Development of Health Aspects of the Technical Assistance Programme


Recalling the authorization given to the Director - General by the Board at its sixth session (resolutionEB6.R1) " to implement the expanded programme of technical assistance as approved by the ThirdWorld Health Assembly ... and, in implementing the programme ... to give as high a priority as possible

51 See Appendix 13 to the Board's report on Technical Assistance, page 123.52 See Appendix 12 to the Board's report on Technical Assistance, page 122.

RESOLUTIONS 29

to the following items : (i) stimulation of campaigns against communicable diseases, (ii) professional andtechnical education including fellowships, and (iii) publichealth administration " ;

Considering that the human factor is fundamental to social and economic development, and that theprotection and improvement of health must underlie any programme to raise the standard of living ;

Considering that no rapid progress in raising the standards of living of under -developed areas couldbe expected by piecemeal methods ;

Considering that resolution 222 (IX) of the Economic and Social Council provides that (1) " the kindsof services to be rendered to each country shall be decided by the Government concerned " ; (2) " thetechnical assistance furnished shall ... be designed to meet the needs of the country concerned and ... beprovided as far as possible in the form which that country desires " ; and (3) " the work undertaken bythe participating organizations under the expanded technical assistance programme should be suitablefor integration with their normal work " ;

Considering the further requirement of resolution 222 (IX) that " the participating organizations,when reviewing and placing in order of priority the requests which they receive, should so far as possibleensure that due regard is paid to the needs of the various applicants and to their geographical distribu-tion " ;

Considering the desirability that the activities of WHO be carried out on as wide a geographical basisas is consistent with the available resources and the ability of countries and territories to absorb suchactivities ;

Recognizing the need for integration of the total programme of Technical Assistance for economicdevelopment and the fact that such integration can be accomplished in an orderly manner only over aperiod of time ;

Considering that the Executive Board at its ninth session (resolution EB9.R21) requested the Director -General and the regional committees, in planning and co- ordinating health programmes, to be guided bythe following considerations :

(1) the responsibility of WHO to act as the directing and co- ordinating authority on internationalhealth work ;

(2) the inseparability of social, economic and health factors ;

(3) the major purpose for which aid is provided ;

(4) the kind of assistance needed and the rate at which it can be absorbed in orderly development ;andConsidering that WHO is the competent body for the determination of criteria and priorities for

technical projects in the health field,

1. EXTENDS and AMPLIFIES the priorities adopted by the Executive Board at its sixth session for healthprogrammes financed under the Expanded Programme of Technical Assistance for Economic Developmentaccording to the following criteria :

(1) Assistance in the health field should be designed primarily to strengthen the basic health serviceof the country and to meet the most urgent problems affecting large sections of the population, withdue regard to the stage of social or economic development of the country concerned.

(2) Efforts should be directed towards measures of preventive as compared with curative medicine,it being fully recognized that the line between preventive and curative medicine is a tenuous one, andthat, for the development of optimal health programmes, activities more directly related to curativemedicine must in some instances be undertaken.

(3) Professional and technical training and education, including assistance to educational institutionsand fellowships directly related to projects for economic and social development and preferably apart thereof, should form essential elements of the programme. Emphasis must be laid on the trainingof nurses and auxiliary personnel in giving assistance to national training schemes for the developmentof national and regional training programmes as particularly needed by the under -developed countries.


(4) Control of major communicable diseases should be directly related to improving the health ofthe population for productive purposes.(5) Development and improvement of the standard of environmental sanitation is essential for theimprovement of health and the raising of the standard of living, especially when undertaken in relationto social, industrial or agricultural schemes.(6) Other basic factors for the promotion of a healthier, and therefore a more productive, populationshould include such measures as health education of the public, improvement of maternal and childhealth and of nutrition.(7) Measures should be taken to mitigate the probable consequences of economic changes concurrentwith the economic and social development. Social and occupational health measures must not,therefore, be ignored.(8) Demonstration and pilot projects of limited duration for applying new methods and techniques,and designed to act as catalysts and produce an impact in the country, should be undertaken, sincethey offer an effective means of quick and successful transfer of knowledge.

2. REITERATES the importance attached to an equitable geographical distribution of the assistance whichcan be made available to countries, taking into account the ability of the countries and territories to absorbsuch assistance ;

3. BELIEVES that it is not economically sound to abandon or curtail projects which are in operation withthe assistance of any one of the participating organizations in order to make funds available for startingnew projects, whether in the same or other fields, because of the resulting loss of the work already done ;

4. REQUESTS the Director - General to call the attention of the Technical Assistance Board and its ExecutiveChairman to the fact that it is desirable that greater efforts be made to utilize all the available currenciesand services contributed to the Expanded Programme, and that to reach this objective it will be necessaryto give priority to projects which will make this possible.

EB11.R57.7 Technical Assistance Programme : Conditions of Service for Experts

The Executive Board

NOTES the conditions of service for Technical Assistance experts 58 announced by the ExecutiveChairman and adopted at the twenty- second meeting of the Technical Assistance Board.

EB11.R57.8 Technical Assistance Programme : Central Administrative, Indirect Operational and Project Costs


Having reviewed the definition of central administrative costs, indirect operational costs and projectcosts adopted by the Technical Assistance Board ; 54

Having considered the comments of the United Nations Advisory Committee on Administrative andBudgetary Questions on these definitions,55

1. BELIEVES that the definitions are suitable ;

2. URGES that the Technical Assistance Board take whatever action is necessary to carry out the suggestionof the Advisory Committee according to which " efforts should be made to distribute indirect operationalcosts to the respective projects, possibly on a general pro rata basis ".

53 See Appendix 15 to the Board's report on Technical Assistance, page 127.54 See Appendix 16 to the Board's report on Technical Assistance, page 129.55 UN document A/2270, paras. 7 and 10 (reproduced on page 105 of the Board's report on Technical Assistance)

RESOLUTIONS 31

EB11.R57.9 Long -term Planning and continued Financing of the Technical Assistance Programme

The Executive Board,Recalling resolution EB7.R84 of the Board at its seventh session, concerning the need for long-

term planning and for continued contributions to the Special Account for Technical Assistance ; andConsidering resolution 84 adopted by the seventh session of the United Nations General Assembly

on 21 December 1952,58

NOTES with satisfaction that arrangements are expected to be made for the expansion of the TechnicalAssistance programme and its continued progress.

Handb. Res., 1st ed., 3 ; (Twenty -sixth meeting, 3 February 1953)for EB11.R57.5 : 7.1.3

EB11.R58 World -Wide Campaign against Smallpox


Having noted the report of the Director- General dealing with further action on general world healthproblems ; and

Taking note of resolution WHA4.80 of the Fourth World Health Assembly, referring to the need fora general co- ordinated programme calling for action by all governments to improve health conditions,to eliminate sources and vectors of diseases and to raise the level of protection against certain communicablediseases by vaccination and other methods ;

Noting also the interest expressed by two regional committees in campaigns against smallpox,

1. RECOMMENDS that the Sixth World Health Assembly consider the adoption of the Director -General'ssuggestion that WHO should stimulate certain world -wide programmes ;

2. CONSIDERS that a campaign against smallpox would be suitable for such a programme ; and

3. REQUESTS the Director -General to submit to the Sixth World Health Assembly a study on the ways ofcarrying out such a world -wide campaign, including :

(1) a general programme of work to be implemented by WHO ;(2) the estimated costs to the Organization.

Handb. Res., 1st ed., 1.3.17 (Twenty-fourth meeting, 2 February 1953)

EB11.R59 Dental Hygiene and Preventive Dentistry


Having considered a communication transmitted to the Director - General by the International DentalFederation containing proposals for the development of measures relating to dental hygiene and preventivedentistry ; ó7

Considering the resolutions on this subject adopted by the Third and Fourth World Health Assem-blies, and the Executive Board at its eighth session ; 58

56 Reproduced in Appendix 7 to the Board's report on Technical Assistance, page 117.57 See Appendix 5 to the Board's report on the Proposed Programme and Budget Estimates, page 94.68 Off. Rec. World Hlth Org. 28, 26 ; 35, 18 ; 36, 3


Recognizing the desirability of including this important function among the future activities of WHO,

BELIEVES that, because of the financial stringencies facing the Organization, no additional budgetaryprovision should be included in the programme and budget for 1954.

Handb. Res., 1st ed., 1.11.7.1 (Twenty- seventh meeting, 4 February 1953)

EB11.R60 Local Costs to be borne by Governments


Taking into consideration resolution WHA5.59, and in particular the recommendation that the Techni-cal Assistance Committee of the Economic and Social Council " consider the possibility of removing therequirement for governments to provide lodging and travel per diem in the country " to experts assignedto projects financed by the Special Account for the Expanded Programme of Technical Assistance forEconomic Development ;

Noting that WHO, in respect of projects financed from its regular budget, is still bound by theprovisions of resolution WHA4.60, which states that governments should assume responsibility for asubstantial part of the costs of services with which they are provided, including " lodging for staff employedon projects in the recipient country," and " should contribute such further costs or facilities, includingall or part of subsistence allowances, as may be mutually agreed upon between the governments andWHO " ;

Desiring to establish a uniform criterion for the operation of projects under both Technical Assistanceand regular budget funds in accordance with the intention expressed in resolution WHA5.59 and in reso-lution EB11.R57.5 of the Executive Board at its eleventh session,

1. EXPRESSES THE OPINION that the requirement for governments to provide lodging and other subsistenceallowances to experts assigned to field projects financed under the regular budget should be removed ; and

2. REQUESTS the Director- General to prepare a study of the financial implications of such a policy forsubmission to the Executive Board at its thirteenth session.

Handb. Res., 1st ed., 7.1.3 (Twenty -sixth meeting, 3 February 1953)

EB11.R61 Maintenance and Travel Costs of National Candidates attending National Training Coursesorganized with the Help of WHO


Having considered the proposal of the Regional Committee for South -East Asia concerning main-tenance and travel costs of national candidates attending national courses in their own country organizedwith the help of WHO,b9


The Sixth World Health Assembly,Cognizant of the necessity for providing assistance to governments in training nationals of their

countries to meet the specific health needs of the individual country,

1. DECIDES that a five -year plan for financial subsidy of national training courses organized with theassistance of WHO may be applied on a matching basis, the Organization and government each

59 See report of the Regional Committee for South -East Asia on its fifth session, section 10.

RESOLUTIONS 33

providing 50 per cent of the total cost in the first year and the percentage of costs in succeeding yearsbeing as follows :

WHO participation Government participation

Second year 40 60Third year 30 70Fourth year 20 80Fifth year 10% 90Succeeding years 100

2. DECIDES further that, on the request of regional committees or of the government and as a transi-tional arrangement, WHO may, as an exception to the above policy, assist during the years1953 and 1954 in providing maintenance and travel costs for national candidates attending nationalcourses organized with the assistance of WHO, to the extent of one -half the cost of travel and a mini-mum per diem allowance to meet out -of- pocket living expenses of trainees ; and, further,3. REQUESTS the Director- General to present this proposal to the Technical Assistance Board withthe request that it adopt the same policy for the Technical Assistance programme.

Handb. Res., 1st d., 1.6 ; 7.1.5 (Twenty -sixth meeting, 3 February 1953)

EB11.R62 Proposed Programme and Budget Estimates for 1954


Having examined the Director -General's Proposed Programme and Budget Estimates for the financialyear 1954 80 in accordance with the requirements of Article 55 of the Constitution and with due regard tothe terms of resolution WHA5.62 of the Fifth World Health Assembly,1. SUBMITS these proposals to the Sixth World Health Assembly ;

2. INVITES the attention of the Health Assembly to its specific comments and recommendations thereon ; 61

and

3. RECOMMENDS that the Director -General's Proposed Programme and Budget Estimates for 1954 beadopted.

II. The Executive Board,

Having reviewed the activities proposed to be carried on in 1954 under the Technical Assistanceprogramme,

RECOMMENDS that the Sixth World Health Assembly approve these activities, subject to anymodification which may be necessary in order to adjust them to the amount of funds which may becomeavailable.

Handb. Res., 1st ed., for paragraph 1 : 2.1 (Twenty- seventh meeting, 4 February 1953)for paragraph II : 3

EB11.R63 Suggestion for a Future Organizational Study

The Executive Board


The Sixth World Health AssemblyREQUESTS the Executive Board at its thirteenth session to give particular attention to a study of

programme analysis and evaluation and to submit a report thereon to the Seventh World HealthAssembly.

Handb. Res., 1st ed., 7.2 (Twenty- seventh meeting, 4 February 1953)

so Off. Rec. World Hlth Org. 4461 See page 41.


EB11.R64 Priorities in awarding Fellowships


Having considered a request from the Regional Committee for Europe that the question of revisingresolution WHA5.27, calling for priority to be given to under -developed countries in the awarding offellowships, should be placed on the agenda of the Sixth World Health Assembly ;

Having noted a report of the Director - General on the implementation of this resolution,

1. CONSIDERS that the resolution should be interpreted as establishing priority in fellowships for under-developed countries only in cases where the requests from all countries cannot simultaneously be met,with respect either to the funds available or to placement facilities ;

2. NOTES that no such eventuality has arisen ; and

3. BELIEVES consequently that there is no need to place the question of revising this resolution on theagenda of the Sixth World Health Assembly.

Handb. Res., 1st ed., 1.6.2 (Twenty -fifth meeting, 3 February 1953)

EB11.R65 Procedure for Consideration of the 1954 Programme and Budget Estimates by the Sixth WorldHealth Assembly


Believing that the procedure for consideration of the Proposed Programme and Budget Estimatesfor 1953 at the Fifth World Health Assembly operated satisfactorily,

Believing that a similar procedure should be followed at the Sixth World Health Assembly,

RECOMMENDS that the Sixth World Health Assembly adopt the following resolution :

The Sixth World Health Assembly

1. ESTABLISHES a Committee on Programme and Budget to :

(1) review the Annual Report of the Director - General ;

(2) consider whether the annual programme follows the general programme of work for 1953-1956 ,

(3) recommend the budgetary ceiling for 1954, after examination of the main features of theprogramme ;

(4) review and recommend the programme and budget for 1954, including the amounts to bedevoted to each section of the total budget ; and

(5) study such other items as are referred to it by the Health Assembly ;

2. ESTABLISHES a Committee on Administration, Finance and Legal Matters to :

(1) review the financial position of the Organization, including(a) the Financial Report and the Report of the External Auditor,(b) the status of contributions,(c) the status of the Working Capital Fund, Assembly Suspense Account, PublicationsRevolving Fund and any other funds which have a bearing on the financial position of theOrganization ;

(2) determine the scale of assessments for 1954 ;

RESOLUTIONS 35

(3) review the parts of the budget for 1954 dealing with organizational meetings and adminis-trative services and report thereon to the Committee on Programme and Budget ; and

(4) study such other items as are referred to it by the Health Assembly ;

3. DECIDES that when item (3) under paragraph 1 is being considered in the Committee on Programmeand Budget there will not be a meeting of the Committee on Administration, Finance and LegalMatters.

Handb. Res., 1st ed., 2.3 (Twenty -sixth meeting, 3 February 1953)

EB11.R66 Provisional Agenda for the Sixth World Health Assembly

The Executive Board

APPROVES the proposals of the Director - General for the provisional agenda for the Sixth World HealthAssembly, as amended.


EB11.R67 Technical Discussions at Future Health Assemblies


Having studied the question of technical discussions at future World Health Assemblies, in conformitywith the request of the Fifth World Health Assembly (resolution WHA5.77) ;

Having considered a report of the Director -General on this subject,

1. RECOMMENDS :

(1) that special technical discussions should be included in the arrangements for future HealthAssemblies ;

(2) that such technical discussions should not be superimposed on the formal work of the HealthAssembly but should deal with one of the main subjects covered by the objectives of the Organization ;

(3) that the subject selected for each Health Assembly should be of universal interest and suitablefor group discussion by national health administrators ;

2. BELIEVES that for the time being it is preferable that the subject selected should not be discussed in theregional committees before it is discussed at the Health Assembly ; and

3. SUGGESTS that the question of technical discussions be kept under review by the Board after eachHealth Assembly.

Handb. Res., 1st ed., 4.1.2.1í (Twenty- seventh meeting, 4 February 1953)

EB11.R68 Duration of Sessions of the Health Assembly


Having been requested by the Fifth World Health Assembly (resolution WHA5.49) to carry out,in conjunction with the Director -General, an examination of the work of the Health Assembly with a viewto the completion of its sessions within a substantially shorter period than at present,

1. Is OF THE OPINION that many improvements have taken place in the past years which have resulted ina substantial and progressive shortening of sessions of the Health Assembly and that an attempt to shorten


their duration further might not be consistent with the numerous functions and important responsibilitiesof the Assembly ;

2. REQUESTS the Director - General to continue to prepare and organize the sessions of the Health Assemblywith a view to limiting their duration to a reasonable minimum compatible with the agenda of the session.


EB11.R69 Frequency of Sessions of the Health Assembly

The Executive Board

TRANSMITS to the Sixth World Health Assembly the following draft resolutions for the amendmentof the Constitution and for the necessary transitional and other arrangements with respect to the frequencyof sessions of the Health Assembly :

1. The Sixth World Health Assembly,Considering the proposal made by the Governments of Denmark, Finland, Norway and Sweden

concerning the frequency of sessions of the Health Assembly and the studies made by the WorldHealth Organization in order that effect might be given to this proposal ; 62

Having examined the text of the amendments to Articles 13, 14, 15, 16, 26, 34 and 55 of theConstitution communicated by the Director - General to Member States on 6 October 1952 ;

Noting that the provision of Article 73 of the Constitution, which requires that proposed amend-ments to the Constitution shall be communicated to Members at least six months in advance of theirconsideration by the Health Assembly, has been duly complied with,

1. ADOPTS the following amendments to the Constitution :In Article 13 substitute " at least once in every two years in regular session " for " in regularannual session " ;In Article 14 substitute " regular " for " annual " ;In Article 15 substitute " regular " for " annual " ;In Article 16 substitute " regular " for " annual " ;In Article 26 substitute " once " for " twice " ;In Article 34 delete " annually " ; after " financial statements " insert " and the programme " ;In Article 55 delete " annual " ; after " to the Board the " insert " programme and " ; after" the Organization " insert " at such intervals and for such periods as the Health Assemblymay determine " ; after " such " insert " programme and ",

the amended Articles consequently reading as follows :

Article 13

The Health Assembly shall meet at least once in every two years in regular session and insuch special sessions as may be necessary. Special sessions shall be convened at the request ofthe Board or of a majority of the Members.

Article 14

The Health Assembly, at each regular session, shall select the country or region in which thenext regular session shall be held, the Board subsequently fixing the place. The Board shalldetermine the place where a special session shall be held.

62 See Off. Rec. World Hlth Org. 28, 57 ; 32, 9 ; 35, 39 ; 40, 18, 52 ; 42, 23, 411

RESOLUTIONS 37

Article 15

The Board, after consultation with the Secretary - General of the United Nations, shalldetermine the date of each regular and special session.

Article 16

The Health Assembly shall elect its President and other officers at the beginning of eachregular session. They shall hold office until their successors are elected.

Article 26

The Board shall meet at least once a year and shall determine the place of its meeting.

Article 34

The Director - General shall prepare and submit to the Board the financial statements and theprogramme and budget estimates of the Organization.

Article 55

The Director - General shall prepare and submit to the Board the programme and budgetestimates of the Organization at such intervals and for such periods as the Health Assembly maydetermine The Board shall consider and submit to the Health Assembly such programme andbudget estimates, together with any recommendations the Board may deem advisable.

2. DECIDES that two copies of this resolution, drawn up in each of the five official languages of theWorld Health Organization, the text in each language being equally authentic, shall be signed by thePresident of the Sixth World Health Assembly and by the Director- General of the World HealthOrganization, of which one copy shall be transmitted to the Secretary -General of the UnitedNations, depositary of the Constitution, and one copy retained in the archives of the World HealthOrganization.IN FAITH WHEREOF we have appended our signatures hereto.

DONE at Geneva this day of 1953 in twocopies each in the Chinese, English, French, Russian and Spanish languages.

President of the Sixth World Health Director -General of the World HealthAssembly Organization

II. The Sixth World Health Assembly,Considering its resolution amending Articles 13, 14, 15, 16, 26, 34, and 55 of the Constitution with

respect to the frequency of Health Assembly sessions,ADOPTS the following related transitional and other arrangements :

I. Transitional Arrangements

RESOLVES that an annual session of the Health Assembly shall meet in the year following the entry intoforce of the amendments to the Constitution ;

II. The Executive Board

DECIDES that following the entry into force of the amendments the following measures shall applywith regard to the Executive Board :

1. There shall be delegated to the Executive Board the power to promote and conduct research inthe field of health under the provisions of Article 18 (k) of the Constitution, within the frameworkof the programme and budget adopted by the Health Assembly.2. The Executive Board shall be authorized, in application of paragraph 3 of Article X of the Agree-ment between the United Nations and the Organization, to request at any time an advisory opinion


from the International Court of Justice on any subject within the competence of the Board under theexpress provisions of the Constitution or by delegation by the Health Assembly.

3. The Executive Board shall be empowered to approve in detail the programme and budget submittedfor the second year of the two -year period by the Director -General in accordance with paragraph 1 ofPart III of this resolution.

4. The Executive Board shall examine the financial statements of the Organization, together withthe report of the External Auditor for the previous year, in the year in which the Health Assemblydoes not meet.

5. The Executive Board shall be empowered to approve, for transmission to the Economic andSocial Council, the Annual Report of the Director - General in the year in which there is no HealthAssembly.

6. In order to give effect to Articles 24 and 25 of the Constitution, the Health Assembly shall electat each regular biennial session a total of twelve Members entitled to designate persons to serve onthe Board, of which six shall enter upon their three -year term immediately and the remaining six inthe following year.

III. Financial and Administrative Arrangements

DECIDES that following the entry into force of the amendments, the following financial and adminis-trative arrangements shall apply :

1. The Director - General shall submit a two -year programme and budget, in detail for the first yearand in more general terms for the second year. The Health Assembly shall approve the programmeand budget for the first year and approve an extension of the programme, and fix a budget ceilingfor the second year. The Director -General shall elaborate and submit the programme and budgetfor the second year, already approved in general terms by the Health Assembly, to the ExecutiveBoard for approval.

2. A separate scale of assessments shall be established for each of the two years.

3. A separate Working Capital Fund Resolution shall be adopted for each of the two years.

4. The financial statements of the Organization shall be rendered annually.

5. The external audit shall be made annually and shall be reported simultaneously with the renderingof accounts.

6. The Director - General shall include in each annual budget provision for one -half the cost of aHealth Assembly.

7. Notwithstanding the provisions of the Financial Regulations, a special account shall be establishedto which shall be credited the amounts budgeted for Health Assemblies in the years in which noAssemblies are held.

8. The Director - General shall prepare and submit his report to Member States and to the UnitedNations annually.

9. The period of office of representatives of the Health Assembly to the Staff Pension Committeeshall be three years, the Assembly electing two Members entitled to designate representatives to theCommittee and two Members entitled to designate alternate representatives to the Committee, ofwhom one representative and one alternate shall take office immediately, and the remaining two in thefollowing year.

IV. Rules of Procedure and Financial Regulations

REQUESTS the Director -General to prepare and to submit to the session of the Health Assembly referredto in Part I of this resolution such revisions to the Rules of Procedure of the Health Assembly and to theFinancial Regulations as may be required to give effect to the Articles of the Constitution as amended andto this resolution.

Handb. Res., 1st ed., 4.1.3.VI (Twenty -sixth meeting, 3 February 1953)

RESOLUTIONS 39

EB11.R70 Date and Place of Twelfth Session of the Executive Board

The Executive Board

DECIDES to hold its twelfth session in the Palais des Nations, Geneva, Switzerland, commencing onThursday, 28 May 1953.

Handb. Res., 1st ed., 4.2.5.I (Twenty- seventh meeting, 4 February 1953)

EB11.E71 Allocation of Resources as between Regions


Having considered the Director -General's Proposed Programme and Budget Estimates for 1954 withparticular reference to the relationship between the various programmes planned in each country in eachregion ;

Having considered the statement made by the Director - General concerning the way in which theresources of the Organization are allocated as between regions,

1. BELIEVES that the Director -General and the Executive Board should continue to study the guidingprinciples governing allocations to regions ; and

2. REQUESTS the Director - General to submit a report on this subject to the Board at its thirteenth session.

Handb. Res., 1st ed., 5 (Tenth meeting of the Standing Committee onAdministration and Finance, 31 January 1953)

PART 2

REPORT OF THE EXECUTIVE BOARD[EB11/83]

3 February 1953

I. PROPOSED PROGRAMME AND BUDGET ESTIMATES FOR 19541

Introduction

The Fifth World Health Assembly (resolutionWHA5.62) directed that the Board's review of theannual budget estimates in accordance with Article 55of the Constitution should include the considera-tion of :

(1) whether the budget estimates are adequate toenable the World Health Organization to carryout its constitutional functions, in the light of thecurrent stage of its development ;(2) whether the annual programme follows thegeneral programme of work approved by theHealth Assembly ;(3) whether the programme envisaged can becarried out during the budget year ; and(4) the broad financial implications of thebudget estimates, with a general statement of theinformation on which any such considerationsare based.

The Executive Board at its tenth session (resolutionEB10.R21) decided to establish the whole Boardas the Standing Committee on Administration andFinance, to adopt in the name of the Board anyrecommendations, resolutions or reports withouthaving to refer its findings to the Executive Boardas such. In the same resolution, the Board furtherdecided to set up any necessary sub -committees orworking parties for the study of technical, administra-tive and budgetary questions which were of a parti-cularly complex nature requiring detailed examina-tion. These decisions followed a resolution passed bythe Board at its ninth session (resolution EB9.R28).The procedure adopted by the Board at its tenthsession and acted upon at its eleventh session isdifferent from the one followed in previous years,

1 This section of the report, along with resolution EBI 1.R62,was submitted to the Standing Committee on Administra-tion and Finance by its Drafting Committee (composed ofDr. A. L. Bravo, Professor G. A. Canaperia and Dr. H. B.Turbott) and was adopted by the Standing Committee andby the Executive Board on 4 February 1953.

when the Standing Committee on Administrationand Finance (consisting of seven of the Board'smembers) met prior to the session of the full Boardto examine and review the annual budget estimates.In reviewing the Proposed Programme and BudgetEstimates for 1954, the Board did not find it necessaryto establish any working party as referred to inresolution EB10.R21.

General Review of Programme and Budget Estimates

1. The Executive Board at its tenth session, notingthat the Fifth World Health Assembly had passed noresolution on the form of presentation of the pro-posed programme and budget estimates for 1954,but recalling that the Fourth World Health Assembly(resolution WHA4.56) in connexion with the 1952budget had requested " the Director- General tocontinue this form of presentation of his annualprogramme and budget estimates ", adopted aresolution (EB10.R11) requesting the Director -General to present his estimates for 1954 and futureyears in accordance with the resolution of the FourthWorld Health Assembly and the criteria whichthe Board had established at its eighth session inresolution EB8.R28.

The Executive Board agreed that the form ofpresentation of the proposed programme andbudget estimates for 1954 was in general in conformitywith that of the programme and budget estimates forthe two previous years, and with the criteria laiddown by the Board as referred to above. It notedthat it had been possible for the Director -General, asrecommended by the Board at its tenth session, toreduce the size of the programme and budget docu-ment by using thinner paper and small type, therebyeffecting economy both in production and distri-bution. The Board had previously given its approvalto the presentation of personal statutory allowancesin one sum without a breakdown into the variousheadings of the purpose -ofexpenditure code byindividual projects or organizational units.

- 41 -


2. In examining the organizational structure theBoard noted that certain organizational changesentailed by the further development of the Organi-zation and some shifting of emphasis had takenplace. The former Division of Co- ordination ofPlanning and Liaison, for example, has been dis-established and three separate Offices have beenestablished, directly responsible to the Director -General : the Office of External Relations, the Officeof Technical Assistance and the Office of Reportsand Analysis. In the Department of Central TechnicalServices, the Division of Health Statistics has beenamalgamated with the Division of EpidemiologicalServices. In the Department of Administration andFinance, the functions of the former Office of Con-ference and General Services have been separatedinto two parts, one part being assigned to a newlyestablished Conference and Office Services Section,in the Division of Administrative Management andPersonnel, and the other part being assigned to theOffice of Supply, directly responsible to the AssistantDirector - General of the department.

The Board noted also that, in accordance with thedefinition of " functions ... constituting administra-tive expenses " approved by the Executive Board atits second session,2 the Office of Reports and Analysisand the Office of Supply have been included inAppropriation Section 5 (Advisory Services).

3. The Board noted that, in accordance with theprinciple approved in resolution WHA5.71 of theFifth World Health Assembly, an understandinghad been reached with UNICEF to the effect that,as from 1 January 1954, the World Health Organi-zation should assume financial responsibility" subject to the limitation of its financial resources "for the costs of all international BCG personnel,provided that the relevant BCG activities formedpart of tuberculosis- control projects in keeping withthe general policy of the Organization.

It was noted also that, subject to these sameconditions, such costs would likewise be borne bythe Organization in respect of personnel requiredbefore 1 January 1954 for new BCG projects approvedby the Organization, as well as of additional staffrequired for existing projects, in so far as thesecosts have not already been provided for underallocations made by the UNICEF Executive Board.

4. The Executive Board observed that in thecolumn Other Extra -Budgetary Funds, previouslycalled Other Required Imported Supplies and Equip-ment, for the first time detailed information is given

2 Off. Rec. World Hlth Org. 14, 17, 43

of the activities administered by the Pan AmericanSanitary Bureau and financed either by MemberStates of the Pan American Sanitary Organizationor from other sources, such as the Technical Co-operation Programme of the Organization ofAmerican States and grants from private institutions.

5. An examination of the details included in theprogramme and budget estimates shows that,although it has still not proved possible to incorporatecomplete data on the estimated contributions fromgovernments in local funds towards the implemen-tation of projects within their countries, as requestedby the Board at its eighth session (resolutionEB8.R28), substantial progress in this direction hasbeen made. Thus, out of the 108 countries andterritories in which it is proposed to carry outactivities, the requested information has beenobtained from 67, i.e. from 62 per cent. Whilst thetotal estimated contributions for 1954, namely$20,550,573, show a decrease as compared with therevised estimates for 1953, namely $29,219,731, thisis to be explained largely by the fact that it is difficultfor governments to furnish eighteen months ormore in advance of the expected implementation ofprojects, the financial aspects of which have still tobe approved by the World Health Assembly, detailedinformation as to the probable extent of their con-tributions. It is to be explained also by the fact thatcontributions expected to be made by some govern-ments towards the cost of implementation of projectsduring 1953 may not extend into 1954. As anexample, the Board noted that the estimated con-tribution by one government in respect of the 1953programme amounts to $7,500,000, whereas noinformation is yet available as to the amount likelyto be contributed in respect of the 1954 programme.

While, in view of all the circumstances, the Boardis of the opinion that satisfactory progress ha s beenmade, it believes that further progress can be madein obtaining more complete data of this kind infuture years.6. It was noted that, in accordance with therecommendation of the Executive Board in itsReport on the Proposed Programme and BudgetEstimates for 1953,$ the budget document againincludes a schedule showing the scales of assessmentof contributions from Member States for the threeyears coveted by the estimates, the amounts to beassessed in order to finance the 1954 budget beingbased -tentatively and for purposes of comparisononly -upon the approved 1953 scale and on theDirector -General's proposed budget for 1954. It

3 Off. Rec. World Hlth Org. 40, 41, para. 4

REPORT : PROPOSED PROGRAMME AND BUDGET ESTIMATES FOR 1954 43

will, however, be recalled that in resolutionsWHA5.57 and WHA5.56 of the Fifth HealthAssembly the Board was requested to study thescale of assessments as a whole and the assessmentof the Republic of China in particular. In thisconnexion, the Board adopted resolution EB11.R30,postponing a full study of the matter until its thir-teenth session, and is therefore not recommendingany change in the scale of assessment for 1954.

The Board also noted that, in accordance with thewish expressed in its Report on the Proposed Pro-gramme and Budget Estimates for 1953,4 the infor-mation on salary schedules had been extended toinclude not only the salary schedule for inter-nationally recruited staff but also those for locallyrecruited staff, and that it now indicates the numbersof staff in each grade. In the case of the RegionalOffice for Africa, it was realized that, pending theestablishment of a corresponding scale in localcurrency, the present Geneva scale has to be applied.The Board recommends the continued inclusion ofthis information in the programme and budgetestimates for future years.

7. With regard to the various parts of the total1954 programme and budget, the Board noted that,of the total estimated expenditure, operating andtechnical services account for 93.4 % in 1954compared with 94.4 % in 1953 and 91.9 % in 1952,whilst the corresponding figures for administrativeservices are 5% for 1954, 4.1 % for 1953 and 6% for1952. The Board also noted, with satisfaction, thatcontinued emphasis is being given to education andtraining services, which in 1954 are estimated to cost$1,491,804, as against $878,034 for advisory anddemonstration services under regular funds.

8. The Board observed that, in some regions, arearepresentatives had been appointed and stationedin certain countries with the object of assisting inthe co- ordination of all international health workwith national health work and with the work of otherspecialized agencies in the countries concerned.These appointments were of an experimental nature,the results of which should be carefully studied bythe Director -General, although it was noted that sofar those results seemed to be promising. The Boardwas assured that the appointment of such officers didnot involve any further decentralization of theadministrative and financial responsibilities vested inthe regional offices. With regard to the zone officesof the Region of the Americas, reference is given toparagraph 51.

9. Viewed in its entirety, and taking into accountthe criteria established by the Economic and SocialCouncil at its eleventh session and the priorities putforward by the Council at its thirteenth session,4the programme proposed by the Director -Generalis, in the opinion of the Board, technically sound,well -balanced and in conformity with the generalprogramme of work envisaged by the Organization,thus permitting steady progress to be maintained inthe development of the programmes approved andimplemented or commenced during the precedingyears. All the projects included in the proposedprogramme for 1954 have formed the subject ofclose consultation and collaboration with theMember States concerned. Five out of six regionalprogrammes were examined in detail by the regionalcommittees concerned before being submitted, withtheir recommendations, to the Director -General.In the case of the Eastern Mediterranean Region,circumstances again made it impossible to convene asession of the Regional Committee during 1952.Consequently it became necessary to resort to visitsby regional officers to various countries and tocorrespondence, with the object of securing generalagreement in regard to that regional programme.In the planning of projects in individual countries,attention has again been focused upon the needfor their integration into the economic and socialstructure of the country concerned.10. The Board noted that the effective workingbudget for 1954 (regular funds) proposed by theDirector - General amounts to $8,547,202 comparedwith the $8,485,095 approved for 1953 by the FifthWorld Health Assembly -an increase of $62,107(in addition to which provision is made for $25,000 toestablish a Special Fund for Extra Costs of Organi-zational Meetings, as requested by the Board at itstenth session, in resolution EB10.R25, making atotal increase of $87,107), resulting mainly fromnormal salary increments and the rising cost ofsupplies, materials and services. The gross budgetamounts to $9,930,000, of which $850,000 is expectedto be available from casual income, including theuse of a portion of the cash balance in the AssemblySuspense Account, leaving an amount of $9,080,000proposed to be financed by assessments againstall Members, towards which active Members wouldbe expected to contribute $7,722,202 compared with$7,637,329 in respect of 1953.

In this connexion, the Board made a comparisonof the annual total budgets and effective workingbudgets of the Organization since its inception, asfollows :

4 Off. Rec. World Hlth Org. 40, 41, para. 4 5 ECOSOC resolutions 324 (XI) and 451 (XIV)


1949 1950 1951 1952 1953 1954

US $ US $ US $ US $ US $ US $

Total budget as voted or proposed 5,000,000 7,501,500 7,300,000 9,077,782 9,832,754 9,930,000Effective working budget (ex-

penditure level) - 6,300,000 6,232,057 7,677,782 8,485,095 8,547,202

With regard to the 1949 budget it was recalledthat the First World Health Assembly, in approvingit,8 recognized that it would be necessary for theDirector -General to delay starting activities to theextent of some 25 to 30 per cent in order to ensurethat expenditure should not exceed the amount of$5,000,000 voted. The Executive Board at its thirdsession therefore concluded, in reviewing the pro-gramme and budget estimates for 1950, that it wasthe intention of the Health Assembly that " WHOshould undergo orderly expansion during 1949 andthat it should begin operations in 1950 at a $7,000,000level ".' In point of fact, the Second WorldHealth Assembly approved a budget level of over$7,500,000 for 1950. The effect of certain Membersbecoming " inactive ", however, made it necessaryto establish the expenditure level within the limits ofthe funds which could reasonably be expected to bereceived for the year. Allowing, therefore, fornormal increases in service costs, the expenditurelevel which the First World Health Assemblyvisualized would be reached by the end of 1949was not reached until 1952.

By the end of 1951 the process of regionalizationand decentralization had been completed with theestablishment of the Regional Organization forAfrica. The establishing of all the regional organi-zations has resulted in more effective planning andimplementation of field programmes, as is evidencedby the increase as compared with 1952 of a little over$800,000 in the effective working budget for 1953approved by the Fifth World Health Assembly.

While the Board notes that the relatively smallincrease in the 1954 budget estimates, as referredto above, does not reflect any expansion of fieldactivities, it considers the Director -General's Pro-posed Programme and Budget Estimates for 1954adequate to enable the Organization to carry out itsconstitutional functions in the light of the currentstage of its development, subject to the observationsof the Board on the availability of funds under the

Expanded Programme of Technical Assistance out-lined elsewhere in this report.

11. It will be recalled that, in its report on theprogramme and budget estimates proposed by theDirector -General for 1953, the Board expressed itsconcern in regard to the implications in futureyears on the assessments against Member States ofthe unusually high amount of casual income whichwas available towards the financing of the 1953budget.8 At that time it was estimated that thecasual income towards the financing of the 1954budget would amount to $790,000. In fact the amountis now estimated at $850,000, which the Board issatisfied will be available in cash. Included in thisamount is $156,900 which the Director -Generalsuggests be withdrawn from the cash portion of theAssembly Suspense Account. The Board recom-mends that the Sixth World Health Assemblyapprove this withdrawal from the Assembly SuspenseAccount and its use as suggested by the Director -General.

Again the Board expresses its concern and invitesthe attention of the World Health Assembly to therepercussions which the high amount of casualincome towards financing the 1954 budget will haveon assessments against Member States in subsequentyears when the same amount of casual income willclearly not be available.

12. In considering the proposed programme to befinanced from funds expected to be made availableunder the Expanded Programme of TechnicalAssistance, the Board noted that the projectsincluded had been based upon requests submittedby the counhies concerned, and noted that, in general,it followed the programme of work approved bythe World Health Assembly. The Board formed theopinion also that the programme was in keepingwith the guiding principles established under resolu-tion 222 (IX) of the Economic and Social Council,as well as under later decisions of the Council andthe General Assembly. It was noted that, whilst

6 Of Rec. World Hlth Org. 13, 102, 3197 Off. Rec. World Hlth Org. 17, 27, para. 33 8 Of Rec. World Hlth Org. 40, 41, paras 7 and 8


estimated expenditure for 1952 amounts to $5,089,846,the cost of continuing projects together with thatof new projects is expected to amount in 1953 to$9,455,358. It was noted further that the estimatesfor 1953 for new projects were based on a 35deduction for delays in implementation of newprojects. The estimated cost of the proposed pro-gramme for 1954 is $10,276,445. In 1954 a deductionof 20 % for delays in starting new projects has beenmade. It is, however, a matter of grave concern tothe Board, having regard to the responsibility of theOrganization for ensuring that the internationalhealth programme shall be well balanced andconform to the general programme of work of theOrganization, that according to the information atpresent available the funds to be allocated to WHOout of Technical Assistance funds for 1953 fall soshort of the requirements as to necessitate a seriouscurtailment of activities. The Board considered indetail the various aspects of the Organization'sparticipation in the Expanded Programme ofTechnical Assistance, with special reference to theserious financial situation which has arisen in respectof the 1953 programme, and invites the attention ofthe Sixth World Health Assembly to the separatereport (page 95 of this volume) and resolutionsadopted by the Board in this connexion (EB11.R57and EB1 1 .R57. 1-9).

13. In considering whether the programme envi-saged can be carried out during the year underreview, the Board took note of the fact that in theintroduction to his Proposed Programme andBudget Estimates for 1954 the Director -General madethe following remarks :

The 1954 regular budget is only slightly higherthan that of the preceding year because we expectthat increased resources will be available throughthe United Nations Technical Assistance Pro-gramme, and that the UNICEF allocations forhealth programmes will remain at least at thepresent level.

While the Board is confident that the total pro-gramme envisaged for 1954 can be implementedduring the budget year, this will be possible only ifthe increased resources materialize as anticipated bythe Director -General. The Board realized that thefinancial stringency facing the Organization in 1953in respect of Technical Assistance funds wouldhave some effect upon the implementation of theproposed Technical Assistance programme for 1954but found it impossible at this stage to determine theextent of the implications.

14. Although the Board notes that at the time ofpreparation of the budget estimates of the WorldHealth Organization it is not possible to foresee theamount of funds which will be placed at the disposalof the Organization for the Technical Assistanceprogramme envisaged, it wishes to emphasize thatprojects under this programme may be implementedonly to the extent that such funds are expected to bemade available and recommends that the Director -General should include an explanatory note to thiseffect in future budget documents.

Appropriation Resolution

15. An examination of the proposed AppropriationResolution for 1954 shows that it differs from thepattern of that approved by the Fifth World HealthAssembly for 1953 in only one respect. This has beennecessitated by the request made by the Board atits tenth session (resolution EB10.R25) that theDirector -General should include in his programmeand budget estimates for 1954 an amount of $25,000" to be used for the initial establishment of theSpecial Fund for Extra Costs of OrganizationalMeetings ". The proposed Appropriation Resolutionfor 1954 thus includes a new Part and AppropriationSection, namely : Part IV (Special Funds) andSection 9 (Special Fund for Extra Costs of Organi-zational Meetings). Consequently, what formerlyappeared in the Appropriation Resolution as Part IV(Reserve) and Section 9 (Undistributed Reserve) hasnow become Part V and Section 10.

The Board accordingly recommends to the SixthWorld Health Assembly the adoption of the textof the Appropriation Resolution as proposed by theDirector -General.

Working Capital Fund Resolution

16. The Board, noting that the Working CapitalFund Resolution as proposed by the Director -General is essentially the same as that for 1953,recommends it to the Sixth World Health Assemblyfor adoption.

Detailed Consideration of the Regular Programme andBudget Estimates

17. In considering the details of the proposedregular programme and budget estimates, attentionwas given by the Board to the differences, by unitsand functions, between the estimates for 1954 andthose for 1953. These differences are tabulated inAppendix 1 to this report and the following para-graphs contain the comments of the Board regardingthe detailed proposals of the Director -General.


Organizational Meetings

18. With regard to the proposed increase of $1,500in the provision for meetings of the Executive Boardand its committees, the Board noted that the estimatewas based on the best information available for 1953,taking account of the probable increase in the costof supplies in 1954, including the estimated additionalcost of production and distribution of documents.It was, however, recognized that the amount thatwould ultimately be required would depend uponvarious factors, the effects of which cannot beaccurately determined in advance, such as the actualduration of sessions of the Board, the work to beperformed and the studies to be carried out by it.The Board expressed the hope that the full amountof the provision might not be required and that anyresultant savings might be used for other organi-zational meetings.

19. The Board noted that the cost of duty travelin connexion with regional committee meetingsfluctuates considerably from year to year, beinginfluenced mainly by the places where the meetingsare held, since additional expenditure on dutytravel is inevitable in cases where meetings are heldelsewhere than at the regional headquarters. In thecase of the Regional Committee for Africa, it wasnoted that the cost of the meeting held at Monroviain 1952 was appreciably higher than the estimatedcosts for 1953 and for 1954, owing to the fact thatthe Regional Office had not yet been establishedat Brazzaville with the result that the meeting hadto be serviced by persons sent from Geneva. TheRegional Office is now functioning at Brazzaville sothat the expenditure on duty travel in connexionwith the meetings scheduled for 1953 and 1954should be correspondingly reduced. Whilst re-cognizing that, under Article 48 of the Constitution,it is a matter for the regional committees alone todetermine the place of each meeting, the Boardadopted a resolution for consideration by the SixthWorld Health Assembly (resolution EB 11. R50, III)to the effect that, in the interests of economy, regionalcommittees be invited to consider the possibilityof holding their meetings at the regional head-quarters every second year, as a matter of policy.

Central Technical Services

20. The Board noted that the provision for CentralTechnical Services showed a net increase of $55,593over that for 1953, reflected principally in theprovisions for personal services and allowances,travel, and grants -in -aid to three institutions in

implementation of resolutions EB9.R11 and EB9.R62adopted at the ninth session of the Executive Board.The amounts which it is proposed to provide inrespect of these grants -in -aid are as follows :

US $Blood -Group Reference Laboratory 3,000Dysentery Reference Laboratory, Oxford . . . 3,500International Shigella Centre, Atlanta 12,000

$18,500

21. The Board further discussed the administrativerearrangements which had been made by the Director -General in the fields of epidemiology, health statistics,and co- ordination of research in communicablediseases, and noted that these are designed :

(a) to enable the Organization to make available,internationally as well as internally, better healthstatistical advice ;

(b) to meet the need for epidemiological services ;and

(c) to remove certain anomalies and administrativedifficulties.

These developments were considered also to bein line with various resolutions of the Fourth andFifth World Health Assemblies and of the eighthand ninth sessions of the Executive Board. It wasnoted also that the improved services did not entailany increase in staff or other budgetary provisions.

With regard to the co- ordination of research, theBoard noted that the Organization did not itselfnormally undertake actual research, but endeavouredto assist in the co- ordination of national activitiesin those fields in which WHO programmes were beingdeveloped. Experience had shown that it was notpossible for co- ordination in many varied fields tobe the responsibility of any one headquarters unit ;consequently it had become the responsibility of alloperational units, regional offices and expert com-mittees, etc.

22. In considering the detailed estimates of expen-diture relating to the epidemiological services theBoard noted that the application of the InternationalSanitary Regulations (WHO Regulations No. 2)would necessitate the employment of consultantsto study certain technical, legal and administrativeaspects. The Board requested the Director - Generalto bear in mind the desirability of using the servicesof the regular staff, including the legal whereverpossible, though it was recognized that this staffcould scarcely undertake additional tasks.


23. In considering the estimates relating to theInternational Classification of Diseases, Injuries andCauses of Death, the Board noted that it was pro-posed that the grant to the Centre for problems arisingout of the application of the Classification be in-creased from $5,040 for 1953 to $9,000 for 1954.This Centre, at present located in the United King-dom, had been established as a result of the adoptionof WHO Regulations No. 1 and of the InternationalClassification. Having regard to the view expressedby the Expert Committee on Health Statistics that,in order to understand and appreciate the differentproblems to which the International Classificationwas giving rise, the Centre should not be located inany one country continuously, it was possible thatthe Centre might be transferred to Washington in1954. Part of the increase in the provision was,therefore, intended to provide for the possibility ofthis transfer. The increase would also, however,permit of the establishment of a small internationaladvisory group to assist the Centre in dealing withthe increased volume of work arising out of theincreasing use by national administrations of theRegulations and the International Classification.24. The Board noted with satisfaction that theTuberculosis Research Office was hopeful of under-taking studies relating to tuberculin sensitivity andallergy in additional countries without any increasebeing proposed for the 1954 budget.25. In discussing the proposed provisions in respectof Library and Reference Services, the Board notedthat the amount provided for library books was$15,000 and that, although this was the same as therevised estimate for 1953, the amount originallyapproved for 1953 by the Fifth World HealthAssembly had been $20,000. This reduction hadbeen made possible by the application by theDirector - General of measures of economy whichwould continue to be applied.26. The Board devoted some considerable time toa discussion on the various publications producedand distributed by the Organization. In particular,the Director -General was requested to give specialconsideration to the possibility of effecting improve-ments in the Weekly Epidemiological Record,including a more expeditious and less costly formof distribution. The Director - General was alsorequested to consider the practicability of givingmore emphasis, in the publications of the Organi-zation, to problems of public -health administration.

Advisory Services (Headquarters)27. The Board noted that the estimated cost ofAdvisory Services at headquarters represented an

increase of $30,093 over that for 1953. In particular,the Board noted that :

(a) the increase was due mainly to increased costsin respect of personal services and allowances ;(b) in the Division of Communicable- DiseaseServices, two new posts have been provided for-an administrative assistant in the Office of theDirector and a medical officer (laboratory consul-tant) in the Endemo- epidemic Diseases Section -,the additional cost being, however, partly offset bythe elimination of a post of technical assistant inthe Tuberculosis Section ;(c) additional consultants (a total of 24 consul-tant months) have been provided for in theDivisions of Communicable- Disease Services,Organization of Public -Health Services and En-vironmental Sanitation, at an aggregate additionalestimated cost of $30,400 ;(d) although two posts of storekeeper and clerk,previously included in the Office of Supply, havebeen transferred to the United Nations, an amountequal to their salaries and other expenses will bepaid to the United Nations from the commonservices provision ; and(e) various adjustments in respect of Grants andContractual Technical Services are expected toresult in a net decrease of $9,000.

28. In the course of further discussions on theactivities of the Organization relating to tuber-culosis, the Board noted that the interest of theOrganization in research was being continuallywidened and that special attention was being givento the problem of vaccination against this disease.In this connexion, the Board emphasized the needto ensure the closest possible co- ordination of thework of the Tuberculosis Research Office in Copen-hagen and the Tuberculosis Section at headquarterson the one hand with the associated field projectson the other.

29. In noting the contribution being made by theOrganization towards the expenses of nationalinfluenza centres, amounting to $2,500, the Boardwas assured that close contact was being maintainedwith such centres and with certain large -scale vacci-nation experiments at present in progress. Whilstconcurring in the view that present medical knowledgewas inadequate for precise techniques of control tobe laid down, the Board agreed that 1954 would bean appropriate year for a session of the ExpertCommittee on Influenza, which should be requiredto review the work done not only by laboratoriesassociated with the Organization in this field but


also by others engaged in such research, to adviseupon possible measures of influenza control, and tosum up current knowledge of virus types.

30. In considering the proposals relating to public -health services, the Board discussed a communicationwhich had been addressed to the Director -Generalby the Secretary -General of the International DentalFederation. This communication, which is re-produced as Appendix 5 to this report, referred tovarious resolutions of both the Executive Boardand the World Health Assembly, emphasizing theneed for the development by WHO of an inter-national dental health programme and the collationof information relating to preventive dentistry.Considering the importance of studies on an inter-national level, with special reference to nutritionand diet, methods of fluoridation of drinking water,topical application of fluorine, and oral hygieneand conservative treatment as a prerequisite to thesuccessful application of measures in preventivedentistry, the Federation urged the appointment bythe Organization of a permanent dental officer.Noting that the Director -General had sought toimplement the directions given by the HealthAssembly and the Board in the past by the employ-ment of temporary consultants to carry out compara-tive studies of documentation on research at presentbeing conducted, the Board adopted resolutionEB 11. R59.

31. The Board reaffirmed the important andfundamental place of nutrition as a factor in manyWHO programmes and in the public -health fieldgenerally. Although it was noted that both FAO andUNICEF had an interest in nutrition, the Boardwas of the opinion that consideration should begiven, in future years, to the possibility of procuringincreased financial provision to enable the Organi-zation to play a more active role in this connexion.

32. In considering the programme relating to thehealth education of the public, the Board notedthat the Organization was endeavouring to base itsprogramme on the development of the most effectivehealth education techniques and the most suitablematerials in relation to local requirements ; alsothat co- operation with UNESCO in fundamentaleducation projects was being maintained.

33. Noting that it was proposed to hold a meetingof the Expert Committee on Meat Hygiene in 1954,the Board expressed the desire that its terms ofreference should be extended to include meat hygienefrom the time of slaughter to the time of distribution.

34. The Board questioned the need for the con-tinuation in 1954 of the grant of $6,000 paid to theInternational Council of Nurses in connexion withthe study of post -basic nursing education. In thelight, however, of further information furnished bythe Director- General, the Board was satisfied that thework was of great importance in the field of publichealth and that it would be impossible for theOrganization itself to achieve the same results withouthaving at its disposal the resources contributed bythe Council at minimal cost to the Organization.

35. In the light of detailed information furnishedby the Director - General regarding the functionsof the Division of Environmental Sanitation, theBoard commented on the extreme value of the workof the division but considered that the expansion ofrural sanitation activities was a factor which requiredto be taken into account in the future budgetarypolicies of the Organization. The division is con-cerned with the formulation of principles, thepreparation of papers, and the stimulation generallyof interest in environmental sanitation, includinghousing, and the Board considered that governmentsshould be encouraged to make more use of theservices of the division. In this connexion, it wasnoted that an agreement was being negotiated withUNICEF for the joint undertaking of a globalprogramme of rural sanitation in under -developedcountries, and that the Organization was co- operatingactively with public -health laboratories on thequestion of food sanitation.

36. In considering the provision made for duty travelin connexion with visits to national organizations,such as the American Public Health Associationand the Royal Sanitary Institute of Great Britain,the Board questioned the need therefor. It wasexplained, however, that such conventions hadproved to be an excellent forum for the presentationof papers upon the programmes and activities ofthe Organization and for the comparison of noteswith other experts working in the same or relatedfields ; also that they afforded an opportunity ofmaking useful contacts in connexion with therecruitment of personnel trained in environmentalsanitation. The Board noted that representation atsuch meetings might well be undertaken by the staffof other appropriate units of the Organization.

37. In connexion with the grant -in -aid of $29,000to the Council for International Organizations ofMedical Sciences, the Board noted the need forincreased co- ordination between international scien-tific bodies, by international meetings, and the


considerable efforts made by the Council to improvethe situation and to develop successful congresstechniques.

38. With regard to the proposed provision of$2,000 for the collection of data on medical education,the Board was pleased to learn that a draft directoryon training institutions was in the press, and thatit was proposed that similar directories should bepublished from time to time.

39. The Board noted that the Office of Reports andAnalysis, while included in the budget estimatesunder the Appropriation Section for AdvisoryServices in view of its advisory functions, is directlyunder the authority of the Director- General. Itrecognized that there was a demand for morespecific justification for the project activities of theOrganization and for more factual information onresults achieved. The Board was informed that inorder to ensure that reports on field work were moreprecise and provided a basis for a more valid inter-pretation of results, this office continued its work ondeveloping more adequate reporting methods andtechniques. The purpose of the Office was to ensurethe factual information which was an importantfactor in decisions on whether a programme orproject should be continued, expanded, restrictedor even abandoned. It was realized that, in the analysisof such a wide variety of programmes as was under-taken by the Organization in different countries, itwould not be possible to apply any single method.The Board was satisfied that the Office of Reportsand Analysis, in performing the very importantfunction of developing methods of analysis andevaluation of the Organization's programme, is andwill be working very intimately with the regionaloffices and with all related organizational units atheadquarters as well as with the governmentsconcerned.

Expert Committees

40. The Board examined in detail the proposalsrelating to expert committee meetings in 1954,namely :

(1) Committee on International QuarantineThe agenda of the meeting includes a review of the

International Sanitary Regulations and their working;consideration of amendments to the InternationalSanitary Regulations ; consideration of draft regu-lations for the control of insect vectors, togetherwith comments by governments ; consideration of adraft manual on hygiene and sanitation of airports ;consideration of such questions and disputes arising

out of the application of the Regulations as may bereferred by the Director -General to the committee.

(2) Expert Committee on Health Statistics

This committee met last in 1951. The agenda ofthe meeting will include consideration of the recom-mendations and report of the international con-ference of representatives of national committeeson vital and health statistics ; consideration ofinformation accumulated since the 1948 revisionof the International Statistical Classification ofDiseases, Injuries and Causes of Death ; and recom-mendations thereon for inclusion in the obligatoryreview of that Classification to be carried out in 1955.

(3) Expert Committee on the International Pharma-copoeia

Up to 1953 two meetings of this committee willhave been held each year. In 1954 an attempt willbe made to deal with the agenda of the committeein one session. This agenda includes the preparationof an addendum to the Pharmacopoea Internationalesand of the second edition of both volumes.

(4) Sub - Committee on Non -Proprietary NamesThis meeting will be held immediately after the

meeting of the Expert Committee on the Inter-national Pharmacopoeia. The number of pharma-ceutical preparations is increasing rapidly and theneed for international non -proprietary names growsaccordingly.

(5) Expert Committee on AntibioticsThis committee will not meet in 1953. At the

1954 meeting it will review developments in thepreparation of new antibiotics, their specifications,clinical uses and biochemical and toxic properties,in order to ensure uniform technique.

(6) Expert Committee on Biological Standardization

The number of preparations, e.g. antibiotics,antigens, enzymes and hormones, whose biologicalstandards cannot be specified by chemical andphysical tests, is rapidly increasing. Further existingstandards require to be replaced when their stocksupply is exhausted. In order to keep pace with itsresponsibilities, the committee should meet in 1954.

(7) Expert Committee on Drugs Liable to ProduceAddiction

The agenda of this meeting aims at continuingwork arising out of the 1925 and 1931 Opium Con-ventions and the Paris Protocol of 1948, and toreview developments in the field of production of


synthetic drugs able to produce addiction. Thiswork includes an obligation to advise the UnitedNations on all aspects of this problem.

(8) Joint Expert Committee on the Blind (UNIspecialized agencies)

Joint Expert Committee on the Deaf (UNIspecialized agencies)

As a result of the activities of the TechnicalWorking Party on the Rehabilitation of the Physi-cally Handicapped, established by the Adminis-trative Committee on Co- ordination, joint expertcommittees in which WHO, the United Nations,ILO and UNESCO will participate are proposedfor the study of the rehabilitation of the blind andof the deaf. Meetings of these two committees wereoriginally scheduled for 1953 (see Official RecordsNo. 39, page 171) but have been postponed until1954. WHO participation is of great importancebecause of the need to present the medical point ofview adequately. Not only rehabilitation but alsothe prophylaxis of blindness and of deafness willbe considered.

(9)

(10) Expert Committee on Midwifery Training

This meeting follows the recommendation of theExpert Committee on Maternity Care (1952) that" a joint expert committee composed of members ofthe Expert Advisory Panels on Nursing and onMaternal and Child Health be convened at theappropriate time to give further consideration to thetraining of midwifery personnel at all levels ".9It is expected that considerable time will be devotedto the training of midwife- aides. This is a very topicalmatter and is one aspect of the training of auxiliarypersonnel in general.

(11) Joint ILO /WHO Committee on OccupationalHealth

The 1954 meeting of the Joint Committee onOccupational Health will carry a step forward thework done at the first and second sessions. The firstsession merely defined the subject and the relativespheres of interest of ILO and WHO. The secondsession discussed in particular the relationship ofpublic -health services to the health of the workers.At the 1954 session, it is intended to consider morespecific questions, such as the organization of healthservices in agricultural enterprises, the organizationof health services in groups of small industrial plants,or other such specific problems defined at the 1952meeting. Emphasis will be laid on the needs of

9 World Hlth Org. techa. Rep. Ser. 1952, 51, 21

under -developed countries undergoing industriali-zation ; such discussions should be of considerablevalue from the point of view of the TechnicalAssistance programme for economic development.

(12) Expert Committee on Mental Health

The last meeting of this committee took place inNovember 1952. Its meeting in 1954 is necessaryin order to review in detail the general principlesof the policy on problems of mental health in thelight of experience gained since this policy wasput forward at the earlier meeting of that committee.

(13) Alcoholism Sub - Committee

The last session of this sub -committee (of theExpert Committee on Mental Health) took place inOctober 1951. It will be necessary to convene thesub- committee in 1954 in order to review the expe-rience of the regional seminars on alcoholism whichwill have been held in the preceding two years, aswell as the considerable development in the Organi-zation's alcoholism programme which has occurredin the last two years.

(14) Expert Committee on Insecticides

There is perhaps no field of public health in whichscientific developments have been more rapid, or inwhich there is greater demand for up -to -date infor-mation, than that of insecticides. For the past threeyears it has been considered desirable to hold onemeeting of the committee each year. In the interimperiods the secretary of the committee is in constantcontact with the members of the Expert Panel onInsecticides to secure data on research and experiencerelating to the many facets of this subject.

No meeting of the Expert Committee on Insec-ticides is scheduled for 1953. It is considerednecessary to have a meeting in 1954, especiallysince aspects of the subject relating to the toxico-logical effects in humans and the resistance of variousinsects are being discussed in addition to insecticidespecifications.

(15) Expert Committee on Influenza

The first session of this committee was held in1952. By 1954 the committee would be able toreview all the work done in the two -year period bylaboratories associated with the WHO influenzaprogramme, with the purpose of predicting influenzaepidemics and the type of virus expected to beresponsible. The committee should also review allinformation by then available on recent advancesin vaccination and in the preparation of vaccines ;


this may make it possible for it to recommend themethod of choice for wide -spread vaccination in thecontrol of influenza.

(16) Joint Expert Committee on Meat Hygiene(WHO /FAO)

It is recognized that there is a wide_variation in thestandards of meat inspection and practice throughoutthe world. It would be most useful if certain modernstandards could be recommended, keeping in mindcountries of differing economic development. Thisneed was particularly emphasized by the WHO /FAOconsultants on meat hygiene, who surveyed 17

countries for WHO and FAO in 1951 and 1952.

(17) Expert Committee on NursingThis committee will not have met since 1951. So

far the emphasis in the committee's sessions hasbeen on education of nurses, without considerationof matters of organization and administrationwithin the profession. The time is now ripe for studyof these questions, particularly as they relate tonursing services in hospitals.

The committee will be asked to consider theadministration of nursing services and to studystaffing patterns in public -health and hospitalnursing services, bearing in mind the cost of theservices and the efficiency of the nursing team.

In preparation for the meeting, studies are beingundertaken in several countries, some with theassistance of WHO.

41. Having regard to the request of the Fifth WorldHealth Assembly (in resolution WHA5.64) that theBoard should examine very carefully the necessity forconvening further meetings of expert committeesor establishing new committees, the Board satisfieditself that the proposals of the Director- Generalproviding for 17 committee meetings during the year(compared with 24 for 1953), resulting in a decreaseof $42,421 in the estimates for this AppropriationSection, were justified. It was noted also that it wasproposed to hold only two conferences, namely,a conference on prosthetic appliances and a malariaconference. The former is to be convened at therequest of the ad hoc Technical Working Party (ofthe Administrative Committee on Co- ordination)on the Rehabilitation of the Physically Handicapped.The latter is to be held in Asia for the exchange ofscientific information accruing as a result of thenumerous field activities planned for that area.

Administrative Services

42. The Board noted that the proposed provisionfor Administrative Services represented an increase

of $24,529 as compared with that for 1953, theincrease being mainly in respect of personal servicesand allowances ; of the total increase $4,656 relatedto the Office of the Director -General and $16,013to the Department of Administration and Finance.The Board noted also that these estimates did notentail any additional staff, in spite of the fact thatthere had been a considerable increase in the work-load.

Regional Offices

43. It was noted that the overall provision inrespect of Regional Offices reflects an increase of$43,682, due mainly to various cost -of- living adjust-ments to the salaries of internationally recruitedstaff, certain revisions in the salary scales of locallyrecruited staff, normal salary increments, changes inthe provisions for statutory travel and commonservices and, in the Regional Office for Africa, threenew posts for locally recruited staff.

Advisory Services (Field)

44. The Board noted that the provision in respectof field projects for 1954 was $2,369,828 comparedwith $2,501,166 for 1953. The provision for 1954includes $1,638,146 for projects continued from1953, leaving an amount of $731,692 for new projectswhich are expected to commence in 1954. Of thelatter, projects in the category of Education andTraining Services are estimated to cost $494,848 asagainst $236,844 for Advisory and DemonstrationServices projects. Details of the proposals are setout in Appendix 2 to this report, and they include forpurposes of comparison projects completed in1952, projects continued in 1953 and projectsexpected to commence in 1953.

45. In view of the fact that, in most cases, theproposals relating to the field activities had beenexamined in detail by the regional committees of theregions concerned, the Board confined its review ofthe regional programmes and budget estimates to thesalient features of the proposals, in the course ofdiscussions with the responsible regional directors.

AFRICA

46. The Board was given a brief summary of thedevelopments which had taken place in this region,including the holding of the second session of theRegional Committee in Monrovia in July /August1952 and the removal of the Regional Office toBrazzaville from Geneva towards the end of October


1952. It was noted that some of the projects includedamong the field activities proposed for 1954 shouldbe regarded as provisional since they had beenplanned on the basis of verbal requests made duringthe last session of the Regional Committee and it wasessential first to carry out surveys. For this region,provision had been made for a minimum staffwhich included a programme officer and public -health officers assigned to three different zones (theEast, West and South of the Region) defined on anepidemiological basis, although it was not intendedthat any zone offices should be established.

47. The Board gave special consideration to theproposed appointment of a social anthropologistand concluded that, in view of the multitude of typesof African culture and the resulting problems inany approach to health matters, the proposedappointment was necessary.

THE AMERICAS

48. The Board noted that the overall budget forthe Region was considerably augmented by thecontributions from the American States to the PanAmerican Sanitary Bureau, and that it had been foundpossible to show in the WHO budget document, forpurposes of comparison, details of the proposedPASB programme and budget estimates togetherwith the WHO regional proposals. It was notedthat projects for the eradication of the Aëdes aegyptimosquito were in progress and in several countrieshad become an integral part of the general pro-grammes for the control of insect -borne diseasesand, as such, had been supported by UNICEF andTechnical Assistance funds. The policy was todevelop general rather than specialized programmesand efforts are being made to bring all the controlmeasures against such diseases under the sameprogramme.

49. Details of a special UNICEF /WHO yawseradication programme in Haiti were brought to thenotice of the Board. The latter was interested tolearn that the programme, which had been inprogress since 1950, had resulted in 90 % of thepeople requiring treatment being treated with peni-cillin in maximum doses of 600,000 units for adults,with satisfactory results.

50. In general, the regional programme laid emphasison strengthening governmental health services, andon stimulating the initiation within countries ofprogrammes which could be continued out of localresources.

51. It was noted that it had been found impossibleefficiently to administer the Region from Washingtonand that consequently the PASB and Regional Officehad been decentralized, zone offices being establishedin Mexico City, Guatemala, Lima, Buenos Airesand Rio de Janeiro. It was the intention that allprogrammes, and recommendations relating thereto,should be initiated in the zones and submitted to theRegional Office through the zone offices which wouldin future be responsible for the maintenance ofcontacts with the governments in the zones. TheBoard noted, in this connexion, that it was expectedthat the establishment of the zone offices wouldresult in a reduction of staff in the WashingtonOffice (particularly in respect of the medical public -health staff), owing to dispersal to the zone offices.

SOUTH -EAST ASIA

52. It was noted that, in this region, the workof the Regional Office had been focused on thecontrol of communicable diseases and on trainingprogrammes.

53. In malaria control, for instance, large -scalecountry -wide programmes were being developed inmost of the countries within the Region and it wasexpected that within the next three to five yearssome two hundred million people would receiveprotection, as a result of the initial work undertakenby WHO and national organizations and with assis-tance provided under bilateral and multilateral agree-ments. Two important yaws -control programmeswere being developed with the aid of UNICEFsupplies and both international and national person-nel in Indonesia and Thailand. They entailed masscampaigns in rural areas to an extent seldom knownin medical history. It was expected that theywould continue in operation for two to three years.By April 1952 four and a half million persons hadbeen protected under these two programmes. Inthe field of tuberculosis, the Regional Office hadhelped to set up a complex of demonstration centresin many countries and was also assisting in thefoundation of national tuberculosis -control servicesand in the strengthening of existing services.54. With regard to the training programmes, theBoard noted that support was being given to under-graduate medical education and that emphasis wasbeing placed on the provision of internationalpersonnel as well as on the granting of fellowships.A number of teaching missions had also beenorganized and it was hoped that these would resultin the collection of sufficient information to makeit possible to improve and expand the existing medical


college facilities and to enable the governmentsconcerned to remedy deficiencies in that field.

55. The Board was informed that the work beingcarried on in collaboration with UNICEF representedalmost half the total programme expenditure. Therewere large -scale maternal and child health pro-grammes for which UNICEF provided the suppliesand WHO helped to provide the training facilities.

56. In considering the administrative arrangementsin force in the Region, the Board noted that arearepresentatives had been appointed for Burma,Ceylon and Indonesia and that it was hoped toappoint such representatives also in India andThailand. In Afghanistan the work was being doneby the WHO publichealth adviser who had beenappointed at the request of the Government. Thefunction of these representatives was to keep theRegional Office informed of developments in thecountries concerned (particularly in relation tothe conception, planning and implementation ofneeded programmes), to act as liaison officers, andto assist in the co- ordination of all health pro-grammes in the areas concerned.

EUROPE

57. The Board noted that, in view of the stage ofdevelopment of most of the European countries, itwas not possible to concentrate on selected diseases,but that instead there was a wide variety of healthprogrammes based upon the special interests orrequirements of the governments concerned. Thelong -term programme for the European Regionwas therefore based on the following primaryobjectives :

(1) Studies aimed at the development of adequatenational health services. One such study (conductedtogether with the Governments of France and theUnited Kingdom and in collaboration with theRockefeller Foundation) on the needs of thefamily unit in health and social services, wasexpected to be completed in 1953 and would befollowed by a regional conference on the utilizationand training of family health and social - welfareworkers.

(2) Exchange of experience between countriesand between technical officers through the mediumof seminars, symposia and the like.

(3) Co- ordination of health policies betweencountries or groups of countries on the analogy,for example, of the International Anti- Venereal-Disease Commission of the Rhine.

(4) Education and training through fellowshipsand through assistance to training institutions.

Because of these considerations it was natural thatthe greater part of the projects in the EuropeanRegion were classified as inter -country programmes.

EASTERN MEDITERRANEAN

58. The Board noted, with regret, that circumstanceshad again precluded the convening of a session ofthe Regional Committee for the Eastern Mediter-ranean, with the result that the. Regional Directorhad been obliged to prepare the regional programmewithout assistance from the committee. The pro-gramme, however, had been based on governmentrequests, surveys carried out by the regional staff,and individual contacts with governments.

59. The general programme of the Region wasfounded on three main principles, namely :

(a) assistance to countries in the development oftheir publichealth administrations ;

(b) assistance to countries in the development oftraining facilities for all types and grades of healthpersonnel appropriate to their stage of develop-ment ; and

(c) assistance in dealing with the accepted WHOpriorities and with priorities peculiar to or inherentin the Region.

60. The first of the three principles was being appliedby appointing public -health administrators andother technical officers as government adviserswhere requested ; by granting fellowships to technicalpersonnel with a view to their employment in theappropriate capacity in their national public- healthadministrations ; by developing rural health pro-grammes to demonstrate integrated health andwelfare services ; and by planning seminars in whichpublic -health administrators may participate anddiscuss health problems of common interest.

61. Assistance in training was based on the stage ofdevelopment of the countries concerned and rangedfrom advice and assistance in connexion with theestablishment and development of national trainingfacilities for appropriate categories of health per-sonnel to be used in the national health services, tothe granting of fellowships and the encouragementof the more developed countries to provide trainingfacilities not only for their own benefit but also forthe benefit of other countries within the Region.


62/3. In connexion with the application of WHOpriorities, as adapted to the inherent needs of thecountries concerned, the Board noted that theprojects provided for in the 1954 programmeincluded bilharziasis and trachoma control, rehabili-tation of crippled children, control of cerebrospinalmeningitis epidemics, and plague control.

WESTERN PACIFIC

64. The Board noted that the proposals for thisRegion comprised 64 projects in all and that theestimated expenditure would be distributed amongthese projects in approximately the followingproportions :

Malaria 14

Tuberculosis and BCG vaccination . . . 6

Venereal diseases and treponematoses 6

Endemo -epidemic diseases 4

Public -health administration 28

Nursing 22Maternal and child health 12

Environmental sanitation 6

65. The Board also noted that the RegionalOrganization was experiencing special difficulties incarrying out its functions owing to the unsettledconditions obtaining in many of the countries in theRegion. Moreover, the lack of accommodationfor internationally recruited staff in many countrieswas proving a real obstacle to the recruitment of suchstaff required for the implementation of projectswithin those countries. Also, many governmentswere experiencing difficulty in meeting the localexpenses of WHO personnel.

66. In spite, however, of the many difficultiesencountered, relations with the various governmentsin the Region continued to be good and the closestco- operation was being maintained with UNICEFand other international and bilateral agenciesconcerned in the promotion of local health pro-grammes.

REGION UNDESIGNATED

67. The Board noted that the proposals in respectof projects to be financed out of regular funds wouldentail an estimated expenditure of $128,940 in1954, and those out of Technical Assistance fundsan amount of $101,756, making a total of $230,696.Of this amount $204,996 was being provided foradvisory and demonstration services and $25,700for education and training services.

Programme and Estimated Expenditure under theExpanded Programme of Technical Assistance

68. In the course of its examination of the Director -General's proposed programme and budget esti-mates for 1954 to be financed out of regular fundsthe Board at the same time, as has been its previouspractice, reviewed the proposals relating to theprogramme (including central administrative andindirect operational costs) to be financed out offunds expected to be made available to the WorldHealth Organization under the Expanded Programmeof Technical Assistance. It was noted that, subjectto the necessary funds being placed at the disposalof the Organization, the net expenditure envisagedwould amount to $10,276,445 for 1954 (allowingfor delays in the implementation of new projectscalculated on the basis of a 20 % deduction) comparedwith $9,455,358 for 1953 (allowing for similar delayscalculated on the basis of a 35 % deduction).Appendix 3 gives a comparison of estimated ex-penditure by units between 1954 and 1953. Assumingthe percentage share of the Technical Assistancefunds to be made available to the Organization in1954 remains at approximately 22 % of the total,that total would need to be between 45 and 50 milliondollars.

69. With regard to field projects, it was noted thatprovision had been made for new projects to becommenced in 1954 at an estimated cost of $2,096,092,comprising $944,188 for advisory and demonstrationservices and $1,151,904 for education and trainingservices. Appendix 4 gives the estimated costs ofprojects over the three -year period 1952 to 1954.As previously stated, however, the Board, whilstrecognizing that the financial stringency facingthe Organization in relation to the 1953 TechnicalAssistance programme would have implications forthe implementation of the 1954 programme, wasunable at the present stage to determine the extentto which the 1954 proposals would be affected.

Conclusion

70. After completing its detailed review of theDirector- General's Proposed Programme and BudgetEstimates for 1954 the Executive Board decided torecommend their adoption by the Sixth WorldHealth Assembly, involving a total budgetaryprovision of $9,930,000, which would provide foran effective working budget of $8,547,202 appor-tioned among the different parts and sections ofthe proposed Appropriation Resolution as follows :


Appropriation Purpose of Appropriation AmountSection US $

PART I : ORGANIZATIONAL MEETINGS

1. World Health Assembly 159,500

2. Executive Board and its Committees 87,450

3. Regional Committees 44,400

Total - Part I 291,350

PART II : OPERATING PROGRAMME

4. Central Technical Services 1,556,752

5. Advisory Services 4,375,685

6. Regional Offices 1,149,277

7. Expert Committees and Conferences 141,757

Total - Part II 7,223,471

PART III : ADMINISTRATIVE SERVICES

8. Administrative Services 1,032,381

Total - Part III 1,032,381

SUB -TOTAL - PARTS I, II, III 8,547,202

PART IV : SPECIAL FUNDS

9. Special Fund for Extra Costs of Organizational Meetings . . 25,000

Total - Part IV 25,000

PART V : RESERVE

10. Undistributed Reserve 1,357,798

Total - Part V 1,357,798

TOTAL - ALL PARTS 9,930,000


Appendix 1

REGULAR PROGRAMME : COMPARISON OF PROPOSED PROGRAMME AND BUDGETESTIMATES FOR 1954 WITH APPROVED PROGRAMME AND BUDGET ESTIMATES FOR 1953,

BY APPROPRIATION SECTIONS

Numberof posts

Organizational unit/functions

Estimated expenditure Difference

1953 1954 1953 1954 Amount

US$ US$ US$ORGANIZATIONAL MEETINGS

World Health Assembly 167,300 159,500 (7,800)Executive Board and its Committees 85,950 87,450 1,500

Regional Committees :Africa 9,600 9,600 -The Americas 9,000 16,000 7,000South -East Asia 10,000 4,000 (6,000)Europe 5,600 5,600 -Eastern Mediterranean 4,000 4,000 -Western Pacific 5,200 5,200 -

- - TOTAL - ORGANIZATIONAL MEETINGS 296,650 291,350 (5,300) (1.79)

CENTRAL TECHNICAL SERVICES

(Personal Services, Allowances and Travel)

8 8 Office of the Assistant Director -General . . . 65,011 65,102 91

Epidemiological and Health Statistical Services2 2 Office of the Director 19,782 20,077 295

19 19 Epidemiological Information and MorbidityStatistics 98,938 103,502 4,564

10 10 International Quarantine 67,055 70,722 3,66714 14 Epidemiological Intelligence Station, Singapore 38,471 38,488 17

5 5 Statistical Studies 30,987 34,724 3,7373 3 International Classification of Diseases and

Causes of Death 23,395 27,465 4,0704 4 Technological Services 26,228 25,749 (479)

Therapeutic Substances2 2 Office of the Director 17,520 17,665 1454 4 Biological Standardization 42,880 46,182 3,3025 5 Pharmaceutical Section 26,688 28,321 1,6332 2 Addiction -producing Drugs 21,139 17,104 (4,035)2 2 Antibiotics and Insecticides 16,510 16,505 (5)

52 52 Tuberculosis Research Office, Copenhagen . 189,216 186,681 (2,535)

Editorial and Reference Services20 20 Office of Director 83,779 87,486 3,70713 13 Technical Publications 71,538 75,123 3,5854 4 Health Legislation 27,678 28,344 666

11 11 Documents and Official Records 61,649 65,219 3,5709 9 Translation 66,313 69,016 2,703

17 17 Library and Reference Services 78,452 82,157 3,705

Grants and Contractual Technical Services . . . 53,205 74,265 21,060

Contractual Editorial Services 5,000 5,000 -Publications 149,280 141,680 (7,600)

Acquisition of Library Books 15,000 15,000 -


Numberof posts

Organizational unit /functions


1953 1954 1953 1954 Amount

US $ US $ US $

Epidemiological Telegrams and Broadcasts, Geneva 11,000 11,000

Biological Standard Supplies 300 300

Common ServicesHeadquarters 140,655 147,844 7,189Copenhagen 44,284 46,819 2,535Singapore (including telegraphic expenses). 9,206 9,212 6

206 206 TOTAL - CENTRAL TECHNICAL SERVICES 1,501,159 1,556,752 55,593 3.70

ADVISORY SERVICES

Headquarters(Personal Services, Allowances and Travel)

15 15 Office of the Assistant Director -General . . 72,037 74,879 2,842

Communicable- Disease Services3 4 Office of the Director 22,646 36,312 13,6665 5 Malaria and Insect Control 35,379 35,245 (134)7 6 Tuberculosis 42,946 38,379 (4,567)5 5 Venereal Diseases and Treponematoses 40,403 36,742 (3,661)9 10 Endemo- epidemic Diseases 69,155 81,708 12,553

Organization of Public -Health Services2 2 Office of the Director 21,399 21,483 843 3 Public -Health Administration 38,270 45,703 7,4333 3 Nursing 31,626 32,224 5982 2 Social and Occupational Health 26,540 24,916 (1,624)2 2 Health Education of the Public 16,167 20,082 3,9155 5 Maternal and Child Health 40,260 42,450 2,1903 3 Mental Health 50,657 51,872 1,2152 2 Nutrition 39,870 39,831 (39)

7 7 Environmental Sanitation 76,868 81,226 4,358

Education and Training2 2 Office of the Director 20,277 20,834 5574 4 Fellowships 32,690 33,917 1,2273 3 Exchange of Scientific Information 19,721 21,229 1,5083 3 Assistance to Educational Institutions 38,650 41,107 2,457

3 3 Office of Reports and Analysis 36,913 36,366 (547)

12 10 Office of Supply 66,241 56,206 (10,035)

Special Literature 2,000 3,000 1,000

Grants and Contractual Technical Services . 84,460 75,460 (9,000)

Common Services at Headquarters 100,468 104,565 4,097

100 99 Total - Headquarters 1,025,643 1,055,736 30,093 2.93

Field

Communicable- Disease Services4 3 Malaria and Insect Control 59,219 74,083 14,864

13 19 Tuberculosis 199,868 284,596 84,72814 13 Venereal Diseases and Treponematoses 196,681 138,403 (58,278)7 8 Endemo -epidemic Diseases 191,626 133,912 (57,714)


Numberof posts



1953 1954 1953 1954 Amount

US$ US$ US$Organization of Public -Health Services

76 85 Public -Health Administration 1,297,351 1,463,953 166,60229 36 Nursing 345,646 406,644 60,998

4 5 Social and Occupational Health 114,315 154,831 40,5162 2 Health Education of the Public 69,532 36,402 (33,130)

18 14 Maternal and Child Health 397,417 306,705 (90,712)7 8 Mental Health 218,010 136,075 (81,935)

Nutrition 13,770 7,800 (5,970)

9 8 Environmental Sanitation 218,027 136,188 (81,839)

2 2 Education and Training (Regional advisers) . . 33,906 35,207 1,301

Therapeutic Substances and Insecticides 8,650 5,150 (3,500)

185 203 Total - Field 3,364,018 3,319,949 (44,069) (1.31)

285 302 TOTAL - ADVISORY SERVICES 4,389,661 4,375,685 (13,976) (0.32)

REGIONAL OFFICES11 14 Africa 99,061 120,165 21,104

43 43 The Americas 339,773 345,025 5,25239 39 South -East Asia 157,583 157,119 (464)16 16 Europe 111,208 114,225 3,01733 33 Eastern Mediterranean 192,024 203,120 11,09626 26 Western Pacific 205,946 209,623 3,677

168 171 TOTAL - REGIONAL OFFICES 1,105,595 1,149,277 43,682 3.95

EXPERT COMMITTEES AND CONFERENCES

Central Technical Services 67,334 51,962 (15,372)Advisory Services 96,844 69,795 (27,049)Printing 20,000 20,000 -

- - TOTAL - EXPERT COMMITTEES AND CONFERENCES 184,178 141,757 (42,421) (23.03)

ADMINISTRATIVE SERVICES

(Personal Services, Allowances and Travel)Office of the Director -General

8 8 Director -General's Office 89,412 90,889 1,47712 12 Office of External Relations 98,389 95,908 (2,481)14 14 Public Information (including supplies and

materials) 120,523 126,183 5,660

34 34 Total - Office of the Director- General 308,324 312,980 4,656 1.51

Administration and Finance4 4 Office of the Assistant Director -General . . 44,852 44,923 714 4 Legal Office 25,537 26,367 8305 5 Internal Audit 44,301 46,380 2,079

Administrative Management and Personnel2 2 Office of the Director 18,452 23,287 4,8356 6 Administrative Management 43,558 39,732 (3,826)

13 13 Personnel 73,225 71,525 (1,700)28 28 Conference and Office Services 117,508 123,041 5,533

Budget and Finance2 2 Office of the Director 18,369 19,164 7958 8 Budget 49,620 54,506 4,886

24 24 Finance and Accounts 122,898 125,408 2,510

96 96 Total - Administration and Finance 558,320 574,333 16,013 2.87


Numberof posts



1953 1954 1953 1954 Amount %

Common ServicesHeadquartersNew York

TOTAL - ADMINISTRATIVE SERVICES

GRAND TOTAL

US $

123,55217,656

US $

129,91315,155

US $

6,361(2,501)

130 130 1,007,852 1,032,381 24,529 2.43

789 809 8,485,095 8,547,202 62,107 0.73

Summary of Increases and Decreases by Major Functions

1953

US$

1954

US$

DifferenceAmount

US $

Organizational Meetings 296,650 291,350 (5,300) (1.79)Central Technical Services 1,501,159 1,556,752 55,593 3.70Advisory Services 4,389,661 4,375,685 (13,976) (0.32)Regional Offices 1,105, 595 1,149,277 43,682 3.95Expert Committees and Conferences 184,178 141,757 (42,421) (23.03)Administrative Services 1,007,852 1,032,381 24,529 2.43

8,485,095 8,547,202 62,107* 0.73

* The total increase of $87,107 is made up of this amount plus $25,000 for the Special Fund for Extra Costs of OrganizationalMeetings provided for in Part IV, Section 9, of the proposed 1954 Appropriation Resolution.

Appendix 2

REGULAR PROGRAMME : ESTIMATED COST OF PROJECTS FOR THE THREE -YEAR PERIOD 1952 -1954

Projects

1952 Estimates 1953 Estimates 1954 Estimates

Completedprojects

Continuingprojects

Continuedprojects

Newprojects

Continuedprojects

Newprojects

Africa

AngolaEnvironmental sanitation

French Africa 1Malaria and insect controlPublic- health administration (Fellowships) . .

US $

3,9005,000

US $ US $ US $

12,941

US $

13,127

US $

1 For practical reasons this heading is meant to include French territories in Africa as well as trusteeship territories underFrench administration in Africa.


Projects


Completedprojects

Continuingprojects

Continuedprojects

Newprojects

Continuedprojects

Newprojects

US$ US$ US$ US$ US$ US$Fligh Commission Territories (Basutoland, Swaziland

and Bechuanaland)Tuberculosis (Demonstration and training centre) 3,900Nutrition 3,900

Kenya

Public- health administration (Training equip-ment) 500

Public- health administration (Fellowships) . . . 1,000

Liberia

Public- health administration (Fellowships) . . . 10,835Environmental sanitation (Fellowships) . . . . 3,020

Mauritius

Endemo- epidemic diseases (Whooping cough) . . 1,000

Mozambique

Environmental sanitation (Fellowships) . . . .4,000

Nigeria

Endemo -epidemic diseases (Onchocerciasis) .3,000

Public -health administration (Teaching equip-ment) 4,200

Northern Rhodesia

Endemo- epidemic diseases (Yellow fever) . . . 2,600Public -health administration 7,800Nutrition 7,800

Sierre LeoneTuberculosis 1,300

Southern RhodesiaTuberculosis 1,300

Union of South AfricaPublic- health administration (Fellowships) . . 24,000 24,000Mental health (Fellowships) 1,525

Zanzibar

Tuberculosis (Fellowships) 3,100

Inter - Country Programmes

Tuberculosis 160Venereal diseases and treponematoses . . . . 2,600Endemo -epidemic diseases 2,600Endemo- epidemic diseases (Leprosy) 4,000Maternal and child health (Survey) 2,600Mental health 4,000Malaria and insect control (Malaria conference)Malaria and insect control (Training course) . . 12,000 28,243Endemo- epidemic diseases (Bilharziasis con-

ference)Endemo -epidemic diseases (Yellow -fever confer- 18,250

ence) 15,000Public -health administration (Fellowships) . . 27,165Nursing (Conference and study tour) . . . . 18,250


Projects


Completedprojects

Continuingprojects

Continuedprojects

Newprojects

Continuedprojects

Newprojects

US$ US$ US$ US$ US$ US$Inter- Country Programmes (Continuation)

Nursing (General survey) 1,600Maternal and child health (Conference on

African child problems) 10,000Maternal and child health (Conference on child

psychology) 15,000Nutrition (Conference at Fajara) 5,695

TOTAL - AFRICA 86,800 102,891 37,127 84,093

The Americas

Argentina

Tuberculosis (Fellowships) 4,100Venereal diseases and treponematoses (Fellow-

ships) 680Public -health administration (Fellowships) . . 21,300 12,000Nursing (Fellowships) 4,100Maternal and child health (Fellowships) . . . 2,500Environmental sanitation (Fellowships) . . . . 4,100

Bolivia

Public -health administration (Model health unit) 54,995Public- health administration (Fellowships) . . . 8,000Venereal diseases and treponematoses (Fellow-

ships) 1,200

Brazil

Environmental sanitation (Garbage disposal). . 30,026Venereal diseases and treponematoses (Fellow-

ships) 2,500Public -health administration (Fellowships) . . . 27,700

British Guiana

Maternal and child health (Fellowships) . . . 4,000

Canada

Public -health administration (Assistance toschools of public health) 7,000

Chile

Venereal diseases and treponematoses (Cardio-lipin production centre) 25,818 24,668

Environmental sanitation (Garbage disposal) . 36,500Tuberculosis (Fellowships) 6,500Endemo- epidemic diseases (Fellowships) . . . . 1,200Public -health administration (Fellowships) . . . 8,000Public -health administration (Medical literature) 2,000Nursing (Fellowships) 13,000Maternal and child health (Fellowships) . . . 4,000Nutrition (Fellowships) 4,000


Projects


Completedprojects

Continuingprojects

Continuedprojects

Newprojects

Continuedprojects

Newprojects

US$ US$ US$ US$ US$ US$Colombia

Public -health administration (Hospital adminis-tration) 3,900

Venereal diseases and treponematoses (Post-graduate training centre, Callao- fellowships) 1,500

Costa Rica

Public -health administration (Medical literature) 500

Cuba

Public -health administration (Fellowships) . . . 1,500

Dominican Republic

Public -health administration (Fellowships) . . 4,270

Ecuador

Tuberculosis (Bacteriology) 7,000Venereal diseases and treponematoses (Post-

graduate training centre, Callao -fellowships) . 1,300Endemo -epidemic diseases (Fellowships) . . . . 2,150Public -health administration (Fellowships) . . 6,000Nursing (Fellowships) 6,850Environmental sanitation (Fellowships) . . . 4,000

El Salvador

Tuberculosis 41,060Public -health administration (Fellowships) . . 9,200Medical literature 150

Guatemala

Tuberculosis 23,743

Tuberculosis (Training for mass radiography) 5,625Public -health administration (Fellowships) . . . 3,500Maternal and child health (Fellowships). . . . 3,500Nutrition (Fellowships) 3,500Environmental sanitation (Fellowships) . . . . 3,500

Haiti

Venereal diseases and treponematoses (Yaws) . . 31,400 26,326 24,526Health education of the public (Fellowships) 4,000Maternal and child health (Fellowships) . . . 4,000

Honduras

Endemo- epidemic diseases (Fellowships) . . . 2,500Environmental sanitation (Fellowships) . . . . 5,500

Jamaica

Tuberculosis (Bacteriology) 7,000Tuberculosis (Training for mass radiography) 5,625

Mexico

Endemo -epidemic diseases (Fellowships) . . . . 3,000Nursing education 35,377


Projects


Completedprojects

Continuingprojects

Continuedprojects

Newprojects

Continuedprojects

Newprojects

US$ US$ US$ US$ US$ US$Nicaragua


Panama

Public -health administration (Fellowships) . . 3,500

Paraguay

Public -health administration (Fellowships) . . .4,000

Health education of the public (Fellowships) 1,600Environmental sanitation (Fellowships) . . . .

4,000

Peru

Tuberculosis (Training for mass radiography) 5,700

Public -health administration (Fellowships) . . .11,000

Environmental sanitation (Fellowships) . . . .6,000

Surinam

Public- health administration (Medical literature) 500

United States of America

Endemo -epidemic diseases (Rabies) 2,000Public -health administration (Fellowships) .

8,000Public -health administration (Schools of public

health -fellowships)Nursing (Fellowships) 4,000

27,000

Health education of the public (Fellowships) 2,200Environmental sanitation (Fellowships) . . .

4,000

Uruguay

Tuberculosis (Fellowships) 2,500Tuberculosis (Bacteriology) 7,000Venereal diseases and treponematoses (Fellow-

ships) 1,800Venereal diseases (Seminar in Sao Paulo) . . .

690

Public -health administration (Fellowships) .3,480

Health education of the public (Fellowships) 1,600 8,000Maternal and child health (Fellowships) . .

4,000Mental health (Fellowships) 16,000

Venezuela

Tuberculosis (Training for mass radiography) 5,625Public -health administration (Fellowships) . . . 9,000Environmental sanitation (Fellowships) . . . . 4,000


Tuberculosis (Statistician, BCG) 9,400Venereal diseases and treponematoses 3,900Endemo -epidemic diseases (Diphtheria and

whooping cough) 3,000Social and occupational health (Centre for

rehabilitation of physically handicapped) . . 4,600 9,126 7,801


Projects


Completedprojects

Continuingprojects

Continuedprojects

Newprojects

Continuedprojects

Newprojects

US$ US$ US$ US$ US$ US$Inter - Country Programmes (Continuation)

Mental Health 3,900 7,800

Nutrition 9,450

Venereal diseases and treponematoses (Post-graduate training centre, Callao) 8,800 8,800

Venereal- disease seminar, Sáo Paulo 4,525

Endemo -epidemic diseases (Brucellosis seminar) 13,050

Endemo- epidemic diseases (Rabies -control train- 12,390 12,390ing course)Public -health administration (Fellowships) .

27,000 45,000

Public -health administration (Veterinary public-health, fellowships) 10,000

Public -health administration (Seminar on healthservices for small communities) 16,000

Public -health administration (Assistance to medi-cal schools) 26,000 47,500

Nursing (Workshop) 23,550

Nursing (Fellowships) 20,000 30,000

Health education of the public (Seminar) . .2,600 28,046

Mental health (Fellowships) 10,500

Mental health (Seminar on alcoholism) . .18,200 21,850

Mental health (Seminar on mental health). .19,052

Nutrition (Conference)Environmental sanitation (Fellowships)

9,87031,200

Environmental sanitation (Seminar for sanitaryengineers) 2,600 2,730

TOTAL 378,860 56,800 94,748 327,924 208,485 189,897

South -East Asia

Afghanistan

Malaria and insect control 26,236 13,844Vital and health statistics 1,000Environmental sanitation 15,126 8,926 8,501Venereal diseases and treponematoses (Fellow-

ships) 5,200Public -health administration (Dentistry fellow-

ships) 4,800Nursing school (male), Kabul 5,027 18,366 17,416Nursing school (female), Kabul 6,318 6,368Maternal and child health (Fellowships) . 5,200Maternal and child health (Refresher course) 880 880

Burma

Endemo- epidemic diseases 11,887 9,778 6,736Nutrition 4,500Public -health administration (Regional medical

mission) 24,231Public- health administration (Medical literature) 700Nursing (Selected schools (i)) 7,544 31,889 24,360Nursing (Selected schools (ii)) 14,436Nursing (Postgraduate school of nursing) . 15,436Maternal and child health (Refresher course) 5,393 900

Ceylon

Venereal diseases and treponematoses 24,996 27,681 13,644Endemo -epidemic diseases (Leprosy) 26,028 24,313


Projects


Completedprojects

Continuingprojects

Continuedprojects

Newprojects

Continuedprojects

Newprojects

US$ US$ US$ US$ US$ US$Ceylon (Continuation)

Public -health administration (Medical andsanitary services) 4,629 19,802 17,002

Public -health administration (Hospital adminis-tration and planning) 19,105 2,370

Tuberculosis (Fellowships) 5,000Public -health administration (Regional medical

mission) 24,231Public -health administration (Abstract Archives

of Alcohol Literature) 300 300Nursing (Colombo School of Nursing) . . . . 5,900 13,146 21,997Maternal and child health (Fellowships) . . 10,000Nutrition (Fellowships) 5,000

French Settlements in India

Public -health administration (Medical literature) 1,200Public -health administration (Fellowships) . . . 1,500Maternal and child health (Fellowships) . 1,000 2,750

India

Endemo- epidemic diseases (Cholera research) 8,240 8,500Endemo- epidemic diseases (Plague) 8,880 14,784 7,784Mental health 1,200Tuberculosis (Fellowships) 3,250Venereal diseases and treponematoses (Fellow-

ships) 5,400Venereal diseases and treponematoses (Madras

Medical College and General Hospital) . . . 21,468 24,154 6,619Public -health administration (Fellowships) 3,750Public -health administration (Seth G.S. Medical

College, Bombay) 10,226 10,811Public -health administration (Lady Reading

Health School, Delhi) 11,436 15,646Public -health administration (Abstract Archives

of Alcohol Literature) 300 300Nursing (Calcutta project) 15,659 23,783 40,147Nursing (Bombay project) 11,888 42,318 30,640Nursing (Madras project) 6,189 5,868 6,068Nursing (Postgraduate course in midwifery) . 4,600Nursing (Refresher course) 5,950 5,955 5,955Maternal and child health (College of nursing,

Delhi) 21,504 15,740Maternal and child health department of All-

India Institute of Hygiene and Public Health(Fellowships) 15,045

Maternal and child health (Paediatrics seminar) 32,570Mental health (Fellowships) 1,000 7,020Mental health (All -India Institute of Mental

Health) 34,394 43,269

Indonesia

Tuberculosis (Demonstration and training centre) 102,950Tuberculosis (Fellowships) 2,930Endemo -epidemic diseases (Leprosy, fellowships) 3,000


Projects


Completedprojects

Continuingprojects

Continuedprojects

Newprojects

Continuedprojects

Newprojects

US$ US$ US$ US$ US$ US$Indonesia (Continuation)

Public -health administration (Fellowships) . . . 5,400Public- health administration (Orthopaedic sur-

gery) 8,226Nursing (Fellowships) 9,250 25,965Nursing (Postgraduate school for nurse teachers,

Bandoeng) 11,428 6,368Maternal and child health (Fellowships). 3,150Maternal and child health (Refresher course in

paediatrics) 20,784

Portuguese India

Mental health 750Tuberculosis (Fellowships) 2,625Venereal diseases (Fellowships) 875

Thailand

Endemo- epidemic diseases (Leprosy) 6,555Endemo- epidemic diseases (Filariasis survey) . 2,297Mental health 8,726 16,031Tuberculosis (Fellowships) 8,400Venereal diseases and treponematoses (Fellow-

ships) 5,150Public -health administration (Fellowships) . . - 4,930 6,130Nursing (Refresher course) 1,705 1,890

Inter-Country Programmes

Nursing (Working regional conference for nursingleaders) 17,065

TOTAL - SOUTH -EAST ASIA 136,239 216,873 317,519 216,123 342,445 165,463

Europe

Austria

Maternal and child health (Handicapped children) 7,800 2,600Mental health 2,250 5,350Public -health administration (Fellowships) . . . 250

Belgium itPublic -health administration (Fellowships) . . . 6,870 6,870Public -health administration (Medical literature

and fellowships) 9,000 910

Denmark

Public -health administration (Fellowships) . . . 6,150 6,150Social and occupational health (Fellowships) 4,600Maternal and child health (Medical literature) 3,900Mental health (Medical literature and fellow-

ships) 2,650 910Mental health (Course on psychiatry) 10,700 8,550


Projects


Completedprojects

Continuingprojects

Continuedprojects

Newprojects

Continuedprojects

Newprojects

US$ US$ US$ US$ US$ US$Finland

Maternal and child health 2,600 2,600Public -health administration (Fellowships) . . 1,591Mental health (Special literature) 1,050 910

France

Maternal and child health (Handicapped children) 2,600 2,600Tuberculosis (Fellowships) 1,100Endemo- epidemic diseases (Fellowships) . . . . 1,900Public -health administration (Fellowships) . . . 504 5,400 5,400Public -health administration (Assistance to

medical training institutions) 1,800 7,900 7,900Social and occupational health (Fellowships) 7,300Maternal and child health (Fellowships) . . 2,450Mental health (Special literature) 1,050 910Environmental sanitation (Fellowships) . . . 550

Germany

Maternal and child health (Handicappedchildren) 2,600 2,600

Venereal diseases (Fellowships) 1,270Endemo- epidemic diseases (Fellowships) . . . 1,600Public -health administration (Fellowships) . . . 750 4,650 4,650Public- health administration (Assistance to

medical training institutions) 8,000 8,000Social and occupational health (Fellowships) . 1,000Maternal and child health (Fellowships) 6,770Mental health (Special literature and fellowships) 1,800 910Environmental sanitation (Fellowships) 2,250

Greece

Maternal and child health (Handicapped children)

rceland

6,990 14,300 14,300

Public -health administration (Fellowships) . . 3,800 3,800Nursing (Fellowships) 2,050Mental health (Fellowships)

rreland

2,600

Tuberculosis (Fellowships) 500Public -health administration (Fellowships) . . 7,150 7,150Nursing (Fellowships) 1,800Social and occupational health (Fellowships) . . 1,000Mental health (Fellowships and special literature) 1,850 910

7aly

Maternal and child health (Premature infants) 6,100Maternal and child health (Handicapped children) 1,670 2,600 2,600


Projects


Completedprojects

Continuingprojects

Continuedprojects

Newprojects

Continuedprojects

Newprojects

US$ US$ US$ US$ US$ US$Italy (Continuation)

Public- health administration (Fellowships) . 3,600 3,800 3,800Public- health administration (School of public

health) 7,500 10,800 10,800

Morocco (French Protectorate)

Public -health administration (Fellowships) . . 3,100 3,100

Netherlands

Venereal diseases (Clinical co- operative syphilistherapy study) 1,850

Tuberculosis (Fellowships) 1,050Endemo- epidemic diseases (Fellowships) . . . . 300Public -health administration (Fellowships) . 5,000 5,000Public -health administration (Training school) 150 17,550 12,800Nursing (Fellowships) 750Social and occupational health (Fellowships) 3,000Maternal and child health (Fellowships) . . . 2,240Mental health (Fellowships) 750Nutrition (Fellowships) 700

Norway

Mental health 1,300 1,300Tuberculosis (Fellowships) 750Public -health administration 6,400 3,100 3,100Public -health administration (Medical University) 6,600 6,600Nursing (Fellowships) 1,350Social and occupational health (Fellowships) . . 3,843Mental health (Special literature and fellowships) 2,050 910

Portugal

Endemo- epidemic diseases (Fellowships) . . . . 1,200Public -health administration (Fellowships) . . . 2,500 2,500Public -health administration (Assistance to edu-

cational institutions) 6,600 6,600

Spain

Maternal and child health (Handicapped children) 2,600 2,600Public- health administration (Medical literature

and teaching equipment) 3,150

Sweden

Venereal diseases and treponematoses (Fellow-ships) 3,350 7,850 7,850

Public -health administration (Fellowships) .

Nursing (Fellowships) 2,000Social and occupational health (Fellowships) 6,000Mental health (Special literature) 1,050 910

Switzerland

Tuberculosis (Fellowships) 350 3,800Public -health administration (Fellowships) . . . 1,100 3,800


Projects


Completedprojects

Continuingprojects

Continuedprojects

Newprojects

Continuedprojects

Newprojects

US$ US$ US$ US$ US$ US$Switzerland (Continuation)

Social and occupational health (Fellowships) 3,500Mental health (Special literature) 1,050 910

Trieste

Tuberculosis 420

Tunisia

Tuberculosis (Fellowships) 1,350Public- health administration (Fellowships) . . . 800 3,100 3,100

Turkey

Tuberculosis (Demonstration and training centre) 12,014Endemo- epidemic diseases 5,200Social and occupational health 3,500Tuberculosis (Fellowships) 7,200Public -health administration (Fellowships) 7,500 19,300 12,400Public- health administration (School of public

health) 5,200 10,400Social and occupational health (Fellowships) 3,100

United Kingdom

Public -health administration (Fellowships) 7,600 7,600Social and occupational health (Fellowships) 7,900Maternal and child health (Fellowships) . . 6,400

Yugoslavia

Maternal and child health (Handicappedchildren) 2,600 2,600

Mental health (Special literature) 1,050


Malaria and insect control (Symposium on in-secticides) 3,775

Venereal diseases and treponematoses (Inter-national Anti -Venereal- Disease Commissionof the Rhine) 1,597 1,200 1,200

Endemo- epidemic diseases (Conference on vacci-nation and seroprophylaxis against commu-nicable diseases) 13,500

Endemo -epidemic diseases (Trachoma survey) 2,700Public -health administration (Morbidity survey,

Denmark) 4,500 6,150 5,600Public -health administration (Conference on

teaching of preventive medicine) 10,000 9,380 9,380Public -health administration (European con-

ference of medical librarians) 1,950Public -health administration (Reimbursement of

income tax) 8,000Nursing 9,422Social and occupational health (Pilot study of

family health and welfare workers) 16,500 8,612Health education of public (Conference on

health education) 4,573 11,400Maternal and child health (Symposium on

relations between paediatricians and childpsychiatrists 3,400 11,500

70 EXECUTIVE EOARD, ELEVENTH SESSION

Projects


Completedprojects

Continuingprojects

Continuedprojects

Newprojects

Continuedprojects

Newprojects

US$ US$ US$ US$ US$ US$

Inter- Country Programmes (Continuation)

Maternal and child health (Study group on neo-natal period) 12,800

Maternal and child health (Handicapped children) 14,730

Mental health 7,070

Environmental sanitation (European conferenceof sanitary engineers) 19,100 17,560 18,495

Environmental sanitation (European conferenceon housing and town planning) 9,030

Malaria and insect control (Insect- control trainingcourse) 9,500 8,200 8,200

Tuberculosis (Thoracic surgery course, Gro-ningen) 3,343

Tuberculosis (Training course) 6,800

Venereal diseases and treponematoses (Portdemonstration centre) 20,600 29,389 14,495

Venereal diseases (Seminar on Treponema palli-dum immobilization test) 1,100

Endemo- epidemic diseases (Seminar on zoonoses) 20,000 13,500 13,500

Endemo- epidemic diseases (Conference on vaccineproduction for diphtheria and whooping cough) 21,000

Public -health administration (Training course) 6,700 19,900 19,900

Public -health administration (Public -health tra-velling study -group) 17,900 18,450

Public- health administration (Rural public -health training course) 5,458 11,800 11,300

Public -health administration (Supplies andmedical literature) 650

Nursing (Public- health nursing conference) . . 20,500 13,600

Nursing (Training course for nurse educators) 6,300

Social and occupational health (Conference ontraining and utilization of family health andwelfare workers) 13,250

Social and occupational health (Course in in-dustrial hygiene) 3,610 4,800 4,800

Social and occupational health (Training coursein rehabilitation of physically handicappedadults) 20,990 19,700

Social and occupational health (Anaesthesiologytraining centre, Copenhagen) 65,500 24,300 23,000

Social and occupational health (Anaesthesiologytraining centre, Paris) 9,848 25,678 35,278

Social and occupational health (Seminar onoccupational health) 25,779 15,000

Social and occupational health (Symposium onallergic diseases) 11,000

Maternal and child health (Travelling study -group on school health services) 12,135

Maternal and child health (Conference on schoolhealth services) 15,750

Maternal and child health (Training course oncare of handicapped children) 10,500 6,000

Maternal and child health (International Chil-dren's Centre training course) 8,440 15,000 15,000


Projects

Inter -country Programmes (Continuation)

Mental health (Seminar on mental hygiene andpublic health)

Mental health (European seminar on alcoholism)Mental health (UNESCO conference on mental

health of children)Mental health (World Federation for Mental

Health, summer school on children's develop-ment and survival)

Mental health (Study -group on electro- physio-logy)

Mental health (UN seminar on social case -work)Mental health (Child psychiatry seminar, Oslo)Mental health (UN seminar on foster -home care,

Oslo)Environmental sanitation (British Council training

course on engineering aspects of public health)Therapeutic substances and insecticides (Anti-

biotics research and production, fellowships)Therapeutic substances and insecticides (Centre

testing new insecticides)

TOTAL - EUROPE

Eastern Mediterranean

Cyprus

Public -health administration (Clinical surgery)

Egypt

Venereal diseases and treponematoses . . .

Social and occupational healthMental healthPublic -health administration (Fellowships) .

Public -health administration (Quarantine fellow-ships)

Public- health administration (Orthopaedics fellow-ships)

Public -health administration (Dentistry fellow-ships)

Public -health administration (Anaesthesiologyfellowships)

Maternal and child health (Fellowships) . .

Mental health (Fellowships)

Ethiopia

Endemo- epidemic diseases (Infectious diseases)Public -health administration (Long -term fellow-

ship programme)Maternal and child health (Fellowships) . .

Iran

Malaria and insect controlPublic -health administration (Fellowships) .


Completedprojects

Continuingprojects

Continuedprojects

Newprojects

Continuedprojects

Newprojects


15,85011,600

3,500

24,920

1,100305

18,100

75

2,250

5,150 5,150

3,500

280,703 292,019 326,359 232,630 413,468 105,080

4,800

42,96013,450 25,151 36,219

9007,000 16,000

1,800

3,000

3,000

3,6003,000

980

24,576 8,001

77,800 25,000 30,0008,000

25,950 21,950 24,8306,800 7,000 10,000


Projects


Completedprojects

Continuingprojects

Continuedprojects

Newprojects

Continuedprojects

Newprojects

US$ US$ US$ US$ US$ US$Iran (Continuation)

Public -health administration (Hospital laboratory) 25,000Environmental sanitation (Fellowships) . . . . 4,000 4,000

Iraq

Endemo- epidemic diseases (Ankylostomiasis) . . 3,900Endemo- epidemic diseases (Parasitic diseases) 3,900 3,900Public- health administration (Fellowships) . . . 11,950 13,000 18,000Public -health administration (Anaesthesiology

fellowships) 2,780Public -health administration (Royal Medical

College, Baghdad) 5,359 5,417Mental health (Fellowships) 950Mental health (School for backward children) 9,059Nutrition (Fellowships) 1,000

Israel

Public- health administration (Rehabilitation ofthe physically handicapped) 22,809 6,784

Public -health administration (Fellowships) . . 15,050 36,000 20,000Health education of public (Fellowships) . . . 2,600Environmental sanitation (Fellowships) . . 8,000

Jordan

Maternal and child health (Demonstration andtraining centre) 32,426 48,702

Mental health 2,100 6,401 2,375Public -health administration (Fellowships) . . . 2,850 10,000 8,000

Lebanon

Public -health administration (Public -health labo-ratory) 21,267

Maternal and child health (Crippled children'scentre) 1,800 21,913 17,568

Endemo- epidemic diseases (Epidemiology fellow-ships) 3,000

Public -health administration (Fellowships) . . . 11,000 12,000Public - health administration (Microfilm labo-

ratory) 5,000

Libya

Public- health administration (Long -term fellow-ship programme) 14,000 16,000 24,000

Pakistan

Public -health administration (Fellowships) . . . 24,000 20,000Public- health administration (Assistance to

medical schools) 10,570 25,102 16,002

Saudi Arabia .

Endemo -epidemic diseases (Leprosy survey) . 4,600Maternal and child health 29,884 37,135Public -health administration (Fellowships) . . . 5,500Public- health administration (Long -term fellow-

ship programme) 10,000 13,000 15,000


Sudan

Endemo- epidengitis) .

Public -health aEnvironmental

SyriaTuberculosisMaternal and c.Public -health a

Inter- Country Pr

Tuberculosis (IPublic -health a

income tax)Public -health aNursing (GroutMaternal and

in school heMental health

To

Western Pacific

Australia

Public -health aNursing (Fello

Cambodia

Public -health aNursing

Hong KongTuberculosis

Japan

Maternal andrehabilitatio

Maternal andinfants)

Tuberculosis (IPublic -health

statistics, fellPublic- health a

health) .Maternal and

capped child:

Mental healthMental health

health) .

Korea

Public -health a

New ZealandPublic -health a

Projects


Completedprojects

Continuingprojects

Continuedprojects

Newprojects

Continuedprojects

Newprojects

iic diseases (Cerebrospinal menin-


dministration (Fellowships) . . .

8,6703,000 3,500

sanitation (Fellowships) . . . . 3,500 3,500

96,440Iild health (School health services) 11,800 3,9003ministration (Fellowships) . .

ogrammes

legional assessment team, BCG)dministration (Reimbursement of

7,100 5,000

12,754

10,500

17,907

10,000dministration (Group fellowship) 12,600) fellowship in nursing education)child health (Group fellowshipilth)

6,800

12,600(Seminar) 1,320 16,400

rAL - EASTERN MEDITERRANEAN

dministration (Fellowships) . .

vships)

74,970 312,750 262,071 259,021 415,840 49,059

4,2004,200

dministration 4,572 8,965 8,96520,500 29,480 28,140

'ellowships)

child health (Poliomyelitis andof crippled children)

child health (Care of premature17,000 14,000

9,000

11,300 8,200fellowships) 7,000Ldministration (Vital and healthowships)dministration (Institute of public

5,000 3,500

child health (Physically handi-ren, fellowships) 3,500

8,500

(Fellowships) 1,700(National institute of mental

33,500

dministration 26,406

dministration (Fellowships) . . . 5,000


Projects


Completedprojects

Continuingprojects

Continuedprojects

Newprojects

Continuedprojects

Newprojects

US$ US$ US$ US$ US$ US$Philippines

Maternal and child health 12,300Mental health (Child guidance clinic) 3,900 21,300 5,200Venereal diseases and treponematoses (Fellow-

ships) 3,500

Singapore

Tuberculosis 25,226 18,001Public -health administration (Hospital records) 5,717Public -health administration (Artificial limbs

and surgical appliances) 5,717Tuberculosis (Fellowships) 7,500 11,000Maternal and child health (Fellowships) . . . 4,700

Viet Nam

Public -health administration 1,275

Inter -country programmes

Tuberculosis (BCG area supervising team) 5,464 17,035Tuberculosis (Inspection of BCG laboratories) 3,800Endemo- epidemic diseases (Trachoma) . . 6,200Endemo- epidemic diseases (Smallpox survey) 11,226Endemo- epidemic diseases (Leprosy seminar) 10,640Public -health administration (Conference and

study tour) 45,000Public -health administration (Quarantine seminar) 19,500Public -health administration (Fellowships) . . 32,000Mental health (Seminar) 16,800

TOTAL - WESTERN PACIFIC 26,075 57,272 81,945 160,396 91,841 138,100

Region Undesignated

Countries Undesignated

Tuberculosis 10,650 9,704Public -health administration (Liaison with

UNICEF, Bangkok) 17,600 16,426 20,235Public -health administration (Liaison with

UNICEF, New York) 13,100 16,243 29,696Public -health administration (Liaison with

UNICEF, Paris) 10,600 10,491 12,929Public -health administration (UNRWAPRNE) 64,657 66,675 66,080

TOTAL - REGION UNDESIGNATED 116,607 119,539 128,940

TOTAL - FIELD PROJECTS 983,647 1,052,321 1,202,181 1,298,985 1,638,146 731,692*

* This is made up of :Advisory and demonstration services $236,844Education and training services $494,848


Appendix 3

TECHNICAL ASSISTANCE : PROPOSED PROGRAMME AND ESTIMATED EXPENDITURE FOR 1954COMPARED WITH 1953

Numberof posts



1953 1954 1953 1954 Amount

CENTRAL TECHNICAL SERVICES US $ US $ US $


Office of the Assistant Director - General . . . 4,660 4,950 290

Therapeutic SubstancesOffice of the Director 1,000 1,000 -Biological Standardization 1,000 1,000 -

2 Antibiotics and Insecticides 29,922 - (29,922)

Editorial and Reference Services2 2 Documents and Official Records 9,562 10,032 4703 3 Translation 21,619 21,589 (30)1 1 Library and Reference Services 4,110 4,027 (83)

Common Services at Headquarters 7,231 5,622 (1,609)

8 6 TOTAL - CENTRAL TECHNICAL SERVICES 79,104 48,220 (30,884) (39.04)

ADVISORY SERVICES

Headquarters(Personal Services, Allowances and Travel)Office of the Assistant Director -General . . . . 1,090 1,090Communicable -Disease Services

Office of the Director 16,400 26,850 10,450Malaria and Insect Control 2,350 3,050 500Tuberculosis 2,550 2,425 (125)Venereal Diseases and Treponematoses . . . . 2,770 3,750 980

4 4 Endemo- epidemic Diseases 35,665 26,975 (8,690)

Organization of Public -Health ServicesOffice of the Director 570 - (570)

1 1 Public -Health Administration 9,900 12,498 2,5081 1 Nursing 6,004 9,850 3,8462 2 Social and Occupational Health 13,387 17,382 3,9951 1 Health Education of the Public 24,957 21,974 (2,983)

Maternal and Child Health 3,275 1,830 (1,445)Nutrition 3,620 1,870 (1,750)

I 1 Environmental Sanitation 17,418 18,006 588Education and Training Services

Office of the Director 1,300 1,600 300Fellowships 3,600 2,650 (950)Exchange of Scientific Information 2,630 2,580 (50)

2 2 Assistance to Educational Institutions 17,955 19,919 1,9642 2 Office of Reports and Analysis 21,806 21,867 617 7 Office of Supply 26,710 27,050 340

Special Literature 2,000 3,000 1,000Common Services at Headquarters 18,982 19,687 705

21 21 Total - Headquarters 234,139 245,903 11,764 5.02

Field

Communicable- Disease Services175 71 Malaria and Insect Control 868,705 694,105 (174,600)148 163 Tuberculosis 1,755,432 1,599,250 (156,182)


Numberof posts



1953 1954 1953 1954 Amount

Communicable- Disease Services (Continuation)US$ US$ US$

58 51 Venereal Diseases and Treponematoses . . . . 718,464 540,850 (177,614)61 51 En demo-epidemic Diseases 970,892 779,338 (191,554)

Organization of Public- Health Services173 194 Public -Health Administration 2,476,798 2,769,951 293,15363 78 Nursing 699,743 856,752 157,009

2 1 Social and Occupational Health 54,660 26,376 (28,284)12 11 Health Education of the Public 166,045 139,244 (26,801)

149 153 Maternal and Child Health 1,181,173 1,348,118 166,945Mental Health 1,300 2,200 900

10 10 Nutrition 207,231 117,088 (90,143)

33 24 Environmental Sanitation 526,973 507,490 (19,483)

5 5 Education and Training (Regional advisers) . . 62,296 66,777 4,481

21 18 Therapeutic Substances and Insecticides 197,449 168,862 (28,587)

810 830 Total - Field 9,887,161 9,616,401 (270,760) (2.74)

851 851 TOTAL - ADVISORY SERVICES 10,121,300 9,862,304 (258,996) (2.56)

REGIONAL OFFICES2 6 Africa 9,683 33,425 23,742

20 20 The Americas 100,192 106,578 6,38624 24 South -East Asia 54,812 54,267 (545)

7 7 Europe 29,314 30,420 1,10621 21 Eastern Mediterranean 100,832 108,330 7,49816 16 Western Pacific 104,188 103,568 1,380

90 94 TOTAL - REGIONAL OFFICES 399,021 438,588 39,567 9.92

ADMINISTRATIVE SERVICES


Office of the Director- GeneralDirector -General's Office 3,000 4,380 1,380

7 7 Office of Technical Assistance 55,743 54,764 (979)4 4 Public Information 28,262 29,165 903

11 11 Total - Office of the Director -General 87,005 88,309 1,304 1.50

Administration and FinanceOffice of the Assistant Director -General . . 5,090 3,710 (1,380)

2 2 Legal Office 8,893 9,260 3673 4 Internal Audit 32,937 46,296 13,359

Administrative Management and Personnel5 3 Administrative Management 21,556 18,843 (2,713)7 7 Personnel 26,096 26,349 2535 3 Conference and Office Services 8,715 8,964 249

Budget and Finance5 5 Budget 25,428 25,355 (73)

10 10 Finance and Accounts 49,371 51,953 2,58233 34 Total - Administration and Finance 178,086 190,730 12,644 7.10

Common Services at Headquarters 39,767 42,181 2,41444 45 TOTAL - ADMINISTRATIVE SERVICES 304,858 321,220 16,362 5.37

973 996 GRAND TOTAL 10,904,283 10,670,332 (233,951) (2.14)

Less deduction for delays in implementation . . 1,448,925 393,887

Net total 9,445,358 10,276,445 821,087


Appendix 4

TECHNICAL ASSISTANCE : ESTIMATED COST OF PROJECTS FOR THE THREE -YEAR PERIOD 1952 -1954

Projects


Completedprojects

Continuingprojects

Continuedprojects

Newprojects

Continuedprojects

Newprojects

US$ US$ US$ US$ US$ US$Africa

Angola

Tuberculosis (Fellowships) 4,000Public -health administration (Fellowships) . . . 20,000Maternal and child health (Fellowships) . . . 4,000Nutrition (Fellowships) 8,000

Belgian Congo

Nutrition 3,900 3,900Public -health administration (Fellowships) . - 40,000 40,000Nursing 12,000

French Africa 1

Malaria and insect control 6,317 20,068 20,068Nutrition 3,900 3,900

Gambia

Malaria and insect control 8,726

Gold Coast

Malaria and insect control 2,750 5,976Malaria (Fellowships) 4,000Venereal diseases and treponematoses (Yaws,

fellowships) 4,000Endemo- epidemic diseases (Onchocerciasis,

fellowships) 4,000Public -health administration (Fellowships) . . . 12,000

High Commission Territories (Basutoland, Swazilandand Bechuanaland)

Tuberculosis (Demonstration and training centre) 21,760Nutrition 8,926

Kenya

Tuberculosis 21,761Endemo- epidemic diseases (Bilharziasis) . . . . 5,200 8,926Social and occupational health (Occupational

diseases) 3,900 8,926Environmental sanitation 10,056Public -health administration (Fellowships) . . . 8,000 12,000Nursing (Fellowships) 4,000

Liberia

Malaria and insect control 8,903 26,352 26,852Tuberculosis 1,300 38,469Venereal diseases and treponematoses (Yaws) 9,970 33,352 29,352

For practical reasons this heading is meant to include French territories in Africa as well as trusteeship territories underFrench administration in Africa.


Projects


Completedprojects

Continuingprojects

Continuedprojects

Newprojects

Continuedprojects

Newprojects

US$ US$ US$ US$ US$ US$Liberia (Continuation)

Endemo- epidemic diseases (Bilharziasis) . . . 4,000 8,926Health education of the public 3,961 8,001 8,001Public -health administration (Fellowships) . . 5,740 40,000 40,000

Mauritius

Tuberculosis 1,300 21,760

Mozambique

Tuberculosis (Fellowships) 4,000Endemo- epidemic diseases (Bilharziasis, fellow-

ships) 4,000Public -health administration (Fellowships) . . . 24,000Maternal and child health (Fellowships) . . . 4,000Nutrition (Fellowships) 8,000

Nigeria

Malaria and insect control 23,052 20,352Tuberculosis 21,835 19,135Venereal diseases and treponematoses (Yaws) 39,952 29,352Endemo- epidemic diseases (Rabies, fellowships) 4,000Public- health administration (Fellowships) . . 8,000 12,000

Nyasaland


Ruanda-Urundi

Nutrition 5,200Public- health administration (Fellowships) . . 20,000 20,000

Seychelles

Environmental sanitation 39,300

Southern Rhodesia

Tuberculosis 19,800

Tanganyika

Public -health administration 8,543 7,693Nutrition 4,576 4,151

Inter -Country Programmes

Malaria and insect control (Assistance to malariainstitute, Amany) 66,853 63,303

Malaria and insect control (Training course,Yaoundé) 40,000

Tuberculosis (Training course) 12,000Endemo- epidemic diseases (Rabies training course,

Nairobi) 25,000Endemo- epidemic diseases (Leprosy training

course) 12,000Public -health administration (Health statistics

training course) 12,000Public -health administration (Rural health

training course) 12,000Public -health administration (Fellowships) . . . 40,000 40,000


Projects


Completedprojects

Continuingprojects

Continuedprojects

Newprojects

Continuedprojects

Newprojects


Inter - Country Programmes (Continuation)Health education of the public (Training course) 12,000Nutrition (Training course, Marseilles) 21,700Nutrition (Training course) 25,000Environmental sanitation (Training course) . . 12,000

TOTAL - AFRICA 27,440 29,151 87,773 518,343 350,802 415,547

The Americas

Bolivia

Malaria and insect control (Insect control) . . . 15,126 14,001Tuberculosis (Laboratory expert, BCG) . . . . 650Endemo- epidemic diseases (Smallpox control) 19,950Maternal and child health (Children's hospital,

La Paz) 40,000 17,035Nursing education 3,300 57,624 57,868Environmental sanitation (Study of water supply,

La Paz) 16,400

Brazil

Endemo- epidemic diseases (Microbiology demon-stration) 7,076

Endemo- epidemic diseases (Immuno -chemistrydemonstration) 3,500 8,676 2,475

Maternal and child health 12,826Nutrition (Amazon valley project) 1,823 30,252 16,001

Chile

Endemo- epidemic diseases (Communicable -disease control) 92,055 24,000

Public -health administration (Health demonstra-tion area) 70,061 83,529

Therapeutic substances and insecticides (Peni-cillin production) 12,000 19,252

Colombia

Public -health administration (Veterinary public -health department) 21,126 20,551

Public- health administration (Expert in public -health administration) 4,000

Public -health administration (Bogotá MunicipalHealth Department) 32,778 28,353

Environmental sanitation 4,000 18,526Environmental sanitation (Insect control and

yellow fever) 51,100 44,694 19,926Public -health administration (Fellowships) . . 32,000Maternal and child health 20,650 30,093 25,568Environmental sanitation (Training centre for

sanitary inspectors) 34,600 34,600

Costa Rica

Nursing (School of Nursing, San José) . . . . 65,400 48,495 47,616

Cuba

Malaria and insect control (Insect control) . . 13,000 21,110 13,568


Projects


Completedprojects

Continuingprojects

Continuedprojects

Newprojects

Continuedprojects

Newprojects


Dominican RepublicMalaria and insect control (Insect control) . . 70,000 29,785Venereal diseases and treponematoses (Yaws) 28,227 16,901

EcuadorTuberculosis (Teaching centre) 25,550 27,092Venereal diseases and treponematoses . . . . 30,820 15,568 15,568Endemo- epidemic diseases (Yellow fever) . . 14,830 10,001Endemo- epidemic diseases (National institute

'of health) 23,590 45,020 21,551Public -health administration (National veterinary

publichealth services) 21,126Health education of the public 16,126 15,001Maternal and child health 380 34,910 32,135Nutrition (National institute of nutrition) . . . 13,676Public -health administration (Veterinary public

health) 21,126 20,001

El SalvadorPublic- health administration (Health demonstra-

tion area) 124,500 69,888 61,288

GuatemalaVenereal diseases and treponematoses (Serolo-

gical laboratory) 17,290 14,659 14,659Public -health administration (Rural health

services) 49,652 56,586Social and occupational health (Rehabilitation

of the physically handicapped) 25,510Nutrition 7,267 4,809Environmental sanitation (Garbage disposal) . 4,960 17,226Nursing (Nursing education) 33,909 46,468

HaitiMalaria and insect control (Insect control) . . . 7,950 18,068 13,568Public- health administration (Health demonstra-

tion area) 98,964 92,139Public -health administration (Fundamental edu-

cation) 14,300 23,295Public -health administration (Public- health labo-

ratory) 57,909

HondurasHealth education of the public 19,000 12,776 4,000

JamaicaTuberculosis control 9,700 5,206Tuberculosis laboratory 12,375

MexicoVenereal diseases and treponematoses (Border

project) 48,252 48,028Endemo- epidemic diseases (Rabies) 53,500 18,702Nursing (Courses for nursing instructors) 25,000 28,700 28,700Health education of the public (Regional funda-

mental education centre) 18,700 24,929 23,754

NicaraguaPublic -health administration (Rural health

services) 21,759 53,761Health education of the public 12,500


Projects


Completedprojects

Continuingprojects

Continuedprojects

Newprojects

Continuedprojects

Newprojects


Panama

Public- health administration (Rural health ser-vices) 29,000 77,803 76,037

Environmental sanitation (Training course forlaboratory technicians) 21,320

ParaguayMalaria and insect control (Insect control) . . 13,750 9,167 9,807Tuberculosis 60,000 72,253 27,952Venereal diseases and treponematoses 21,574 42,144 42,204Endemo -epidemic diseases (Ankylostomiasis) . 69,510 54,440 67,040Maternal and child health (Field team) . . . . 16,730 35,475 24,743Public -health administration (Assistance to school

of medicine) 4,620 19,232 9,057

Peru

Endemo- epidemic disease (Plague) 17,376 8,000Public- health administration (Assistance to me-

dical records libraries) 5,620 6,420Public -health administration (Callao health

centre) 6,700 61,720 47,196Public -health administration (Health demonstra-

tion area, Chiclayo) 79,869Public -health administration (Veterinary public -

health services) 17,126 20,001Health education of public (Ica health centre) 10,100 6,993 7,714Maternal and child health (Field team) . . . . 15,400 56,636 31,136Environmental sanitation (Insect control) . . 9,400 36,469Nursing (Nursing education) 32,184 42,184

Trinidad

Tuberculosis (Bacteriological laboratory) . . . 2,600

Venezuela

Public -health administration (Health demonstra-tion area) 80,629 75,004


Malaria and insect control (Insect control, Carib-bean area) 20,100 58,754 43,004

Public -health administration (Inter- AmericanCenter of Biostatistics) 20,900 81,788 76,623

Public -health administration (Joint field missionon indigenous populations) 5,300

Environmental sanitation (Insect control andyellow fever, Central America) 72,400 80,219 38,553

Public -health administration (Assistance toschools of public health) 99,250 142,500

Nursing (Workshop on principles of teachingand supervision) 30,800

Environmental sanitation (Training in environ-mental sanitation) 91,578 112,957

Environmental sanitation (Training course forwaterworks operators) 17,000

TOTAL - THE AMERICAS 93,800 1,017,914 1,378,869 1,092,413 1,853,876 185,613


Projects


Completedprojects

Continuingprojects

Continuedprojects

Newprojects

Continuedprojects

Newprojects


South -East Asia

Afghanistan

Malaria and insect control 23,784Tuberculosis 15,000 85,681 42,966Public -health administration 7,467 10,301 8,001Public- health administration (Vital and health

statistics) 12,626 9,901Maternal and child health (Maternal and child

health /venereal disease project) 67,137 111,803 120,373Public -health administration (University of

Kabul) 17,793 8,001 12,201

Burma

Malaria and insect control 34,048 37,665 36,709Tuberculosis (Demonstration and training centre) 39,107 75,165 33,205Public -health administration (Vital and health

statistics) 11,703 11,455Public -health administration (Rural health unit,

Lashio) 44,660Public -health administrator 3,843Public -health administration (Social services

survey) 645Maternal and child health (Maternal and child

health /venereal disease project)Nutrition

gg 063 125,58820,197

81,1688020,322

Tuberculosis (Medical college, Rangoon) . 3,000 12,401 11,234Public -health administration (Teachers' training

institutions, Rangoon) 12,567 7,484Public -health administration (Health assistants'

school, Rangoon) 10,226 10,178Nursing 3,950

Ceylon

Malaria and insect control (Training centre, insect -borne diseases, Kurunegala) 17,166 12,797 9,979

Tuberculosis (Control project, Colombo) . 9,096 11,188 12,188Tuberculosis (Demonstration and training project

outside Colombo) 44,952 22,852Health education of public 12,817 9,666 3,000Maternal and child health (Demonstration and

training centres, Colombo and Kalutara) . 23,620 63,429 30,710Nutrition 4,872 8,383Nutrition (Zoonoses, food hygiene) . . . 6,870Therapeutic substances and insecticides (DDT

production) 13,625 26,954 34,955Public -health administration (Institute of hygiene,

Kalutara) 11,736Nursing (Kandy school of nursing) 15,718 22,422 29,232Health education of public (Fellowships) . . . 5,000Environmental sanitation (Fellowships) . . 4,400 3,570Environmental sanitation (Port health and

quarantine fellowships) 2,575

French Settlements in India



Projects


Completedprojects

Continuingprojects

Continuedprojects

Newprojects

Continuedprojects

Newprojects

India

Malaria and insect control (Joint WHO /FAO

US $ US$ US$ US$ US$ US $

project, Terai) 58,878 59,814 40,653

Tuberculosis (Demonstration and training centres,Delhi, Patna and Trivandrum) 101,043 66,110

Tuberculosis (Demonstration and training centres(two) undesignated) 160,130

Tuberculosis (Demonstration and training centres,Calcutta and Hyderabad) 11,000 86,137 60,592

Tuberculosis (BCG demonstration and training) 71,879 38,976

Tuberculosis (Thoracic surgery teaching centre,Delhi) 41,671 28,421

Venereal diseases and treponematoses (Yaws) 6,229 13,501

Endemo- epidemic diseases (Trachoma pilotproject) 13,943 16,878

Public -health administration (Population studies) 13,299 5,617

Public -health administration (Vital and healthstatistics) 15,340

Maternal and child health (Maternal and childhealth /nursing project, Hyderabad) . . . 54,970 81,105

Maternal and child health (Maternal and childhealth /nursing project, Madras) 46,042 54,362

Maternal and child health (Maternal andchild health /nursing projects, States unde-signated (i)) 41,330 139,154

Maternal and child health (Maternal and childhealth /nursing projects, States undesignated (ii)) 41,330

Nutrition (Zoonoses, food hygiene) 7,715

Therapeutic substances and insecticides (Anti-biotics production) 40,875 37,597 37,597

Therapeutic substances and insecticides (DDTproduction) 36,555 37,655

Venereal diseases and treponematoses (Fellow-ships) 5,415

Venereal diseases and treponematoses (Cardio-lipin production, fellowships 3,500

Venereal diseases and treponematoses (LadyHardinge Medical College) 9,227 9,577

Endemo- epidemic diseases (Physiotherapy school,Bombay) 8,500 21,002 21,617

Public- health administration (Trivandrum Me-dical College) 6,662 17,611 8,501

Public- health administration (School of TropicalMedicine, Calcutta) 3,016 13,001 12,011

Public -health administration (All -India Instituteof Hygiene and Public Health) 6,458 14,511 8,501

Public -health administration (Visiting team ofmedical scientists) 64,400

Nursing (Fellowships) 35,070 35,070Nursing (Ludhiana project) 4,377 18,650 12,336Nursing (Refresher course) 840


Projects


Completedprojects

Continuingprojects

Continuedprojects

Newprojects

Continuedprojects

Newprojects


India (Continuation)

Health education of public (Fellowships) . . 3,510Nutrition (Fellowships) 3,510Environmental sanitation (Fellowships) . . . 3,510

Indonesia

Malaria and insect control 21,098 32,949 13,459Tuberculosis (Demonstration and training centre,

Bandoeng) 34,762 61,121Tuberculosis (BCG) 17,286Venereal diseases and treponematoses (Yaws) 19,102 33,857 25,717Endemo- epidemic diseases (Plague) (Fellowships

in 1953) 1,964 8,226Maternal and child health 16,660 23,359 74,683Nutrition 10,364 22,103 6,876Public -health administration (Visiting team of

medical scientists) 54,316Nursing (Postgraduate course in public -health

nursing, Jakarta) 9,218Health education of public (Fellowships) . . . 3,710 3,710Environmental sanitation (Sanitation and hygiene

in and around ports) 6,410

Portuguese India


Thailand

Tuberculosis 42,537 59,169 96,641Tuberculosis (BCG demonstration and training) 16,986Tuberculosis (BCG production) 3,522 3,626Tuberculosis (Thoracic surgery centre) . . . . 46,095 37,930Venereal diseases and treponematoses 32,371 35,822 40,382Public -health administration (Vital and health

statistics) 8,130 7,260Maternal and child health (Rural health unit,

Chiengmai, extension of maternal and childhealth /nursing project) 14,196 25,531 32,914

Maternal and child health (Bangkok project) . . 27,655 49,856 61,338Environmental sanitation 28,151 12,856Malaria and insect control (Fellowships) 1,900 8,035Nursing (Postgraduate school of nursing,

Bangkok) 18,434 19,964Maternal and child health (Fellowships) . . . . 3,670Maternal and child health (School of health,

fundamental education project, Chachoengsao) 12,302 18,617 13,352


Public- health administration (Vital and healthstatistics) 2,649

TOTAL - SOUTH -EAST ASIA 26,727 863,435 1,430,170 706,402 1,638,125 370,974


Projects


Completedprojects

Continuingprojects

Continuedprojects

Newprojects

Continuedprojects

Newprojects

US$ US$ US$ US$ US$ US$Europe

Austria

Tuberculosis 19,750 8,300Venereal diseases and treponematoses 4,800Maternal and child health (Serum and vaccine

production) 11,550Maternal and child health services 8,300Environmental sanitation 7,950 6,800Public -health administration (School of public

health) 15,100 25,900Public- health administration (Medical library

organization) 7,000 5,600 6,650

Finland

Tuberculosis 12,250 12,250Venereal diseases and treponematoses 3,500Endemo- epidemic diseases 7,000 7,200Public- health administration 17,300 10,200 15,000Nursing 15,950 7,250Social and occupational health 44,400 16,200 12,800Maternal and child health 17,000 9,750Environmental sanitation 23,900 2,850 3,200Public- health administration (Medical library

organization) 2,300 7,700

France

Endemo- epidemic diseases (Trachoma, Algeria) 21,635 17,285

GreeceTuberculosis (Demonstration and training centre) 16,471 67,004 52,429Venereal diseases and treponematoses 1,300Endemo- epidemic diseases 7,200 10,550Public -health administration 10,550Maternal and child health (Rural health services) 2,660 10,650 7,800Public -health administration (Assistance to school

of public health and other educational institu-tions) 7,187 7,450 13,950

Public -health administration (Medical libraryorganization) 1,300 5,400 1,300

Morocco (French Protectorate)Endemo- epidemic diseases (Trachoma) . . . 12,450 12,450Maternal and child health 7,000

Spain

Endemo- epidemic diseases 13,500 39,700 22,500Health education of public 7,450 9,500Maternal and child health 7,000 7,000Environmental sanitation 5,450Public- health administration (Public- health train-

ing school and library) 10,250 11,800Maternal and child health (Care of premature

infants, fellowships) 6,500

Trieste

Tuberculosis (Fellowships) 3,100 4,050Social and occupational health (Fellowship) . . 3,500 1,550 4,650 .

Maternal and child health (Fellowships) . . 950 1,900Mental health (Fellowships) 1,450Nutrition (Fellowships) 1,400 1,550 1,550


Projects


Completedprojects

Continuingprojects

Continuedprojects

Newprojects

Continuedprojects

Newprojects


Tunisia

Endemo- epidemic diseases (Trachoma) . . . 10,900 10,900Maternal and child health 7,000

Turkey

Tuberculosis (Chemotherapy) 750Venereal diseases and treponematoses 19,900 47,094 40,329Endemo- epidemic diseases 17,700 8,850Public -health administration 10,500 28,077 8,850Maternal and child health 28,800 11,959 24,110Nursing (School of nursing) 28,250 33,227 21,827

Yugoslavia

Tuberculosis 44,000 49,000Endemo- epidemic diseases 25,700 18,000Endemo- epidemic diseases (Assistance to virus

laboratories) 30,800Endemo -epidemic diseases (Assistance to micro-

biological laboratories) 66,465Public -health administration 19,200 20,100Public -health administration (Health statistics) 1,300 3,500Health education of the public 46,950Maternal and child health (Rural services) . . 7,900 6,600Mental health 1,300 2,200Nutrition 45,175

sanitation 67,060Public -health administration (Medical library

organization) 44,050 29,300 30,200Environmental sanitation (Institute of hygiene) 1,300 19,400

Inter -Country Programmes

Endemo- epidemic diseases (Brucellosis centre) 6,600 6,600Social and occupational health 3,775Health education of the public 6,000

TOTAL - EUROPE 273,325 265,218 314,711 321,385 551,030 71,850

Eastern Mediterranean

Cyprus

Public -health administration (Regional radio-logical centre) 1,200

Egypt

Tuberculosis (Demonstration and training centre) 77,690 76,001 42,825Tuberculosis (BCG) 11,037Endemo- epidemic diseases (Bilharziasis) . . . . 13,642 32,935 19,785Endemo -epidemic diseases (Trachoma) . . . . 92,386Public -health administration (Health demonstra-

tion area) 20,000 114,047 135,067Public -health administration (Hospital adminis-

tration) 4,000 7,800Nursing (Advisory team) 20,943Nutrition (Pellagra) 2,600 7,800Therapeutic substances and insecticides (DDT

production) 2,500 38,654 29,436Malaria and insect control (Malaria training

institute) 30,834


Projects


Completedprojects

Continuingprojects

Continuedprojects

Newprojects

Continuedprojects

Newprojects


Egypt (Continuation)

Malaria and insect control (Insect -borne diseases,fellowships) 2,700

Endemo -epidemic diseases (Trachoma) . . . . 2,142 9,234Endemo -epidemic diseases (Virology, fellowships) 7,000Endemo- epidemic diseases (Plague, fellowships) 4,500Public- health administration (Visiting team of

medical scientists) 14,500Social and occupational health (Fellowships) 7,500Environmental sanitation (Ibrahim University) 10,550 12,001Environmental sanitation (Alexandria University) 7,750

Ethiopia

Tuberculosis (Tuberculosis centre) 46,143 48,570Tuberculosis (BCG) 25,402Venereal diseases and treponematoses 35,431 40,352 30,352Endemo -epidemic diseases (Leprosy) 7,692 1,308Public -health administration 3,330 8,001 8,001Maternal and child health 49,660Public -health administration (Training centre for

auxiliary personnel) 32,311Environmental sanitation (Fellowships) . . .

8,000 8,000

Iran

Tuberculosis (Demonstration and training centre) 88,992 67,679 58,354Tuberculosis (BCG) 11,134Venereal disease and treponematoses 23,042 40,727 30,352Endemo -epidemic diseases (Trachoma) . . . . 3,000 96,386Endemo- epidemic diseases (Leprosy) 8,401 2,375Public- health administration . . . . . . 15,890 30,907 29,190Public -health administration (Rural health survey) 5,850Social and occupational health (Survey) . . . 6,450Maternal and child health 25,000 37,660 37,135Nutrition 10,050Environmental sanitation (Insect -borne diseases) 29,500 20,124 37,299Endemo -epidemic diseases (Trachoma, fellow-

ships) 1,600Public -health administration (Health demonstra-

tion area, Egypt, fellowships) 1,500Public -health administration (Regional radio-

logical centre, fellowships) 4,500Public -health administration (Vital and health

statistics, fellowships) 4,750Public- health administration (Assistance to me-

dical schools) 13,751 40,004Public -health administration (Visiting team of

medical scientists) 10,000 10,000 15,000Public -health administration (Dentistry, fellow-

ships) 9,000Nursing (Training school) 7,193 32,918 42,353Nutrition 4,000 38,952


Projects


Completedprojects

Continuingprojects

Continuedprojects

Newprojects

Continuedprojects

Newprojects


Iraq

Malaria and insect control 42,170 32,252 21,285Tuberculosis 67,000 61,477 66,854Tuberculosis (BCG) 6,784Venereal diseases and treponematoses (Bejel) 17,875 19,585Endemo- epidemic diseases (Bilharziasis) . . . . 19,513 21,551Endemo- epidemic diseases (Leprosy) 1,533 7,242Public -health administration (Advisory team) 2,142 23,236 22,786Public- health administration (Rural health centre) 49,432 47,486Maternal and child health (Demonstration and

training centre) 34,142 37,135Malaria and insect control (Fellowships) . . .

2,700Endemo- epidemic diseases (Trachoma, fellow-

ships) 800Public -health administration (Health demonstra-

tion area, fellowships) 1,500Public -health administration (Regional radio-

logical centre, fellowships) 4,500Nursing 20,567 11,134Health education of public (Fellowships) 4,000Environmental sanitation (Training of sanitary

inspectors) 7,400

Israel

Malaria and insect control (Insect -borne diseases) 29,000Tuberculosis 27,000 43,901 30,635Venereal diseases and treponematoses . . . . 200Endemo- epidemic diseases (Zoonoses) 4,900Endemo- epidemic diseases (Central diagnostic

laboratory and serum and vaccine laboratory) 6,800Nursing (Training school) 14,119 22,951 20,351Nursing (Nursing college) 38,952Environmental sanitation (Fellowships) . . . 9,200

Jordan

Tuberculosis (Demonstration and training centre) 57,884 35,135Tuberculosis (BCG) 6,642 11,134Endemo- epidemic diseases (Trachoma) . . . . 32,386Public -health administration (Rural health centre) 48,297 49,486Public -health administration (Public -health labo-

ratory) 8,449 17,134 12,134Malaria and insect control (Fellowships) . . . . 2,700Endemic- epidemic diseases (Fellowships) . . . 800Public -health administration (Long -term fellow-

ship programme) 8,000Environmental sanitation (Fellowships) . . . 4,500

Lebanon

Malaria and insect control 32,800 32,990 4,000Tuberculosis (Demonstration and training centre) 54,660Public -health administration 12,150 8,000


Projects


Completedprojects

Continuingprojects

Continuedprojects

Newprojects

Continuedprojects

Newprojects

US$ US$ US$ US$ US$ US$Lebanon (Continuation)

Public -health administration (Rural health deve-lopment programme) 42,321 47,486

Maternal and child health (Demonstration andtraining centre) 17,090 24,180

Environmental sanitation 4,500Endemo- epidemic diseases (Trachoma, fellow-

ships) 800Public -health administration (Health demon-

stration area, Egypt, fellowships) 1,500Public -health administration (St. Joseph Univer-

sity) 14,600 10,850Nursing 13,850Environmental sanitation (Fellowships) . . . . 4,500

:ibya

Malaria and insect control (Insect -borne diseases) 13,776Tuberculosis 11,134Public -health administration 22,000 22,775 22,580Health education of public 22,451 8,001Maternal and child health (Demonstration and

training project) 11,143 19,135Nutrition (Survey, Cyrenaica) 3,900Public -health administration (Training of auxi-

liary personnel) 25,378Nursing (Fellowships) 10,800Nursing (Education programme) 9,851 16,702

'akistan

Tuberculosis (Demonstration and training centre,Karachi) 49,725 44,670 20,568

Tuberculosis (Demonstration and training centre,Dacca) 16,000 46,186 51,686

Tuberculosis (BCG demonstration and training) 11,134Venereal diseases and treponematoses (Demon-

stration and training centre, Chittagong) . . 49,255 32,919Venereal diseases and treponematoses (Demon-

stration and training centre, Karachi) . . . . 23,275 34,944Endemo- epidemic diseases (Cholera) 8,900 122,885 103,580Public -health administration (Field training area,

Lahore) 65,899 59,487Maternal and child health (Demonstration and

training centre, Karachi) 25,710 30,270Maternal and child health (Children's hospital,

Karachi) 18,318 31,486Maternal and child health (Demonstration and

training centre, Dacca) 3,425 34,002 30,270Maternal and child health (Demonstration and

training centre, Lahore) 38,420 21,955Maternal and child health (Demonstration and

training centre, Peshawar) 15,350 28,450 20,680Environmental sanitation 8,236


Projects


Completedprojects

Continuingprojects

Continuedprojects

Newprojects

Continuedprojects

Newprojects

US$ US$ US$ US$ US$ US$Pakistan (Continuation)

Therapeutic substances and insecticides (DDTproduction) 11,600 38,437 29,219

Endemo- epidemic diseases (Trachoma, fellow-ships) 1,600

Public -health administration (Regional radio-logical centre, fellowships) 9,000

Public- health administration (Assistance tomedical schools) 36,577 24,002

Public -health administration (Punjab Institute ofHygiene) 4,300 14,151 16,002

Nursing 7,009 6,784Nursing (Training school, Dacca) 2,160 26,218 17,918Environmental sanitation (Fellowships) . . . 4,500

Saudi ArabiaMalaria and insect control 51,190 20,352 20,352Venereal diseases and treponematoses . 15,043 41,202 30,352Endemo- epidemic diseases (Quarantine station) 8,000 26,452 16,002Public -health administration 5,184 8,018Public -health administration (Central diagnostic

laboratory) 26,226Environmental sanitation (Training course for

sanitarians) 15,959 16,918Endemo- epidemic diseases (Trachoma, fellow-

ships)

Somalia

Malaria and insect control 55,952

Sudan

Tuberculosis 3,829 9,918Endemo- epidemic diseases (Cerebrospinal menin-

gitis) 78,138

Syria

Malaria and insect control 14,567 52,352 25,352Tuberculosis 79,197 71,012Venereal diseases and treponematoses (Bejel/

syphilis) 20,952 20,352Endemo- epidemic diseases (Bilharziasis and

malaria) 47,014 37,600Public -health administration 9,151 16,002Maternal and child health 6,580 28,135 23,635Endemo- epidemic diseases (Trachoma, fellow-

ships) 1,600Public- health administration (Health demonstra-

tion area, Egypt, fellowships) 1,500Public- health administration (Regional radio-

logical centre, fellowships) 4,000Nursing (Training programme) 10,945 33,656 40,075

Yemen

Public -health administration 4,575 8,001

'rater- Country Programmes

Endemo- epidemic diseases ( Bilharziasis survey) 2,480Endemo -enidemic diseases (Trachoma) . . . . 20,552


Projects


Completedprojects

Continuingprojects

Continuedprojects

Newprojects

Continuedprojects

Newprojects

US$ US$ US$ US$ US$ US$Inter - Country Programmes (Continuation)

Endemo- epidemic diseases (Seminar on eyediseases) 15,800

Public -health administration (Vital and healthstatistics) 1,400

Public- health administration (Regional trainingcourse in radiology) 57,600

Nursing (Regional college) 33,101 45,052Health education of public (Joint UNESCO/

WHO fundamental education project) 30,235 19,785Maternal and child health (Group fellowship in

paediatric education) 20,200Environmental sanitation (Sanitary engineering

group fellowship) 22,100

TOTAL - EASTERN MEDITERRANEAN 82,430 927,052 1,607,001 1,109,148 2,060,860 690,420

Western Pacific

Brunei

Nursing 8,271

Cambodia

Malaria and insect control 15,960 19,591 22,234Tuberculosis 1,426 6,192 18,742Maternal and child health 19,600 9,015 9,015Public -health administration (School for " offi-

ciers de santé ") 28,819 28,369

China (Taiwan)Malaria and insect control 37,040 29,686 42,486Venereal diseases and treponematoses 40,235 14,785Endemo- epidemic diseases (Trachoma) . . . . 11,300Maternal and child health 13,065 36,535 21,535Environmental sanitation 10,500Endemo- epidemic diseases (Plague, fellowships) 5,000Public -health administration (Fellowships) . . . 10,500Nursing .24,310 50,809 52,390

Hong KongTuberculosis 5,000Maternal and child health 12,180 35,219 30,219Nursing 5,717

JapanEnvironmental sanitation 26,443Public -health administration (Hospital admini-

stration, fellowships) 7,000Public -health administration (National institute

of health and national hygiene laboratory,fellowships) 10,500

Nursing (Fellowships) 3,700Environmental sanitation (Fellowships) . . . . 9,500

Korea

Public -health administration 50,822 50,000


Projects


Completedprojects

Continuingprojects

Continuedprojects

Newprojects

Continuedprojects

Newprojects


Laos

Malaria and insect control 23,712 20,712Venereal diseases and treponematoses 13,100 35,512 27,512Maternal and child health (Demonstration and

training centre) 11,991 15,008Public -health administration (Fellowships) . . 5,000 6,000 6,000

Nursing (Fellowships) 3,000 6,000 6,000

Malaya

Tuberculosis 11,226

Endemo- epidemic diseases (Rabies) . . . . . 3,200Public- health administration (Rural health

training centre) 10,859 15,868Nursing 18,300 41,551 42,031

Netherlands New Guinea

Malaria and insect control (Fellowships) . . . 5,000 5,000

North Borneo

Tuberculosis 1,000Nursing 30,440 23,265 29,11.5

Philippines

Malaria and insect control (Malaria pilot project) 23,940 25,308 13,279Tuberculosis 11,890 11,837Endemo- epidemic diseases (Bilharziasis pilot

project) 18,200 33,244 32,569Public- health administration (Vital and health

statistics) 7,800Public- health administration (Fellowships) . . . 7,000 42,500Public -health administration (University of the

Philippines) 34,104 11,922Nursing (Fellowships) 6,150 25,500Nursing (Midwifery training)Nutrition (Fellowships)

9,0849.000

Sarawak

Malaria and insect control (Malaria pilot project) 24,480 19,310 17,593Public -health administration (Health survey) . 4,500Health education of public 5,950 13,484 6,784Public -health administration (Fellowships) . . . 3,340Environmental sanitation (Fellowships) . . . . 2,700

Singapore

Public -health administration (Urban health centre) 4,500 47,404Public- health administration (University of

Malaya) 11,750 77,607 64,007Nursing (Education programme) 5,290 11,584 18,318

Viet Nam

Malaria and insect control 16,300 11,039Tuberculosis 1,426 15,282 13,517


Projects


Completedprojects

Continuingprojects

Continuedprojects

Newprojects

Continuedprojects

Newprojects

Viet Nan (Continuation)

Public- health administrationPublic -health administration (Hospital planning)Maternal and child health


Malaria and insect controlVenereal diseases and treponematosesNursingPublic- health administration (Visiting team of

medical scientists)Public -health administration (Health statistics

seminar)Nursing (Seminar)Nutrition (Training course)Environmental sanitation (Training course) .

TOTAL - WESTERN PACIFIC

Region Undesignated

Bahrein

Tuberculosis

Countries Undesignated

TuberculosisPublic- health administration (Supply services)Public- health administration (UNRWAPRNE)Tuberculosis (inter- regional tuberculosis con-

ference)Venereal diseases and treponematoses (Inter-

regional course on venereal- disease control)Venereal diseases and treponematoses (Yaws

seminar)Endemo- epidemic diseases (Rabies seminar,

New Delhi)

TOTAL - REGION UNDESIGNATED

TOTAL

US$

6,000

25,40025,500

US$

25,0206,2009,130

US$

15,91234,00019,708

US$

21,326

7,800

I7,400

US$

17,692

28,252

7,800

US$

65,000

21,400

120,761 333,107 575,743 298,366 690,079 318,086

47,000

49,750

2,8009,700

3,0007,335

94,250

38,130

44,188

13,96617,902

25,700

96,750 12,500 10,335 132,380 58,154 43,602

721,233 3,448,377 5,404,602 4,178,437 7,202,926 2,096,092*

* This is made up of :

Advisory and Demonstration ServicesEducation and Training Services

$ 944,188$1,151,904


Appendix 5

COMMUNICATION FROM THE INTERNATIONAL DENTAL FEDERATION

24 January 1953Dear Sir,

The International Dental Federation has the honour tosubmit to the Director -General of the World Health Organiza-tion the following memorandum and hopes that he willfind it of sufficient importance to place before the currentsession of the Executive Board.1

The official relationship between the World Health Organi-zation and the International Dental Federation has existedsince 1948 and the Federation now asks that the appointmentof a permanent dental officer may be considered, as it isfelt that with no permanent contact it is impossible for theFederation to give the practical assistance in dental matterswhich the World Health Organization may ask for as partof the field of public health. Furthermore, it is believed thata permanent dental officer would be essential in the buildingup of any dental public -health programme.

In several sessions of the World Health Assembly resolu-tions were passed regarding the necessity of adding odonto-stomatology to the activities of the World Health Organization.In the First World Health Assembly, 1948, it was agreed torefer the Polish proposal on dental medicine and stomatologyto the Executive Board for study.2

[The original letter goes on to mention other WHO resolu-tions on the subject of a dental -health programme, quoting thatof the Executive Board at its second session (Official RecordsNo. 14, page 21), of the Fourth World Health Assembly (reso-lution WHA4.5), and of the Executive Board at its eighthsession (resolution EB8.R10).]

In 1950 the World Health Organization appointed Dr.Philip Blackerby of Battle Creek, United States of America,as a short -term dental consultant. Dr. Blackerby after threemonths presented his report.

After a lapse of two years, Professor G. Toverud of Oslo,Norway, was appointed on 1 December 1952 as a short -termconsultant for five months, so that his appointment will endon 30 April 1953.

This is a brief summary of what has happened since 1948and the Council of the International Dental Federation isof the opinion that short -term dental consultants are of littlevalue in building up a practical dental programme.

The Federation believes, on the other hand, that a per-manent dental officer can be of the greatest help both for theaims of the World Health Organization and for the usefulco- operation of the International Dental Federation, and

' In accordance with paragraph (3) (iii) of WHO's principlesfor relations with non -governmental organizations

2 Off. Rec. World Hlth Org. 13, 153

urges the continuance of the term of office of the presentdental consultant, and asks that in the budget for 1954 asum be set aside for a permanent dental officer.

From 1948 up to this year, the representative of the Inter-national Dental Federation, Dr. A. E. Rowlett of Leicester,Great Britain, has had discussions in Geneva on the variousproblems in the field of odonto -stomatology, and during thefirst week of the current session of the Executive Board,Dr. C. F. L. Nord of Amsterdam, the Netherlands, hasvisited Geneva as the representative of the Federationand has reported to the Council that not only was hereceived in the most courteous manner by the various officersof the World Health Organization whom he asked to see,but also that his views were received sympathetically whenhe stated his opinion that the absence of a permanent dentalofficer made the establishment of a dental programme well -nigh impossible, but that the presence of Professor Toverud-even for so short a time in office-considerably facilitatedthe necessary contacts.

The Council considers that measures in preventive dentistrycan only be a success in the future, from the world healthpoint of view, when studies on an international level havepreceded eventual conclusions. This means :

(1) Study of nutrition and diet ;(2) Methods of fluoridation of the drinking water andother sources ;(3) Topical application of fluorine ;(4) Correct methods of oral hygiene and conservativetreatment.

Furthermore, little improvement on methods can be expectedif there is no international agreement upon standard methodsof control (e.g. on the incidence of dental caries) and an inter-national agreement on ancillary personnel for the applicationof preventive methods.

Close co- operation will make it possible, with little costto the World Health Organization, to establish and furthera preventive dental -health programme for the benefit of allparties concerned. The International Dental Federationwould be most willing to assist in this way.

In conclusion, it is hoped that these brief remarks haveemphasized the importance which the International DentalFederation places on this matter, and it earnestly requeststhat consideration be given to the desirability of continuingthe work of the present dental consultant, and to the appoint-ment of a permanent dental officer in 1954.

Yours faithfully,(signed) Gerald LEATHERMAN

Secretary- General

[EB11 /81]31 January 1953

II. WHO PARTICIPATION IN THE

UNITED NATIONS EXPANDED PROGRAMME OF TECHNICAL ASSISTANCE 1

The Executive Board presents to the Sixth WorldHealth Assembly its report concerning the partici-pation of WHO in the United Nations ExpandedProgramme of Technical Assistance.

Since the Fifth World Health Assembly autho-rized the Executive Board to act on its behalf inconnexion with any aspect of the programme(resolution WHA5.61), the Board took action oncertain of the questions dealt with in this report,as indicated in the resolutions which it has trans-mitted to the Sixth World Health Assembly (EB11.R57 and EB11.R57.1 -9).

The Board appreciated the presence of the Execu-tive Chairman of the Technical Assistance Boardat the time of its study of this item of its agenda. Hisstatement to the Board is reproduced as Appendix 1to this report.

In making this report to the Sixth World HealthAssembly on the participation of the World HealthOrganization in the United Nations ExpandedProgramme of Technical Assistance, the ExecutiveBoard calls particular attention to developmentsduring 1952 which will have a decisive effect on theprogramme in 1953. The first financial period ofthe programme (1 July 1950 -31 December 1951)saw the slow development of a new approach tointernational co- operation for the economic develop-ment of under -developed countries. The secondfinancial period (1952) has been one of great increasein activities under the Expanded Programme asdemonstrated by the detailed information whichappears in the first part of this report.

1. Report on 1952 Activities

The rate of growth of WHO's part in the ExpandedProgramme of Technical Assistance in 1952 isstrikingly brought out by the large number of pro-jects in operation on 31 December 1952 or for whichextensive planning and preparations for implemen-

1 For composition of the Working Party on the ExpandedProgramme of Technical Assistance, by which this report(along with resolutions EB11.R57 and R57.1 -9) was submittedto the Board, see Annex 2.

tation had been substantially carried out by thegovernments and the Director -General. The develop-ing of health activities demands long planning andnegotiation with the government and the processof finding and engaging suitable experts and makingcertain that equipment and supplies will be on handfor demonstration and training projects. Fundsbecame available to WHO from the ExpandedProgramme in the latter half of 1950 and thenecessary preparations before operations could beginprevented the programme from getting well launchedbefore the latter part of 1951.

Projects in Operation

At the end of 1951, there were 71 projects inoperation or under way. The comparable figure for1952 was 167 ; their distribution by countries andthe type of programmes are given in Appendix 2.A list of the 22 projects completed in 1952 alsoappears therein. During 1952, 92 agreements weresigned with governments for Technical Assistanceprojects.

Requests received

The growing awareness among the technicallyless developed countries of their need for TechnicalAssistance in the health field as an integral part ofprogrammes of social and economic developmentis reflected in the numbers of requests WHO hasreceived in this programme. By the end of 1952,there were 127 new requests from 55 countries andterritories. This figure does not include requests fromhealth authorities for additional personnel andfellowships in connexion with projects alreadyplanned or started.

Fellowships

In general, fellowships under the Expanded Pro-gramme were awarded in 1952 as in the past as partof a project, in order to train personnel to continueand to enlarge the programme after internationalassistance was withdrawn. Appendix 3 gives the

--95-


breakdown of the 369 fellowships awarded in 1952by the country or territory of origin of the Fellowsand their fields of study.

Experts

As compared with the 155 experts recruited in1951, during 1952 there were 220 experts recruited.On 31 December 1952 there were 247 experts workingin projects under the Technical Assistance pro-gramme. There is attached as Appendix 4 a tableshowing their numbers by nationality and theirdistribution in the regions.

The Board was informed that the Economic andSocial Council, at a meeting on 22 July 1952, adopteda resolution 2 expressing to the participating organi-zations its satisfaction at the work of the large numberof experts working in the field in this programme ;it also noted with gratification the truly internationalcharacter which had been significant in the imple-mentation of the programme. This aspect of theWHO programme of Technical Assistance is illus-trated in Appendices 2, 3 and 4.

2. Legislative Developments in the Administration ofthe Expanded Programme of Technical Assistance

As a result of a review by the AdministrativeCommittee on Co- ordination and the TechnicalAssistance Committee of the Economic and SocialCouncil, a reorganization of the Technical AssistanceBoard was established by the Economic and SocialCouncil at its fourteenth session, and the basicresolution on Technical Assistance, ECOSOC reso-lution 222 (IX), was amended by ECOSOC reso-lution 433 A (XIV) at that session (see Appendix 5).The Technical Assistance Committee of the Economicand Social Council also adopted a resolution definingin some detail the functions to be performed by theExecutive Chairman (see Appendix 6).

The Executive Board wishes to call the attentionof the Sixth World Health Assembly to the fact that,although the Third World Health Assembly notedwith approval the original establishment of theadministration of the Expanded Programme ofTechnical Assistance (resolution WHA3.116), theWorld Health Assembly has not yet considered theamendments thereto which were adopted in July1952 by the Technical Assistance Committee andthe Economic and Social Council (Appendices 5and 6).

A full -time Executive Chairman of the TechnicalAssistance Board, Mr. David Owen, formerlyUnited Nations Assistant Secretary- General for

2 ECOSOC resolution 433 B (XIV)

Economic Affairs, was appointed. The Secretariatof the Technical Assistance Board was considerablystrengthened and 19 resident Technical Assistancerepresentatives were appointed to 23 countries.

Review and Supervision of the Expanded Programme

Although the revised system, as defined in theresolutions cited above, has been in operation onlya short time, it is already evident that the detailedexamination of the development of the programmeand its operation by the Executive Chairman andthe Technical Assistance Board has a considerableeffect on the work carried out by the organizationsparticipating in the Expanded Programme ofTechnical Assistance.

The guiding principles set up by the Economic andSocial Council in resolution 222 (IX) provide thatthe projects falling within the competence of parti-cipating organizations should be carried out bythem ; that the co- ordination of their work shouldbe effected with due regard to their constitutions andthe relations established between them ; and thatthe work undertaken by the participating organiza-tions under the Expanded Programme should besuitable for integration with their normal work.The reorganization which has been introducedtends to strengthen the centralization of the opera-tion of this programme, and to that extent intro-duces complexities and to some degree limits thefreedom of choice and action of the participatingorganizations, although the decision as to the kindof service to be rendered to each country is, as in thepast, based on the request of the government con-cerned.

The Executive Chairman, under the terms of hisinstructions from the Economic and Social Council,is required to undertake an annual review of theprogramme of the participating organizations, andthe Council has laid down that all programmes andprojects, both current and proposed, are subject toprior review and approval by the Board on the basisof recommendations by the Executive Chairman,regardless of whether they are to be financed fromfunds which have been allocated automatically, orfrom funds allocated from the Retained Contribu-tions Account. In pursuance of this policy theExecutive Chairman appointed four consultantsduring the months of October and November 1952to review the total proposed programme of theparticipating organizations for 1953. Further detailsof this review are given in Section 3 below.

It is clear that the Economic and Social Counciland the General Assembly of the United Nationshave been concerned with regard to the supervision

REPORT : EXPANDED PROGRAMME OF TECHNICAL ASSISTANCE 97

of the Expanded Programme. Not only had theyearlier recommended to the participating agenciesthat their respective parts of the Expanded Pro-gramme should be reviewed and approved by theirown governing bodies, but, as a result of the recentreorganization, a central review has also beenintroduced. In the case of WHO, both the ExecutiveBoard and the World Health Assembly have fromthe very beginning reviewed and approved WHO'spart of the Expanded Programme activities. It is,of course, necessary for the Executive Chairman andthe Technical Assistance Board, who are responsiblefor co- ordinating the total programme, to draw upguiding principles for the development of the pro-gramme, and review it for the purpose of achievingintegration and balance.

The Board took note of the statement of theTechnical Assistance Committee on the administra-tion of the Expanded Programme 3 to the effect that :

the TAB secretariat should be strengthened asthe Chairman finds it necessary. The secretariatshould, however, be limited in size to the minimumnecessary to carry out its duties. Wheneverpossible, such services as are available in theSecretariat of the United Nations and participatingagencies should be utilized in order to avoidunnecessary expense, and the TAB staff should inno way duplicate the technical skills provided bythe specialized agencies, or substitute its judgmentfor the judgment of the agencies in technicalmatters.In view of the developments in the organization

of the administration of the Technical Assistanceprogramme, the Executive Board adopted resolutionEB 11.57.2.

Co- ordination at Country Level, Resident TechnicalAssistance Representatives

The Economic and Social Council having stressedthe importance of the co- ordinating function as anessential measure for economic development atthe country level,4 the reorganization has also hadthe purpose of ensuring a wider application of thisprinciple through the appointment of residentTechnical Assistance representatives in additionalcountries where Technical Assistance programmesare in operation.

As foreseen in the Constitution, WHO is graduallyassuming its proper role, " to act as the directingand co- ordinating authority on international healthwork."5 The Director- General has therefore

8 UN document E/2238, para. 14UN document E/2238, paras 20 and 21

5 Constitution, Article 2 (a)

appointed area representatives who are expected toassist in co- ordinating all internationally assistedhealth activities in many countries where largehealth programmes are now in operation, financednot only from WHO and Expanded Programmeresources, but also from those of bilateral and multi-lateral health agencies.

Another function of WHO, according to theConstitution, is " to establish and maintain effectivecollaboration with ... governmental health admi-nistrations ... " 6 It is therefore the opinion of theExecutive Board that WHO is not in a position tointerpose any other administrative unit for communi-cations with health ministries, to or substituteindirect channels such as the resident TechnicalAssistance representatives referred to above. Theconstitutional provision for direct relationship withhealth ministries was made because technical nego-tiations between the Organization and the govern-ment could be undertaken only through such directcontact.

In the case of WHO, the Organization's represen-tatives work not only on Technical Assistanceactivities but on equally important regular pro-gramme activities. It would, therefore, be quiteimpracticable to interpose the resident TechnicalAssistance representatives in their contacts with thehealth ministries.

As has been said, it was the gradual growth of thehealth programmes in under -developed countriesparticularly which necessitated the appointment ofWHO area representatives as co- ordinators ofinternationally -assisted publichealth programmes.The same type of development has also taken placein other organizations, which appoint chiefs ofmission in countries where they are undertakinglarge activities. The relationship between the agencyrepresentatives and the resident Technical Assistancerepresentatives is in the process of evolution. Experi-ence will show how collaboration can best beachieved between them in the interests of betterinternational aid to the requesting governments.

The Executive Board was aware of the report ofthe Technical Assistance Committee concerningthe difficulties of defining precisely the day -to -dayrelationship of resident representatives with theexperts appointed by participating organizationsand the agreement of the committee that :

Subject to the general principles of resolution222 (IX), the resident representatives shouldperform the following functions, it being under-stood that the closest contact and co- operation will

6 Constitution, Article 2 (b)7 UN document E/2238, para. 20


be constantly maintained between the residentrepresentatives and the officers of the participatingagencies, and the local representatives of bilateraland other multilateral programmes :

(a) Co- operate with and assist the governmentof the country concerned in making arrange-ments designed to facilitate the development ofplans and projects and be available to thegovernment in the development of such plans.(b) Co- ordinate and integrate the expandedtechnical assistance activities of the participatingagencies within a country, relying on repre-sentatives of the participating agencies forjudgments on technical matters, and provideadministrative support as required.

The Executive Board, in view of the above consi-derations, adopted resolution EB11.R57.3.

3. Review by the Technical Assistance Board of the1953 Programme

As stated earlier, the Executive Chairman of theTechnical Assistance Board appointed four consul-tants to carry out a review of the programmes andprojects proposed to be carried out by the participat-ing organizations in 1953. The consultants reportedto the Executive Chairman, who used their recom-mendations, at his discretion, in the course of thetwenty- second meeting of the Technical AssistanceBoard.

The study by the consultants was made entirelyon the documents submitted to them by the parti-cipating agencies. Furthermore, they had no back-ground of any specific field of activity of the parti-cipating agencies except that they had all had a longexperience of administration in the economic fieldin different parts of the world. The study wasbelieved by the Technical Assistance Board to beof value in that it provided the first basis on whichthe Board could undertake a project -by- projectreview of the total programme as planned and asit is largely in operation at present, in accordancewith the request of the Technical Assistance Com-mittee and the Economic and Social Council.

The Board was informed that the main conclusionsto be derived from the study were :(1) The need for a more equitable geographicaldistribution of Technical Assistance. It was appa-rent from the study that in many instances countrieswere receiving Technical Assistance at a higherproportionate rate than the relative size of theirpopulations and geographical areas would indicate,while other countries were receiving considerablyless. While the consultants recognized that in sucha programme no equitable distribution throughout

the world can be achieved except over a considerableperiod of time, they pointed out that the TechnicalAssistance Board should begin to take the factorinto serious account. In studying this aspect ofthe problem they had tried as far as possible toascertain what aid, other than that from the UnitedNations, such governments were receiving. Thebasis for this computation was recognized as notentirely adequate, but was the best available tothem.

(2) In discussing the principles for the programmereview the consultants were confronted with agreat many complicating factors which made theirtask very difficult. It was not possible for them toassess the relative merits of the various types ofactivity, but as economists they came to the conclu-sion that by and large the activities undertaken bythe participating organizations under the ExpandedProgramme were of the right type and were beingimplemented very well. Their tentative recommen-dations were that the first task of the ExpandedProgramme should be to foster measures, bothdirect and indirect, for increasing food productionand availability. The second, they felt, should bethe development of new forms of production outsidethe field of food and new sources of productiveactivity for the rising populations. The increase ofefficiency in production and distribution was theirthird objective. They also stressed, as the fourthpoint, that the Technical Assistance programmeshould include a large provision for education andtraining.

Without a good knowledge of the specialized fieldeof activity of the various participating agencies, itwas natural that the consultants found themselvesin difficulties in evolving any detailed principles ofpriority. In the health field, they considered that theprimary objective of the Expanded Programme shouldbe the reduction of the incidence of debilitatingdiseases, with a view to improving the efficiency ofproduction and distribution. The Executive Boardwas informed that during the discussions in theTechnical Assistance Board, with the consultantsparticipating, it became quite evident that theirinevitable lack of knowledge of the principles onwhich publichealth work is based made it impossiblefor them properly to assess the various types ofactivity undertaken by WHO. For example, secondpriority was given to WHO projects designed toimprove publichealth administration and environ-mental sanitation and to train rural public- healthand district nurses. The consultants indicated thatthey had grave doubts about the inclusion in theExpanded Programme of such projects as those


relating to maternal and child health, nutritionprojects of the nature of those for improving foodlaws, etc., and projects for " tours of teams ofdistinguished medical scientists " (medical teachingmissions). They considered that the impact of theseactivities on economic development was so remotethat they not only gave them the lowest prioritybut doubted their inclusion in the programme at all.

The Executive Board concurred in the very con-siderable extent of disagreement with the details ofthe priority classification suggested by the consul-tants which the representatives of WHO had indi-cated at the twenty- second meeting of the TechnicalAssistance Board. It understood that the consul-tants fully realized that it is the agency itself which hasthe competence in its own field, in consultationwith the requesting governments, to draw up itspart of the programme whose larger objective is

economic development. WHO has developed broadcriteria, and indications of priorities within thosecriteria, in its general programme of work for aspecific period (approved by the Executive Boardat its fifth and seventh sessions and by the Thirdand Fourth World Health Assemblies 8). The basiccriteria were believed by the Executive Board to bestill valid, but in the light of the development of aprogramme review by the Technical AssistanceBoard and its Executive Chairman, a certainextension and amplification was felt desirable.

The principles of the Economic and Social Council,as laid down in its basic resolution and the subsequentdiscussions at the Technical Assistance Committeeand the Technical Assistance Board, show that theprimary objective for economic development is tohelp countries to strengthen their national economythrough the development of their industries andagriculture. The technical assistance provided shouldincrease the productivity of material and humanresources so as to contribute to higher standardsof living for the entire population. Social conditionswhich directly affect economic development mustform an important part of this programme. It isfully realized that assistance must be given to helpcountries to meet their basic needs, but the urgencyof the needs of different countries varies, and equit-able distribution is not easy to achieve. The inte-gration of different programmes and the concentra-tion of effort must be stressed.

Of Rec. World Hlth Org. 25, 30 ; 28, 15 ; 32, 55 ; 35, 71

The Executive Board also recalled that the FourthWorld Health Assembly, in resolution WHA4.27,had requested " that in the future special attentionshould be given by the Executive Board and theDirector -General to the importance of assistingMember States, particularly under- developed States,to draw up short- and long -term health programmesfor their respective territories, in order to promotethe orderly development of public -health measuresand to utilize to the best advantage, along with thenational resources, the help that may becomeavailable from time to time from WHO and othersources."

The Executive Board, after studying the variousaspects of the review of the Technical Assistanceprogramme, adopted resolution EB11.R57.1 (Legis-lative responsibility for the review and approval ofthe programme) and resolution EB11.R57.6 (Criteriafor the development of health aspects of the pro-gramme).

4. The Financial Situation Anticipated for 1953

The Executive Board understood that one of themost serious factors which entered into the pro-gramme review mentioned above was that agencieshad made plans to use more money in 1953 thanappeared in December 1952 to be at the disposal ofthe Technical Assistance Board to allocate. TABat its twenty- second meeting (December 1952)examined the financial position of the programmeon the basis of available resources and those expectedfrom payment of unpaid pledges for the first twofinancial periods, as well as anticipated collectionof pledges still to be made in 1953. The TechnicalAssistance Board had agreed to the ExecutiveChairman's estimate of funds which would be avail-able for expenditure in 1953 as follows : 9

1. Contributions : US $

First period (actual) . . . . 19,739,000

Second period (estimated) . . 17,000,000

36,739,000

2. Expenditures :

First period (actual) . . . 6,439,000

Second period (estimated) . 19,500,000

25,939,000

3. Special Reserve 3,000,00

TAB document TAB /SR.22, Annex I


4. Estimated carry -over to 1953(excluding special reserve) . .

5. Estimated collections in 1953 on1953 pledges (a) Minimum . .

6. Estimated funds to be availablefor all purposes (a) Minimum

7,800,000

17,500,000

25,300,000

The Executive Board noted that, while the estimateof collections in 1953 is very conservative, theTechnical Assistance Board does not have a workingcapital fund on which to draw pending the paymentof pledges, although a Special Reserve of $3,000,000has been established. The Technical AssistanceCommittee, the Economic and Social Council andthe General Assembly 10 of the United Nations haverecommended a target of the equivalent of approxi-

mately $25,000,000 in contributions for 1953. TheUnited Nations Negotiating Committee is consultinggovernment representatives in an attempt to reachthis amount, and the formal pledging conference(Technical Assistance Conference) will meet inNew York on 26 and 27 February. If this 1953target is reached and the corresponding pledges paidearly enough, and also if the pledges in arrears for1952 and 1951 are paid promptly, the serious finan-cial situation with which WHO is confronted in thisprogramme for 1953 could be largely alleviated.Information regarding the collection of contribu-tions for the first two financial periods of theprogramme appears in Appendices 8 and 9.

The decisions of the Technical Assistance Boardwith regard to financing the programme in 1953follow : 11

TABLE I

Central Administrative and Indirect Operational Costs

1.

2.

Estimated funds to be available for all purposes

Earmarked as ceilings for (a) central administrative and (b) indirectoperational costs, when lumped together, by agencies :

US $

25,300,000

UNTAA 955,000ILO 457,000FAO 1,204,000

UNESCO 581,000

ICAO 190,000

WHO 914,000 12

4,301,000

3. Earmarked for TAB Secretariat 450,000

4. Earmarked for resident Technical Assistance representatives . . 949,000

5. Balance available for approved projects and programmes 19,600,000

6. Total 25,300,000

10 A /Resolution /84 of the seventh session (see Appendix 7)11 TAB document TAB /SR.22, Annex II12 It should be noted that this exceeds the amount estimated by WHO to be required for this purpose ; the amounts were

earmarked on a percentage basis, and all savings will be available to WHO for meeting project costs.


TABLE II

Total Amounts, . by Agency "

Agency Amountearmarked

Amountreserved

Totalfor projects

Centraladministrativeand indirect

operational costs

Total

US$ US$ US$ US$ US$

UNTAA . . . 2,177,000 2,176,000 4,353,000 955,000 5,308,000ILO i,041,000 1,041,000 2,082,000 457,000 2,539,000FAO 2,744,000 2,745,000 5,489,000 1,204,000 6,693,000UNESCO . . . 1,325,000 1,325,000 2,650,000 581,000 3,231,000ICAO 431,000 431,000 862,000 190,000 1,052,000WHO 2,082,000 2,082,000 4,164,000 914,000 5,078,000

Totals 9,800,000 9,800,000 19,600,000 4,301,000 23,901,000

In view of the financial crisis confronting theExpanded Programme, the Executive Chairmanappeared before the Economic and Social Councilon 16 December and made the statement whichappears in Appendix 10.

The seriousness for WHO of the financial situa-tion for 1953 in the Technical Assistance programmeis obvious : the 1953 column of the ProposedProgramme and Budget Estimates for the FinancialYear 1954 14 shows that $9,455,358 would be requiredto finance the work planned to be carried on underthe Technical Assistance programme in 1953. Thecost of merely carrying on, in 1953, projects inoperation as at 31 December 1952, plus the continuingcentral administrative and indirect operational costs,would be $6,550,000.

The representatives of WHO at the twenty -second meeting of the Technical Assistance Boardemphasized the adverse effect which the financialsituation would have on the Technical Assistanceprogramme now being carried out by WHO. TheWHO statement was incorporated in the record ofthe meeting (see Appendix 11).

In the face of the financial crisis, which involvesthe entire programme of WHO, the Director- Generalfelt it imperative that all Members of WHO be

13 The amounts " earmarked " for each agency are forthose projects and programmes in operation prior to 1 March1953 ; the amounts " reserved " for future earmarking foreach agency at the Technical Assistance Board's twenty -third meeting in March 1953 are for projects and programmesto be approved at that time on the basis of the review ofprogrammes at that meeting.

1J Of Rec. World Hlth Org. 44, 36

advised of the situation. Accordingly, on 19 Decem-ber 1952 he cabled all Member States and AssociateMembers as follows :

IN MEETING ECOSOC 16 DECEMBER EXECUTIVECHAIRMAN TECHNICAL ASSISTANCE BOARD MADESTATEMENT REGARDING EXPANDED PROGRAMME

TECHNICAL ASSISTANCE ECONOMIC DEVELOPMENTCONFIRMING AND REINFORCING HIS FORMER STATE-MENTS TO SECOND COMMITTEE GENERAL ASSEMBLYSTOP I WISH TO DRAW YOUR ATTENTION TOCONCLUSION EXECUTIVE CHAIRMAN REGARDINGFINANCIAL SITUATION THIS PROGRAMME AFTERREVIEW 22ND SESSION TAB STOP HE FURTHERSTATED THAT AT 23RD SESSION TAB IN FEBRUARYOR MARCH THERE WILL BE ANOTHER REVIEW FINAN-CIAL SITUATION AND IF SUBSTANTIAL AMOUNT UN-PAID PLEDGES NOT RECEIVED BY THEN OR IF TARGETOF 25 MILLION IN FIRM PLEDGES FOR 1953 NOTREACHED IT WILL BE NECESSARY FOR SOME AGENCIES

TO CUT BACK POSTPONE OR ABANDON WORKALREADY STARTED AND THEY WILL NOT BE ABLETO EMBARK ON ANY NEW DEVELOPMENTS SAVE AT THE

EXPENSE OF COMMITMENTS ALREADY ENTERED INTO.

ONE OF AGENCIES REFERRED TO BY EXECUTIVECHAIRMAN IS WHO WHICH HAS NOW REACHEDPOINT WHERE NO NEW PROJECTS MAY BE STARTEDAND PROJECTS ALREADY IN OPERATION MAY BECURTAILED OR ABANDONED IN 1953 SHOULD

APPEAL OF EXECUTIVE CHAIRMAN FOR PROMPTPAYMENT OF UNPAID PLEDGES AND GOAL OF 25MILLION FOR 1953 NOT RECEIVE FAVOURABLE

ANSWER FROM PARTICIPATING GOVERNMENTS


IN VIEW OF RECOGNIZED IMPORTANCE OF HEALTHPROGRAMMES IN ECONOMIC DEVELOPMENT I FEEL

MY DUTY INFORM YOUR GOVERNMENT THIS SITUA-TION AND SUGGEST YOU TAKE ANY ACTION YOUFEEL APPROPRIATE FOR HELPING NEGOTIATING

COMMITTEE OF GENERAL ASSEMBLY AND TECHNICAL

ASSISTANCE CONFERENCE MEETING LATTER PARTJANUARY REACH 25 MILLION TARGET FIXED BYGENERAL ASSEMBLY FOR 1953 TECHNICAL ASSISTANCE

PROGRAMME PLEDGES

CHISHOLM UNISANTÉ

The Executive Board was informed that the govern-ments which have to date replied to this cableindicate their concern at the unsatisfactory financialcondition of the Technical Assistance programme.

5. The Problem to be met as a Result of the FinancialSituation

The Organization, at the time of the eleventhsession of the Executive Board, was in the difficultposition of having a well planned Technical As-sistance programme for 1953, developed by theregional committees and the Director- General, recom-mended by the Executive Board, and approved bythe World Health Assembly, for which the Organiza-tion would not have sufficient funds from the UnitedNations Special Account. It was also clear thathealth programmes must be based on a great dealof forward planning in which not only WHO butalso the health administrations must negotiate andbuild up details of projects to meet the needs of thecountries. In addition, the governments must budgetin advance to meet the local costs of the internationalprojects. This was done ; a well -planned programmewas in operation. Governments had made provisionin their own budgets for these projects and hadplanned to provide for the growth and expansion ofthe programme, and for new activities. The ExecutiveBoard was much concerned with the unfortunateeffect on the present and future health activities ofthe countries, if, instead of following the natural,logical course of development in the approvedprogrammes, many activities had to be cut down orsuspended at this stage. The Executive Board,as early as its seventh session, foresaw the need forassuring adequate financing for the programme whenit adopted resolution EB7.R84 which, inter alia," notes that many projects under Technical As-sistance for Economic Development may requirefinancing for not less than two or three years, andthat fully integrated programmes need to be estab-lished for each country and, where possible, for

each region " ; and " draws the attention of theTechnical Assistance Committee to the desirabilityof examining the necessity for long -term planning,and, in particular, for contributors to TechnicalAssistance funds to undertake to continue theircontributions over a period of several years, whichwould enable the participating organizations toinitiate and carry out longer -term projects ".

The alternatives which the Board considered were :(1) Finding additional sources of funds, e.g. bysupplementary contributions to the budget ofWHO by the Member governments. The pos-sibility of voluntary contributions was foreseen bythe Fourth World Health Assembly (resolutionWHA4.41).

(2) Authorizing the Director - General to drawon the Working Capital Fund 15 to the extentauthorized to finance these activities for the timebeing, the expenditure from the Working CapitalFund to be made good by reimbursement fromthe Special Account in the event that funds becomeavailable, or by a supplementary budget to reim-burse the Fund later.(3) Investigating the possibility of obtainingadditional UNICEF support for those healthactivities of WHO which meet the eligibilityrequirements of UNICEF ; in addition, in manyother programmes of common interest to WHOand UNICEF, UNICEF could be requested toconsider providing a larger share of the supplies,thereby releasing WHO funds for other activities.The Director - General has already opened nego-tiations with the Executive Director of UNICEFto investigate these possibilities.(4) Investigating the possibility of either bilateralor multilateral programmes of Technical Assistancetaking over some of the planned activities of thoseactually in progress in the health field to a greaterextent than they have done before.(5) Requesting the Director - General to continueto operate in accordance with the approved pro-gramme for 1953 in the hope that in March of thatyear, when the Technical Assistance Board reviewsthe financial situation after governments have madetheir pledges for 1953, further sums of money willbe available. To the extent that the funds nowavailable and which are later available permit theprogramme to be implemented, WHO would con-tinue to implement it. If, later in the year, sufficientfunds are not available, as many projects as neces-sary would be brought to a close or suspended.

15 See resolution WHA5.18.


(6) Requesting the Technical Assistance Boardto institute a United Nations Appeal for TechnicalAssistance on the lines of the United NationsAppeal for Children.The Executive Board, having studied the above

alternatives, adopted resolution EB11.R57.4. Italso felt that every possible measure should be takento avoid in future years such a critical financialsituation, and with that goal in view adopted resolu-tion EB11.R57.9.

6. Participation of Member States in Certain Costsincurred in the Operation of Technical AssistanceProjects

The Executive Board recalled that the Fifth WorldHealth Assembly (resolution WHA5.59) consideredthat the then existing regulations with respect to theparticipation of governments in costs incurred bythe participating agencies in the operation of variousTechnical Assistance projects presented serious ob-stacles to the provision of Technical Assistance ;the Health Assembly had recommended a broader,more flexible policy to meet this problem.

The Technical Assistance Committee at the four-teenth session of the Economic and Social Council(July 1952) considered the problem and reported asfollows :

16

The Committee noted that certain recipientcountries felt that the costs they were expected tobear under the present system constituted tooheavy a burden, thereby preventing them fromtaking as full advantage of the Programme asthey otherwise might. In expressing this view, therepresentatives of these countries on the Com-mittee stressed that the costs of lodging, localtransportation and travel per diem of experts,and the external travel costs of fellowships andscholarships awarded under the Expanded Pro-gramme, should be the responsibility of the par-ticipating organizations if the Programme wasto be effectively carried out. While other delega-tions were not prepared to go so far as this, it wasunanimously agreed by the Committee and theparticipating organizations that the present methodof assessing local costs had given rise to difficultiesand that certain specific local costs, which up tothe present had been listed as a normal charge onrecipient governments, were in many cases imped-ing the normal implementation of the Programme.

It was felt that various alternative methods ofassessing local costs had not been sufficiently

16 UN document E/2304, paras 25 -28

explored either by the Committee or by the Techni-cal Assistance Board. The resolution adopted bythe Technical Assistance Committee is intended tofacilitate the current operation of the Programme.However, the Committee would discuss the wholequestion of local costs again as soon as possibleon the basis of a full report to be submitted by theBoard.

As an example of alternative methods of assess-ing local costs the Technical Assistance Boardmight give consideration to the possibility ofsubstituting for the detailed breakdown of localcosts to be borne by governments, as listed inthe Santiago Resolution of TAC, a system of lump -sum contributions towards local costs. A methodof assessment which might be followed would befor recipient governments to contribute at thebeginning of each financial year a fixed percentageof the estimated costs to the agencies of theirprogrammes in that country, agency by agency.A justification of the disbursements made by theagencies would be furnished at the end of the year.The views of the Technical Assistance Board wererequested on this proposal, together with theirrecommendations as to the percentage rate whichmight be adopted.

In the meantime the Committee wished to callthe attention of the Board to the desirability ofimplementing its resolution on local costs in sucha manner as to provide the necessary relief en-visaged under the resolution, thus facilitating theconclusion of agreements of Technical Assistance.

The Technical Assistance Committee at its twenty -seventh meeting, in July 1952, adopted the resolutionon local costs which appears in Appendix 12. TheTechnical Assistance Board was obliged, by therequest of the Technical Assistance Committee, toexplore alternative methods of assessing local costs.To meet that obligation, the Board developed thesystem described in Appendix 13. The representativesof WHO and UNESCO recorded certain objectionsto the proposal, in so far as it related to a lump -sumcontribution in local currency for fellowships(Appendix 14).

The Executive Board was informed that the pro-posed plan would be considered by the TechnicalAssistance Committee at its next meeting.

The Executive Board, having considered the plansubmitted to the Technical Assistance Committee bythe Technical Assistance Board, adopted resolutionEB11.R57.5. In adopting this resolution the Exe-cutive Board kept in mind the resolution of theFifth World Health Assembly on this subject ; inview of the present financial situation, it also took


account of the fact that to remove entirely the presentrequirement that governments pay the local costsfor experts would require for WHO an additional$400,000 to $600,000 from the Special Account in1953.

7. Other Items for Information

(1) Conditions of Service for Technical AssistanceExperts

After a considerable period of attempting toadjust the conditions of service of Technical As-sistance experts to the normal practices of the variousparticipating agencies, the Executive Chairmanannounced the policy to be followed by all participat-ing agencies in the employment of Technical As-sistance experts, and the policy was adopted by theTechnical Assistance Board at its twenty- secondmeeting. This policy statement is reproduced asAppendix 15.

The Executive Board took note of these conditionsof service in resolution EB11.R57.7.

(2) Briefing of Experts serving in the ExpandedProgramme

The Executive Board was informed that, pursuantto a decision of the Technical Assistance Board,17

the Executive Chairman had appointed an expert tosurvey the present arrangements for the briefing andorientation of experts, to make a preliminary ap-praisal of the effectiveness of these arrangements andto formulate suggestions, if necessary, for theimprovement of the existing practices, including thedesirability and possibility of establishing a jointbriefing centre.

The Technical Assistance Board considered theconsultant's findings and recommendations 18 indetail and agreed that : each agency should give dueemphasis to briefing and, if practicable, employ abriefing and reports officer ; the agencies in Genevashould give further consideration to the possibilityof integrating their briefing resources ; the agencybriefing officers should meet together in 1953 ; atthe present time no action should be taken to estab-lish regional briefing centres (one of the chiefproposals of the consultant), but a specialist onbriefing should be attached to a selected residentTechnical Assistance representative ; and furtherdetails of the possible improvement of briefing pro-cedures should be developed at a later date.'9

The need for proper briefing on social and culturalaspects was emphasized at the twenty -second meeting

17 TAB document TAB /SR.18 /Rev.1, paras 81 -8218 TAB document TAB /R.203 and Add.l12 TAB document TAB /SR.22 paras 39 -40

of the Technical Assistance Board. The ExecutiveBoard was informed that WHO has continued toutilize the Briefing Committee previously establishedat headquarters and the Organization has indicatedits willingness to co- ordinate its efforts in briefingwith those of the other agencies in so far as theregionalized structure of WHO will permit.

In this connexion, the Executive Board recalledthe standards of work and personnel set out inresolution 222 (IX) of the Economic and SocialCouncil and believes that the adequate briefing ofexperts is important in order that they may under-stand the objectives of the programme and WHO'srole therein.

(3) Fellowships and Training

The Executive Board was informed that the Techni-cal Assistance Committee in its fifth report to theEconomic and Social Council20 noted with satis-faction that " in all cases ... the training schemesprovide for the personnel trained through interna-tional assistance to be usefully employed afterwardsfor the benefit of the country ". The committee" also hoped that continued efforts would be directedtowards the development of training facilities withinthe recipient countries themselves ". Regardingseminars, the committee stated that " in view of thelimited financial resources available, such seminarsas may be organized should deal with subject- mattersof unquestionable value to economic developmentwhich lend themselves to this particular form ofassistance ; seminars should be carefully preparedand should not be too brief nor their attendance toolarge. The governments concerned should be in fullagreement as to their usefulness."

(4) Equipment and Supplies

The Executive Board was informed that the Techni-cal Assistance Committee had made the followingobservations on this subject :

21

The Committee noted the policy followed bythe [Technical Assistance] Board regarding theprovision of equipment under the ExpandedProgramme. Under this policy the participatingorganizations exercise their judgment as to themerits of each case and determine the amountof equipment to be provided for each project. TheBoard indicated that whenever the cost of equip-ment surpasses 25 per cent of the total cost of theproject for which it is provided -as in demonstra-tion projects -this information is reported to

80 See UN document E/2304, paras 14 -17.-21 UN document E/2304, paras 19 -20


the Chairman. The Committee recommended thatillustrative information of such cases be includedin future TAB reports.

Late delivery of equipment having sometimesproved to be a major obstacle in the operationof important projects, it would be desirable forgovernments of equipment -supplying countriesto take steps to improve the situation, providedspecific cases are brought to their attention.

(5) Utilization of Non - Convertible Currencies

The Executive Board noted that the followingobservation of the Technical Assistance Committeewould, if followed, have certain repercussions on thecase of currencies other than US dollars or Swissfrancs in the regular budget of WHO : 22

The Committee noted that, in order to preservethe international character of the programme,special efforts are being made by the Board andthe participating organizations to find appropriateuses for non -convertible currencies contributed tothe Special Account. However, to the extent thatthese efforts do not yield results in securingtechnical services or equipment usable under theExpanded Programme, it should be possible forthe organizations to make arrangements for theexchange of currencies in the Special Accountwith other currencies available to these organi-zations under their regular programmes.The Executive Board was informed of the extensive

efforts which the Director- General has made toutilize the various currencies and services availableunder the Special Account.

(6) Definition of Central Administrative Costs,Indirect Operational Costs, and Project Costs

The Technical Assistance Board has adopteddefinitions of the above costs which, in the case ofcentral administrative costs, follow the definitionoriginally adopted by the Executive Board at itssecond session.23 The definitions are reproduced inAppendix 16.

(7) Audit Reports relating to Expenditure by Spe-cialized Agencies of Technical Assistance Fundsallocated from the Special Account

The United Nations General Assembly on 20December 1952 24 accepted the audit reports relatingto expenditure by specialized agencies of TechnicalAssistance funds allocated from the Special

22 UN document E/2304, para. 2123 Off Rec. World Hlth Org. 14, 43, 1724 At its 409th plenary meeting (A /Resolution /57)

Account for the first financial period, and took noteof the observations thereon of the Advisory Com-mittee on Administrative and Budgetary Questions.

Among the observations made by the AdvisoryCommittee were the following : 25

In appraising the above figures, the AdvisoryCommittee takes account of the following con-siderations : (a) that indirect operational costs(grouped in the above table with administrativecosts), though not directly identifiable with specificprojects, are essentially of an operational cha-racter ; and (b) that heavy administrative costswere unavoidable during the initial stages of theExpanded Programme. But, allowing for theseconsiderations, the Committee still finds theproportion of administrative costs to total expen-diture to be extremely high. It is possible, in itsopinion, that central servicing units have beenexpanded in advance of actual needs and on a scalewhich is not warranted by the present developmentof direct country activities. This aspect of thequestion appears even more important than theprecise volume of expenditure already incurred.The Committee specifically recommends that thecompetent legislative bodies of the specializedagencies should give this subject adequate consi-deration.

As regards the definitions laid down by TABfor " central administrative costs ", " indirectoperational costs " and " project costs ", theAdvisory Committee suggests that efforts shouldbe made to distribute indirect operational coststo the respective projects, possibly on a generalpro rata basis. It presumes that there will be acontinuous exchange of views between agenciesin order to obviate possible differences in thetreatment of expenditure under these main headsamong the participating organizations.

The Executive Board, after considering paragraphs(6) and (7) above, adopted resolution EB11.R57.8.

(8) LegislativeActivities

Review of Technical Assistance

The United Nations Advisory Committee onAdministrative and Budgetary Questions 26 in itstwenty -fifth report, to the seventh session of theUnited Nations General Assembly, commented asfollows :

26 UN document A/2270, paras 7 and 1026 UN document A/2287, paras 31 -32


It appears that, although adequate arrangementsexist for the scrutiny of past activities, the legislativebodies in most cases do not take an active part inthe formulation of programmes and the approvalof projects. The body at present entrusted withthe approval of projects is the Technical AssistanceBoard, which is composed of secretariat repre-sentatives. The Advisory Committee is of theopinion that projects should receive advanceconsideration by legislative bodies, if only inbroad outline, and that a review of projects,whether continuing or terminated, should be madeat periodic intervals. Thus, the necessary measure

of co- ordination can be assured between activitiesunder the regular budget of the agencies and thoseunder the technical assistance programme.

The Committee also suggests that the admi-nistrative costs of technical assistance programmesshould be subjected to detailed examination bythe competent committees of agencies in orderthat such items may receive the same severescrutiny as regular expenses.The Executive Board wishes to call attention to the

fact that, in the case of WHO, the Board and theWorld Health Assembly have exercised the respon-sibilities mentioned by the Advisory Committee.

Appendix 1[From EB1I /Min /17 Rev.l]

20 March 1953

STATEMENT OF THE EXECUTIVE CHAIRMAN OF THE TECHNICAL ASSISTANCE BOARDAT THE ELEVENTH SESSION OF THE EXECUTIVE BOARD

Mr. OWEN, Executive Chairman, Technical AssistanceBoard, speaking at the invitation of the Chairman, statedthat the Expanded Programme of Technical Assistance wasone of the great constructive international enterprises of thetimes, in which the United Nations and all the specializedagencies shared. It was also a great experiment not only inthe international economic field but also in administrativeco- ordination. The Technical Assistance Board was importantnot only as the instrument for carrying out the ExpandedProgramme but also as an experiment in co- ordinating theefforts of a number of international agencies working indifferent specialized fields which did, however, look towardsmuch the same sets of governments for their support. Ata time when governments were meeting with increasingdemands on their funds, it was important that the internationalorganizations should show that it was possible to do greatconstructive work economically and without duplication, andthat each could reinforce the others' work.

As Executive Chairman of the Technical Assistance Board,his responsibility was not merely to make the Expanded Pro-gramme a success but also to act as trustee for the voluntarilycontributed funds of some 65 countries and to see that theprogramme was prudently managed and all resources fullyused. At the same time, he felt himself almost a member ofthe Secretariat of WHO as well as of the other specializedagencies, acting as their servant to help them carry out theirpart of the programme in co-operation with each other.However, the responsibilities incumbent upon the ExecutiveChairman of the Technical Assistance Board involved himin actions which might at times be incompletely understoodby those who were very naturally preoccupied with particularparts of the Expanded Programme.

After the clear statements made at the preceding meetingit was hardly necessary for him to give in detail the reasonsfor the establishment of the Technical Assistance Board orthe various steps that had been taken at the twenty- secondmeeting of that Board to deal with the budgetary situation.He would, however, give some explanation concerning certainpoints which had been touched upon by previous speakers.

It would be recalled that, as a result of the decision takenby the Technical Assistance Committee of the Economicand Social Council, the former system of relying upon certainpercentages for the allocation of Technical Assistance fundshad been substantially modified, and the Technical AssistanceBoard had been made responsible for conducting a reviewof all Technical Assistance requests addressed to any agencybefore the adoption of the annual programme. The Exe-cutive Chairman had also been requested to undertakea review of the programmes of all the agencies and to submitcertain recommendations to the Technical Assistance Boardfor consideration. In pursuance of that request, and consider-ing that his staff was inadequate for the undertaking of socomplex a study, he had appointed four consultants to preparea report which would assist him and the Board to decide onthe programme for 1953. He would point out parentheticallythat those four consultants were not all professional academiceconomists ; they came from very different parts of the world-Argentina, Burma, the United Kingdom and the UnitedStates -but they had all had long experience of administrationin the economic field and all at one time or another in theircareers had been responsible for establishing scales of priorityfor government expenditure.

Their study had shown that the expenditure represented bythe Technical Assistance projects put forward by the different


agencies amounted to almost twice the resources that wouldbe available. It was expected that between 20 and 25 milliondollars would be available ; the aggregate cost of the proposedprojects, however, amounted to some 43 million dollars.The consultants had concluded, after careful examination,that every agency had received requests for enough goodprojects to require the spending of more funds than would belikely to become available. They consequently found itdifficult to apply criteria for establishing priorities along thelines contained in their original terms of reference, and hadsubmitted a report giving their views on how the situationmight be met. Their recommendations had been based onthe principle of ensuring an equitable geographical distributionand upon a general scheme of priorities based not upon whatwould be the priorities in any particular specialized field ofaction, but upon what activities were considered most impor-tant for economic development.

The report had proved most stimulating and useful andhe hoped that all those concerned with the Expanded Pro-gramme of Technical Assistance would discuss it whenconsidering their future policies ; but he would indicatethat it was in no way binding and had not been endorsedeither by himself or by the Technical Assistance Board.He was, however, grateful for the independent advice thathad been given.

The problem, however, was the same whether there existeda report by independent consultants or not ; it was that thenumber of valid projects of assistance in economic develop-ment exceeded the aggregate resources available. He hadtherefore had to make a number of recommendations for the1953 programme, pending further knowledge of what contribu-tions would be received from governments. Some of hisoriginal assumptions had been rather cautious but that, hefelt, was only proper. It did now, however, seem likely thatan additional million dollars would be available which hadnot been foreseen, and it was possible to have a somewhatclearer idea of the amount likely to be received for 1953.Moreover, the target figure for 1953 was 25 million dollars ;he would be surprised if less than 20 to 21 million dollars werereceived, and it was even likely that more than that amountwould be available. He thought it likely that for 1953 therewould be available 3 or 4 million dollars more than the mini-mum figure of 171 /2 million which he had used as the basisof his recommendations to the Technical Assistance Boardin December 1952. If more did become available, then anamount slightly larger than that originally earmarked couldbe distributed to the specialized agencies in March 1953 andwould, he hoped, help to fill the 28 per cent gap which hadbeen referred to at the previous meeting. However, it wouldstill be necessary for WHO to review its programme in orderto see if some pruning could be effected or if certain projectscould not be extended over a longer period in order to meetthe immediate difficulties.

There was a strong case for maintaining that the financesof the Expanded Programme could be placed on a far moresatisfactory basis. It was, for instance, most unsatisfactorythat the funds available for a given calendar year were not

definitely known until the end of February of that year.He had stressed to various bodies of the United Nations theneed for establishing the finances of the programme on apermanent and continuing basis. That others shared thisview was clear from the fact that the Second Committee ofthe current session of the General Assembly had adopted aresolution requesting the Economic and Social Council atits next session to examine the whole matter. There wereconstitutional difficulties in the case of certain governmentswhich found it difficult to make commitments for more thanone budgetary year, but it was possible that the Economicand Social Council might be able to reach a solution enablingthe Technical Assistance Board to consider its action morethan one year in advance. The Second Committee of theGeneral Assembly had also authorized the Economic andSocial Council, when the latter had decided on the targetfigure and the programme to be endorsed for future years,to convene the Negotiating Committee of the General As-sembly (which raised funds for future years) immediatelyafter the 1953 summer session of the Council. That meantthat the negotiating mechanism could be set in action in lateSeptember or early October and the total finances for 1954would be known well in advance. Whatever the figure decidedupon, it would be possible to plan the work for 1954 morerationally.

Another question of importance was that of the administra-tive costs of the Technical Assistance programme. Therecould be no doubt that the existing administrative structurewas better twice as large. Further-more, the theory of Technical Assistance was so acceptableto under -developed countries the world over, and the workperformed seemed to be so valuable, that sound businesscould probably be conducted at twice the present level ofexpenditure. There was thus a case for further expandingthe existing programme whether in the course of one year orover a much longer period of time. There was also, however,a case for a very rigorous examination of administrativecosts. That the administrative structure was costly wasperhaps due to the fact it had originally been designed fora programme expected to be larger. Nevertheless, if anexamination were made of the administrative arrangementsof the various agencies and of the secretariat of the TechnicalAssistance Board, as well as of the very valuable system ofresident representatives, it might be possible to devise anumber of methods for economizing. He doubted whethersuch economies would have an immediate effect upon thepresent financial crisis but at least they would make it possibleto approach governments with a clear conscience that theExpanded Programme was being carried out in the simplestand most expeditious manner.

He had that morning heard a number of speakers referto what seemed a serious financial crisis in WHO ; it wasfeared that the funds expected to become available wouldfall far short of those committed. He reiterated that hethought the gap would in fact prove rather smaller than ithad originally appeared. The Executive Board might wishhim to explain how not only WHO but all the other participat-


ing organizations had fallen into that situation. In the firstyear or two of the Expanded Programme the resources avail-able had considerably exceeded the amount which could beabsorbed in programmes, and a number of governments hadnaturally expressed surprise that the United Nations andspecialized agencies should ask for further funds if they wereunable to use those they already had. The various organiza-tions had therefore been urged to begin operations as soonas possible in order to avoid such criticism and in order toensure continuing financial support. That had been done and,as a result of a natural snow -balling process -one projectrequest leading to another -an understandable situation hadsuddenly arisen in which the Technical Assistance programmewas no longer operating below its resources but was over-committed. The situation, however, was unlikely to recur,since in the future it would probably be possible to planprogrammes considerably ahead.

In order to deal with the crisis he would suggest that theWHO Secretariat again review the programme with a viewto extending its commitments in time where possible. Inthat manner it might be possible to economize on the expen-diture for 1953 to some extent. At the same time it might bepossible to delay fulfilling certain commitments until the endof February 1953, when the amount available would bedefinitely known. On such matters as WHO's negotiationswith UNICEF he would not comment, for they concernedonly the organizations interested. In brief, in view of thefigures he had given, he did not feel that the crisis would beunsurmountable.

He would also make some remarks concerning certainfunctions which had to be performed in common by thevarious agencies, whatever the administrative structure ofTechnical Assistance.

First, there was the problem of the source of funds. Itwas possible that governments might decide to add sub-stantial Technical Assistance funds to the normal budgets ofthe various agencies -but that was unlikely. There wasincreasing disquiet at the number of separate appeals forfunds made to governments. One great merit of the presentscheme was that the eight participating organizations made ajoint request for a single Technical Assistance fund, to whichin 1952 some 65 different countries had made voluntarycontributions in addition to their normal contributions tothe various agencies. The system also had the merit of ensuringa wider range of contributions. But it did produce its owncomplications, one of which was that the contributions weremade in a large number of different currencies. One of themajor problems of the Technical Assistance Board was todetermine how the variety of currencies contributed was tobe used. The freely convertible currencies, ofcourse, presentedno problem, but there were many others which could onlybe used within a limited geographical area or for particularpurposes. One of the achievements of the Technical AssistanceBoard had been made through the missions recently sent outto a number of governments which made substantial contribu-tions but which were reluctant to advance any further fundsif steps were not taken to use the currencies concerned. As

a result of the arrangements made with those governments,it had been possible to add approximately $1,000,000 to theavailable resources in the past few months. That was merelyone of the problems which clearly had to be dealt with centrallyon behalf of all the agencies.

It was also necessary to deal with the question of uniformconditions of service for experts and uniform conditions forthe provision of Technical Assistance to governments. Nothingwas more disruptive to the official life of a mission than thefeeling that there was considerable inequality in the treatmentof different experts, that they were receiving different ratesof pay and working under different conditions of service ;and nothing was more annoying to officials of countriesreceiving Technical Assistance than having to make differentfinancial arrangements to meet the local expenses of thestaff of different agencies. The Technical Assistance Boardhad, however, considered the problem and had made a numberof proposals for its solution. That was another problemrequiring action by a central body.

There was also the matter of the Expanded Programme ofTechnical Assistance itself. That programme had been setup in order to assist the under -developed countries to developtheir economic resources, account being taken of all thefactors affecting such development. There was however aclear implication that care should be taken to ensure thata properly balanced economic programme was instituted.The attempt to ensure balanced economic development hadbeen made at two levels. At the centre, the Technical Assis-tance Board had conducted a programme review and, with theassistance of the four consultants, it had striven to arrive atsome conception of what was going on country by country.At the country level, a system had been adopted of appointingresident representatives who represented all the agenciesconcerned in the country to which they were accredited. Theresults of that system abundantly justified its use and he feltthat it should be strengthened and perhaps somewhat extended,since a properly balanced programme was ensured by dis-cussion and close co- operation with each government orwith the government departments most immediately concerned.It was also necessary to co- operate with other bodies assistinggovernments, such as the Ford Foundation and the agenciesset up under the Colombo Plan and the Point -Four Pro-gramme. A considerable degree of success had been achievedin co- ordinating activities with them and the arrangementswere very largely honoured in the field. It was, of course, inthe field that the most important work was done, and theresident representative, if he was trusted by the agencies andthe government and recognized as representing all the agencies,was a person who could ultimately ensure the success of theprogramme.

Whatever doubts he himself had concerning the futurecertainly did not derive from the quality of the work done sofar. The programme had proved itself eminently successfulin practice, and he was certain that it could be considerablyexpanded in the future and that the governments on whosecontributions it depended would recognize its value and


would be willing to continue their contributions, provided theyconsidered it well managed. His only doubt, indeed, waswhether the administrative structure would commend itselfover a period of time to the contributing governments. Itcould do so only if the participating agencies played a loyaland enthusiastic part in making the experiment work. Hehimself was very gratified at the way in which the variousautonomous agencies, each with their own programmes andpolicies, had managed in so short a time to work out rough-

and -ready but satisfactory solutions to the many problemsof inter -agency co- operation. A number of problems stillexisted, and there was a certain residual fear concerning theautonomy of the agencies. However, he felt certain that byworking together, in the spirit of the resolution setting up theExpanded Programme and of the covenants and constitutionsof each organization, the United Nations and the specializedagencies could make a triumphant success of the ExpandedProgramme.

Appendix 2

WHO TECHNICAL ASSISTANCE ACTIVITIES : PROJECTS IN OPERATION IN DECEMBER 1952

Country TABnumber

Type of programme 1952 obligationsincurred

US $Afghanistan AFG -5 Public- health administrator 8,331

AFG -7 Maternal and child health /venereal- disease control 65,967AFG -11 Professor of epidemiology 18,707

Austria AUS -4 Comprehensive (Public health, etc.) 15,053

Bolivia BOL -5 Children's Hospital, La Paz 21,680BOL -11ECU -34 Field mission on indigenous populations 1,189PER -25

Brunei BRU -1 Nursing education 9,000

Burma BUR -7 Maternal and child health /venereal- disease control 95,722BUR -9 Malaria control 36,776BUR -15 Tuberculosis control 27,897

Cambodia CAM -2 Malaria and insect control 19,506CAM -5 Maternal and child health 21,135

Ceylon CEY -3 Health education 12,353CEY -9 Maternal and child health 22,614CEY -15 Training centre for control of insect -borne diseases 16,841CEY -16 Tuberculosis control 6,725CEY -18 Hospital dietetics 5,369CEY -19 DDT plant 16,004CEY -23 Nursing education (Kandy) 19,833CEY -48 Environmental sanitation (Fellowships) 4,600

Chile CHI -10 Pilot plant for penicillin 7,547

China CHA -3 Maternal and child health 16,370CHA -4 Malaria control 46,685CHA -5 Nursing 19,720

Colombia COL -7 Maternal and child health 20,225COL -11 Insect control 45,926COL -14 Public -health administration (Fellowships) 6,475COL-27 Public -health administration (Expert assistance) 2,429

Costa Rica COS -13 Nursing education 69,392

Cuba CUB -9 Insect control (supplies purchased) 6,525


Country TABnumber


US $Dominican Republic DOM -2 Insect control 80,234

Ecuador ECU -10 Tuberculosis training centre 27,340ECU -18 Yellow -fever control 8,263ECU -20 Venereal- disease control 31,636ECU -28 Assistance to national institute of health 5,713

Egypt EGY -1 Health demonstration area 24,930EGY -14 Bilharziasis control 13,365EGY -17 Trachoma control 2,916EGY -19 DDT plant 6,659EGY -29 Tuberculosis control 64,534EGY -31 Nutrition (Pellagra) 3,786

El Salvador SAL -3/4 Health demonstration area 103,724

Ethiopia ETH -4/5 Venereal- disease control 36,405ETH -6 Public -health administration 3,754ETH -7 Leprosy control 8,493

Finland FIN -6 Comprehensive (Public health, etc) 92,192

French West Africa FWA -1 Malaria control 4,885

Greece GRE -6 Control of tuberculosis and other communicable diseases : Assistanceto medical training institutions 33,451

GRE -13 Maternal and child health 4,526

Haiti HAI -7 Health education 16,867HAI -22 Insect control (supplies purchased) 451

Honduras HON -5 Health education 10,069

Hong Kong HOK -1 Maternal and child health 4,335

India IND -2 Food production and health standards 60,291(FAO /WHO)IND -7 Antibiotics production 44,749IND -14 Venereal- disease control 3,700IND -22 Principal, Trivandrum Medical College 7,730IND -23 DDT plant 4,500IND -26 Professor of pharmacology 3,036IND -31 Population studies 14,611IND -36 Professor of physiological and industrial hygiene 7,411IND -46 Physiotherapy school 4,921IND -54 Tuberculosis control 100,046IND -57 Yaws control 4,769

Indonesia INS -1 Health education (supplies purchased) 2,017INS -4 Malaria control 22,574INS -7 Nutrition institute 11,321INS -9 Tuberculosis control 33,498INS -10 Treponematosis control 17,033INS -13 Maternal and child health 20,348

Iran IRA -5 Insect control (supplies purchased) 22,170IRA -7 Venereal- disease control 22,352IRA -19 Public -health administrator 17,255IRA -21 Trachoma control 3,200IRA -23 Nursing education (Tabriz) 11,708IRA -28 Tuberculosis control 51,739IRA -29 Maternal and child health 20,470IRA -45 Vital statistics 5,249IRA -52 Dentistry 6,900

Iraq IRQ -1/24 Bejel /syphilis control 19,910IRQ-1 3 Leprosy control (supplies purchased) 80


Country TABnumber


US $Iraq (Continuation) IRQ -15 Malaria control 46,793

IRQ -16 Tuberculosis control 35,564IRQ -37 Public -health administration 3,330

Israel ISR -7 (b) Environmental sanitation (Fellowships) 9,999ISR -7 (y) Tuberculosis control (Supplies purchased) 15,602ISR -15 (b) Nursing school 18,688ISR -32 Zoonoses control 4,952

Jamaica JAM -8 Tuberculosis control 4,010

Japan JPN -4 Fellowships in various fields 18,786

Jordan JOR -11 Environmental sanitation (Fellowships)JOR -20 Public -health laboratory 7,776

Laos LAO -I (d) Yaws control 14,453LAO -1 (c) Public -health administration (Fellowships) 5,040

Lebanon LEB -6/9 Environmental sanitation 6,936LEB -10 Malaria control 36,703LEB -11 Public -health administrator 13,268LEB -12 Maternal and child health 24,530LEB -13 Public -health nursing 13,235LEB -21 Lecturer in preventive medicine 11,758

Liberia LIR -7 Public -health administration 4,810LIR -9 Yaws control 6,221LIR -16 Malaria control 4,870LIR -17 Health education (Supplies purchased) 621

Libya LIB -1 Public- health administration 28,110LIB -10 Health education 6,599

Malaya MAL -1 Nursing school 26,669MAL -6 Rabies control 3,402

Mexico MEX -6 Veterinary public health (Rabies control) 29,010MEX -9 Health education 16,768

Nicaragua NIC -3 Health education 14,226

North Borneo NBO -2 Nursing school 31,351

Pakistan PAK -9 Cholera control 10,772PAK -11 (a) Venereal- disease control, Karachi 25,888PAK -33 Nursing School, Dacca 4,778PAK -21 Establishment of DDT plant 11,325PAK -34 (b) Maternal and child health, Lahore 42,142PAK -34 (e) Tuberculosis demonstration and training centre, Karachi 51,560PAK -34 (f) Tuberculosis demonstration and training centre, Dacca 16,500PAK -34 (c) Maternal and child health (Demonstration and training centre, Peshawar) 23,389PAK -34 (d) Maternal and child health (Demonstration and training centre, Dacca) . 4,523PAK -35 Field training area 1,494

Panama PAN -10 Public- health administration 19,017

Paraguay PAR -3 Maternal and child health 13,483PAR -4 Ankylostomiasis and smallpox control 57,863PAR -5 Venereal- disease control 20,714PAR -7 Tuberculosis control 50,888PAR -10 Insect control 8,553

Peru PER -8 Insect control 2,749PER -12/30 Public- health administration 2,943PER -15 Clinical- history records library 7,418PER -24 Public -health administration 11,141PER -26 Tuberculosis control 606PER -27 Maternal and child health 481


Country TABnumber


US $

Philippines PHI -19 (a) Bilharziasis control 23,182PHI -19 (b) Malaria pilot project 30,707PHI -23 Nursing 5,830PHI -28 Veterinary public health 4,715

Sarawak SAR -2 Malaria control 27,325SAR -4 Health education of the public 15,305

Saudi Arabia SAU -2 Quarantine station for pilgrims (Supplies purchased) 2,988SAU -3 Venereal -disease control 10,190SAU -5 Malaria control 53,359

Singapore SIN -1 Medical education (University of Malaya) 7,890SIN -3 Maternal and child health 6,193

Spain SPA -2 Zoonoses control and meat inspection 17,102

Syria SYR -1 Malaria control 24,897SYR -14 Maternal and child health 7,171SYR -15 Public- health nursing 7,859

Thailand THA -10 Health education 8,060THA -12 Maternal and child health 29,892THA -13 Tuberculosis control 44,187THA -27 Rural maternal and child health and publichealth nursing 15,656THA -29 Treponematosis control 33,534THA -39 Malaria control (Fellowships) 1,845

Trieste TRI -2 Fellowships in various fields 11,542

Turkey TUR -6 Public -health administration 15,887TUR -27 Maternal and child health 18,556TUR -20 Nursing education 23,539

Viet -Nam VIE -2 Public -health administration 19,566VIE -3 Malaria control 19,747VIE -4 (a) Maternal and child health 289VIE -4 (b) Hospital organization 5,272

Yugoslavia YUG -7 Comprehensive (Communicable- disease control, etc.) 294,415

Regional Projects in Operation

The Americas GUA -9HON -7 Insect control (Central America) 19,646NIC -4PAN -12JAM -10 etc. Insect control (Caribbean Area) 11,355CHI -18 Inter -American Center of Biostatistics (UN, TCA) 6,466GUA -12 Nutrition (INCAP) 3,473GUA -13 Venereal -disease control (Training centre) 17,692LAT -3 Environmental sanitation 2,149

WHO TECHNICAL ASSISTANCE ACTIVITIES - PROJECTS COMPLETED IN 1952

Brazil BRA -27 Nutrition survey, Amazon Valley 2,022

Burma BUR -19 Public -health administration 190

Colombia COL -10 Public health (Fellowships)Egypt EGY -26 Public- health administration (Hospital organization and management) 3,929

India IND -20 Training in tuberculosis nursing 564

Iran IRA -6 Industrial health survey 7,285IRA -22 Nutrition survey 11,206IRA -30 Medical education 7,389*IRA -41 Rural- health survey 6,107

* This project was listed as completed in 1951 but further expenditure was incurred in 1952.


Country TABnumber


US $

Israel ISR -15 (c) (d) Central diagnostic and serum laboratory (Survey) 2,914ISR -19 Venereal- disease control (Survey) 182

Mexico MEX -15 Course for nursing instructors 24,791

Philippines PHI -16 Medical social science (Fellowships) 3,750

Syria SYR -7 Bilharziasis survey 2,782

Turkey TUR -19 Venereal- disease control (Survey) 14,472TUR -21 Tuberculosis control (Chemotherapy) 850

Regional FRA-1 Nutrition training course for African Region (with FAO) 21,905WEP-3 Health statistics training course for Western Pacific Region (with United

Nations) 30,845JAP -2MAL -4 Nursing education 6,297)}

PHI -27WEP -1 Nursing education 34,952

Inter -Regional MID -4WEP -4 Rabies seminar and training course in Coonoor 50,717SEA -2PHI -12LIR -4

Yaws control (Symposium in Bangkok) 49,621

Appendix 3

NUMBER OF FELLOWSHIPS AND SCHOLARSHIPS AWARDED UNDER TECHNICAL ASSISTANCE IN 1952

By Country or Territory of Origin

African Region Paraguay 1 Egypt 5

Belgian Congo 3Venezuela 1 Eritrea 1

French Cameroons 2 Windward Islands 7 Ethiopia 1

French Equatorial Africa . 1Iran 18

French West Africa 2 South -East Asia Iraq 2

Liberia 4 Afghanistan 1Israel 7

Madagascar 2 Burma 6 Lebanon 3

Nigeria 1 Ceylon 3 Libya 3

Portuguese Guinea 1 India 13 Pakistan 5

Sao Tomé 1 India, Portuguese 1Syria 3

French Togoland 1 Indonesia 13 Western PacificThailand 5

Australia 6The Americas

Europe Cambodia 3

Bolivia 6 China 7

Brazil 1Austria 5 Hong Kong 2

Colombia 5 Finland 27 Japan 9

Costa Rica 5 France 1* Korea 5

Ecuador 5 Greece 9 Laos 8

El Salvador 3 Netherlands 1* Malaya 7

Guatemala 1Spain 3 Netherlands New Guinea . . . 1

Haiti 2 Trieste 7 New Caledonia 1

Honduras 1Turkey 7 North Borneo 1

Jamaica 2 United Kingdom 1* Papua and New Guinea . . . . 1

Mexico 7 Yugoslavia 73 Philippines 14Netherlands Antilles 3 Sarawak 2Nicaragua l Eastern Mediterranean Singapore 3

Panama 3 Cyprus 2 Viet Nam 1

* Group discussion leaders


By Field of Study

Public -health administration 22 Mental health and child guidance 3 Venereal- disease control . 33

Hospital administration . 6 Health education 6 Tuberculosis control 23

Environmental sanitation . 16 Occupational health 5 Endemo -epidemic diseasesFood and drug control 5 Nutrition and dietetics 27 control 83

Nursing (including public healthand midwifery) 52

Health statisticsDental care and hygiene

18

2

Clinical and medical sciences :Education 31

Maternal and child health. 26 Malaria control 11 Total 369

Appendix 4

WHO TECHNICAL ASSISTANCE PROGRAMME ACTIVITIES IN 1952 :DISTRIBUTION OF EXPERTS BY NATIONALITY

CountryTotal number

of experts(all regions)

Experts on Duty as at 31 December 1952 ExpertsRecruitedin 1952 1

RegionsTotal number

of experts(all regions)Africa Americas South -East

Asia Europel EasternMediterranean

WesternPacific

Argentina 2 2 2

Australia 3 1 2 1

Austria 3 2 1 1

Belgium 3 1 2 3

Bolivia I 1

Brazil 12 12 10

Canada 23 2 10 1 4 6 15

Ceylon 2 2 I

Chile 6 5 1 2

China 2 2

Colombia 5 5 1

Costa Rica 1 1

Cuba 1 1 l

Denmark 11 2 1 7 1 9

Ecuador 1 1 2

Egypt 7 7 8

Finland 5 3 2 3

France 8 1 1 5 1 12

Germany I

Greece 5 1 2 2 5

Guatemala 1 1

Haiti I 1

India 10 7 1 2 5

Ireland 3 2 1 1

1 Including those who have left and those recruited but not yet on duty


CountryTotal number

of experts(all regions)

s

Experts on Duty as at 31 December 1952 ExpertsRecruitedin 19521

RegionsTotal number

of experts(all regions)Africa Americas South -East

Asia Europe EasternMediterranean

I WesternPacific

Israel 1

Italy 3 1 1 1 4

Japan 1

Korea 1 I

Mexico 3 3 1

Netherlands 10 1 8 1 8

New Zealand . . . 3 3

Norway 3 2 1 3

Panama 1 1

Peru 2 2 1

Philippines 2 1 I 2

Portugal 3 1 1 1 1

Spain 1 1 2

Sweden 5 4 1 4

Switzerland 3 1 2 3

Union of South Africa 5 3 2 4

United Kingdom . . 42 3 20 1 15 3 42

United States of America 43 18 7 2 11 5 58

Yugoslavia 1

Stateless 1 1 1

Total 247 1 58 84 6 68 30 220

Including those who have left and those recruited but not yet on duty

Appendix 5

RESOLUTION 433 A (XIV) OF THE ECONOMIC AND SOCIAL COUNCIL

Resolution 222 (IX) 1 of the Economic and Social Councilwas amended as follows by the Council on 11 June 1952 :

The Economic and Social Council,Desiring to improve the present machinery for the admi-

nistration and co- ordination of the Expanded Programmeof Technical Assistance with a view to achieving maximumresults under it,

Believing that the appointment of a full -time ExecutiveChairman of the Technical Assistance Board will promotethose ends,

1. Decides to amend its resolution 222 (IX) as follows :

1 See Handbook of Basic Documents, fifth edition, p. 145.

Paragraph 3:In place of the sentence reading : " The Secretary - General

or his representative shall be Chairman of the Board ",substitute the following :

" The Secretary -General, after consultation with theexecutive heads of the participating organizations, shallappoint a full -time Executive Chairman of the Boardwho shall have such responsibilities and functions withinthe purposes of this resolution as the Economic andSocial Council may assign to him and which it mayalter as it sees fit " ;

For sub -paragraph (h), substitute the following :


"(h) Decisions relative to recommendations orproposals made by the Executive Chairman or by membersof the Board will normaIIy be taken by general agreementbetween the Executive Chairman and all members of theBoard. When general agreement cannot be reached,recommendations or proposals shall be consideredapproved when a majority of the members of the Boardpresent and voting and the Executive Chairman are inagreement. If no agreement can be reached, the mattermay be referred to the Technical Assistance Committeeeither by a majority of the members of the Board presentand voting or by the Executive Chairman " ;

Paragraph 4:Delete and renumber the subsequent paragraphs accord-

ingly.

Paragraph 4 (former paragraph 5):Substitute the following :" The secretariat of the Technical Assistance Board

shall perform, under the supervision of the ExecutiveChairman, such functions as the efficient operation of theBoard may require. Whenever the need arises, theExecutive Chairman shall make arrangements wherebythe executive heads of the participating organizationsmay assign members of their staffs to the secretariat ofthe Technical Assistance Board " ;Approves the terms of reference of the Executive Chairman

which are set forth in the Technical Assistance Committeeresolution.2

2 See following appendix.

Appendix 6

RESOLUTION No. 3 OF THE TECHNICAL ASSISTANCE COMMITTEE

The Technical Assistance CommitteeDirects the Executive Chairman to be appointed under

paragraph 3 (revised) of resolution 222 (IX) to perform thefollowing functions :

(a) To examine programme proposals submitted byparticipating organizations, which may include both formalrequests submitted by governments and projects which are inpreliminary stages of discussion, with a view to facilitatingin agreement with the Governments, the development ofintegrated country programmes, consulting with agencies asappropriate ;(b) To make such recommendations to the TechnicalAssistance Board as he may deem appropriate with respectto all programme proposals or projects, including ear-marking or allocation of funds ;(c) After approval of programme proposals or projects bythe Board, to earmark the necessary funds, and as projectplans become final, to allocate funds without further refer-ence to the Board ;(d) In exercising continuous supervision of the programme,to appraise the effectiveness of the activities of the parti-cipating organizations financed from the Special Account,and the results achieved, bearing in mind the desirabilityof keeping the proportion of administrative to operationalexpenditures as small as possible consistent with efficiency,and to make recommendations to the Board, availing

' See UN document E/2238. Resolution No. 1 appearsin the second report of TAC to the Economic and SocialCouncil (UN document E/1920, Add.l, p. 1) : ResolutionNo. 2 appears in Annex I to the third report of TAC to theCouncil (UN document E/2102, p. 13).

himself to the fullest extent possible of the services of therepresentatives of the participating organizations ;(e) To review the adequacy of the co- ordination andintegration of activities financed from the Special Account,keeping himself fully informed of activities financed by theagencies from their own budgets and of all other technicalassistance programmes both bilateral and multilateral, andto make appropriate recommendations to the Board ;(f) To convene and preside over the meetings of theBoard ;

(g) In the intervals between meetings, to act on behalf ofthe Board, under conditions laid down by the Board ;normally to consult its members before taking action on allmatters of major importance, and to report to it on theactions taken on its behalf ;(h) Under conditions agreed by the Board, to sign orauthorize signature of basic and comprehensive countryagreements with governments ;(i) In agreement with the Board, to appoint residentTechnical Assistance representatives and to determine theirterms of reference ; to supervise the activities of suchrepresentatives and to establish an effective system ofreporting between himself and such representatives ;(j) To establish, after consultation with the Board,administrative rules and procedures on such matters asreporting, objects of expenditure definitions, salary andper diem rates, etc. ;(k) To report on behalf of the Board to the TAC onthe operation of the programme and proposed futureprogrammes ;

(1) To supervise the Secretariat of the Board.


Appendix 7

RESOLUTION ON TECHNICAL ASSISTANCE ADOPTED BY THE UNITED NATIONS GENERAL ASSEMBLYAT ITS SEVENTH REGULAR SESSION

The following resolution (A /Resolution /84) was adopted bythe General Assembly at its 411th plenary meeting, on thereport of the Second Committee :

The General Assembly,

Believing that the Expanded Programme of TechnicalAssistance has demonstrated its value as an effective inter-national means of assisting in the economic developmentof under -developed countries,

Convinced that the expansion of the programme and itscontinued progress can make an important contribution tothe achievement of higher standards of living for the peoples ofunder -developed areas,

Recognizing that governments requesting technical assistance,on the one hand, and the participating organizations of theTechnical Assistance Board, on the other hand, would be ablemore effectively to plan and administer their programmes inthe future if they had information concerning the amountsof money to be pledged by contributing governments at anearlier date than has been possible in respect of the first threeyears of operation under the Expanded Programme,

1. Notes with satisfaction the action taken by the Economicand Social Council under resolution 433 A (XIV) of 11 June1952 ;

2. Approves the financial arrangements set forth in theannex hereto as agreed by the Economic and Social Councilin paragraph 4 of its resolution 433 B (XIV) of 22 July 1952 ;

3. Urges governments to contribute to the programme for theyear 1953 towards the goal of US $25 million suggested by theEconomic and Social Council in resolution 433 B (XIV) ;

4. Urges governments which have not paid their pledgesfor the first or second financial periods to the ExpandedProgramme to make early payment to the Special Account ;

5. Requests the Negotiating Committee for Extra -BudgetaryFunds, appointed pursuant to the General Assembly's resolu-tion of 25 October,' to undertake, in addition to alreadyassigned tasks and as soon as convenient after the closingof the sixteenth session of the Economic and Social Council,negotiations with governments regarding their pledges to theSpecial Account for the year 1954 towards the goal to besuggested by the Council at that session ;

6. Requests the Council to study the feasibility of workingout estimates for the programme on a basis longer than aone -year period, and to report thereon to the General Assemblyat its eighth session.

Annex : Financial Arrangements

Agreed by the Economic and Social Councilunder paragraph 4 of its resolution 433 B (XIV)

Contributions received for the third financial period shallbe allocated as follows :

(i) Fifty per cent of total pledges for 1953, up to but notexceeding $10 million, shall be automatically available forallocation to the participating organizations in accordancewith paragraph 8 (c) 2 of Council resolution 222 A (IX),as amended, out of the contributions received for thethird financial period ;

(ii) The balance of contributions received shall be retainedin the Special Account for further allocation, as providedin the resolution of the Technical Assistance Committeeof 23 May 1952, approved by the Economic and SocialCouncil on 11 June 1952 in resolution 433 A (XIV).

' A /Resolution /22 Formerly paragraph 9 (c)


Appendix 8

COLLECTION OF CONTRIBUTIONS FOR THE FIRST FINANCIAL PERIOD ENDING 31 DECEMBER 1951,AS AT 31 DECEMBER 1952

(Advices received from Executive Chairman)

Name of country Currency

Contributions pledgedBalance

in dollarequivalentLocal

currencyUS dollarequivalent

Afghanistan Afghanis 119,084 7,001 -Argentina Argentine pesos 1,000,000 200,000Australia Australian pounds . . . . 178,971 400,921 -Austria Austrian schillings . . . . 500,000 19,231 -Belgium Belgian francs 13,500,000 270,000 -Bolivia Bolivianos 750,000 12,500 12,500Brazil Cruzeiros 1 8,500,000 459,459 -Burma Burmese rupees 35,714 7,500Canada Canadian dollars . . 850,000 772,727 -Ceylon US dollars

Ceylon rupees 66,8501,000

14,009 -Chile Chilean pesos 5,400,000 90,000 -China US dollars 10,000 -Colombia US dollars 51,020 -Costa Rica US dollars 5,000 -Cuba Cuban pesos 2 50,000 50,000 -Denmark Danish kroner 660,000 95,555 -Ecuador US dollars 6,300 -Egypt Egyptian pounds . . . . 28,500 81,850 -El Salvador US dollars 5,000 -Ethiopia Ethiopian dollars . 50,000 20,129 -Finland Finnish marks 1,155,000 5,000 -France French francs 422,624,000 1,207,500 -Greece Greek drachmae 304,425,000 20,295 -Guatemala Equivalent of $5,000. . 5,000 5,000Haiti US dollars 6,000 -Honduras US dollars 8,000 -India Indian rupees 1,190,476 250,000 -Indonesia Rupiah 463,000 121,522 -Iran Equivalent of $40,000 . 40,000 40,000Iraq Iraqi dinars 1,787 5,005 -Ireland Irish pounds 5,000 13,994 -Israel Israeli pounds 100,00 27,98& -Italy Equivalent of $93,000 . 93,000 93,000Korea US dollars 5,000 -Lebanon Lebanese pounds . . . . 14,365 6,556 -Liberia US dollars 8,000 -Luxembourg Belgian francs 126,000 2,520 -Mexico Mexican pesos 300,000 34,682 34,682Monaco French francs 1,000,000 2,857 -Netherlands Netherlands guilders . . . 1,520,000 400,000 -New Zealand New Zealand pounds . . 45,000 124,138 -Norway Norwegian kroner . . . . 250,000 34,999 -

Brazilian contribution : Accepted as payment in full for goods and services offered2 Cuban contribution : $25,000 in US dollars ; 25,000 Cuban pesos equal to $25,000

REPORT : EXPANDED PROGRAMME OP TECHNICAL ASSISTANCE 119


Contributions pledgedBalance

nuUSdollarin ardvaleinnt

equivalentLocalcurrency

US dollarequivalent

Pakistan Pakistan rupees 467,000 140,663 -Philippines Philippine pesos 3 100,000 50,000 -Sweden Swedish kronor 500,000 96,525 -Switzerland Swiss francs 1,000,000 233,645 -Syria Syrian pounds 25,000 11,410 11,410Thailand Bahts 425,000 19,758 -Turkey Turkish pounds 514,186 183,638 -United Kingdom Pounds sterling 760,000 2,128,255 -United States of America US dollars 12,007,500 12,007,500 -Uruguay Uruguayan pesos . . 151,000 99,408 99,408Venezuela Equivalent of $44,000 . 44,000 39,600Yemen Indian rupees 20,000 4,200 -Yugoslavia Yugoslav dinars' . . . . 2,500,000 50,000 -

20,070,260 335,600

3 Philippine contribution : $25,000 in Philippine pesos ; $25,000 in goods and services offered4 Yugoslav contribution : $10,000 in US dollars ; 2,000,000 dinars equal to $40,000

Appendix 9

COLLECTION OF CONTRIBUTIONS FOR THE SECOND FINANCIAL PERIOD ENDING 31 DECEMBER 1952,AS AT 31 DECEMBER 1952

(Advices received from Executive Chairman)


Contributions pledged Balanceoutstanding

in US dollarequivalentLocal


Afghanistan Afghanis 119,084 7,001 7,001Argentina Argentine pesos 1,000,000 200,000 -Australia Australian pounds . . . . 84,962 190,000 -Austria Austrian schillings . . . 500,000 19,231 9,615Belgium Belgian francs 13,500,000 270,000 -Bolivia Bolivianos 750,000 12,500 12,500Brazil Cruzeiros 8,500,000 459,459 459,459Burma Burmese rupees 38,095 8,000 -Cambodia US dollars 5,000 -Canada Canadian dollars . . . . 750,000 750,000 -Ceylon Pounds sterling 5,338 15,000 -Chile Chilean pesos 5,400,000 174,194 -China US dollars 10,000 -Colombia Equivalent of $100,000. 100,000 100,000Costa Rica US dollars 5,000 -



Contributions pledged Balanceoutstanding

in US dollarequivalentLocal


Cuba US dollars 50,000 50,000Denmark Danish kroner 750,000 108,585 -Dominican Republic US dollars 6,000 -Ecuador Sucres 94,500 6,300 6,300Egypt Egyptian pounds 28,500 81,850 -El Salvador US dollars 5,000 -Ethiopia Equivalent of $20,000 . 20,000 20,000Finland Finnish marks 2,310,000 10,000 -France French francs 372,625,000 1,064,643 -Germany, Federal Republic of Marks 500,000 119,048 119,048Greece Greek drachmae . . . . . 304,425,000 20,295 -Guatemala US dollars 7,500 7,500Haiti US dollars 12,000 -Honduras US dollars 8,000 -Iceland Iceland kroner 40,714 2,500 -India Indian rupees 1,309,524 275,000 -Indonesia Rupiah 500,000 43,860 -Iran Equivalent of $40,000 . 40,000 40,000Iraq Iraqi dinars 1,797 5,000 -Ireland Irish pounds 5,000 14,002 -Israel Israeli pounds 10,000 28,003 -Italy Equivalent of $93,000 . . 93,000 93,000Japan Yen 2 28,800,000 80,000 -Korea US dollars 5,000 5,000Laos Equivalent of $5,000 . . . 5,000 5,000Lebanon Lebanese pounds . . . 15,000 6,846 6,846Liberia US dollars 12,000 -Luxembourg Belgian francs 125,000 2,500 -Mexico Mexican pesos 300,000 34,682 -Monaco French francs 1,000,000 2,857 -Netherlands Netherlands guilders . . . 1,520,000 400,000 -New Zealand New Zealand pounds . 45,000 124,138 124,138Nicaragua Cordobas 25,000 5,000 5,000Norway Norwegian kroner . . . . 400,000 55,999 -Pakistan Pakistan rupees 500,000 151,103 -Panama Balboas 3,000 3,000 3,000Paraguay US dollars 5,000 5,000Philippines Philippine pesos 100,000 50,000 25,000Saudi Arabia US dollars 15,000 -Sweden Swedish kronor 2,000,000 386,623 29,292Switzerland Swiss francs 947,672 218,862 -Syria Syrian pounds 25,000 11,410 11,410Thailand Bahts 425,000 34,000 -Turkey Turkish pounds 514,186 182,000 -United Kingdom Pounds sterling 450,000 1,260,151 -United States of America US dollars 11,400,000 11,400,000 1,400,000Uruguay Equivalent of $50,000 . . 50,000 50,000Venezuela Equivalent of $20,000 . . 20,000 20,000Viet Nam Indochina piastres . . . . 155,325 7,500 -Yugoslavia Yugoslav dinars 3 . . . . 15,000,000 50,000 -

18,824,642 2,614,104

1 The French Parliament in approving the contribution reduced the original pledge by 50,000,000 French francs.2 Paid pounds sterling 28,508 convertible into yen3 $10,000 in US dollars ; 12,000,000 dinars equal to $40,000


Appendix 10

STATEMENT BY Mr. DAVID OWEN, EXECUTIVE. CHAIRMAN OF THE TECHNICAL ASSISTANCE BOARD,DELIVERED BEFORE THE ECONOMIC AND SOCIAL COUNCIL, 16 DECEMBER 19521

I must thank the Council, through you, Mr. President, forthe courtesy which makes it possible for me to make a briefstatement to you this afternoon in my capacity as ExecutiveChairman of the Technical Assistance Board.

Since my appointment which took effect on August 1st,I have, with the help of four distinguished consultants, beenable to conduct a comprehensive review of the TechnicalAssistance plans of the Agencies taking part in the ExpandedProgramme for the year 1953, and I have been able to discussthe provisional results of this review with my colleagues in theTechnical Assistance Board in the light of what we know ofour financial situation and prospects.

Paradoxically, the findings of this review have at the sametime been encouraging and disturbing. They have beenencouraging for two reasons. In the first place the recordshows that the programme has rapidly gained momentum,and the participating organizations will have spent or obligatedover three times as much in 1952 as they did in the first financialperiod. Actually, they will have spent or obligated by theend of this month rather more than our annual income for1952, by drawing on the balance left over from last year.The former complaint that we were not making full use of thefunds contributed by Governments to the Special Account is

In the second place, the record is encouraging for its de-monstration of the growing interest of Governments in theTechnical Assistance programme, expressed in the greatlyncreased volume of requests for help. This would not ofitself be wholly convincing, for not all requests and the projectswhich flow from them are of equal value from the point ofview of economic development. But the programme reviewhas been extremely heartening in showing that all save asmall proportion of the projects submitted by the Agenciesare good projects ; and because the estimated cost of thegood projects submitted greatly exceeds prospective resources,

1 TAB document TAB /SR.22, Annex IV

Agencies will be able, to the extent to which existing firmcommitments permit, to concentrate on the ones which theyand the Governments concerned consider to be the mostuseful.

I must repeat, however, that these encouragements areaccompanied by new anxieties. The programme, havingproved itself to be an effective programme, has now reacheda critical stage in relation to the financial resources whichmust sustain it. In the second year -1952- pledges from65 countries amounted to $18,824,642, of which $7,136,401remains to be collected. For the third year -1953 -we havethe target figure of $25 million set by this Council at itsfourteenth session, an amount which the General Assemblyhas by a resolution of the present session urged Governmentsto pledge at the forthcoming Technical Assistance Conference.But it is now plain that unless Governments which have notyet done so fulfil their pledges for 1952, and unless contri-butions for 1953 reach the target figure, it will not be possibleto carry out all the commitments which Agencies have alreadyentered into, let alone embark on the implementation of newprojects which are now under consideration or which arelikely to come up in response to future requests. If a sub-stantial amount of already pledged money, still outstanding,is not received, or if the target figure for 1953 is not reached,it will be necessary for some Agencies to cut back, postpone,or abandon work already started in a number of countries,and they will not be able to embark on any new developmentssave at the expense of commitments already entered into.

That these things should be so is a sign of the health andvitality of the programme, but is is also a danger signal ofwhich the Agencies participating in the Technical AssistanceBoard are now taking serious account by a rigorous andsometimes heartbreaking review of their current and pros-pective undertakings. May I earnestly appeal to GovernmentsMembers of this Council, and through them to all Govern-ments Members of the United Nations and of the SpecializedAgencies, to ensure that this great constructive programmeshould not fail for lack of financial resources.

Appendix 11

STATEMENT MADE BY THE REPRESENTATIVE OF WHO AT THE TWENTY -SECOND MEETINGOF THE TECHNICAL ASSISTANCE BOARD, DECEMBER 19521

I have to state, in the name of the Director -General of WHO,the position of the Organization with regard to the recom-mendations of the Executive Chairman concerning the ear-marking of funds for the 1953 projects or programmes.

The WHO rate of expenditure has been steadily increasing

1 TAB document TAB /SR.22, Annex III

every month. For October, it amounts to $361,000. Projectedover a 12 -month period this would mean $4,332,000. Takinginto account the projects starting or increasing in size between1 November and the end of the year, the cost of carrying on,in 1953, projects started in 1952 would be $5,967,000.

The total amount earmarked for all field activities in 1953is $4,164,000, which could be slightly increased by savings in


our administrative and indirect operational costs. The existingprojects should then be cut back by about 28 %.

I wish to repeat that this does not take into account anynew projects, some of which are so far advanced in preparationthat we are involved in a fair amount of expenditure earlyin the year. We had to place orders for supplies for whichwe must pay. One example, among others, is the case ofAustralian supplies. Also some new projects require extremelylong preparation, involving at least moral obligations towardscertain types of high -level experts, not to mention what couldbe regarded by the Governments as a commitment.

We fully support your efforts to achieve a better integrationof the programme within the limits of available resources,and we will do all we can to assist you by following so far aswe can your recommendations. We must however emphasizethat as practically all our projects in operation are long -termprojects, mainly in the form of demonstration activities inco- operation with national teams, and in many cases otherorganizations, we cannot make any substantial revision of ourcontinuing programme during the short period before20 February. Since our Governing Bodies have taken, inaccordance with the recommendations of the GeneralAssembly, an active part in the formulation of programmesproject by project, no substantial revision of this continuingprogramme could, in any case, be made without at leastreporting to our Governing Bodies, and this revision shouldbe done according to policies and criteria laid down, oraccepted, by the World Health Assembly. Therefore, until thisreview has been undertaken by our Governing Bodies, WHOwill continue the projects already in operation and reserves itsposition regarding the reduction or abandonment of suchprojects later in the year.

To avoid misunderstanding, I should like to reaffirm ourrecognition of the [ Technical Assistance ] Board's authority

to approve or disapprove projects to be financed out ofExpanded Programme funds and we sincerely hope that at thetime when WHO's programme of Technical Assistanceactivities will be examined by the Board at its twenty -thirdmeeting, supplementary funds will be available so that ourprogramme will obtain the necessary approval. Should theWHO programme fail to obtain the approval of the Board, itwould be the responsibility of the Board, on the Chairman'srecommendations, to decide how the programme should beadjusted to the resources available.

We strongly hope that it will be possible for youMr. Chairman, in the course of the year to allocate fundswhich would become available due to the payment of contri-butions in excess of your present estimates. In other words,the fate of the part of the Technical Assistance programmefor which WHO is responsible is dependent upon the paymentof arrears of pledges and, to a greater extent, on reachingthe goal of pledges for 1953. It is therefore essential to drawthe attention of the nations to the present financial situation.This situation is in fact a crisis of growth but of a seriousnature.

The general feeling among the contributing Governmentshas been that we are not yet in a position to spend the resourcesat our disposal. It is essential to make clear that we havereached this stage and that we are even in a position to spend -on projects already started in collaboration with the Govern-ments concerned--more than we have. It is for this reasonthat we have requested you to report this situation to theTechnical Assistance Committee and that we feel it essentialthat, after this report, the facts be brought to the knowledge ofthe General Assembly in the Second Committee. This wouldput a strong emphasis on the need for a full implementationof the recommendations made by the Second Committee inits resolution dated 4 November, and draw attention to theneed for much greater resources in future years.

Appendix 12

RESOLUTION No. 4 OF THE TECHNICAL ASSISTANCE COMMITTEE ON LOCAL COSTS,ADOPTED BY THE COMMITTEE AT ITS TWENTY- SEVENTH MEETING 1

The Technical Assistance Committee,

Having considered the difficulties encountered by the parti-cipating organizations and requesting governments in theapplication of the TAC interpretation of the paragraph ofResolution 222 (IX), Annex I, which states that " The request-ing governments should be expected to agree ... normallyto assume responsibility for a substantial part of the costs of

1 See ECOSOC Resolution 433 B (XIV) and UN documentE/2304, Annex II.

technical services with which they are provided, at least thatpart which can be paid in their own currencies ; "

Noting that most of the difficulties arise in connexion withthe provision of lodging, local transportation of experts,and external travel of fellows,

Noting further that under the present interpretation thecontribution of the requesting government may also include-as appropriate in each case -such items as the furnishing ofoffice space ; local personnel services (technical and adminis-trative as well as labour) ; buildings ; supplies and materials


obtainable within the country ; postal and telecommunica-tions ; and medical care for Technical Assistance personnel ;

Reaffirming the principle that governments should make asubstantial contribution to the cost of Technical Assistancein local currency or in kind ;

Decides

1. That the Executive Chairman should in consultationwith the participating organizations and with the assistanceof the Resident Representatives wherever they have beenappointed, ensure that the local cost contributions ofgovernments comply with the principle reaffirmed above,and that in so far as possible uniformity is achieved inarrangements regarding projects of the same nature ;2. That requesting governments should not be requiredto provide the cost of lodging or travel per diem for expertsin respect of such projects and programmes for the imple-

mentation of which extensive staff and other facilitiesare provided by the requesting governments ; in all casesrequesting governments should undertake to secure suitableaccommodation for the experts ;3. That TAB may exempt requesting governments fromfurnishing local transportation when this requirement wouldimpede the carrying out of a project on account of specialcircumstances within the recipient country ;

4. That since requesting governments normally bearsubstantial expenses in connexion with fellowships andscholarships awarded under the Expanded Programme,including salaries, allowances, internal travel costs, insur-ance, etc., governments should not necessarily be requiredto bear external travel costs of fellows and scholars ;

Urges requesting governments to make their maximumcontribution to the cost of Technical Assistance programmes.

Appendix 13

STUDY AND RECOMMENDATIONS CONCERNING LOCAL COSTS 1

I. NEED FOR A NEW SYSTEM

General Statement of TAB Position

1. The Board is in general agreement concerning the variousdifficulties in payment of costs by governments that give riseto the general dissatisfaction with the present system. Someof the objections concern the nature and degree of certainelements of costs required to be paid by the recipient govern-ments under the Expert Programme, notably subsistence andcosts of experts' medical care. Others have to do with thenature of costs borne by governments under the FellowshipProgramme.

2. Finally, there are considered to be unsatisfactory featuresin the present methods of payment by recipient governments.In general, there is an understandable demand for uniformstandards to be applied throughout the Programme in carryingout the basic principle that " governments should make asubstantial contribution to the cost of Technical Assistance inlocal currency or in kind ". (See Annex IX of TAC Resolu-tion No. 4, E/2304.)

3. All members were agreed that technically the proposals herepresented constitute a balanced and workable scheme suitablefor adoption by TAC. The reserved positions taken by FAOare transmitted in Annex I.2 A statement by WHO andUNESCO on Fellowship Costs appears in Annex II.2

1 TAB document TAB /R.224 /Rev.22 Not reproduced here2 Reproduced as Appendix 14 below

Subsistence Costs

4. The greatest difficulties have been those related to subsis-tence costs. The rates of subsistence allowances (includinglodging costs) required to be paid by governments under thepresent scheme have often involved political considerationsthat far outweigh budgetary problems. The rates chargedhave invited comparisons with the rates of salary and allow-ances established for local officials that are difficult forgovernments to defend. Moreover, variations in the natureand method of charges made in the past by various organiza-tions have led to anomalies which are increasingly difficult toexplain before the central ministries of recipient governments.

5. Experts have had to look to the organization employingthem for a part of the allowances due them and to a govern-ment department or agency for the remainder and have beenpenalized either because of differences concerning liability forpayment or delays in payment. Several organizations havetaken remedial steps regarding this question -in some casesby granting subsistence advances in the form of local imprestaccounts for individual experts -but none of the ad hocarrangements employed seemed to the Board to be of acharacter desirable for long -run operation.

6. The problem, in general, is essentially one of ensuring,first, that the amount contributed by governments towardlocal costs is both reasonable and politically acceptable tothem and to the Programme ; secondly, that experts receivepayment of the amounts due them promptly and at regularintervals ; thirdly, that present arrangements for the paymentof the amounts contributed by governments be simplifiedand de- personalized.


Method of Governmental Payment

7. Under present methods, both governments and organiza-tions are involved in settling the detailed claims of experts forsubsistence allowances. These often involve attendant problemsof disbursement, accounting, and auditing. Delay and disputedclaims give rise to friction and misunderstanding which, giventhe present divided responsibility, are inevitable.

8. In some countries, the payments for governments are madeby the resident representative from a local currency fund estab-lished under basic or supplementary agreements, while inother instances the allowances are paid direct by governmentsor by a representative of an organization.

9. It is clearly preferable that experts should in all cases lookto international organizations for the payment of amountsdue them under their contracts. Similarly, it is desirable toavoid as far as possible a divided responsibility for the under-takings given fellows and scholars under the Programme.

10. At the same time, there appears to be a growing desireon the part of governments to substitute lump -sum paymentsfor the present individual payments of subsistence andlodging allowances, and to build a firmer basis for theirannual Special Account contributions.

II. PROPOSALS FOR MEETING LOCAL PROJECT COSTS

Living Costs of Experts

11. The basic proposal which the Board places before theCommittee from the presence of inter-national experts on projects in countries. The scheme suggestedhas three main elements :

(a) Payment of Experts. The whole amount due to experts,including all subsistence and other allowances as well asauxiliary benefits, shall be paid or reimbursed to themdirectly by the employing organization, or, as may bearranged in the case of local currency payments, throughthe office of a resident representative or other official.

(b) Lump -Sum Contributions. The contribution of therecipient government toward the local living costs of expertsshall be paid, not to the expert or on behalf of any individualexpert, but to the Programme in the form of a lump sum oflocal currency.

(c) Calculation of Lump Sum. This lump -sum contributionshall be expressed in terms of the local currency equivalentof a lump sum per anticipated expert year. Where lodgingis actually furnished by governments, credit shall also beallowed. (The method of computation is given in para-graph 13 below.)

With the adoption of this system, the other obligations ofrecipient governments for projects would, as at present, bethese :

(d) Assistance in Securing Quarters. To assist experts(including resident representatives and international staff)in finding living quarters, upon request.

Paragraphs 11 and 12 deal with costs Other than the costsof (a) fellowships and scholarships and (b) special projectcosts, which are considered in Parts V and VI of this paper.

(e) Office Space, Equipment, Supplies. To provide officespace, equipment and supplies, except in so far as theseare supplied from abroad by the Programme under TABpolicies.

(f) Internal Transportation. To furnish internal trans-portation, whether by public carrier or motor vehicle,except that motor vehicles may be provided by the Pro-gramme under TAB policies.

(g) Postal and Telecommunications. To provide postal andtelecommunication services and other means of communi-cation.

Other Project Costs

12. In addition, governments would meet the following fur-ther costs, where appropriate to the project and so negotiated :

(1) Local technical and administrative personnel, as wellas labour ;

(2) Costs of building directly associated with the projects(rent or construction) ;

(3) Project equipment available in the country ;

(4) Project supplies and materials available in the country ;

(5) Other local running costs directly resulting from theproject.

III. IMPLEMENTATION OF NEW POLICY

Determining Lump -Sum Amount

13. The responsibility for determining the lump -sum contri-bution to be expected of each recipient country for each ensuingfinancial period would rest with TAB. After consultation withorganizations, TAB would, for each financial period and asmuch in advance as possible, make this determination in thefollowing way :

(a) Estimate the number of expert man -years expected tobe provided by all organizations to a given country duringthe subsequent financial period.

(b) Determine periodically the TAB subsistence rate foreach country and the portion of such rate that wouldconstitute a fair contribution of local currency expendituresto be paid by recipient governments towards the living costsof experts.

(c) Calculate the estimated local costs for experts by multi-plying the number of anticipated expert man -years by thebasic rate derived in (b) above.5

5 Study of the estimated cost of local living expenses togovernments and agencies led the Board to the conclusionthat a satisfactory rate for each country initially would beSO per cent of the existing TAB full subsistence rate obtainingin the country at the end of the preceding year (i.e. 50 percent of the full daily rate times 365 days). In the light ofsubsequent experience, this base rate could, of course, beadjusted by TAB in consultation with the participatingorganizations.


(d) Advise recipient governments of the total estimatedamount of their contributions to the local living costs ofexperts for the year, the payment of which would be deemedto meet the full financial obligations for the government inrespect of these costs.6

Negotiation for Payment

14. Negotiation for payment should take place on a country -by- country basis and should be the responsibility of theExecutive Chairman of TAB.

15. As the scheme is implemented, every country accepting itshould be required to make an advance payment early in theyear. Where desired, this payment could relate to the firsthalf of the year, the balance to be paid at mid -year beingadjusted to take account of actual programme performance.Such arrangements for split payments would be relatedalso, where this was a factor, to the legislative time -table of thecountry and the fiscal period used for national budgetarypurposes.

16. A policy respecting waivers of such payments for limitedperiods in particular cases (e.g. Iran) will be required. Whileappreciating the position of UNESCO in proposing a slidingscale related to national resources in respect to such payments,and that the initial basic rate be established at 40 per centof the existing TAB scale, the Board recommends that theinitial basis for contributions of governments to such costsshould be the 50 per cent rate referred to in (c) [ footnote 5 ]above and that waivers, in so far as granted for limited periods,should be on a complete rather than a partial basis. TheBoard also points out that, with the adoption of this plan, thegranting of waivers by organizations individually would nolonger be feasible.

Annual Revision of Lump -Sum Amount

17. Revision of the annual amount established as the lump -sum contribution of a recipient country might have occurredat mid -year, as foreseen in paragraph 15 above. In the lastmonth of the year, a calculation will have to be made of thecontribution toward local costs to be requested for the suc-ceeding financial period.

18. The method to be followed in this calculation would be :(a) Calculate basic amount as in paragraph 13 above, and(b) Adjust this estimate upwards or downwards after takingaccount of the amount by which the government's totalpayments for the current year fell short of or exceeded theamounts due in respect of the number of expert man -yearsactually provided in the current year.

New Structure of the Special Account

19. For purposes of financial reporting to governments, itis recommended that the lump -sum contributions made byrecipient governments should be considered as contributionsto the Special Account. Under this concept, the Special

6In so far as a government provided lodging in kind,credit the government, in respect thereto, at the flat rate of50 per cent of the TAB subsistence rate for the country.

Account would consist, for reporting purposes, of two separateparts, namely :

Part A: voluntary contributions (pledged and paid in accor-dance with ECOSOC resolution 222 (IX)) ;Part B: local cost contribution (obtained from recipientgovernments in respect of living costs of experts).

20. Once paid, the element identified as " Part B " wouldmerge with the other monies in the Special Account, and theuse of such monies would be subject to all normal conditions.

21. Nothing in this arrangement would pre -judge the dispo-sition of such internal financial questions as whether, inparticular cases, the local cost contribution should be bankedand disbursed centrally or in the field.

IV. SPECIAL PROBLEMS

Transitional Arrangements

22. Recognizing that governments will wish to explore thefinancial and other consequences of the scheme and willneed to make suitable administrative and financial arrange-ments, it is contemplated (in paragraph 14 above) that thetransition to the new system would take place on a country -by-country basis.

23. Moreover, because of the financial undertakings that theProgramme would be called upon to assume under the scheme,it would be advisable to require that governments deposit theappropriate contribution for the remainder of the year 1953in the Special Account, on or before the date when the newscheme is to become effective in the recipient country.

Collection, Disbursement and Reporting

24. These aspects of the system are under study by the Boardlooking toward the development of procedures both forcollection and disbursement to assist in the achievement ofthree objectives : (a) simplicity and ease of administration ;(b) sufficient diversity to meet varying country or regionalsituations ; and (c) maximum use of joint administrativeservices available through the offices of resident represen-tatives or other offices, as appropriate.

25. On the matter of statistical and financial reporting oflocal cost contributions received, it is assumed that it wouldnot be necessary or desirable to arrange for audit reports to thepaying governments individually.

Medical Care Arrangements

26. One effect of the proposal in paragraph 11(a) abovewould of course be to transfer the direct responsibility formeeting commitments in respect of medical care for experts(as well as resident representatives and their internationalstaff) from recipient governments to the participating organi-zations. This is considered a desirable step in any eventbecause of the contingent liability and of the effect uponmorale of present divided responsibilities.


27. While it is proposed that the Programme directly meetthe costs of medical care assumed under contractual obliga-tions with experts, this would not preclude the use of satis-factory government facilities in particular cases, including,for example, coverage under a national health scheme.

28. The Board considered a statement of proposed policyto guide organizations in the administration of a medicalcare plan. This statement is to be used by the Board in itsstudy of a detailed plan.

V. FELLOWSHIP COSTS 7

29. Present arrangements for division of costs betweensending governments and organizations vary widely. In somecases substantially the total cost of the fellowship or scholar-ship is covered by the organizations, including travel costs.In other instances, a substantial part of the travel is paid bysending governments. One organization which has the policyof requesting sending governments to share in the cost ofexternal travel has in fact borne the full cost for a majorityof the countries represented in its fellowship programme.

30. The most recent views of the Technical AssistanceCommittee on financial policy concerning fellowships are tobe found in Resolution No. 4 of the Committee, adopted inJuly 1952, which contains the following statement of policy :

... since requesting governments normally bear substantialexpenses in connexion with fellowships and scholarshipsawarded under the Expanded Programme, includingsalaries, allowances, internal travel costs, insurance, etc.,governments should not necessarily be required to bearexternal travel costs of fellows and scholars.

31. It is to be observed that external travel costs virtuallyalways represent a charge on the balance of payments and forthe most part this means hard currency debits. Furthermore, thecountries to which it is most desired to extend the benefits ofthe fellowship and scholarship programmes generally involvethe largest external travel costs because of their remotenessfrom the centres to which fellows and scholars tend to go.

32. After a considerable discussion of existing practices andtheir implications in terms of possible agreement on a standardcost formula, the Board decided to present to the Committeefor its consideration the following proposal:

(a) Each sending government shall be requested to makea lump -sum contribution in local currency of $200 perfellowship or scholarship awarded, except that the amountshould be $100 for " regional " fellowships or scholarships.

(b) Organizations will, as at present, assume no responsi-bility for the cost of travel and subsistence within the reci-pient country or for salaries of government servants.

Attention is called to the statement of WHO and UNESCOon fellowship costs (reproduced as Appendix 14 below).

(c) Organizations will, however, assume direct respon-sibility for obligations undertaken with or on behalf offellows and scholars during their absence from country ofresidence, including inter alia: (1) stipend ; (2) travel(international and within the country of training) ; (3) tui-tion ; (4) books and appropriate related technical supplies.

33. No proposal is made at this time on the question ofliability and arrangements for insurance and medical care ofscholars and fellows. The Board advises the Committee thatproposals made early this year by the TAB Working Groupon Fellowships were reviewed, at the Board's request, byACC's Consultative Committee on Administrative Questionsand that CCAQ expects to make recommendations on thematter at its next session in the spring of 1953.

34. The point was made in discussion that the establishmentof a clear and common policy on waivers would becomeincreasingly important if the principle of a fiat fee, representinga fraction of total fellowship costs, were adopted.

VI. SPECIAL PROJECTS COSTS

35. Attention was given to the problems of governmentalfinancial participation in the case of " special projects ",by which was meant projects which do not fall easily into thecategory either of country missions or of fellowships. Themost common examples of special projects to date havebeen training institutes and centres on a regional basis,regional seminars, and regional demonstrations.

36. The Board wished to emphasize that, subject to suchpolicies on particular questions as TAB has developed andmay in the future develop, the financial arrangements forspecial projects are of necessity a matter for case -by -casedetermination after suitable negotiations with governmentsconcerned. The Board considers that in respect to the externaltravel costs for such projects, the policy should be that inparagraph 32 above, except that " worker -trainees " andparticipants in long -term training centres sponsored byorganizations should be excluded from any cost formula.

37. So far as institutes and seminars are concerned, maximumadvantage is taken of offers of host countries or other partici-pating governments to provide local facilities, local suppliesand equipment, and teaching personnel. Ordinarily all costsof personnel recruited for a special project by an organizationare paid by the organization, on the same basis as experts.In the case of participants in seminars and institutes, agenciestend to follow the same policies as in the case of fellowships.They meet per diem costs directly and seek payment of travelcosts by the sending government in so far as this would beexpected for normal fellowships.

38. The Board was informed that FAO has in preparation acompilation of its various policies and practices concerningspecial projects, which it initiated as a means of determiningthe extent to which a codification of basic policies was possibleand which it will distribute to other agencies for comment.


Appendix 14

STATEMENT BY WHO AND UNESCO ON FELLOWSHIP COSTS

As indicated during the discussion in the Technical AssistanceBoard on this subject, the World Health Organization andUNESCO feel that, rather than establish a standard costformula under which each sending Government would berequested to make a lump -sum contribution in local currencyin respect of fellowships and scholarships, the Agencies shouldassume full travel costs and that no standard fixed fee shouldbe charged.

The position of these Agencies results from ResolutionNo. 4 of the Technical Assistance Committee,2 which acknow-ledges the substantial expenses Governments bear in connexionwith fellowships and indicates that they should not necessarilybe required to bear external travel costs of fellows and scholars.

The argumentation given in the report of TAB doesalso appear to us to lead to an opposite conclusion, and wouldseem to support our proposal that governments should not berequested to make payments in respect of fellowships andscholarships over and above the various expenses they alreadyincur in local currency. Moreover, these Agencies do not feelthat the formula for government contributions to local costshas any particular relevance to external travel costs of fellow-ships.

In this connexion the World Health Organization custo-marily makes an agreement with the Government and withthe fellow under which the fellow is obliged to serve the

1 TAB document TAB /R.224 /Rev.2, Annex II2 See Appendix 12.

Government for three years after his return from his fellowship.During that period WHO receives reports from the fellowand the Government on the use to which he is putting theknowledge gained through his fellowship. It is our feeling thatthis system is more useful and effective in assuring that thefellowship programme will contribute to the economic deve-lopment of a country than could be any system of a flat chargeto Governments. It is of interest to note that the RegionalCommittee for South -East Asia, at its meeting in September ofthis year, recommended that the period of three years' servicebe extended to five or even ten years. In the view of WHO,this indicates that the Governments themselves realize thatthis approach is well designed to strengthen the health servicesof the countries.

UNESCO's experiences have been similar to the onesindicated above.

It should also not be forgotten that fellowships are availablefrom a number of other sources, particularly US bilateralprogrammes and the Colombo Plan. To our knowledgeneither of those sources of assistance requires a payment of thesort proposed and we feel that if the Expanded Programmeof Technical Assistance is to require such payment it will beplaced in the position of being less desirable to the recipientGovernments than the other programmes.

One final small point exists in that a number of participatingGovernments offer without charge fellowships in various cate-gories of study. It would be difficult to justify requirement of aflat fee basis from those Governments who make the samesort of payments to such Governments.

Appendix 15

CONDITIONS OF SERVICE FOR TECHNICAL ASSISTANCE EXPERTS

Statement of Policy by the Executive Chairman

I. CONDITIONS OF SERVICE

With the exception of positions at the headquarters ofparticipating organizations, and of persons hired for less thanone year, all positions paid for out of the Special Accountshall be divided into two categories. The first category willbe called " Continuing Posts " and the second category willbe called " Project Posts ".

A. Continuing Posts

A continuing post is one that will be designated by theExecutive Chairman on the recommendation of an Agency

1 See TAB document TAB /R.220.

and will be a post established to carry out a function whichcan be reasonably expected to continue for an indefiniteperiod of time. This would mean that the post should beforeseen for at least five years or more. The general conditionsin the area of the post should also be such as to permit thedependants of a staff member to accompany that staff memberto the duty station and to anticipate reasonably normalliving conditions.

Conditions for Continuing Posts

Any person who is assigned to a continuing post for aperiod of one year or more, regardless of the total lengthof the assignment time, will have the same conditions of


service as any regular member of the staff of that Agencyfrom his date of assignment. This implies the use of theregular Agency conditions of service, including salary scale,differentials, pension funds, and all other conditions whichthe Agency uses for its regular staff.

B. Project Posts

All other posts (except headquarters posts and short-termexperts) established out of funds from the Special Accountwill be designated as project posts.

(a) Conditions for Project Posts

Any person newly appointed to a project post, or anyperson transferred from one project post to another, will besubject to the conditions of service outlined in Part IIof this paper and as later specifically set forth in the TABManual of Personnel Policies and Procedures ; except thatpersons receiving the transitional allowance in Part III 2shall not receive the staff benefits provided in Part II. Anystaff member (i) transferred from a position in a participatingAgency (and who is deemed to have re- employment rightswith such organization), or (ii) who is transferred from acontinuing post to a project post, will continue to be coveredby the standard Agency conditions of service, plus theaddition of the project service allowance defined below aspart of the conditions attaching to a project post.

(b) Project Service Allowance

The project service allowance normally should be suchas to cover the cost of suitable lodging for experts andnormally would be established at a rate approximating40 per cent of TAB subsistence rate for the country. Inestablishing this project service allowance for any country,however, I shall have due regard for additional factorssuch as exceptional living costs and hardship. In no event,however, would the project service allowance be less than40 per cent of the TAB subsistence rate in any locality,except where suitable lodging is furnished in kind.

C. Short -Term Experts

Experts hired for short periods of time, up to one year,need to have different consideration, whether or not they areto occupy a project post or a continuing post. Therefore, forany expert hired for less than one year (not one year or less)I propose that :

(a) The salary scale for continuing and project posts beutilized, i.e. the regular United Nations salary scale, providedhowever that any agency may, at its option running until31 December 1953, continue to employ experts (less thanone year) under existing TAB provisions. Agencies shouldexercise reasonable judgment in selecting the appropriatesalary amount from the scale, not only to fit the level of thework and the expert, but so as to use a rounded monthlyamount in discussing salary with the experts.

2 Not reproduced here

(b) The full TAB subsistence allowance as presentlyprovided will be payable for the duration of the assignment.The normal staff benefits (other than the proposed socialsecurity coverage) are not applicable. Where the totalservice or contractual service for an expert extends himbeyond one year, his conditions of service shall be convertedto those applicable to the post he occupies, continuing orproject. This provision will not apply if the extensionbeyond one year is for a period of less than 30 days.

D. Payment of Experts' Allowance

All experts employed under the Expanded Programme willbe entitled to receive project service allowances directly fromthe employing (participating) organization and will not beexpected to look to host governments for the payment of anysuch allowances.

II. SPECIFIC CONDITIONS APPLICABLE TO PROJECT POSTS

The conditions which I intend to apply to project posts andstaff assigned to these posts are listed below according tomajor items :

(a) Salary

It is proposed that the salary scale as presently in use inthe United Nations and the Specialized Agencies, butwithout application of differentials, as in cost -of- livingadjustments, be adopted for project posts. This scaleprovides, in my view, sufficient levels to enable the Agenciesto select the one most appropriate to the level of complexityof the job and to the competence of the expert. I believethat we should not maintain a separate TAB salary scalewhen no end is achieved thereby. It is assumed that Agencieswill normally appoint staff to the entrance salary of theappropriate level.

(b) Salary Increments

It is proposed that staff members appointed to projectposts should be eligible to receive increments at the timeand in the amount provided by the United Nations salaryscale. In the case of an expert appointed for one yearwhose contract is extended, it would be presumed that heserved without a break in service and would thereby becomeeligible to receive the salary increment due at the beginningof the second year of service.

(c) Project Service Allowance

Project service allowance will be such as to cover thecost of suitable lodging for experts, and normally would beestablished at a rate approximating 40 per cent of the TABsubsistence rate for the country. In establishing this ratefor any country, however, the Executive Chairman of TAB.will take cognizance of additional factors such as exceptionalliving costs and hardship. In no event, moreover, would theproject service allowance be less than 40 per cent of theTAB subsistence rate in any locality, except where suitablelodging is furnished in kind.


(d) Children's Allowance

It is proposed that staff in a project post be eligible toreceive children's allowances in accordance with the termsand conditions as generally agreed to by the United Nationsand the Specialized Agencies.

(e) Education Grant

It is proposed that staff in project posts be eligible toreceive an education grant in accordance with the termsand conditions as generally agreed to by the United Nationsand the Specialized Agencies.

(f) Dependency Credit

In its use of a gross salary scale, the United Nationsallows a dependency credit in the amount of $200 for astaff member with eligible dependants in determining theamount to be deducted in reducing the staff member'sgross salary to a net salary. UNESCO provides in itssalary system an additional allowance of $200 for eachstaff member with eligible dependants. I propose to institutethe payment of a dependants' allowance in the amount of$200 or the establishment of a dependency credit in theamount of $200 for all staff under the Expanded Programme,depending upon whether the Agency uses a net or grosssalary scale.

(g) Installation Allowance

It is proposed to continue the present provisions in theTAB Personnel Manual for the payment of an installationallowance for experts assigned to or transferred betweenproject posts.

(h) Home Leave

It is proposed to continue the present provisions forhome leave as they exist in the TAB Manual, subject tominor modifications suggested by the Working Party(TAB /R.211, p. 7, paras 25 and 26).

(i) Annual Leave

It is proposed to continue the present provisions forannual leave as they exist in the TAB Manual.

(j) Sick Leave

It is proposed to continue the present provisions forsick leave as they exist in the TAB Manual.

(k) Annual Travel Home

It is proposed to continue the present provisions forannual travel to residence as laid down in the ExecutiveChairman's October cable.

(1) Removal

It is proposed to continue the present provisions forremoval as they exist in the TAB Manual, subject to theamendments recommended by the Working Party(TAB /R.211, p. 7, paras 27 -30).

(m) Clothing and Equipment

Since Agency practices vary considerably as to whetherequipment is supplied to an expert and /or whether theclothing allowance is used, and since the Working Partywas divided on the question of these two items, I proposeto continue the present TAB Personnel Manual provisionsin respect of them but will consider the possibility of blend-ing the two items into a single provision and clarifying andsimplifying the rules for their use. It seems to me thatthere is justification for a clothing and /or equipment pro-vision. I am aware, however, that there are difficulties in theadministration of such a provision. I will give early attentionto this matter.

(n) Pension Fund

It is proposed that ultimately the Agencies would followtheir present practices for regular staff with respect to theparticipation in the Pension Fund for project posts and,in the meantime, I will make arrangements in accordancewith the recommendations contained in paragraphs 37 and38 of the report of the Working Party to have the fullimplications of the use of the Pension Fund in respect toexperts employed under the Expanded Programme exploredby the Secretary of the United Nations Joint Staff PensionFund. At such time as a report is available, I will considerwith the Agencies the desirability of making the necessaryarrangements for the use of the Fund by the ExpandedProgramme. In any event, I propose that we should postponethe general application of the Pension Fund provisions forproject posts until 1 January 1954.

Appendix 16

DEFINITION OF ADMINISTRATIVE AND INDIRECT OPERATIONAL COSTS

1. For reporting purposes it is necessary to distinguishbetween the purely administrative expenses and those generaloperational expenses that cannot be specifically identifiedwith individual projects.

2. The Organizations distinguish, in their accounts andreports, expenditures under the following categories in accord-ance with the definitions specified below :

1 See UN document E/2304, Annex III.

(a) Central Administrative Costs : these are Headquarterscosts which include :

(i) costs related to over -all functions such as performedby staff which determine general policies, and over -allplanning of the programme as a whole ;

(ii) costs related to general office services, budgeting,auditing, accounting, record keeping, personnel andpublic information functions ;


(iii) travel and related costs of representatives of organiza-tions attending meetings of the Technical AssistanceBoard and its Working Groups ;

(b) Indirect Operational Costs : these are costs (otherthan central administrative costs) which are not directlyidentifiable with specific projects, but are of an opera-tional nature.

These include all costs in connexion with :

(i) planning and technical supervision directly relatedto specific fields of activity ;

(ii) planning and technical supervision directly relatedto specific regions ;

(iii) equipment, supplies, etc., which are used in thefield for operational purposes, but cannot appropriately

be exclusively charged as the costs of an individualproject in view of their common use on more than oneproject ;

(iv) all costs related to the engagement of residentrepresentatives except when these representatives havespecifically been appointed for one particular project ;

(v) costs related to the setting up of a joint briefingcentre ;

(vi) costs, of experts serving in an unassigned pool(pending assignment to specific projects) ;

(c) Project Costs : these are direct operational costs whichcan be identified with a specific project ; it should be abasic principle that all costs which can be directly chargedto a specific project should be herein included.

III. ORGANIZATIONAL STUDY ON THE EDUCATION AND TRAINING PROGRAMME

The following study is submitted by the Executive Board for the consideration of the Sixth World HealthAssembly (see resolution EB11.R53). In Appendix 2 will be found a summary of the opinions expressed at theeleventh session of the Board when the study was discussed (in the course of the twenty fourth, twenty-fifth andtwenty -sixth meetings).

1. WHO'S OBJECTIVES IN EDUCATION ANDTRAINING

1.1 Introduction

It is in the Constitution of the Organization thatthe general objectives in the field of professionaleducation and training, as in any other field, are to befound. Article 2 provides that among the functionsof the Organization are :

(j) to promote co- operation among scientific andprofessional groups which contribute to theadvancement of health ; .. .

(o) to promote improved standards of teachingand training in the health, medical and relatedprofessions ; .. .

(q) to provide information, counsel and assistancein the field of health ;

These constitutional obligations and certain inheritedfunctions from preceding international health orga-nizations, as well as general demands for services,have combined to make education and trainingfundamental functions of the World Health Organi-zation. The present study will attempt to show howthese are undertaken not only by certain specificunits but also as part of most WHO programmes. Inlater sections of this report, references will be madeto various Health Assembly and Executive Boardresolutions which have established the policiesof the Organization in this matter and given generalform to its education and training programme.

1.2 Objectives

Briefly stated, the objectives of WHO in the fieldof health and medical education and training are to :

(1) determine world needs by regions and bycountries for trained personnel in the variousbranches of health and medicine ;

(2) assist countries in meeting these needs ;

(3) establish standards of training, and of thequalifications of personnel ;

(4) determine appropriate methods and tech-niques for use in international and nationalprogrammes.

The attainment of these general objectives willinvolve :

(1) surveys by countries and by regions ofnumbers and categories of medical and healthpersonnel, existing and required ;

(2) surveys of the number and nature of insti-tutions available to assist in national and inter-national education and training programmes ;

(3) studies of techniques, methods, curricula,and content of courses, available for internationaluse in these fields ;

(4) assistance to national institutions in develop-ing their suitability and capacity for traininginternational personnel ;

(5) assistance to countries in securing trainedpersonnel in the categories required ;

(6) the co- ordination of various national insti-tutions and arrangements for providing trainingfor international personnel ;

(7) a system for international collaboration inexchanging information, techniques and methods ;

(8) plans for assisting countries in developingsuitable programmes of training and education,to include standards, techniques, courses, andarrangements for external assistance ;

- 131 -


(9) arrangements for international fellowships,visiting teams, courses, tours, etc., especially in thefields of current WHO programmes.

1.3 Some Historical Features

There is not space to give a detailed account, butit is important to recall that much internationalactivity, promoted both by official and by unofficialmeans, antedated the World Health Organization inthe fields of training and education. The HealthSection of the League of Nations, apart from itsgeneral programmes which contributed to education,had undertaken such training and educationalenterprises as study tours, exchange of medicalpersonnel, etc. It is of interest to recall that theseLeague programmes and techniques owed much ininspiration and material assistance to the Rocke-feller Foundation, which -though other voluntaryand private bodies also contributed -did so muchof the early international work in health education.Its various techniques -study tours, exchange ofpersonnel, demonstration teams and fellowships -have been so amply developed and tested as to bea most useful source of experience for WHO.

Apart from such stores of experience to draw upon,WHO also directly inherited the health educationalwork initiated by the United Nations Relief andRehabilitation Administration (UNRRA). At thebeginning of 1947, the Interim Commission of WHOtook over the health activities of this agency. Amongthe training activities were a programme of fellow-ships and the provision of medical literature andteaching equipment to selected; training institutions.This assistance, given from funds transferred fromUNRRA, was limited to the war -stricken countriesof central and eastern Europe and of Asia. At theend of 1948, the availability of WHO's own fundsmade it possible to provide fellowships and medicalliterature to all countries requesting such assistance.

The Interim Commission of WHO prepared aprogramme of education and training which wasaccepted by the First World Health Assembly. Thisprovided for the continuance and expansion of thework on fellowships, exchange of personnel, andteaching and demonstration teams. In accordancewith the system of priorities adopted by the FirstWorld Health Assembly this work was concentratedon the priority subjects : malaria, venereal diseases,tuberculosis, maternal and child health, environ-

mental sanitation and nutrition. At each subsequentHealth Assembly, special resolutions have beenadopted on education and training over and abovethe . resolutions approving the general programme.For example, the Second Health Assembly requestedthe Director- General to encourage the establishmentand development by governments of nationaleducational institutes in the field of health, and toencourage the development of courses having aninternational character at existing educational insti-tutes (resolution WHA2.7). The Third WorldHealth Assembly, in resolution WHA3.2, took noteof the report of the first session of the Expert Com-mittee on Professional and Technical Education ofMedical and Auxiliary Personnel,1 in which theimportance, of the sociological and preventivecomponents in the education of . health personnelwas emphasized, and called the attention of countriesto the necessity of adequate preparation of medicaland other personnel essential for health care. Atits sixth session the Executive Board emphasized thedesirability of making studies of the types of medicaleducation in general, and of education in publichealth and social medicine in particular, in variouscountries, in accordance with the recommendationsOf the expert committee (resolution EB6.R35).

Owing partly to decisions of the Health Assemblyitself that have enlarged the Organization's field ofactivity, and partly to the increasingly dominant roleof national requests in the framing of regionalprogrammes, the earlier system of priorities haslargely lapsed. One result has been that the trainingand education programmes now cover many moresubjects than the original priorities.

The present methods of drawing up and carryingout programmes have also been influenced by thetransition from the rehabilitation objectives of theearly UNRRA programmes to the present objectiveof meeting the requirements of individual countriesfor co- ordinated programmes, frequently of a long-term character. Supplies and equipment, for example,are now provided with more discretion, and onlywhere they are an essential part of a project. Thereis too the development of fellowships from beingisolated arrangements to being an essential part of anational health project. Group training, inter-regional arrangements and study of educationaltrends are further features of the newer outlook.

1 World Hlth Org. techn. Rep. Ser. 1950, 22

REPORT : 'EDUCATION AND TRAINING PROGRAMME 133

The education and training programme has alsocome to be more directly integrated into WHO'sgeneral programme. The elaboration, as requiredby the Constitution, of a general programme ofwork covering a specific period gave considerableemphasis to the fundamental function of WHO asan international body concerned in developingeducation and training programmes.

The present WHO policy in relation to programmesof assistance to Member Governments is based ontwo main requirements : firstly, measures under-taken with the object of strengthening nationalhealth administrations, and secondly, the developmentof arrangements, both international and national, foreducating and training health and medical personnel.These have become the two main features of all WHOprogrammes developed on the basis of nationalrequests through regional offices during the last threeyears. They are the elements on which planning for1954 in terms of the general programme of work isalso being evolved.

2. STUDIES OF EDUCATIONAL TRENDSAND PROMOTION OF TEACHING STANDARDS

2.1 Standards of Professional Education and Train-ing : WHO's Role

In its first formulation of the general programmeof work covering a specific period 2 (subsequentlyapproved by the Third World Health Assembly inresolution WHA3.1) the Executive Board recognizedthe role of the World Health Organization in thepromotion of standards of professional and technicaleducation, saying :

It is necessary that certain standards be laiddown to which all countries should attempt toconform in their campaigns to modernize theircourses for the training of doctors and otherworkers in the health field. Not only do standardsin medical education require to be raised in manycountries, but there should be a re- orientationof the studies of all medical, nursing, sanitaryand other auxiliary personnel, undergraduateand postgraduate, in the direction of increasedemphasis on modern publichealth (includingpreventive and social) aspects of medicine.The problem of universal standards of training in

medicine, nursing, and public health has been raised

2 Of Rec. World Hlth Org. 25, 30

in the World Health Assembly and in some of theinternational non -governmental organizations, e.g.the World Medical Association, the InternationalCouncil of Nurses, and the International Associationof Universities. Teaching standards in various areashave evolved, according to needs and availability ofresources, usually in close connexion with culturaldevelopments and sometimes under foreign influenceprevailing in a particular historical period. Althoughtraining should be adapted to local conditions, somegeneral understanding of the elements essential to theeducation and training of professional workers ofcomparable status is helpful, and this requiresextensive preparatory work, studies, and exchangeof views and experience on the national and inter-national level, in both governmental and non-governmental groups. Irrespective of how satis-factory the results of such efforts may be, they cannotfail to stimulate interest and progress in medical(and related) education. The increasing trendthroughout the world to consider health one of thebasic human rights (International Covenant onHuman Rights) has intensified the interest of publicauthorities, educators, the professions and thegeneral public in education and training in the healthprofessions.

WHO's assistance to countries and institutions inconnexion with the promotion of teaching standardsis described in the subsequent parts of this report, butmore general activities involving analysis of world-wide trends and formulation and promotion of ideasare discussed here.

2.2 Expert Committees

A general review of the problem, as related tointernational co- operation, was made at the firstsession of the Expert Committee on Professional andTechnical Education in 1950. The committee alsomade a series of statements and recommendationson the training of various groups of public- healthpersonnel and the orientation of medical education.At its second session 2 it dealt with the problem of abalanced medical curriculum and worked out anoutline of its essential elements, with special referenceto the social and preventive aspects of medicine.

2 Report to be published as World Hlth Org. techa. Rep.Ser. 1953, 70


A number of other expert committees have touchedupon problems of education and training of theirown categories of workers (see Appendix 1), andothers have made recommendations on the use offellowships in their special subjects, e.g. antibiotics,bilharziasis, cholera, hygiene of seafarers, theInternational Pharmacopoeia, and malaria. Manyof these expert committee reports contain referencesto the first report on professional and technical educa-tion, and vice versa. Some committees referred specificproblems for study to other committees speciallyqualified to study them, e.g. mental health. Thehigh degree of agreement on needs and future actionindicates the ubiquity and importance of the problemsof education and training.

2.3 Technical Discussions

The increasing interest of governments in trainingproblems led the Executive Board to select theeducation and training of medical and public -healthpersonnel as the topic for the technical discussionsduring the Fourth World Health Assembly.

Although these discussions were informal and werenot intended to lead to any decisions or recommen-dations, they provided an opportunity for the collec-tion and dissemination of information on the trainingof various types of personnel in different countries.Certain common experiences and trends of thoughtwere revealed in spite of the diversity of opinions.The need for orienting medical education towardsthe preventive and social aspects of medicine and forincreasing co- operation between the public- healthservices and teaching institutions was found to bealmost universally recognized. A trend towards theuse of auxiliary personnel in order to increase the effi-ciency of fully trained staff was noted.

These discussions in the World Health Assemblystimulated technical discussions on education andtraining in the Regional Committees for South -EastAsia and for the Western Pacific in 1952.

2.4 Conferences on Educational Problems

Conferences directly or indirectly concerned withprofessional education and training may act as

(a) sources of material for use by WHO and(b) channels for expressing concepts promoted by

WHO. Examples of participation in several suchconferences are given below.

A conference on the teaching of preventivemedicine, social medicine and hygiene in medicalschools was sponsored by WHO in Nancy in 1952,with participants designated by Member States fromEurope. It is generally realized that in most Eu-ropean countries the teaching of preventive andsocial medicine has not kept pace with the progressmade in the teaching of some of the other subjectsin the medical curriculum ; this conference mayprove to be an important step in stimulating remedialaction. In North America, a conference on theteaching of preventive medicine organized in 1952was attended by WHO staff members. WHO hasaccepted the invitation of the World Medical Asso-ciation to take part in the organization of the FirstWorld Conference on Medical Education (London,August 1953) and is actively engaged in planning andpreparatory work for this. WHO also participatedin : the First Pan -American Congress on MedicalEducation (Lima, 1951) ; the General Conferenceof Universities, called by the International Univer-sities Bureau (Nice, 1950) ; the UNESCO Meetingon the Teaching of the Social Sciences (Paris,1952) ; meetings of the International Councilof Nurses, the International Union of MedicalStudents, and the International Union of PublicHealth and Preventive Medicine ; and a seriesof discussions on trends in and methods ofmedical education and training of health personnelheld in various countries in connexion with grouptraining activities (for details, see Section 5).

2.5 Studies and Surveys

WHO makes special studies of particular aspectsof educational problems, sometimes at the requestof governments, and sometimes in co- operation withother agencies. One example is the current studyof paediatric education, in collaboration with theInternational Paediatric Association. This workhas started in Europe, but it is intended to extend itto some of the other regions.

A number of studies of educational trends innursing are now under way, such as the studies oftraining systems for nurses and auxiliary nurses inthe African Region and the surveys of nursing needsand resources in Thailand and in Syria. WHO is

REPORT : EDUCATION AND TRAINING PROGRAMME 135

co- operating with the International Council ofNurses in a study of programmes for the advancededucation of nurses, nursing teachers and adminis-trators and in the publication of a guide for schoolswhich have courses for such workers.

WHO and the Rockefeller Foundation are co-operating in a study on the function and trainingof health and welfare workers, with particular regardto the needs of families receiving health and welfareservices. The study is being made in England by theDepartment of Ecology of the University of Cam-bridge and in France by the Institut d'Etudesdémographiques in Paris. It is expected to becompleted by the end of 1953.

3. UNDERGRADUATE PROFESSIONAL EDUCATIONAND TRAINING : ASSISTANCE TO

EDUCATIONAL INSTITUTIONS

3.1 Introductio n

The focal point of undergraduate professionaltraining and education is the educational institution,such as the college of medicine, the institute ofhygiene, the school of nursing, the college of phar-macy, the veterinary medical school, and the insti-tution for the training of auxiliary personnel. WHOaids such institutions in accordance with resolutionWHA2.7 of the Second World Health Assembly.

Many health problems can be attacked only byjudicious use of trained workers. The problem is todetermine the kinds and numbers of such workersrequired and then to train them. In this endeavourWHO makes its contribution by a six -point pro-gramme of assistance to educational institutionscovering personnel, supplies and equipment, cur-ricula, teaching methods, qualifications of teachers,and organization and management.

3.2 Personnel

One of the most effective measures for strengthen-ing an institution, or some part of it, is the installa-tion of a visiting teacher for a specified period oftime to instruct students and train his successor.WHO cannot undertake to staff faculties per-manently ; it can only help them to start a long -range scheme for replacing senior members.

The attainment of this goal requires, on the partof the institution and the government, comprehensiveplanning in which WHO assists. A typical plan isto assign a teacher to an institution for two years andaward a fellowship to a promising candidate during thefirst of these two years. When the fellow returnsfrom his studies he becomes assistant to the visitingprofessor, who has by this time acquired a certainexperience in that particular society, while the fellowhas gained in professional knowledge. The remainingtime is then spent in bringing together these twocomponents so that the assistant professor has theopportunity of adapting his technical progress to thesocial milieu. During the second year another fellowmay be sent for further training, and yet another inthe third year. Thus at the end of the visiting pro-fessor's assignment there is one person capable ofreplacing him, and one or two others are fitted to bejunior members in the department. Subsequentcandidates may or may not need fellowship studiesto make them eligible to replace the " foreign -trained " group, depending upon how well theseteach their subject to future generations. Manyvariations and expansions of this scheme are possible.

The circumstances under which an institution seeksoutside help of this kind are somewhat varied. Asubject never before taught at the institution maybe considered important enough to warrant theestablishment of a new department of instruction,such as a department of preventive medicine and publichealth in a medical college. Rapid political and eco-nomic changes have sometimes created a suddenshortage of senior teaching personnel. The establish-ment of full -time professorial chairs in place of part -time posts may entail assistance from outside sources,or help may be requested because the latest technicalknowledge in a particular subject has not beencompletely assimilated into the teaching departmentconcerned. WHO has sent teachers to institutionsfor all these reasons as well as others. Administratorsmay also be assigned to an educational institution;this has already been done in one case.

The recruitment of persons qualified to occupyprofessorial chairs in foreign countries is a problemwith no single solution.

3.3 Equipment and Supplies

Scientific subjects cannot be taught withoutmaterials for demonstrating the application of


principles. When WHO assigns teachers, therefore,it dispatches the equipment and supplies necessaryto make good any deficiencies in the institutionconcerned.

Materials provided for educational institutionsinclude :

(1) Medical and scientific literature (such as booksand scientific periodicals) ;

(2) laboratory apparatus (such as glassware andscientific instruments) ;

(3) laboratory supplies (such as chemicals andbiologicals) ;

(4) diagnostic and therapeutic instruments usedfor teaching (for example, microscopes, electro-cardiographs and physiotherapy apparatus).

The visiting professor trains his understudies inthe proper use of the equipment, but maintenanceservices for scientific apparatus are not alwaysavailable. The training of instrument mechanics foreducational institutions will have to be given con-sideration.

3.4 Curricula

A curriculum is an educational plan and shouldexpress the steps whereby certain stated objectivesare approached. It is important that the educationalinstitution should define its goals, especially in termsof the personnel needs of the community (nationalor local). This must include, in the case of a schooltraining health workers, an analysis of the healthproblems, the kinds of professional workers neces-sary, their proposed duties, and the knowledge theymust have in order to perform them. Althoughcertain minimum world -wide standards must beadhered to, especially where degrees are offered, thereis no point in establishing a curriculum which merelycopies that offered in another country. Each mustreflect conditions in and of the society which itserves.

In the drawing -up of a curriculum, many factorsshould be considered besides the relative importanceof the several subjects. Among them are the priorpreparation of the students, the stage of developmentof institution and staff, and the capacity of thesociety to absorb advanced concepts.

WHO is developing a set of principles governingthe curricula of professional educational institutions,on which advice to be given in individual instancesmay be based. By stimulating wider appreciation ofthe fact that existing curricula should be analysed

in the light of acceptable principles, the Organizationassists many institutions to adopt a more realisticpolicy of education and training.

3.5 Teaching Methods

The methods by which knowledge is disseminatedare often as important in attaining educational goalsas is the substance itself. WHO studies and promotesthe teaching methods and techniques most appro-priate under varying circumstances.

3.6 Qualifications of Teachers

There is a growing recognition that neither tech-nical or professional competence nor the performanceof research necessarily means that a person appointedto an academic post is able (a) to communicateknowledge, (b) to stimulate students to learn forthemselves, and (c) to inspire high ideals in thepractice of the profession.

Modern educational psychology holds that theart and science of teaching is a skill which can betaught and learned, and that it does not stem fromcertain indefinable " inner gifts ". In addition toactual performance as tested in the classroom, clinic,and laboratory, a suitable course of training whenadded to certain personal attributes may help producea corps of highly qualified teachers. WHO aids inpromoting these concepts by advice and consultation.

3.7 Organization and Management of EducationalInstitutions

The achievements of an enterprise often dependto a great extent upon the administrative as well as thetechnical skill of its staff. WHO recognizes thatthis is especially true of the director, upon whom fallsthe responsibility for setting the institution's goals,acquiring and utilizing its resources, welding theseparate parts into a whole, and planning its futurecourse. The dean of an institution represents thecentral point from which " reforms " in medicaleducation can start.

3.8 General Functions

WHO is sponsoring, through the InternationalUniversities Association, the compilation of a worlddirectory of medical colleges. It is expected that infuture years similar directories for other categories ofinstitutions will be prepared.


Another project is the preparation of basic inven-tories of teaching equipment and supplies for certaindepartments of medical colleges, such as the depart-ments of anatomy, morbid anatomy, bacteriology,biochemistry, histology, hygiene, pharmacology andphysiology. The collaboration of approximately200 professors from practically all the countries ofthe world was solicited, and their comments andsuggestions were obtained on lists prepared in 1945by the Science Commission of the Conference ofAllied Ministers of Education. The resulting infor-mation has been collated, and will be published incollaboration with UNESCO. These inventories willenable new medical colleges to estimate theirinitial requirements of equipment and supplies, andwill give existing departments an opportunity toreview the materials considered essential for modernteaching. Similar projects for other categories ofinstitution are contemplated.

3.9 Training of Auxiliary Personnel

The training of auxiliaries calls for concertedaction by many organizational units of WHO. Theproblem has three aspects : (a) what kinds ofauxiliaries are needed in different localities ; (b) howthose who are to train and supervise the auxiliariesshould be trained ; (c) how the auxiliaries should betrained. Some auxiliaries are best trained in thecourse of field projects ; others need institutionaltraining as well, and many countries will requireassistance for this purpose.

WHO, the United Nations Social Commissionand UNICEF have all stressed the importance oftraining auxiliary personnel. However, it is necessaryto keep in mind that the " production " of auxiliariesshould correspond to the possibility of their usefulemployment. Any outside assistance in trainingshould therefore be based on the preparedness of thegovernment to make use of such personnel.

In a current WHO programme the training offeredto auxiliary personnel in a number of institutionsis being studied in an attempt to determine : (a) basicsimilarities in student bodies and curricula ; (b) fac-tors which determine the differences in their activities ;(c) principles which may be adapted to broader use.

3.10 Nursing Education

WHO has developed a programme of direct aidto established schools of nursing. Assistance to aspecific institution has often served as a startingpoint for the promotion of a country -wide trainingprogramme.

4. PREPARATION OF ADVANCED QUALIFIEDPROFESSIONAL HEALTH WORKERS :

FELLOWSHIPS

4.1 Introduction

The holder of a WHO fellowship is sent outsidehis own country to pursue special studies for whichsuitable educational facilities are not available athome. In almost every instance, the Fellow hasalready attained professional status (physician,nurse, statistician) and seeks further training in orderto bring to his country a knowledge of the advancesmade in a specialty of health work. A small numberof fellowships is awarded by WHO for undergraduatestudy to nationals of countries which have noinstitutions capable of giving basic professionaleducation and training.

Cognizant of the need for study abroad and of theimportant role that an international organization mayperform in this respect, World Health Assemblieshave established and have given prominence tofellowships in the programme and budget of theOrganization. The fellowship programme, whereby .

selected students are given an opportunity for studyand training in other countries, is considered one ofthe most valuable means of promoting internationalunderstanding and of improving medical and healthstandards in all nations.

4.2 Development of Activities and Procedures

The fellowship activities of WHO began with thelimited programme which the Interim Commissionundertook to carry out as part of its agreement withUNRRA. During 1947 and 1948 the programme wasfinanced from funds granted for the purpose byUNRRA, and was therefore, by necessity, reservedfor the countries entitled to receive UNRRA aid ;only eleven of them -eight in Europe and three in theWestern Pacific -asked for assistance in the form offellowships.

During that early period certain procedures wereintroduced which still continue to form basic ele-ments in the award of fellowships. They include :a request from a government, selection by a com-mittee in the country of origin, acceptance by theOrganization, issue of the award by the Organizationto the Fellow through his government, and placementwith the authorities in the country of study.

During the Interim Commission period it wasalso decided that the Fellow must commit him-self to render services to his government after

138 EXECUTIVE EOARD, ELEVENTH SESSION

the completion of his fellowship, and that theminimum fellowship period should be set at sixmonths, with exceptions for senior staff, for whomthree months were given as a usual minimum.

Resolutions of the First and subsequent WorldHealth Assemblies and of the Executive Board haveeither sanctioned new ideas included in the Director -General's reports and his proposed programmes andbudgets or have introduced them in WHO fellow-ship practices. A resolution of the First WorldHealth Assembly4 (a) included provision for short -term fellowships for candidates in key positions ;(b) expressed the desirability of having the govern-ments contribute to the cost of the fellowships oreven finance them wholly ; and (c) allowedthe granting of fellowships to undergraduates andto foreign employees in the case of countries notpossessing their own graduate health personnelsuitable for fellowships. At the second session of theExecutive Board, the respective contributions of theOrganization and of the candidate's government wereclarified.5 Fellowships were clearly designated as" resident ", " travel ", or both ; monthly, final andfollow -up reports were systematically sought fromthe Fellows ; and a report was expected from thegovernment which had requested the fellowship onthe utilization of the Fellow after his return.

A very important point in the development of thefellowship programme was the emphasis laid by theSecond World Health Assembly on the granting offellowships for group training and the decision toencourage the organization of courses (resolutionWHA2.7). Group training was taken to mean bothtraining in groups and training of groups or teams.The importance was stressed of training in countriesnot far removed in distance and development fromthat in which the Fellow originated, but at the sametime a warning was given against too parochial aspirit. It should be noted that the Joint Committeeon Health Policy, UNICEF /WHO, has also drawnattention to the desirability of placing Fellows intraining centres within their own region in so far assuitable centres are available.

The financing by UNICEF of training activitieswas enlarged to include individual fellowships, andthe Joint Committee on Health Policy, UNICEF/

4 Off Rec. World Hlth Org. 13, 3065 Off Rec. World Hlth Org. 14, 78

WHO, decided that such fellowships should beadministered by WHO on behalf of UNICEF. Thefellowship activities of WHO were further enlargedwhen the Expanded Programme of TechnicalAssistance for Economic Development came intobeing. Fellowships financed from UNICEF orTechnical Assistance funds are administered in thesame way as those financed from the WHO regularbudget.

Another development concerns the unused fellow-ship funds at the end of the year. Such balances wereautomatically carried forward to the next year'sbudget. This practice will come to an end in 1952,and from 1953 no balances which have not alreadybeen committed by an award will be transferred tothe next year. The reason for the change is that, inaccordance with resolution EB8.R28, fellowshipsare being provided as an integral part of projectsor as projects in themselves, and the full amount ofan award is to be a commitment against the fundsof the fiscal year of the award.

The Executive Board resolved at its fifth sessionthat the Director - General should decide on theaward of fellowships, basing his decisions on :(a) experience in the programme ; (b) the recom-mendations of the Expert Committee on Professionaland Technical Education of Medical and AuxiliaryPersonnel ; and (c) the advice of the regionaldirectors.° Consideration has been given by theExecutive Board to language qualifications andthe need for contact with Fellows during their studyperiod, as well as the importance of priorities byregions. The need for prolonged study at one par-ticular centre rather than visits to a series of centres,the need to use more soft -currency countries as centresof study, and the advantages of having candidatessubmit a study of conditions in their own countryhave also been discussed.

The latest decision affecting the fellowship pro-gramme is resolution WHA5.27, which requests theDirector -General, when awarding fellowships forindividual studies, either within or outside a region,to give priority, for the next three years at least, tothe under -developed countries.

The application of the above decisions has ledto a situation which may be briefly described asfollows :

6 Of Rec. World Hlth Org. 25, 13


(1) Some host countries are finding difficulty inplacing Fellows offered to them for training.

(2) Some countries, on the other hand, areencountering difficulty in finding suitable candi-dates to take up fellowships offered.

(3) Some countries cannot spare good candidatesfrom their work.

(4) Difficulties of adaptation exist in the tenureof fellowships because of differences of languageand culture between the Fellow's country and thehost country.

(5) It is not always easy to find suitable employ-ment for Fellows on their return home, bearingin mind the budgetary limitations of governmentsand the expectation by Fellows of increasedremuneration.

(6) Some governments now claim that the bestway they can benefit from international pro-grammes involving fellowships is by receivinggrants for students in their own institutions orfor courses. The Technical Assistance Board hasagreed, on the suggestion of WHO, to make suchgrants to certain nationals within their owncountries when a course or seminar is internationalor regional, that is, when it is open to students fromcountries other than the host country.

(7) The decision (resolution EB8.R28) to makefellowships a component of appropriate projectsmay have affected the questions of proposal andplacement.

It would seem that there are important questionsnow requiring an answer :

(a) Is there sufficient evidence to justify anychange in WHO's policy as regards fellowships ?(b) If there is, what form should such changetake ? Should the provision of fellowships bereplaced to some extent by the provision of moreinternational teaching personnel within requestingcountries, that is, supposing that recruitmentdifficulties can be overcome ?(c) Alternatively, should fellowship regulationsbe amended as indicated in point (6) above ? If itis decided to provide fellowships for attendanceat national courses, should all or part of thefollowing criteria be taken into consideration,in order to ensure that the course has some inter-national features ?

(i) Whether the course is staffed or partiallystaffed by international teachers ;

(ii) Whether the curriculum has been agreedupon in consultations between the governmentconcerned and WHO ;

(iii) Whether the course is designed to meetthe needs of more than one country, for instanceis open to students from other than the hostcountry.

When a health objective has been defined, thetraining of certain categories of personnel is almostalways an integral part of the proposed plan. Theaward of a fellowship, therefore, is related to :(a) the needs ; (b) the process through which thecandidate passes during his studies ; and (e) theutilization of his newly acquired knowledge upon hisreturn.

4.3 Summary Review of Statistical Data

The main developments in policies concerningthe fellowship programme are indicated in thefollowing tables, summarizing, for the period 1947 -51,the data which have appeared in the Annual Reportsof the Director - General, with such modifications asare warranted.

Table 1 gives the number of fellowships awardedeach year for the period 1947 -51, according to thesource of funds. During 1947 -48, the fellowshipprogramme was limited to the countries receivingUNRRA aid.

Table 2 gives the number of inter -regional andregional fellowships for individual and group train-ing awarded each year from 1947 to 1951. Thenumber of regional fellowships (i.e. fellowships forstudy in another country of the same region) hasincreased since 1950. At the same time the numberof inter -regional fellowships has decreased.

Table 3 shows, by region of origin, the numberof inter -regional and regional fellowships andthe number for individual and for group training. InEurope and the Americas training was mainlywithin the region ; the other regions send most oftheir Fellows outside. In Europe, more than a thirdof the fellowships awarded were group- trainingfellowships ; the other regions make use mostly ofindividual fellowships. The distribution of regionaland inter -regional fellowships as shown in Table 3


betokens the fact that in Europe and America thereare almost sufficient facilities for Fellows, which hasreduced the need for study outside the region. Severalfactors, such as small distances between countriesand a large pool of candidates to choose from, seemto have favoured the development of group- trainingprogrammes in Europe.

Table 4 shows the duration of fellowships. InEurope the average duration is 3.83 months asagainst 5.63 to 8.79 for the other regions (the averagefor all the other regions is 7.36 months).

Table 5 gives the number of visits to countries byFellows. It shows that two- thirds of the Fellowsstudied in Europe and one -fourth in the Americas.It also indicates that on the average each Fellowvisited 1.7 countries (2,826 visits to countries madeby 1,708 Fellows).

Table 6 summarizes the subjects of study for whichawards were made, grouped by major headings.Details are given in the Annual Reports of theDirector -General.

TABLE 1

Number of fellowships by source of funds, 1947 -51

Source of fundsYears

1947 1948 1949 1950 1951 Total

UNRRA /WHO. . . . 199 225 - - - 424WHO - - 197 352 511 1,060UNICEF - 2 27 44 66 139Technical Assistance . - - - - 85 85

All Funds 199 227 224 396 662 1,708

TABLE 2

Number and percentage distribution by type of fellowship, 1947 -51

Year

Type of fellowship

Inter -regional Regional Individual training Group training

No. Per cent No. Per cent No. Per cent No. Per cent

1947 . 123 62 76 38 1991948 . 119 52 108 48 2271949 . 144 64 80 36 2241950 . 159 40 237 60 276 70 120 301951 . 219 33 443 67 395 60 267 40

Total 764 45 944 55 1,321 77 387 23


TABLE 3

Number and percentage distribution by region of origin and by type of fellowship, 1947 -51

Region of originTotal

numberof fellow-

ships

Type of fellowship

Inter- regional Regional Individual training Group training

No.l

Per cent No. Per cent No. Per cent No. Per cent

Africa 20 18 90 2 10 20Americas 159 48 30 111 70 159South -East Asia . . 216 137 63 79 37 170 79 46 21Europe 916 212 23 704 77 585 64 331 36Eastern Mediterranean 171 133 78 38 22 162 95 9 5Western Pacific. . . . 226 216 96 10 4 225 100 1

All Regions 1,708 764 45 944 55 1,321 77 387 23

TABLE 4

Average length of a fellowship, by region of origin, 1947 -51

Region of origin Numberof fellowships

Numberof months

Average lengthin months

Africa 20 133.2 6.7Americas 159 895.5 5.6South -East Asia 216 1,420.0 6.6Europe 916 3,507.5 3.8Eastern Mediterranean 171 1,391.5 8.1Western Pacific 226 1,987.0 8.8

All Regions 1,708 9,334.7 5.5

TABLE 5

Total number of visits for study purposes, by region of origin and region of study, 1947 -51

Region of originRegion of study

Africa Americas South-East Asia

EasternEasternMedi-

terraneanWesternPacific Unassigned Total

Africa - 10 - 28 2 - - 40Americas - 132 - 150 - 1 - 283South -East Asia . . . - 62 100 180 14 31 1 388Europe - 225 - 1,279 1 - - 1,505Eastern Mediterranean 18 54 1 162 44 1 4 284Western Pacific. . . . - 193 9 96 5 23 - 326

Total 18 676 110 1,895 66 56 5 2,826

The same Fellow may visit more than one region.


TABLE 6

Number and percentage distribution of fellowships by purpose of study, 1947 -51

Purpose of study Numberof fellowships

Per cent

Communicable diseases 461 27Clinical medicine 239 14Maternal and child health 201 12Public -health administration 177 10Nursing 121 7Sanitation 112 7Basic medical sciences and education . . . 69 4Other 8 328 19

Total 1,708 100

8 Mental health, health statistics, rehabilitation of the handicapped, nutrition, and other health services

4.4 Fellowship Procedure

4.4.1 Selection of Candidates

The national health administration, after decidingon the projects and programmes for which studyabroad is necessary, seeks out the most appropriatecandidates. Determining factors include the actualqualifications of a candidate, his personality,training and experience, or his holding a responsibleofficial position or one otherwise related to the pro-posed work.

An application form is completed by the candidate,who thereby undertakes to serve his government onhis return. This form includes an undertaking bythe government to use the candidate in the field of hisfellowship. It also includes the opinion and recom-mendation of the national selection committee. Thisis an ad hoc body including persons from the field ofstudy proposed. The application form and coveringdocuments are then submitted to the regional officeconcerned. In the case of grouptraining projects(courses, seminars, symposia) lasting less than amonth, a much simpler procedure is used. In theselection of candidates, the co- operation of WHO isoften requested by governments. Final approval ofa candidate is the responsibility of the Organization.

4.4.2 " Placement " of Fellows

On receipt of the application the regional office maymake arrangements for study within the region ormay transmit the application to headquarters withrecommendations for study in a country outside theregion. The choice of the country of study and of theparticular institutions is based on the Fellow's ownrequest, the opinion of the national selection com-mittee, and consultations with national authoritiesand institutions.

When headquarters receives a fellowship applica-tion, a decision is taken, after suitable consultation,concerning the length of study, the countries ofstudy and, tentatively, the suitable institutionstherein. On the basis of this decision a request forplacement is made to the regional office of the coun-try of study, which in turn approaches either thenational health authority or the individual institu-tions of the proposed country of study.

A number of factors delay the whole process ofplacement. Most training institutions have moreapplicants than places, and have to select thosecandidates whom they consider it will be mostprofitable to train. Practically all schools have anadmissions committee and applications have to besubmitted months ahead. Some institutions require


such high standards of previous training and ex-perience that real difficulty is encountered withcandidates from certain areas of the world. Thereis no doubt that without the support of the nationalhealth administrations of the countries of study andthe goodwill of training institutions towards WHOthe admission of a number of candidates would havebeen either delayed or completely blocked. It isappropriate here to pay tribute to the active co-operation and assistance which has been so willinglygiven by all countries and their institutions inproviding facilities for visiting Fellows.

Another occasional delaying factor is lack ofinformation on the candidate's standard of training,his experience, and the type of work he is expectedto do when he returns home. When additional factsare requested by the institution, time may be lost incorrespondence.

The period of the year during which Fellows,especially those not attending regular courses,propose to study are sometimes inconvenient for thereceiving institution. A number of candidates wishto study during the European and North Americansummer holidays, a time rarely favoured by thecountries of study and their institutions.

Many placement problems are avoided by use ofWHO grouptraining programmes, which have beenan important element in increasing fellowshipfacilities.

4.4.3 " Supervision" of Fellows

An important factor in overcoming difficultiesencountered during the period of study abroad andin obtaining good results is the system of contactwith the Fellow. With the usual type of responsibleperson obtaining a WHO fellowship, assistance andguidance are needed rather than supervision.

One method of " supervision " is the monthly reportsubmitted by the Fellow to the Organization. Thisis a summary record of his activities, and also providesthe opportunity for comment and for following theFellow's progress.

It is necessary, in a number of cases, not only tohave a first interview with the Fellow in the countryof study in order to make detailed adjustments inthe planned programme, but also to discuss atintervals with him his problems and their solution.This personal " supervision " is to some extentcarried out at the local level by the personnel of theinstitution visited by the Fellow and at the countrylevel by an officer in the national health adminis-tration through whom the placement arrangementsare made by the Organization.

4.4.4 Follow -up and Evaluation

On the completion of his studies a Fellow isrequired to prepare a final report on his fellowship.In addition, the former Fellow is asked every sixmonths for two years for a progress report on hisprofessional activities and their relation to hisfellowship. These reports provide WHO withinformation useful in future fellowship work.

There is need for a procedure for evaluating theresults of fellowships in terms of effects on the healthservices and health conditions of the countriesreceiving fellowship assistance. Such effects mayinclude : expansion of existing services, introductionof new or improved methods and techniques,establishment of new types of services, contributionto research, improvement of local education andtraining facilities, and the presence of more en-lightened professional leaders. Appraisal of resultswould also provide a country's health authoritieswith an opportunity to judge whether improvementis required in the choice of subjects, the type offellowship studies, or the selection of Fellows.

In the collection of material for such an evaluationthree elements are basic : (a) the application ;(b) the report submitted at the conclusion of thefellowship ; (c) the progress reports.

4.5 Administrative Aspects of Fellowship Work

The division of responsibility for fellowshipsbetween headquarters and other offices of the Orga-nization has passed through four stages. In 1947 -8the Geneva office was handling the fellowships forEurope, and the New York office those for theWestern Pacific Region. After the establishment ofheadquarters in Geneva, and of a Regional Officefor the Americas at Washington, the authority forall fellowship awards was centralized at headquarters,except that the placement of Fellows in the Americaswas delegated to the Washington office (the onlyregional office at that time with such a function).This stage lasted for about a year. In the third stagethe regional offices took over the administration ofregional fellowships and participated in the manage-ment of inter -regional awards ; the FellowshipsSection at headquarters performed the functions ofthose regional offices which were not yet establishedor fully organized. The fourth stage began in October1952, when the Regional Office for Europe was givenresponsibilities similar to those of the Washingtonoffice. Authority for awarding inter -regional fellow-ships, previously exercised by headquarters, has nowbeen delegated to all regional directors.


In this stage of complete decentralization, thefunctions of the Fellowships Section at headquartersare being re- orientated towards inter -regional co-ordination, advice on inter -regional placement, andevaluation of fellowships and of experience withvarious training resources all over the world. Becauseof the large number of former Fellows (about2,500) and the interrelations with other educationaldevelopments, it is also planned :

(a) to develop a network of contacts with formerFellows for the dissemination of scientific infor-mation ;

(b) to study the curricula of training institutionsin order to attempt to adapt existing courses tothe needs of WHO Fellows and establish newcourses for them.

5. POSTGRADUATE EDUCATION : PROMOTION

OF NEW TECHNIQUES AND DEVELOPMENTS

AND EXCHANGE OF SCIENTIFIC INFORMATION

5.1 Introduction

There is a certain level of professional qualificationsbeyond which unilateral teaching becomes unsuitableand impracticable. Such persons as members ofacademic teaching staffs, public -health administra-tors and clinical directors are in this category, andWHO assists governments in bringing to thesegroups opportunities to exchange views and ex-periences so as " to promote co- operation amongscientific and professional groups which contributeto the advancement of health ".9 The value ofsuch opportunities need hardly be stressed.

Information and experience is being exchangedon problems of instructional methods as well as onscientific problems of health and medicine. Fourguiding lines are followed : (1) introduction of newskills and techniques ; (2) promotion of teamwork ;(3) promotion of a balanced approach between thefunctional and the morphological in the under-standing of disease, and between the individual and

9 WHO Constitution, Article 2 (j)

the social setting ; (4) promotion of modern methodsof instruction. In introducing new skills and tech-niques the following principles are observed : (1)New techniques demonstrated must fit into prevailinglocal conditions as far as needs and resources(human and material) are concerned ; (2) Newtechniques must be developed by making the best useof equipment locally available ; (3) Local constructionof teaching and research equipment (universityinstrument workshops, equipment for expert glassblowers, etc.) must be encouraged.

Co- operation among the various departments ofschools is stressed and demonstrated, with particularreference to relations between pre -clinical andclinical departments, between these two and thedepartment of public health and preventive andsocial medicine, and between academic teachinginstitutions and public -health authorities. Thedevelopment of a proper balance between thefunctional and morphological approaches in theunderstanding of disease is stressed, as is the needfor regarding disease not as an isolated biologicalphenomenon but in relation to the social setting.Instruction in small groups and laboratory exercisesare preferred to purely or predominantly didacticteaching. Teaching and training must be adapted tothe conditions in which graduates will exercise theirprofession.

Various types of educational techniques (projects)have by now been either adopted or developed byWHO to suit the needs of countries in differentstages of development. As a rule, these techniquesare not interchangeable or, if so, to a limited extentonly.

When large numbers of people are to be trainedin the same specialty at the same time, the use of atraining centre in combination with group fellow-ships is suitable. When very specialized skills areto be introduced into an advanced medical and healthstructure, special demonstration teams may be used.In other instances, seminars and symposia may be theappropriate methods.

" Polyvalent " educational projects have alsobeen developed, for instance visits of teams of medicalscientists.


The Third World Health Assembly, by resolutionWHA3.2, approved the first report of the ExpertCommittee on Professional and Technical Education,which " endorsed, and recommended the continueddevelopment of, the work of WHO in organizinghighly specialized teams to take part in studygroups and seminars, as a means of exchangingscientific information to promote research andfurther diffusion of recently acquired knowledge ".

5.2 Training Centres

In WHO training programmes, training centresare defined as permanent or quasi -permanenteducational installations and provide training inonly one specialty by regular repetitive courses ofinstruction. Some are operated by educationalinstitutions, others by governments with WHOassistance in the form of expert advice, provisionof teaching personnel and fellowships. Two trainingcentres were functioning in 1951 : the Research andTraining Centre in Antibiotics in Rome, operatedjointly with the Istituto Superiore di Sanità, and theAnaesthesiology Training Centre in Copenhagen,operated jointly with the University of Copenhagen.The second was established to fill primarily the needsof the Scandinavian countries ; in the first threeyears of operation, however, physicians from Austria,Belgium, China, Finland, Germany, Iceland, Israel,Italy, Norway, Spain, Sweden, Switzerland, Turkeyand Yugoslavia received training there. Theannual enrolment rose from 12 to 22. A secondtraining centre for anaesthesiology is about to beopened in Paris. Enquiries and requests from otherregions than the European also reveal increasedinterest in anaesthesiology.

5.3 Special Demonstration Teams

Special demonstration teams are small groups ofinternationally recognized specialists on short -termappointment who demonstrate certain techniqueswhere the prerequisites for their introduction exist.Such teams are being very carefully employed andtheir average stay in any one country has beenapproximately two weeks ; most of them have dealtwith chest surgery. The countries visited includeAustria, Israel, Poland, Turkey and Yugoslavia.Some of the results of these visits illustrate the possi-bilities of the judicious use of short -term consultantsin other education and training techniques. InAustria, for instance, no cardiac surgery whatsoever

had been practised before the two -week visit of theWHO congenital heart disease team. A reportreceived one year after the completion of the workof this team showed that Austrian surgeons hadsince performed 40 cardiac operations. Before thevisit, the ground had been prepared by fellowships,the provision of literature and equipment, and theuse of demonstration teams in conjunction with otheragencies.

A special demonstration team of six will visitEgypt in 1953. Its members, from five differentcountries, will spend two weeks demonstrating recentadvances in ophthalmology, in connexion with theGolden Jubilee meeting of the Egyptian Ophthal-mological Association in Cairo. Ophthalmologistsfrom the entire Eastern Mediterranean Region willattend. A United Nations observer will be present.

5.4 Symposia, Seminars and Study Groups

These terms, often used interchangeably, refer togatherings of a limited number of persons qualifiedto take part in the proceedings, in order to discussinformally some subject, usually a specialized one.

It is very desirable, for the purposes of WHO'sprogrammes, to strive for uniformity in nomen-clature. The following attempt at definition is

partly based on suggestions accepted by the Councilfor International Organizations of Medical Sciences.As there are generally exceptions to any set of defi-nitions, flexibility in application is desirable.

Symposium: a small meeting of outstandingexperts in a distinct field and probably of variousdisciplines, usually not exceeding 15 in number,lasting for several days, with the object of exploringa selected specialized subject.

Seminar : a meeting of specialists either in asingle or in related fields, up to a limit of approxi-mately 100 participants, where there may or maynot be a division into " teachers " and " stu-dents ", with the object of discussing a selectedproblem and of disseminating conclusions.

Study group : a meeting of a small number ofselected experts, designated to explore a certainspecialized problem both individually and col-lectively over a certain period of time in one ormore series of meetings, who may or may notmake any recommendations.


Symposia, seminars and study groups organizedby or participated in by WHO range from those onpurely scientific and academic problems to discussionof common everyday medical or health problems.

The Director -General's Annual Report for 1950lists 11 seminars and symposia, of which 10 lastedfor an average of 10.6 days (individually rangingfrom 2 to 23 days), and one (Inter- American Seminaron Biostatistics) for 81 days. In 1951 there wereeight such meetings, of an average duration of10.8 days (individually ranging from 2 to 38 days).In their organization WHO co- operated with UnitedNations specialized agencies, governments, andnational and other institutions. An example of suchactivities was the Infant Metabolism Seminar(Leyden and Stockholm, 1950) which presentedcertain new features in the choice of subject matterand technique. There was a very wide representationof different medical specialties in this seminar.Extensive participation of specialists in the basicsciences, and particularly in biochemistry, physicalchemistry and atomic physics, stimulated the widerintroduction of certain new methods into clinicalpaediatrics. Although there were 120 participantsin the seminar, it operated like a symposium withnever more than 15 scientists participating in anyone panel.

5.5 Visiting Teams of Medical Scientists (MedicalTeaching Missions)

" Visiting teams of medical scientists " consist ofgroups of usually 8 -15 specialists in different medicaland public -health subjects, ordinarily chosen fromuniversities of various countries, and functioningas ad hoc medical faculties for a period of severalweeks during visits to medical schools of othercountries. Such teams provide opportunities for aninformal exchange of views and experience betweenvisiting and local teaching staffs and for post-graduate (lecture and demonstration) courses. Pro-jects of this nature have been carried out by WHO(mostly jointly with the Unitarian Service Com-mittee) since Interim Commission days : in Austria(1947), in Poland and Finland (1948), in the Phi-lippines (1948), in Israel and Iran (1951), in Burmaand Ceylon (1952, operated by WHO alone). Teamsare now being organized for India and for Indonesiain 1953.

The number of participants in the manifold activi-ties of visiting teams is considerable. It may beassumed that for every team member there are 8 -10local " opposite numbers " who actively engage in

the programme. A team of 12 members wouldtherefore in the course of two months work withapproximately 100 leading local scientists, physicians,or public - health workers. The number of peoplein the audiences always run into hundreds. For manyof them these projects are the first working relation-ship with WHO. Activities on this scale requiremeticulous organization and administration andclose co- operation between headquarters and regions.

5.6 Co- ordination of Medical Congresses

International congresses are a time -honoured andfirmly established method of exchanging scientificinformation. Increasing specialization on the onehand and increasing interpenetration of specialties onthe other raised the problem of the co- ordination ofcongresses as to place, time and subject matter. WHOand UNESCO therefore jointly promoted the crea-tion of a Council for the Co- ordination of Inter-national Congresses of Medical Sciences (CCICMS),now known as the Council for International Orga-nizations of Medical Sciences ( CIOMS). Bothspecialized agencies have taken an active part in thework of the Council since its inception in 1949, andthe Second and Fifth World Health Assemblies laiddown the principles of WHO's collaboration inresolutions WHA2.5 and WHA5.34.

In addition to the problem of co- ordination, theneed for improving congress techniques has alsobecome acute because of the increasing number ofparticipants, with inevitably severe restrictions onpresentation times, and because of the need for smallgroup discussions so as to permit of more extensiveand intensive discussion of some of the problemsthan is possible in plenary meetings. The CIOMShas made serious efforts to improve both co -ordi-nation and techniques.

Since 1949 the membership has been continuouslyincreasing and the Council has become more repre-sentative of international scientific medical organiza-tions. It now constitutes an important link betweenWHO and the non -governmental world of scientists,and has by now developed certain practical methodsthat are yielding results. A conference of organizersof international medical congresses took place, amanual for such organizers is about to be published,some congresses have been successfully co- ordinatedas to time, and symposia preparatory to co- ordinationof subject matter of congresses have been organized,as well as some advanced courses and symposia inconnexion with congresses.


6. EDUCATION AND TRAINING ASPECTSOF OTHER WHO ACTIVITIES

Education and training are, in various forms,represented also in the work of several other unitsof the Organization. Following are a number ofexamples :

6.1 Malaria

Training courses are organized and carried out bythe staffs of national institutions, but the programmeis drafted in agreement with WHO, which alsocontributes by providing lecturers and fellowships.Practical training consists of laboratory and fieldwork, for not less than two months. Two suchcourses were held in 1952, one in Lagos, Nigeria,the other in Lisbon, Portugal.

A Malaria Conference was held at Kampala,Uganda, in 1950. About fifty persons attended anddiscussed the most important aspects of Africanequatorial malaria. Another malaria conference isto take place at Istanbul towards the end of 1953.

Two malaria seminars are planned for 1954 ; oneat Manila to discuss rural malaria in the South -East Asia and Western Pacific Regions, and the otherat Brazzaville to study malaria control in equatorialAfrica. Field demonstration teams are also workingin many parts of the world.

6.2 Health Statistics

WHO has organized training courses in vital andhealth statistics in Cairo, Ceylon, Santiago andTokyo, in co- operation with the governmentsof the host countries and with the United Nations,for the purpose of strengthening the statisticalservices of national administrations.

A training course in vital and health statistics washeld at Cairo in 1951 in accordance with the recom-mendations of the First Regional Conference onHealth Statistics of the Eastern MediterraneanRegion, held at Istanbul in 1950. The Organizationprovided two lecturers, seven fellowships and teachingmaterial, and participated in some of the local costs.The teaching staff was formed by specialists of sevencountries (Chile, Egypt, France, New Zealand,Spain, United States of America, Venezuela). Thirty -seven students from eight countries of the EasternMediterranean Region (Cyprus, Egypt, Ethiopia,Jordan, Lebanon, Libya, Syria, Turkey) attended;

their official positions at home ranged from clerkto chief of section, and only twelve of them had hadprevious training in statistics. Laboratory and fieldtraining (survey) methods were applied in additionto lectures.

6.3 Nursing

Nursing leaders from ten countries took part ina two -week working conference on nursing educationat Geneva in 1952, together with experts in hospitaladministration, education, and social science. Its aimwas to promote an exchange of knowledge andideas. The report on the conference contains sugges-tions for further development of nursing education,especially as regards new teaching methods.

In the Region of the Americas inter -regionalnursing conferences were held in 1949 and 1950 and" workshops " on nursing education in 1951 and1952. An inter -regional conference also took placein the Western Pacific Region in 1952, with produc-tion of teaching materials in nursing education asthe chief subject of study. Preparations are beingmade for nursing- education conferences in theSouth -East Asia and African Regions in 1953 andin the Eastern Mediterranean Region in 1954.

6.3.1 Specialized Nursing

Courses of six to twelve weeks for further trainingof nurse specialists have been organized in the South -East Asia Region. They include a sister tutors' courseand a course for health visitors in Burma, and coursesfor health visitors, paediatric nursing, and tuber-culosis nursing in Delhi.

6.3.2 Auxiliary Nursing

At the request of the Government of Brunei, WHOis assisting in organizing a short training course forassistant nurses who will work in the local hospital.

6.4 Maternal and Child Health

Field training centres in maternal and child healthare being planned for Pakistan, Cambodia, andother countries. Most maternal and child healthprojects are jointly organized with the governments


concerned by UNICEF and WHO. Four centreshave already been set up in Latin America, four in theEastern Mediterranean Region, six in the South -East Asia Region, one in the Western Pacific Region,and one in Turkey.

6.5 Environmental Sanitation

Three seminars have been held in Europe, thelatest in London in October -November 1952. As aresult, European engineers are attempting to frameinternational standards for quality of water and forwater analysis.

6.6 Tuberculosis

The first tuberculosis demonstration centre wasset up in Istanbul in May 1950 ; since then WHOhas taken part in establishing similar centres inAfghanistan, Burma, Ecuador, Egypt, India, Indo-nesia, Iran, Iraq, Pakistan, El Salvador, Syria, andThailand. WHO assists with equipment and providesinternational staff for short periods (six months totwo years) until local staff can take over.

6.7 Treponematoses

Two symposia on syphilis were organized by WHOand the host governments in Helsinki and Paris in1950. The Tenth International Congress in Der-matology considered this the turning point inEuropean syphilology. Other regional symposia ofthe same nature are planned, particularly within thenext five years.

WHO, in co- operation with the Government ofThailand and with UNICEF, conducted the firstinternational symposium on yaws control, held atBangkok in 1952 ; a second international symposiumon the same subject may be held early in 1955 in theAfrican Region.

6.8 Nutrition

WHO encourages Member countries to arrangeadvanced training courses, and to invite neighbouringcountries to send students to them, and assists byproviding lecturers, teaching material, and specialliterature. Training courses in nutrition were heldat Cairo in 1950, at Calcutta in 1951, and at Mar-seilles and in Guatemala in 1952. Another is plannedfor Manila in 1953.

6.9 Occupational Health

A seminar on occupational health was held atLeyden in 1952 for ten European nations. Itsprincipal aim was to promote closer co- operationbetween ministries of health, ministries of labour,social security institutions, and other bodies con-cerned with protecting the health of industrialworkers.

WHO has been invited to participate in ILOseminars on social security. Two of these were heldin 1951 in Costa Rica and Turkey, and one in 1952in Peru. WHO provided lecturers who discussed therelationship between public health and social- securityadministration.

In 1952 WHO assisted in the organization of atwo -month course in rehabilitation for the physicallyhandicapped adult held in Scandinavia and jointlysponsored by WHO, the United Nations Depart-ment of Social Affairs, and ILO. Eight Europeannations participated.

6.10 Publications, Technical Papers and Reports

The Third World Health Assembly, in resolutionWHA3.63, recognized the fundamental importanceof the programme of publications of the Organiza-tion. The principal technical publications are theBulletin, which contains only papers of high technicaland scientific quality, usually appealing only tospecialists ; the Chronicle, a monthly record of thework of WHO and of its chief technical publications ;the Monograph Series, on special aspects of public -

health work ; the International Digest of HealthLegislation, whose name is self- explanatory ; and theTechnical Report Series, which contains reports ofWHO expert committees and other study andadvisory groups.

To this list might be added a vast number of docu-ments and publications designed for the informationof persons inside and outside the Organization, all ofwhich are of educational value. Mention should bemade also of the services rendered to countries byWHO by providing medical literature (books andperiodicals). Many medical libraries have beenhelped with advice and supply of literature.

6.11 Training Activities apart from Definite Projects

In frequent contacts between staff members andofficials of national administrations and traininginstitutions a considerable amount of education andtraining is carried out.


United Nations social -welfare Fellows receiveinstruction at WHO headquarters on problems whichconcern both social welfare and health services.

6.12 Direct Education of the Public in HealthMatters

Professional and technical education is supple-mented by the education of the general public inhealth matters. The public is approached by WHOin two ways : by the activities of the Health Educa-tion of the Public Section and by the work of theDivision of Public Information. It is, of course,recognized that all WHO workers have the respon-sibility of helping to create an informed opinionon health in the society in which they find themselves.WHO facilitates exchange of information betweencountries on health education techniques, planningand operation of courses and programmes, andopportunities for training in this subject.

WHO also makes a more general and directapproach to the public through the work of itsPublic Information Division, which spreads know-ledge of health matters in general and of the achieve-ments of the Organization through the Newsletterand other publications and through press releases,press conferences, exhibits, lectures and radio talks.

7. ORGANIZATION OF EDUCATIONAND TRAINING SERVICES

7.1 Introduction

The organization of education and trainingprogrammes is based essentially on three elements :persons, subjects, and places.

(a) The persons to whom services are offered aredescribed in Sections 3, 4, and 5, which correspondto the three sections of the Division of Educationand Training Services.

(b) The subjects in the programme of educationand training include those described in Section 6,and may be said to be represented by the " tech-nical " units of WHO (such as the Tuberculosis,Malaria, and Maternal and Child Health Sections).

(c) The places where services are offered arerelated to WHO's structure. With the increasingdecentralization of WHO, the regional offices aretaking greater responsibility for operational aspectsof work in countries.

The co- ordination of these three elements intoa homogeneous purposeful activity is perhaps themost important, and most difficult, of the tasksassigned to the Division of Education and TrainingServices.

7.2 Division of Education and Training Services

From the beginning it was obvious that educationand training problems would become one of WHO'smajor preoccupations. In 1949, the original smalleducation unit was combined with the FellowshipsSection and with other units with training functionsand expanded into the Division of Education andTraining Services.

This division now has a director and three sectionchiefs and is organized on a functional basis.

7.2.1 Functions of the Division

The division follows world educational trends anddevelopments through information gathered fromvarious sources, and maintains contacts with nationaland international organizations and institutions -governmental, inter -governmental, and non- govern-mental (such as UNESCO, the International Uni-versities Association, CIOMS, the World MedicalAssociation and the Rockefeller Foundation) -engaged in medical education. The director is thesecretary of the Expert Committee on Professionaland Technical Education.

7.2.2 Expert Advisory Panel

The Expert Committee on Professional and Tech-nical Education of Medical and Auxiliary Personnelwas established in 1949 to advise the Organizationon problems connected with its education and train-ing programmes. Following the general change inthe structure of WHO expert committees, the com-mittee was expanded into an expert advisory panel.

7.2.3 Sections of the Division

The Assistance to Educational Institutions Sectiondeals mainly with problems of undergraduate train-ing, as well as those of postgraduate training inpublic health. The section is composed of one chief,one medical officer, and two secretaries. In addition,a medical training officer works on a temporaryassignment on training problems of auxiliary per-sonnel.

The Fellowships Section, after the recent comple-tion of decentralization, consists of one chief, onemedical officer, one secretary, and one clerk- steno-grapher. Further experience is needed as regards the


staff necessary to carry out the new responsibilitiesof the section.

The Exchange of Scientific Information Sectiondeals exclusively with postgraduate training, withparticular emphasis on raising the standards ofteaching staffs through various methods of exchangeof views and experience among scientists and aca-demic teaching staff. In co- operation with the re-gional offices, this section plans and operates suchpostgraduate training activities as specialized demon-stration teams, seminars, symposia, and visits of

teams of medical scientists. Among the specificheadquarters functions of this section is the compi-lation of information on teaching personnel inmedical and public -health schools and on nationaland international scientific societies. The sectionconsists of one chief, one technical assistant, and onesecretary.

7.3 Other Headquarters Units

The Division of Education and Training Serviceshas planning and operational responsibility forprogrammes that involve more than one specialtyand, as a rule, affect the educational and trainingpatterns of academic institutions, of countries,and of entire regions. In education and trainingprogrammes that concern one particular specialty

for which there is a specialized organizational unitwithin the WHO structure, the main planning andoperational responsibility rests with the specializedunit. In such instances, the Division of Educationand Training Services either has only advisory andco- ordinating functions or may share planning andoperational responsibility.

7.4 Regional Offices

Specific knowledge about local conditions permitsthe staff of a regional office to assess educationalneeds and then to plan certain activities to meetthose needs. Headquarters units collect informationfor the use of the regional office staff and haveparticipated in selected short -term field activities inthe regions, in order to assist in introducing newtypes of educational activities and to maintain directcontact with field conditions and problems.

Headquarters personnel have sometimes beentemporarily attached to the staff of a regional office,

but now the establishment of regional education andtraining units is indicated. Three such units havebeen organized, and the others will follow in 1953.

In the Region of the Americas, education andtraining activities have been assigned to a divisionchief, who is assisted by three professional personsin the fellowship branch and three in the professionaleducation branch, in addition to eight clerical staff.In the European Region the position of educationand training officer has been established. An educa-tion and training officer has been assigned to theSouth -East Regional Office. The Western PacificRegion had, for four months in 1952, the servicesof a consultant education and training officer, but apermanent assignment is in view. In the EasternMediterranean, a position has been established buthas not yet been filled, while the African RegionalOffice is contemplating action in the near future.

It is expected that with intensive efforts in theregions long -range education and training pro-grammes will be worked out in many countries andadequate programmes of assistance developed.

7.5 External Agencies

An important aspect of WHO's education andtraining programme is the relationship to otheragencies interested in this field.

Collaboration with the United Nations has beencarried out mainly in the following fields, withparticular emphasis on the training of auxiliarypersonnel : social affairs, fellowships and social -welfare group training, field training in demon-stration areas, and long -range activities for children.

WHO collaborates with UNICEF in trainingmaternal and child health personnel, developingnational training institutions and courses, and estab-lishing a training centre in Paris for internationalcourses.

Relations with UNESCO are based on the formalagreement between WHO and UNESCO to ofwhich Article I, paragraph 2, states :

In particular, it is recognized by UNESCOthat WHO shall have the primary responsibility

io Reproduced in the Handbook of Basic Documents (p. 109in the fifth edition)


for the encouragement of research, education, andthe organization of science in the fields of healthand medicine, without prejudice to the right ofUNESCO to concern itself with the relationsbetween the pure and applied sciences in all fields,including the sciences basic to health.WHO assists UNESCO in the health aspects of

general educational programmes and, reciprocally,UNESCO helps in certain educational aspects ofWHO programmes, particularly in such subjectsas natural sciences, social sciences, and fundamentaleducation.

Collaboration exists with other specialized agenciesin educational projects of common interest, e.g.

with FAO concerning training in nutrition, and withILO regarding educational aspects of occupationaland industrial health.

Some governments have agreed to provide tech-nical assistance for each other. Recognizing theco- ordinating role of WHO, some of the govern-ments participating in such bilateral schemes co-operate with WHO to establish guiding principles in

technical aspects of educational programmes.WHO also works with non -governmental orga-

nizations, such as the Rockefeller Foundation, theUnitarian Service Committee, and others alreadymentioned in sections 2.4 and 2.5.

8. FURTHER DEVELOPMENTS

8.1 Introduction

The present paper has given an outline of theorigins, historical evolution and present state ofWHO's programme in health education and training.It is to be seen that this subject is not only a majoractivity in itself but is accepted as a component ofnearly all WHO programmes. It is undertaken andadministered by the special education and trainingunits at headquarters and in the field but is also

featured in the work of almost all organizationalunits.

8.2 Present Trends

It is to be seen that at the moment such arrange-ments as international fellowships, study tours,visiting medical teams, personnel training centres,and assistance to educational institutions are the

main methods in use for achieving the definedobjectives. The experimental nature of some of thetechniques and the early character of many of thenational programmes are difficulties preventing anexact appraisal of the progress achieved. However,as has been shown in successive Annual Reports ofthe Director -General, the programmes are goingfar to meet a universal and pressing need. Healthand medical knowledge is being diffused and localpeople are being trained to assume a more adequaterole as administrators, teachers, and practitioners inthe various branches of medicine, health and alliedprofessions. Countries are thereby being furtherassisted to strengthen their national services andeducational institutions ; they are receiving leader-ship, guidance and opportunities to develop theirown internal health and medical training facilities.Co- ordination of arrangements providing for ex-change of knowledge and opportunities for trainingis making it possible to use available resources tothe best advantage.

This report shows that considerable work hasbeen done in arranging study tours, assistance toinstitutions, seminars, and fellowships. It is doubt-ful if a larger programme could have been efficientlyachieved even if more funds had been given. Impor-tant factors which have governed and still governthe nature and size of international programmes arethe limited capacity of existing institutions, thelimited numbers of highly skilled people able andwilling to give time to teaching in institutions orcourses in other countries, and the stage of develop-ment of health services in each country. The diffusionof knowledge, the creation of trained staff, and thedevelopment of educational institutions are all tobe related to and co- ordinated with parallel develop-ments, both internationally and nationally.

8.3 Further Requirements

There is enough evidence to justify the continuanceof the main features of the present programmes.These have reached the stage, both in themselvesand in relation to the greatly expanded programmesevolving in many countries, where expansion is

required if likely future demands from governmentsare to be met. The growth of health programmesstimulated by the various international agencies,multilateral and bilateral, is already revealing the


shortage of trained international and local staff toimplement them. It is accepted therefore that requestsfor assistance from WHO are likely to increasematerially.

It seems clear that WHO will have to continue andeven expand all its present services in these fields.This being so it becomes more urgent to give priorityto a precise study of world needs, country by coun-try and region by region, and of the resources onwhich to draw for teachers, training institutes, andother assistance. This in turn requires the develop-ment of criteria and standards so that programmesto meet defined needs will be more suitable, realisticand efficient. Surveys and studies of the local andnational distribution of the various categories ofmedical and health personnel, existing and required,will lead to better definition of curricula, coursesand standards for use both internationally andnationally. These in turn will give guidance to WHOin developing its forms of assistance to meet therevealed needs. Its fellowships, study tours, exchangeof personnel, and other existing and new methodswill be subject then to desirable change and improve-ment. Experiments in improving educationalmethods and the analysis of results must be a con-tinuing factor in WHO programmes. It is in theinterest of determining the results of such methods,and even more so of assessing their influence on theprogress of countries in improving their generalhealth conditions, that it is imperative to give increas-ing attention to appraising these educational pro-grammes. It will be necessary to study and experi-ment in suitable methods of appraisal and assessment.

Apart from the extension of present programmesand methods it is certain that such special fields ofeducation as health administration, preventive andsocial aspects of medicine, and auxiliary personnelwill require emphasis.

Advances in the health and medical sciencesrequire increasingly complicated technique, costlyapparatus, and highly specialized personnel. WHOwill have to carry an increasing responsibility inmaking such newer knowledge and techniquesavailable to all countries, especially as many coun-tries will not have the resources to develop theirown programmes.

In practically all countries the training of healthand medical administrators deserves increased atten-tion, not only in the field of publichealth adminis-tration, but also in the management of medical,teaching and research institutes, hospitals, voluntaryhealth agencies, etc. WHO will have to makeavailable further resources to meet this need.

The progress of national services from the stageof essential to more complicated services will meanthat WHO too will have to adapt its educationaland training arrangements to provide more spe-cialized assistance in such fields as tuberculosis,venereal diseases, malaria, maternal and child health,mental health, occupational health and ophthal-mology.

The acknowledged importance of health educationand training as a form of international assistanceensures the continuance of these functions in WHOprogrammes. Their development and their adapta-tion to changing world and individual country needswill be the challenge of the future.

Appendix 1

PROBLEMS IN EDUCATION AND TRAINING STUDIED BY WHO EXPERT COMMITTEES

Expert Committee on

Nursing (first session)

Technical ReportSeries No.

Nursing (second session)

Environmental Sanitation (first session)

24 Makes recommendations regarding nursing education andtraining.

49 Considers selection of candidates, programmes of studies,methods of teaching and advanced study.

10 Recommends that WHO give high priority to the trainingof sanitation experts.


Expert Committee on Technical ReportSeries No.

Environmental Sanitation (second report)

Public -Health Administration (first report)

Mental Health (first session)

Mental Health (second session)

Mental Health, Alcoholism Sub -Committee (first session) .

Health Statistics (first session)

Health Statistics (third report)

Tuberculosis (fourth session)

Tuberculosis (fifth session)

School Health Services (first session)

Prematurity (final report)

Maternity Care (first report)

Nutrition (Joint Committee with FAO : second session) .

Brucellosis (Joint Committee with FAO : first session) . .

47 Discusses training for many categories of health workersand suggests establishment of several kinds of trainingcentres.

55 Discusses principles of undergraduate and postgraduatetraining of health workers.

9 Recommends development of postgraduate training facilitiesin each region.

31 Gives comprehensive consideration to the subject ofmental- hygiene training for public -health workers.

42 Considers education on the subject of alcoholism to beinadequate during basic training of physicians, nurses,social workers.

5 Emphasizes the importance of teaching medical statisticsto students in the general categories of health workers,

53 Recommends granting of fellowships for training invital and health statistics.

7 Recommends establishment of permanent training centres.

32 Considers standards of training in demonstration andtraining centres, and recommends the formation of apanel to plan curricula.

30 Considers the subject of proper training and preparationof personnel fundamental ; makes numerous suggestions.

27 Suggests a specialized educational programme.

51 Adopts the principle that adequate training of personnelshould take precedence over other expenditures, andsuggests kinds of training for several categories ofpersonnel.

44 Calls for increased training of workers in nutrition.

37 Recommends expansion of present activities in researchand training.

Appendix 2

DISCUSSION ON THE FOREGOING STUDY BY THE EXECUTIVE BOARD AT ITS ELEVENTH SESSION

1. Summary of the Views of the Board

In its resolution EB11.R53, the Board requested the Director -General " to prepare for the consideration of the Sixth WorldHealth Assembly, as an annex to the study [on the educationand training programme], a résumé of the opinions expressedon this subject at the eleventh session of the ExecutiveBoard." 11

Such a résumé is presented herewith, in the same order asthe several items are presented in the foregoing study. Inaddition, there are attached two notes on fellowships presentedby Dr. Mackenzie and Dr. Hayek (parts 2 and 3 of thisappendix).

11 See minutes of the twenty -fourth, twenty -fifth and twenty -sixth meetings (documents EBI 1/Min/24 Rev.1, EB11 /Min /25Rev.1 and EB11 /Min /26 Rev.1).

Section 3.3: Equipment and Supplies

In addition to the categories of material now furnished,WHO should consider providing films and other visual mate-rial for assistance in medical teaching. The value of thisaction would outweigh the relatively small expenditure offunds.

WHO should consider co- ordinating its activities in thematter of equipment and supplies to educational institutionswith those of other bodies doing similar work, since severalfoundations and the United States bilateral programmes haveput emphasis on this subject.

Section 3.9: Training of Auxiliary Personnel

This subject has received wide attention and interest, andis one of the most important types of assistance which WHO


could provide for under -developed countries. A comparisonwas made of the costs of training at the professional and auxi-liary levels, and it was pointed out that many auxiliariescould be trained for the amount which would have to beexpended to prepare one professional worker. WHO wasurged to devote to the training of auxiliary personnel thepriority it deserved.

An attempt should be made to assist sub -professionalpractitioners by means of seminars and courses so that thisgroup of workers may benefit from additional training and thusgain further qualifications.

Section 4: Fellowships

The discussions centred on three major questions :

(1) A resolution adopted at the second session of the RegionalCommittee for Europe, recommending revision of resolutionWHA5.27 which requested the Director -General to givepriority to the under- developed countries when awardingindividual fellowships. Reference to this question may befound in the foregoing study, Section 4.2.

(2) A resolution of the Regional Committee for South -EastAsia, urging approval of a policy permitting the granting offellowships to nationals of a country to attend nationalcourses organized with the help of WHO. Reference to thisproblem is also made in Section 4.2 of the study.

(3) Some of the fellowship procedures. Pertinent statementsexist in Sections 4.4.1 to 4.4.4 of the study and in the papersof Dr. Hayek and of Dr. Mackenzie.

On the question of priority in granting individual fellow-ships, Dr. Turbott, who was the sponsor of the Fifth WorldHealth Assembly resolution, was asked to clarify it. Theclarification and the ensuing discussion formed the basis ofresolution EB11.R64. Likewise, the discussion on fellowshipsfor study within the country of origin led to resolution EB11.61.No opposing opinions were expressed.

The discussion on the question of fellowship procedureshowed, in general, agreement with the suggestions made byDr. Mackenzie and Dr. Hayek. However, there were someamending proposals, for instance, that copies of the additionalcorrespondence direct between host country and Fellow,which may be required after the arrangements have beenagreed upon by WHO and the host country, should be sentnot only to WHO but also to the national health adminis-tration of the country of origin. Doubts were expressed asto the need for having the Fellow interviewed by WHO as tohis general cultural level. Some members also questioned thefeasibility of requiring schools giving one year's trainingto add comments to the monthly reports of Fellows, but itwas felt that it would be desirable to try to obtain from theinstitution concerned or from WHO an appraisal of the workcarried out by the Fellow during his studies. The need wasalso expressed for having sufficient time to make a soundchoice for group fellowships. In general, it was thought neces-sary to allow for a certain measure of flexibility in order tocomply with differing wishes : for instance, some countriespreferred the Organization to establish direct contact withthe training institutions concerned ; it was also known thatsome institutions objected to supplying periodic reports.

Section 5.5: Visiting Teams of Medical Scientists

In order to derive the greatest benefit from these visits, itwas suggested that a smaller number of subjects be covered,and that each team stay in a country longer than the usual fourweeks. The observations of team members should be sentto national governments, which should forward their impres-sions of the visit to WHO for information.

Section 7: Organization of Education and Training Services

WHO should adopt for auxiliary personnel training, parti-cularly in under -developed countries, the system used forpostgraduate training, and send groups of experts who wouldact as small mobile medical faculties. More students couldthus be trained at smaller cost.

Section 8: Further Developments

Present services in education and training should beexpanded. It would be very valuable for WHO to draw upschemes for initiating surveys of the need for further trainingin the different countries of the world.

2. Paper on Fellowships submitted by Dr. Melville Mackenzie 22

It is often a cause of dissatisfaction among WHO Fellowsthat they are not clearly aware what programme can bearranged for them until after their arrival in the host country.They assume that what they have asked for in their fellowshipapplication will be arranged and they do not know that theirrequests may have been modified, sometimes considerably, by

(1) their own government or the selection committeerecommending an award ;

(2) the regional office of WHO ;

(3) WHO headquarters in Geneva ;

(4) the authorities in the host country, after consultationwith the person who is to receive the Fellow.

Under present arrangements, enquiries for additional infor-mation or about changes of programme have to go back andforward through the above -mentioned channels. It would bea great advantage if, when the general lines of a programmehave been agreed between Geneva and the host country, thelatter and the prospective Fellow could be allowed to writedirect to one another for any further information or explana-tion. Copies of such correspondence could be sent by the hostcountry to the regional office, or Geneva, or both, for infor-

is Originally mimeographed document EB11 /72, 14 Janu-ary 1953


mation. Direct correspondence of this kind would facilitatethe clearing -up of points such as the linguistic standardobtained by the Fellow, the need for accommodation, the dateof his arrival and mode of travel, as well as further pointsabout the professional programme. This arrangement wouldeliminate many of the difficulties at present experienced bythe host countries and would, it is suggested, be much moresatisfactory to the Fellow. Furthermore, the host countrywould welcome, at the time the fellowship application isfirst submitted, a clear and signed statement from the bodyresponsible for the prospective Fellow's proposed programme,whether it be his employer, his government, the regionaloffice or WHO headquarters. Such a statement should indicatefully and precisely what it is hoped that the host country will beable to provide in the way of training, experience and practicalwork, and thus obviate the difficulty which arises when aFellow at his first interview expresses a wish for substantialchanges in what the host country believed to be a courseagreed by the government concerned and the regional officeof WHO.

As regards the length of the fellowship, it would be a greatadvantage for some Fellows to be given the opportunity oftaking a course of instruction for as long as two years incertain subjects, e.g. thoracic surgery and some laboratorycourses. Such a period is essential if the required knowledgeis to be gained, even though the requisite previous training hasbeen received.

The following are notes, set out from the point of view of areceiving country, on the study on the education and trainingprogramme.

Section 4.1, second sentence: Fellows often do not have therequisite background to enable them to benefit by furthertraining. The instruction given must necessarily be of thestandard of the receiving country.

Section 4.2, fourth paragraph, second sentence: The lengthof a fellowship should be a matter for settlement between theauthorities of the host country (after consultation with theappropriate experts) and Geneva. Only senior people in keypositions should be sent for short-term fellowships. Thereare many practical difficulties in making arrangements foraccepting medical undergraduates as Fellows.

Section 4.2, tenth paragraph, item (1) : There is little difficultyin placing Fellows if their previous training is satisfactoryby the standards of the host country. There is however, greatresistance to the acceptance of the inadequately trained orpersons of insufficient linguistic qualifications, and thisincreases the difficulty of persuading institutions to acceptfurther Fellows.

Section 4.4.1, second paragraph, first sentence: The infor-mation given in the fellowship application is often insufficientto decide the previous experience and training of the applicant.The names of the chiefs under whom the Fellow is working, orhas recently worked, should be given. These chiefs may beknown to the person who is asked to receive the Fellow.

It is very important to know precisely what duty the Fellowwill be returning to. This is sometimes quite different from his" present position ".

An official body -WHO headquarters, the regional officeor the Fellow's own government- should inform the hostcountry exactly what type of training it is hoped can be

provided and a copy of the statement should be sent to theFellow.

Section 4.4.2, end of the second paragraph: Direct approachby WHO headquarters or the regional office to individualinstitutions in the host country is very undesirable. Thecentral health authority of the host country is in the bestposition to make the necessary arrangements to meet theFellow's needs. Moreover, if a Fellow has been refusedby an institution to which direct application has been made, itis very difficult to secure a reversal of the decision.

Section 4.4.2, third paragraph, third sentence: In a countrywhere academic courses begin at the end of September orearly October the list of applicants is not considered until theprevious March or April. All WHO applications should be inthe hands of the host country by December of the previousyear to give time for any necessary enquiries.

Section 4.4.3 : Such supervision as can be exercised bythe health authorities of the host country is necessarily slightand there is no means of dealing effectively with Fellows whotake unauthorized leave, change their programme, do not keepappointments, etc. Before leaving his own country the Fellowshould be explicitly informed of the real purpose of his journeyand the diligence and serious application to study expectedof him.

3. Paper on Fellowships submitted by Dr. Hayek 13

The Secretariat is to be congratulated on the very completestudy submitted and on the full information contained init. In particular, congratulations should go to the Directorof the Division, to his staff and to the Chief of the FellowshipsSection, who supervise the execution of the programme witha benevolent watchfulness, and to the staff of the RegionalOffices for Europe and for the Americas, who make everyeffort to facilitate the task of the Fellows from the less fortunatecountries.

More consideration should be given by certain MemberStates to the cultural level of those to whom fellowships areawarded. It is suggested that a reminder to this effect be sentby the Secretariat from time to time to national healthdepartments.

There is sometimes a delay of more than two years betweenthe date of sending the fellowship application of a candidateand the date of receiving a reply from WHO. During thisperiod the candidate waits for something which does notcome ; this creates perplexity in his mind and causes negligenceand diminution of output, etc., all of which could be preventedif the regional office from which the application originates,the Fellowships Section, the Regional Offices for Europe orfor the Americas, and the institutions in the host countryspeeded up the exchange of correspondence. The candidateshould know his fate as soon as possible. It is also essentialthat the national authority be approached with regard to thearrangements to be made.

The decisions as to the candidate, the subject in which he willspecialize and the host institution are taken. The Fellow is

13 Presented at the twenty- fourth meeting of the Board


ready to leave his country. It is suggested that, in so far asit is possible without incurring too much additional expendi-ture, the Fellow should call at his regional office or at head-quarters to make contact with the responsible personnel in thetechnical section dealing with his specialty. Such contacts areuseful and necessary ; the WHO official will be able to obtainsome idea of the general culture of the Fellow and toapprove, in the light of his cultural level, the school and countrychosen or, if necessary, propose changes. This would remedythe too facile criteria followed by certain national departmentsin the selection of Fellows.

It is regrettable that it must be stated here that certainFellows have been sent to countries whose language theyhardly know. This explains the unsatisfactory results obtainedin such cases and the small advantage gained by such Fellows.

It sometimes happens that the Fellow, having arrived inthe host country and on his way to the centre to which he isassigned, finds himself in some uncertainty on account ofWHO's delay in informing the institution to which he is sent.It is essential that these study centres be fully informedregarding the Fellow well before he leaves his countryof origin.

The Fellow is installed and has commenced his studies inthe host country. He appears to show from the beginning acertain levity and to take too many liberties- missing courses,lectures, appointments, practical work, as he feels inclined.The monthly report he presents is not adequate. I suggestthat a Fellow following a year's course should present a reportin quadruplicate at the end of each month to the director ofthe school, who will forward one copy to the regional officeof the host region, one to headquarters (Fellowships Section)and one to the regional office of the region of origin, the fourthcopy going to the responsible department in the Fellow's homecountry. These various copies should carry the remarks of theschool on the behaviour of the Fellow, his application to orneglect of his work. This procedure would seem to be desirablein order to prevent the irresponsibility of certain Fellows whodo not feel themselves bound by any sense of duty or obligationto their superiors in WHO or in the ministry concerned.

On the completion of his studies, the diploma or certificate,as the case may be, is delivered to the Fellow. It should,however, be emphasized that Fellows who follow a practicalcourse after the study course, and those who have a travelfellowship, should obtain certificates, stating the duration of

the course and giving an appraisal of their work, from anyinstitution they have visited. WHO, when it writes to ask insti-tutions to receive a Fellow, should at the same time requestthat such a certificate should be delivered to the Fellow.

In so far as possible, on their way home Fellows should beasked to call again at the office they visited on their way out -either the regional office of the region of origin or headquarters-so that some general evaluation of the advantage they havegained from the fellowship may be made and so that theFellow himself may be able to give his opinion of the hostinstitute at which he has just completed his studies or throughwhich he has passed.

With regard to the follow -up contacts with the Fellow, asmentioned in Section 4.4.4 of the study, I propose thefollowing :

(1) The departmental chief or the national director- general,and not the Fellow himself, should be invited to give a briefgeneral report on the work of the official, on the methods hehas introduced, etc., one year after the fellowship. The Fellowcannot judge himself, and his own account must not beabsolutely relied on.(2) This concerns the Fellowships Section and the publicationssections. All publications relating to the specialty of theFellow should be sent to him after he has resumed his duties -Technical Report Series, WHO Newsletter, etc. -when theycontain any new information on the branch in which theFellow is interested and which he has studied abroad. Tothis end, a list of Fellows should be sent every year from theFellowships Section to the Division of Editorial and ReferenceServices.

I am in entire agreement with Dr. Mackenzie that the customof giving only one year's fellowship should be abandonedwhere two or even three years are necessary, on conditionthat precautions are taken to prevent abuse and that thefull consent of WHO and of the host centre is obtained.

I also agree that more grants should be made to faculties ofmedicine and to private medical and health centres to assistthem in the organization of courses or lectures whichwould enable nationals to pursue their basic or postgraduatestudies in national institutes, as proposed in Section 4.2 of thestudy.

I am also in agreement on the question of travel allowancesfor national and inter -regional study- tours.

ti

IV. ORGANIZATIONAL STUDY ON REGIONALIZATION

1. INTRODUCTION

Scope of this Report

The Executive Board wishes to make clear thatthis report cannot without qualification be describedas a full study of regionalization. It cannot be acomplete study because many of the more importantfacts are not yet available. The oldest regionalorganizations are not yet four years old ; the mostrecent are just starting active work. It is therefore tooearly to expect reliable information that would helpto evaluate at all fully the working of a completelyregionalized organization or to estimate how far thebold decision taken by the First World HealthAssembly has been justified or, except in a veryspeculative way, to judge what disadvantages andwhat advantages were implicit in that decision andhow far they have been avoided or secured. The

therefore, to con-sider this as a partial study based on the experienceavailable to date.

Regional offices have been established one byone, over a period of nearly four years, beginningwith the first year of the Organization's life. Thishas obliged headquarters to act in a dual capacityand to discharge, in addition to its basic responsibi-lities which must by their nature be centralized,functions which could be delegated to regionaloffices but which had to be carried on by headquartersuntil regional offices were established and ready toaccept delegation. The effect has been to postponeor restrict development of some of the properresponsibilities of headquarters. The detailedplanning, co- ordination and supervision now dele-gated to regional offices have hitherto involved theheadquarters staff in the demands for immediateaction which are inevitable in that part of the work,thus making it impossible for them at the sametime to discharge fully their basic and continuingresponsibilities. This fact has contributed to theincompleteness of this study, for the study of region-alization requires consideration of headquarters aswell as of regional offices.

The Meaning of Regionalization

A centralized organization concentrates adminis-trative authority and policy making at headquarters.In a decentralized organization, the governing body,or a person vested with powers by the governingbody, delegates certain authority and responsibilityto subordinate units which have a definite structurewithin the Organization. Regionalization, properlyspeaking, connotes the geographical arrangementsused by WHO to establish decentralization.

However, WHO has in the past not used theseterms in their strict meanings and this report willcontinue to use the term " regionalization " toinclude the principles and practices of decentraliza-tion.

The Broad Implications of Regionalization

The World Health Organization, like all otherspecialized agencies of the United Nations, is basedon the assumption that its supporting and com-ponent units -the national governments -retain fullsovereignty of action within their own areas.

WHO therefore has no direct responsibility forcarrying on health work within countries, althoughit may be called on for advice or help by the govern-ments of those countries. The conception of region-alization as applied to WHO cannot be properlyinterpreted unless account is taken of the fundamentalpurposes and functions of WHO. Regionalizationis an arrangement which applies to the administrativestructure of WHO itself. Since there can be nodelegation of powers which the Organization doesnot possess, it follows that regionalization withinWHO is necessarily limited to certain of the Organi-zation's own functions, and does not in any wayaffect the legislative or executive arrangements ofany government.

An appreciation of the true relations between anyinternational organization and its sovereign Membergovernments will help to avoid misunderstandingthe meaning of terms such as regionalization,decentralization and delegation as applied to WHOand its work in different parts of the world, and willalso help to avoid conclusions based on false analogywith national arrangements. In national arrange-

- 157 -


ments regionalization usually implies in some, degreedelegation of powers, whether legislative, policy -

making or operational. In WHO it must necessarilybe mainly a geographical convenience for givingeffect to the relations between Member governmentsand the Organization. The responsibilities of inter-national organizations such as WHO are new anddifferent and it is to be expected that their organi-zational patterns and methods of work must forsome time to come be experimental. The authoritieswhich the Constitution gives to the Organizationpresent problems and entail responsibilities for whichthere is no comparable precedent experience.

Advantages and Disadvantages

Regionalization, then, is an administrative devicewhich decentralizes into geographical units part ofthe execution of the programme of the Organization.The activities concerned are primarily the assessmentof national needs, the receipt from governments ofrequests for services, the planning and execution ofprojects to meet these requests, and such admin-istrative organization as is necessary to enable thesefunctions to be performed effectively and in harmonywith the general policy of WHO.

Some of the advantages of decentralization maybe summarized as follows :

(a) The policy of an organization can be betteradapted to local circumstances ;

(b) The several aspects of an organization's workcan be better co- ordinated within the area ;

(c) The persons and governments concerned feelthemselves less separated from the source ofcontrol and can more readily consider it as theirown, and not an alien, organization ;

(d) Planning, supervision and provision of ser-vices can be better developed in the light ofspecific requirements of the area served.

Some of the disadvantages are :

(a) It is more difficult to ensure that the actionsof the organization follow a uniform policy ;

(b) More care is needed to see that administrationis not confused by unnecessary variations ofprocedure;

(e) It is sometimes more difficult to use specialistadvice effectively ;

(d) Regionalization is more costly than a cen-tralized administration and the possibilities ofduplication and wasted effort are multiplied ;

(e) There is a risk that the organization maydevelop into a loose federation.

Weighing the advantages and disadvantages ofregionalization, the Director - General, in a statementto the Executive Board at its seventh session, said :

The organization that the World Health Organi-zation is now supporting is not justified on...a regular budget of less than $8,000,000. Theregionalization to which the Organization is

committed is an extraordinarily expensive formof organization. Also, properly developed,properly used, it is an extremely efficient andeffective form of organization. It can producethe services where the services are needed ifthere is any money with which to produce services.1

The detailed discussion in the following sections ofthis report is mainly concerned with the practicalbearing of certain aspects of regionalization onWHO's organization and procedure.

If the Health Assembly, after considering thispartial study, forms the opinion that a fuller studyshould be undertaken, the Board suggests that itshould be done after a further two or three yearswhen more experience of the Organization as awhole, including the fully established regions, willbe available. In such a study, full considerationshould be given to the matters mentioned in Ap-pendix 1 to this report. In addition, it is recom-mended that the study should include reference tothe progress made towards the interchange betweenregions of experience in programme developmentand operating. The Executive Board would begrateful for any suggestions from the Health As-sembly as to the types of information that shouldbe collected for that further study.

1 Verbatim extract from the statement made by the Director -General to the Executive Board at the seventh meeting ofits seventh session

REPORT : REGIONALIZATION 159

2. HISTORY OF REGIONALIZATION

Relevant Provisions of the WHO Constitution

The provisions specifically related to regionalarrangements are contained in Chapter XI of theConstitution, but other articles determine or indicatethe status of regional organizations and their relationto the central organization.

All these provisions of the Constitution fall intotwo main groups, one group giving effect to thegeneral agreement among governments representedat the New York Conference of 1946, at which theConstitution was drawn up, that there must be oneWorld Health Organization. The other group wasintended to reconcile with this view the antecedentexistence of regional health organizations.

The provisions that emphasize the integral charac-ter of the Organization include :

(i) the establishment of WHO " as a specializedagency within the terms of Article 57 of the Charterof the United Nations " (Preamble to the Constitu-tion) ;

(ii) the statement in Article 2 (b) that a functionof the Organization shall be " to establish andmaintain effective collaboration with the UnitedNations, specialized agencies, governmental healthadministrations, professional groups and suchother organizations as may be deemed ap-propriate " ;

(iii) provisions which imply the general super-vision and control by the Health Assembly andthe Executive Board of all activities of the Organi-zation (Articles 18, 19, 21, 28 and 29) ;

(iv) Article 18 (i), which requires the HealthAssembly " to consider recommendations bearingon health made by the General Assembly, theEconomic and Social Council, the SecurityCouncil and the Trusteeship Council of theUnited Nations, and to report to them on thesteps taken to give effect to such recommenda-tions " ;

(v) Article 18 (j) which requires the HealthAssembly " to report to the Economic and SocialCouncil in accordance with any agreement betweenthe Organization and the United Nations."

These provisions of the Constitution establish thefull authority of the Health Assembly and theExecutive Board and therefore determine their re-lation to any regional body which may be established.

Further, the relation of WHO to the UnitedNations, and in particular to the General Assemblyand the Economic and Social Council, requires theacceptance of WHO as an integrated body to nego-tiate and co- operate with the United Nations andits agencies on any question of world health. Thewords of Article I of the Agreement between WHOand the United Nations are significant in that theUnited Nations recognizes the World Health Organi-zation as " the specialized agency responsible fortaking such action as may be appropriate under itsConstitution for the accomplishment of the objectivesset forth therein."

Certain of the provisions of Chapter XI of theConstitution, considered by themselves, may presentsome difficulties of interpretation, but Article 45,which states " Each regional organization shall bean integral part of the Organization in accordancewith this Constitution ", leaves no doubt as to thegeneral intention of the chapter. Close integrationis also implied in Article 51, which confers on theDirector -General authority over the regional office ;and Article 54, which refers especially to the organi-zations which were in existence before the Constitu-tion was signed, provides for their integration withthe Organization " as soon as practicable throughcommon action based on mutual consent of thecompetent authorities expressed through the organi-zations concerned." Articles of the Constitutionother than those cited above give further guidanceas to the form of relationship between WHO andits regional organizations -in particular Articles34, 55 and 56, which deal with the preparation of theannual budget estimates of the Organization ;Article 35, which provides that the Director - Generalshall appoint the staff of the Secretariat ; and Article53, governing the appointment of regional staffother than the regional director. It is also relevantto note that Article 32 prescribes that " The Director -General shall be ex officio Secretary of the HealthAssembly, of the Board, of all commissions andcommittees of the Organization and of conferencesconvened by it." The Director - General has defacto delegated to the regional directors the authorityto act as his representative in the meetings of theregional committees.

The main provisions designed to reconcile with theestablishment of WHO as the sole health organi-zation the antecedent existence of other healthorganizations, and particularly some of stronglyregional character, are as follows :

Article 46 provides for both a regional office anda regional committee. Articles 48, 49 and 50 conferon regional committees substantial rights in regard


to such matters as place of meeting, rules of pro-cedure and regional (as contrasted with general)policy and activities.

Article 52 also provides that " The head of theregional office shall be the regional director appointedby the Board in agreement with the regional com-mittee " and results in the regional director havingto some extent a divided responsibility. Since theDirector - General is the chief technical and admi-nistrative officer of the Organization, it seems clearthat he has the responsibility of advising the Boardon its appointments of regional directors.

As stated above, the provisions of the Constitutionwhich are of direct concern to regional committeesand offices are mostly contained in Chapter XI.Some comments on these articles may be made atthis stage. Article 44 empowers the World HealthAssembly to define areas and set up regional organi-zations, but it should be noted that the article isnot strictly mandatory. Even the duty to definegeographical areas (Article 44 (a)) is dependent uponthe Health Assembly's reaching the decision thatit is desirable to establish a regional organization ina particular area ; and Article 44 (b) is clearly per-missive. It is important also to note that there isnothing final or limited in this procedure. Thepresent six regions with their regional committeesand offices are not necessarily permanent. TheHealth Assembly has full power to change, reduceor increase the number, with the sole restrictionthat the establishment of a regional organizationwithin any geographical area defined by the HealthAssembly is dependent on " the consent of a majorityof the Members situated within each area ... ".

Article 47 prescribes that " Regional committeesshall be composed of representatives of the MemberStates and Associate Members in the region con-cerned. Territories or groups of territories within theregion, which are not responsible for the conductof their international relations and which are notAssociate Members, shall have the right to berepresented and to participate in regional committees.The nature and extent of the rights and obligationsof these territories or groups of territories in regionalcommittees shall be determined by the HealthAssembly in consultation with the Member or otherauthority having responsibility for the internationalrelations of these territories and with the MemberStates in the region." This has required practicalinterpretation of the expression " Member Statesin the region " and the definition of the rights andresponsibilities of Associate Members and ter-ritories " which are not Associate Members ".

This subject is examined in a later part of thisreport.

Article 51 states that the regional office " shallbe the administrative organ of the regional com-mittee " but qualifies this statement by making it" subject to the general authority of the Director -

General ". It is therefore theoretically possibleunder this article for the regional office to receiveconflicting instructions from the Health Assembly,the Executive Board and the Director- General onthe one hand, and from the regional committee onthe other.

Development of Regionalization in WHO

Events in organizations which existed before theWorld Health Organization have influenced thedevelopment of regionalization in WHO. The PanAmerican Sanitary Bureau (PASS) had existed asa regional organization since 1902. The OfficeInternational d'Hygiène Publique (OIHP) had theco- operation of a number of autonomous regionalagencies -the Egyptian Sanitary, Maritime andQuarantine Board, the Pan American SanitaryBureau, and the Eastern Bureau of the HealthOrganization of the League of Nations. The EgyptianSanitary, Maritime and Quarantine Board wasexpanded into the Pan Arab Health Bureau in1946. In this last -named case, the Regional Com-mittee for the Eastern Mediterranean recommendedthat " the functions of the Alexandria SanitaryBureau be integrated within those of the RegionalOrganization of the World Health Organization ".This recommendation was approved by the ExecutiveBoard at its third session.2 The functions and assetsof the former Eastern Bureau of the League weretransferred by the United Nations to the InterimCommission of WHO. Because of the inter -regionalcharacter of the Epidemiological Intelligence Stationat Singapore, it has not been incorporated in any ofthe regions of WHO but is considered as a part ofthe headquarters organization.

/

The development of regionalization in WHOmay be regarded as having begun with the Inter-national Health Conference held in New York inJune and July 1946. A summary of the discussionsand conclusions which led to the adoption of Chap-ter XI of the Constitution by the Conference isgiven in the Proceedings and Final Acts of theConferences In particular, the following extractsfrom those Proceedings indicate something of what

2 Of Rec. World Hlth Org. 17, 16, item 6.23 Off. Rec. World Hlth Org. 2, 23


was in the minds of those who drew up the Constitu-tion :

(i) This text is based upon two major assump-tions :

(a) that both policy- making committees and jadministrative offices will be necessary for theeffective discharge of the Organization's res-ponsibilities at the regional level, and(b) that each regional branch so constitutedshall be " an integral part " of the total organi-zation.

(ii) By unanimously approving Chapter XI asa whole, the Conference recorded its view that theelaborate provisions inserted into the Constitutionas to regional arrangements would at one and thesame time assure unity of action by the centralorganization on health matters of world -wideimport and allow for adequate flexibility inhandling the special needs of regional areas.At this point may be mentioned a declaration by

the Conference which is in effect an interpretationof the Constitution : 4

With regard to the question as to whether thefunctions of Regional Committees are subject tothe general authority of the Assembly, the Con-ference rules that such is implicit in Article A,Section (c) [now Article 45] which reads as follows :

Each regional health organization shall be anintegral part of the World Health Organizationin accordance with this Constitution.

This question of regional organization was one ofthe most controversial subjects discussed at theNew York Conference and this fact is perhaps notsufficiently recorded in the Official Records becausethe greater part of the discussion took place inworking parties of which no minutes were kept ;but the agreed statements just quoted indicate thedifficulty of reconciling the recognized need forone integrated organization with the natural reluct-ance of the then existing international health organi-zations to lose their identity and possibly theiroften substantial record of achievement in a newand untried world organization.

The strong feelings of the governments thatwere interested in ensuring and protecting thecontinuance of the work, and even of preservingthe form, of the regional organizations had muchto do with the adoption of Articles 46 and 47 dealingwith the establishment and composition of regionalcommittees, of Article 50 prescribing the functions

4 Of Rec. World HIth Org. 2, 59

of regional committees, of Article 52 prescribingthe method of appointing the regional directors,and of Article 54 which determined the procedurefor integrating with the new organization the healthorganizations previously existing.

Resolutions of Successive World Health Assembliesand Executive BoardsSince Article 44 of the Constitution 6 is not strictly

mandatory, the present position is not a necessaryconsequence of the Constitution itself but arisesfrom a resolution of the First World Health Assem-bly,6 as follows :

The First World Health AssemblyRESOLVED on the delineation of the following as

geographical areas : (1) Eastern MediterraneanArea, (2) Western Pacific Area, (3) South -EastAsia Area, (4) European Area, (5) African Area,(6) American Area

[Follows a list of countries included in eacharea]

RESOLVED that the Executive Board should beinstructed (1) to establish regional organizationsin accordance with the delineation of geographicalareas decided upon and as soon as the consentof a majority of Members situated in such areashad been obtained ; (2) as regards the EasternMediterranean Area, to integrate the AlexandriaRegional Bureau with WHO as soon as possible ;and (3) as regards Europe, to establish, as soonas possible, a temporary special administrativeoffice to deal with the health rehabilitation ofwar -devastated countries in that area.From the reports of the discussion which led up

to this resolution' it will be seen that it was not atfirst unanimously assumed that regional organi-zations were necessarily to be set up at that stage,that some Members suggested that in the firstplace regional organizations should be set up forparticular parts of the world only, and that someMembers doubted whether the finances of the Organi-zation could support any complete scheme of re-gionalization. The first two opinions are probably

6 This article reads :(a) The Health Assembly shall from time to time define

the geographical areas in which it is desirable to establisha regional organization.

(b) The Health Assembly may, with the consent of amajority of the Members situated within each area sodefined, establish a regional organization to meet thespecial needs of such area. There shall not be more thanone regional organization in each area.6 Resolution [WHA1.72], Handbook of Resolutions and

Decisions, first edition, p. 153Off. Rec. World Hlth Org. 13, 262 -74


now of historical interest only ; the third has beenmentioned in the introduction to this report.

By this resolution the First World Health Assemblyestablished the regional areas substantially as theynow exist. It should be noted that certain areas,especially some islands, were not included in theregions established by this resolution. It is alsoimportant that in this resolution the Health Assemblydelegated to the Executive Board full authority toset up regional organizations within the areasdelineated as soon as the consent of a majority ofMembers situated in such areas was obtained.

In pursuance of the authority so delegated to itthe Executive Board :

(i) at its first session established the RegionalOffice for South -East Asia,8 and at its secondsession provisionally approved the selection ofNew Delhi as the site of the Regional Office ; °

(ii) at its third session approved the establishmentof the Regional Office for the Eastern Mediter-ranean and, conditionally, the selection of Alexan-dria as the site for the Regional Office, subjectto consultation with the United Nations ; to

(iii) at its eighth session, in various resolutions,approved the establishment of the RegionalOffices for the Western Pacific (EB8.R8), Europe(EB8.R46) and Africa (EB8.R14). Various pre-liminary negotiations in regard to each of theseregional offices had previously been noted inresolutions of the World Health Assembly, andthe selection of the sites of these regional officestook into consideration the necessity for consulta-tion with the United Nations.

The Regional Office for the Americas has differedfrom the other regional offices in that its creationresulted from negotiations for the integration ofthe Pan American Sanitary Bureau with WHO.The result of these negotiations was embodied inan agreement 11 between WHO and PASB which wasapproved by the Second World Health Assembly(resolution WHA2.91). Two points in the agreedarrangements should be noted. First, the DirectingCouncil of the Pan American Sanitary Organizationacts as the WHO Regional Committee for theRegion of the Americas. Secondly, the system ofzone offices of PASB ensures liaison between theregional office and the governments of MemberStates.

8 Off Rec. World Hlth Org. 14, 12, item 6.18 Off. Rec. World Hlth Org. 14, 27, item 4.210 Off. Rec. World Hlth Org. 17, 16, item 6.211 Of Rec. World Hlth Org. 21, 382

3. RELATIONS WITH OTHERORGANIZATIONS

Relations with the United Nations and SpecializedAgencies

Article 57 of the Charter of the United Nationsrefers to the establishment, by intergovernmentalagreement, of the specialized agencies. Article 63of the Charter provides that " The Economic andSocial Council may enter into agreements with anyof the agencies referred to in Article 57, definingthe terms on which the agency concerned shall bebrought into relationship with the United Nations."Article 63 also provides that the Economic andSocial Council " may co- ordinate the activities ofthe specialized agencies through consultation withand recommendations to such agencies and throughrecommendations to the General Assembly and tothe Members of the United Nations."

Article 18, sub -paragraphs (i) and (j), of the Con-stitution of WHO includes in the functions of theWorld Health Assembly " to consider recommenda-tions bearing on health made by the GeneralAssembly, the Economic and Social Council, theSecurity Council or Trusteeship Council of theUnited Nations, and to report to them on the stepstaken by the Organization to give effect to suchrecommendations " ; and " to report to the Eco-nomic and Social Council in accordance with anyagreement between the Organization and the UnitedNations." Article 69 provides that " The Organi-zation shall be brought into relation with the UnitedNations as one of the specialized agencies referredto in Article 57 of the Charter of the UnitedNations." The agreement bringing the Organiza-tion into relationship with the United Nations wasapproved by the First World Health Assembly.12

Article 50 (d) of the Constitution also includes inthe functions of the regional committee " to co-operate with the respective regional committees ofthe United Nations and with those of other specializedagencies and with other regional internationalorganizations having interests in common with theOrganization."

The Agreement between the United Nations andthe World Health Organization, whereby the UnitedNations recognizes the World Health Organizationas the specialized agency responsible in the field ofhealth, provides in Article XI that " Any regionalor branch offices which the World Health Organi-zation may establish shall, so far as practicable, beclosely associated with such regional or branch

12 Off. Rec. World Hlth Org. 13, 81, 321


offices as the United Nations may establish."Article XIX of the same Agreement states that :

1. The United Nations and the World HealthOrganization agree to the foregoing provisions inthe belief that they will contribute to the main-tenance of effective liaison between the twoorganizations. They affirm their intention oftaking whatever further measures may be neces-sary to make this liaison fully effective.

2. The liaison arrangements provided for in theforegoing articles of this agreement shall apply asfar as appropriate to the relations between suchbranch or regional offices as may be establishedby the two organizations, as well as between theircentral headquarters.

WHO has also entered into direct formal arrange-ments with several of the specialized agencies,establishing relationships between WHO and theparticular agency. The advantages of the know-ledge, advice and resources available through suchagencies, singly or collectively, make it essential forthe Organization to be effectively associated withthe other members of the United Nations family,and this association is primarily the responsibilityof headquarters. Although a certain limited delega-tion may be made to regional offices for particular!activities in association with those other agencies,Ait is not possible for headquarters to delegate morethan a small part of this responsibility.

The Economic and Social Council at its thirdsession (resolution 13 (III)) requested the Secretary -General of the United Nations to establish a com-mittee on co- ordination (now called the Administra-tive Committee on Co- ordination) to consist ofhimself and the executive heads of the specializedagencies, for the purpose of assuring effective co-ordination of the work of the various agencies.

The emphasis placed on co- ordination has beengreatly increased by the development of the ExpandedProgramme of Technical Assistance for EconomicDevelopment. Even before this the requirementsof co-ordïration had to be met in connexionwith the programmes undertaken in co- operationwith UN ICEF and certain other inter -agencyactivities. These large programmes make availabledirect contributions of material aid ; the parts ofthese programmes relating to health are carried outby means of agreements with WHO, in its capacityas the United Nations specialized agency responsiblefor health. It is therefore in the interest of govern-ments which desire to participate in these programmesto utilize WHO as a single international organizationwhich can negotiate with other agencies to secure

that the needs of their people are dealt with on thewidest and most effective basis.

Although the association of WHO with the UnitedNations and the specialized agencies requires pri-marily central direction, the regional economiccommissions of the Economic and Social Councildear -with the economic problems of groups Ofcountries, and WHO's relations with the economiccommissions can, perhaps, be more effectivelymaintained through regional offices ; certain prob-lëms arise, of course, because the WHO regionsand those of the economic commissions are notconterminous.

It will be seen from the above that regionalizationof any specialized agency is affected by generalpolicies of the United Nations and the Economicand Social Council, and it is necessary to ensurethat relations among the agencies are not adverselyaffected by the greater development of regionalizationin WHO than in the other agencies.

Development of Regionalization in Other Agencies

An outline of the extent to which other membersof the United Nations family have adopted a regionaltype of organization may clarify the general con-siderations relevant to this study. It appears thatthe methods and degree of regionalization foundappropriate to the various organizations havedepended on their functions and objectives. Certainspecialized agencies, for example the InternationalBank for Reconstruction and Development and theInternational Monetary Fund, have found that theirwork is not such as to call for any special regionalmachinery or organization. The agencies that havefound it necessary to develop regional organizationshave based their geographical division on differentcriteria, according to the different nature of theiractivities. As a result, within the entire UnitedNations family there are no conterminous regions,and the boundaries and composition of regionalareas are not identical for any two of the agenciesconcerned.

At this stage WHO has developed regional organi-zations further than any other specialized agency,although, as the total United Nations programme,and in particular the Expanded Programme ofTechnical Assistance for Economic Development,has developed, there has been a general trend to-wards functional regionalization to enable agenciesbetter to co- ordinate their work regionally and locallyand to facilitate liaison with governments. But sofar no regional office of any of the other specializedagencies has authority or autonomy comparable tothose of the WHO regional organizations.


The regional structure within the United Nationsfamily which is most nearly comparable to that ofWHO is perhaps to be found in the United NationsRegional Economic Commissions, of which thereare three : for Europe, for Latin America, and forAsia and the Far East. Under the terms of referenceof all three regional commissions, each commissionis to act within the general framework of the policyof the United Nations and under the general super-vision of the Economic and Social Council. Withinthis framework the commissions have a fairly widelatitude to initiate and participate in measures forfacilitating concerted action for economic reconstruc-tion and development, subject always to the conditionthat no action in respect of any country can be takenwithout the agreement of the country.

Apart from these economic commissions, variousdevices are used by other agencies to collect informa-tion about the countries they serve and to adapttheir policies to the circumstances of those countries.Common to all, naturally, is the method of sendingexperts to survey a country and report to headquar-ters. Some organize regional or country conferenceson special subjects within their purview and some,such as UNESCO, encourage the formation ofnational committees which discuss and publicizein their countries the objectives and programmes ofthe agencies concerned. This method appears tobe most successful in countries where professionaland scientific co- operation is already well established,but to be less effective elsewhere.

UNESCO does not delimit permanent regions :its Executive Board decides ad hoc which countriesshall be invited to join in each group project.UNESCO has recently developed an interestingtype of regionalization 13 in the form of regionalfundamental education centres. It was originallyproposed that the opening of such centres shouldbe spread over a period of some years. Each centrewas to be an autonomous service of the UNESCOSecretariat and the director of each centre wouldhave powers approximating to those of the regionaldirectors of WHO. It is understood, however, thatUNESCO has now concluded that regionalization ofthis type is likely to be effective only in areas wherethere are a number of countries with a commonlanguage and a substantially uniform culture.

FAO has set up subsidiary bodies with a largedegree of autonomy, such as the International Rice

13 UNESCO document 7C /PRG /19

Commission, whose object is to promote nationaland international action as to production, conserva-tion, distribution and consumption of rice, andwhich is empowered, for example, to undertakeco- operative projects for the solution of problemsand to make recommendations for action to itsMember nations. It reports periodically to theDirector - General and the FAO Conference.

ILO has for some time had manpower fieldoffices in Brazil (Sao Paulo), India (Bangalore),Turkey (Istanbul) and Italy (Rome). The Director -

General of ILO recently proposed to the GoverningBody that these should be changed into generalfield offices, to deal with the Technical Assistanceand other operational programmes of ILO, inaddition to their work on questions of manpower.Under this proposal, these field offices would, forthese operational programmes, carry out dutiesvery similar to those of the WHO regional offices,but the directors of the field offices would be res-ponsible to and act under the supervision of theChief of the Field Services Division of ILO. TheGoverning Body, at its meeting in November 1952,noted the proposal of the Director -General and hewas accordingly authorized to develop the proposalat his discretion. A further proposal to increasethe number of field offices will be considered at thesession of the Governing Body to be held in thespring of 1953.

This difference between the regional arrangementsof WHO and various devices of other agenciesconsiderably complicates the procedure for liaisonwith those agencies on field programmes and pro -jects. Only with UNICEF is there a standard agreedprocedure, based first on discussion in the JointCommittee on Health Policy, UNICEF /WHO, and onan agreement that joint UNICEF /WHO programmesshall be presented to and discussed with governmentsjointly by representatives of the two bodies. Amuch more limited agreement, which could usefullybe applied in similar cases, has been reached withUNESCO on its fundamental education projects ina few countries : it has been agreed that WHOshall advise the health ministry on any health aspectsof the projects. More often, however, the arrange-ments for joint work with other agencies havetended to be empirical and to be made ad hoc ineach case. WHO staff working on field projectsare always told, in their briefing, of other agencies'


projects that will affect their work, and are advisedto work with the regional representatives of thoseagencies through the WHO regional office.

The appointment, by the Executive Chairman ofthe Technical Assistance Board, of resident TechnicalAssistance representatives should help to bringmore regularity into the arrangements for co-ordination among agencies. These officials areappointed to act, in the country to which they areappointed, as representatives of the TechnicalAssistance Board and of all the participating organi-zations, and are expected to act in accordance withthe established lines of policy of the agencies aswell as of the Technical Assistance Board. Includedin their terms of reference is the following paragraph :

To assist in ensuring the effective rendering ofassistance by the various Participating Organi-zations and in harmonizing the activities of expertsand specialists provided by these organizations,with a view to assuring the development of well -balanced and co- ordinated Technical Assistanceprogrammes in that country and to keep himselfinformed on the activities of the organizationsand the experts within the country. Experts areresponsible directly to the organizations and reportdirect to them, but they will work in close co-operation with Resident Representatives and thelatter will be called upon to assist in negotiationswith the Government at the policy level, thoughnot at the technical level.

By November 1952 resident Technical Assistancerepresentatives had been appointed for 23 countries :Afghanistan, Australia and New Zealand, Bolivia,Burma, Ceylon, Colombia, Greece, Haiti, India,Indonesia, Iran, Iraq, Israel, Jordan and Lebanonand Syria, Libya, Pakistan, Philippines, Turkey,Uruguay, Yugoslavia.

4. REGIONAL ORGANIZATION

Regional Committees

The functions, duties and membership of regionalcommittees are defined in Articles 46 to 52 inclusiveof the Constitution ; Article 8 of the Constitution,which relates to Associate Members of the Organi-zation, is also relevant.

The interpretation in practice of Article 47 hasgiven rise to three difficult questions :

(a) the exact meaning of the words " MemberStates in the region " ;

(b) the conditions under which Associate Mem-bers should be represented on and participate inregional committees ; and

(c) the position of territories not responsiblefor the conduct of their international relations.This group falls into two sub -groups :

(i) those in which the territories are constitu-tionally part of the metropolitan country ;(ii) those which are constitutionally separatefrom the metropolitan country.

These questions were referred to the ExecutiveBoard by the First World Health Assembly andwere considered at the second and third sessionsof the Board.i4 The Board found itself unable tofind a satisfactory answer to these questions andreferred them back to the Second World HealthAssembly.

On the interpretation of " Member States in theregion ", there were two main views : the first wasthat only those countries whose seat of governmentwas in the region satisfied the definition ; the secondwas that since metropolitan States are responsiblefor the international relations of the territoriesconcerned in the regions, it follows that, so far asconcerns membership of an international organi-zation, the metropolitan government is the govern-ment of the territory in the region and is thereforeentitled to representation on the regional committee.

On Associate Members, the main question waswhether they should have equal rights with MemberStates on the regional committee or whether theirvoting rights should be restricted.

On other territories not responsible for theirinternational relations, the same question of votingrights was discussed as in the case of AssociateMembers. It was also proposed for this class ofterritory that each regional committee should makeits own recommendations for approval by theWorld Health Assembly, on the nature and extentof the obligations of such territories in the regionalorganization.

These questions were discussed by the SecondWorld Health Assembly and its decision was em-bodied in resolution WHA2.103.

Throughout the discussion it was generally agreedthat it would be to the advantage of the Organi-zation and would best promote the objectives of theOrganization in the region to have on the regionalcommittee the widest representation of territoriesin the region compatible with the requirements ofthe Constitution. The resolution mentioned above

14 Off. Rec. World Hlth Org. 14, 26 ; 17, 17


is designed to reconcile these two considerations.The Health Assembly will note that Article 47 ofthe Constitution does not contain a provision as tothe qualifications required of representatives toregional committees similar to that embodied inArticles 11 and 24 with regard to delegates to theHealth Assembly and members of the ExecutiveBoard.

The study made by the Executive Board (Annex 5),in pursuance of resolution WHA5.42, of the rightsand obligations of Associate Members, is of courserelevant to some of the above considerations.

Article 48 of the Constitution provides thatregional committees shall meet as often as necessaryand shall determine the place of their meeting. Theplaces in which meetings of regional committeeshave been held and the meeting places forecast for1953 and 1954 are shown in Appendix 4. TheHealth Assembly will note that these meetings areoften held away from the site of the regional officeand it may wish to consider whether the additionalcost involved in this procedure and the consequentdisturbance of the work of the regional office areoutweighed by the advantages of arousing interestin WHO's work in the different countries of theregion. Similar considerations have, of course,arisen in regard to the place of meetings of theWorld Health Assembly, and in pursuance ofresolution WHA5.48 the Executive Board hasstudied these questions in relation to the meetingsof the Assembly and has made recommendationsto the Sixth World Health Assembly in resolutionEB 1 O. R25.

Article 49 of the Constitution provides thatregional committees shall adopt their own rules ofprocedure.

Article 50 sets out particular functions of theregional committees, most of which are consideredin other parts of this report.

Regional Offices

The Board in earlier sessions has, to a certainextent, examined the regional offices in terms oforganizational structure and administrative efficiencyin connexion with its overall study of these ques-tions.ló The structure and staffing pattern varyconsiderably from one region to another, and, inorder to assist the Health Assembly to understandthe situation, an organizational chart for each officeis given in Appendix 3. These charts show thepositions authorized for 1952, whether they havebeen filled or not. A statement of the composite

16 Off. Rec. World Hlth Org. 26, 23 (paras 119 -24), 92 ;33, 31 ( paras 139 -45)

functions of a regional office is given below. Parti-cular attention is called to the statement of thefunctions of the WHO area representatives. Inthe course of 1952 such representatives were ap-pointed to the staff of the South -East Asia RegionalOffice, and it is possible that similar appointmentswill be made in other regional offices (apartfrom the Pan American Sanitary Bureau -RegionalOffice for the Americas -whose zone offices haverather similar functions).

Composite Functions of a Regional Office

Since some variations exist in the structure andin the names of organizational units in the severalregional offices of WHO, the functional statementsshown in Appendix 2 are not for any particularregional office, but for a composite one.

Communications

The establishment of a regional office, and themeeting in regional committees of representativesof the countries in the region, mean improvedcommunications between WHO and the nationalgovernments in the region but decentralizing thesecontacts between WHO and Member States raisesnew problems of communication between regionaloffices and headquarters, and the solution of theseproblems is essential to the effective functioning ofthe Organization.

There are three chief methods of communicationbetween headquarters and regional offices :

(a) Ordinary correspondence: (i) on policy andon principles of administration ; (ii) on purelytechnical points.(b) Reports: (i) on individual projects or surveys ;(ii) on the work of the regional office as a whole.A new system of reports was brought into opera-tion at the beginning of 1952. Each regionaloffice and headquarters make a quarterly reporton their work, which is sent to each of the otheroffices. It will take a little time to put this report-ing system into full operation, but its results sofar are promising. It should not only providebetter communications within the Organizationbut also make it easier for other agencies andMember States to be informed of what WHOis doing, and for technical officers themselves tojudge how their work is progressing.(c) Visits: The best letters and reports do notpromote mutual understanding so well as personalcontacts. Visits between regions, or betweenheadquarters and regional offices, are expensiveand take time. However, there is no substitute


for such visits if the work of the Organization isto progress in an orderly, effective manner. Thequestion was discussed by the Executive Board atits seventh session.16

Privileges, Immunities and Facilities

The effective operation of individual regionaloffices is to a considerable extent affected by theprivileges, immunities and facilities afforded by thehost government to the regional offices. The hostagreements signed by the Governments of Egypt,France (for the Regional Office for Africa), Indiaand the Philippines contain the same general pro -visions.17 The Regional Office for Europe, whichis temporarily located in Geneva, is covered by thearrangements made for the headquarters office.The pre- existence of the Pan American SanitaryBureau, which is the Regional Office for the Ameri-cas, made it unnecessary to enter into an agreementwith the United States of America ; no agreementexists between PASB and the United States, butprivileges and immunities were defined by Congres-sional action. It may be noted that this did notinclude the exemption of United States employeesfrom United States taxation in respect of salariesand emoluments paid by the Organization.

5. BUDGETARY AND FINANCIALADMINISTRATION

Policy

The articles of the Constitution of WHO whichprovide for budgetary and financial administrationare 18 (f), 34, 50 (f) and 55 -58 inclusive. The FinancialRegulations,18 adopted by the Fourth World HealthAssembly, govern the financial administration of theOrganization. Under Financial Regulation 10.1,the Director -General is required to establish detailedfinancial rules (subject to confirmation by theExecutive Board) and procedures in order to ensureeffective administration and the exercise of economy.The Executive Board at its second session adoptedprinciples 18 for the application of the FinancialRegulations and Financial Rules to regional offices,and for regional budgets. In so doing, the Boarddecided, inter alia, that " the Financial Regulations

16 Off. Rec. World Hlth Org. 33, 32, para. 14517 Of Rec. World Hlth Org. 21, Annex 11 (India) ; 35,

Annex 7 (Egypt) ; 40, Annex 11 (Philippines) ; 46, Annex 4(France -for Regional Office for Africa)

18 Of Rec. World HIM Org. 33, 5610 Off. Rec. World Hlth Org. 14, 25, item 4.1.3

and Rules are applicable to the entire Organization ; "that " all funds received by the Organization will besubject to the Financial Regulations and Rules " ;)and that, " as regional organizations are integralparts of the World Health Organization, theirbudgets must be presented to the World HealthAssembly as part of the budget which the Director -General, in accordance with the Constitution, isrequired to present ; the regional budget shouldinclude the complete plan of operations for theyear and should indicate what part, if any, is expectedto be met by supplementary contributions by theStates in the region."

The Budget Cycle 20

The programme on which the annual budgetestimates submitted by the Director - General arebased must be planned, developed and executed overa three -year period, which is defined as follows :

(a) Planning year : The calendar year in whichthe programme and budget is prepared for approvalby the Health Assembly in the succeeding yearand for execution in the second succeeding year.(b) Approving year : The calendar year duringwhich the Health Assembly approves the pro-gramme and forthe regular programme for the following year.(c) Operating year : The calendar year duringwhich the programme is executed.21

Programme and Budget Estimates

In 1950, the Director - General requested the direc-tors of the then existing regional offices to preparedetailed programme and budget estimates for workto be done in the region and to obtain the recom-mendations thereon of the regional committee, inorder that he might use those plans in preparing hisprogramme and budget for the financial year 1952.This practice has been developed and extended sothat, for the programme and budget estimates for1953 and 1954, all regional directors and regionalcommittees 82 performed this function.

80 To the extent practicable, this process applies not onlyto the regular budget but also to the Expanded Programme ofTechnical Assistance, some alterations being necessary tomeet the requirements of the Economic and Social Council,the Technical Assistance Committee and the TechnicalAssistance Board.

21 For the 1954 programme and budget, the planning yearis 1952, the approving year 1953 and the operating year 1954.

22 Except the Regional Committee for the Eastern Me-diterranean, which met neither in 1951 nor in 1952


Under this system, the Director - General, asearly as possible in the planning year, sends to theregional directors instructions for the preparationof the programme and budget estimates for imple-mentation in the second succeeding year. The

'instructions include programme policy guidance(taking into account decisions of the Health As-sembly and the Executive Board, including the ap-proved general programme of work for a specificperiod) and the form in which the programme andbudget estimates are to be presented. They furtherindicate the tentative allocations (for both theregular and Technical Assistance programmes) tothe region for the regional office and for field activitieswithin the region.

The regional directors prepare the programme andbudget estimates for the region, at the same timerevising, as necessary in the light of developments,the previous estimates for the succeeding year.These are prepared after consultation with govern-ments regarding the international assistance requiredfor the budget year to further the orderly develop-ment of their national health programmes. Regionaldirectors are responsible for assuring that thesecountry proposals conform to general plans andpolicies as defined by the Health Assembly.

The regional director presents the programme andbudget estimates for the region to the regionalcommittee for consideration, since the function ofassisting in the development of his programme andbudget proposals was delegated by the Director -General to regional committees, in accordance withArticle 50 (g) of the Constitution. The estimatesare then submitted to the Director -General, withthe comments and recommendations of the regionaldirector and those of the regional committee.

The Director -General prepares his proposed pro-gramme and budget estimates, taking into considera-tion the proposals of the regional directors and theregional committees, as well as the advice of hisstaff at headquarters.

The programme and budget estimates are sub-mitted to the Executive Board in January of theapproving year, for its comments and recommenda-tions, which, together with the estimates, are presentedto the Health Assembly.

The Director -General's proposed programme andbudget and the recommendations of the ExecutiveBoard are considered in detail by the Health As-

sembly, which decides on the programme it wishesto approve and on the funds to be appropriatedfor regular programme activities. The decision ofthe Health Assembly with respect to the programmeand budget to be financed from regular funds iscontained in the Appropriation Resolution, whichestablishes the total amounts for which obligationsmay be incurred in the following year for the purposesstated in the resolution.

Allotments

The appropriations voted by the Health Assemblyconstitute an authorization to the Director - Generalto incur obligations and make payments for thepurposes for which the appropriations were votedand up to the amounts so voted, but no obligationsmay be incurred or payments made until an allot-ment for the specific purpose has been issued by theDirector -General. Regional directors request allot-ments for specific purposes, e.g., the expenses of theregional office, or a particular project or activity.Initial requests for allotments are accompanied.y a plan of operations (for projects), any commentsor justifications, and the estimated cost for thefinancial year. The request is reviewed at headquar-ters to assure that it is in accordance with the Ap-propriation Resolution and the policies of theHealth Assembly and the Executive Board. Theallotment is issued in writing to the regional director,who is responsible to the Director -General forassuring that obligations are incurred only for thepurposes indicated in the allotment and within theamounts specified in it (a report on all allotmentsissued for the year concerned, i.e., the " operationyear ", is furnished to the Executive Board at itsmid -year session).

Regional offices are responsible for the controland analysis of the allotments which are issued tothem. They decide on obligations to be incurredagainst allotments up to the amounts indicatedfor each main aspect of the work for which theallotment is issued (personal services, allowances andtravel, supplies and equipment, fellowships). Theyare responsible for maintaining records showing atany time the amounts allotted and obligated and theavailable balance of the allotment. Thus, regionaldirectors have been given complete authority toincur obligations for all purposes (including awardsfor fellowships) in executing the approved pro-gramme in the region, within the amounts of theallotments issued to them. They cannot themselves


change the amount of an allotment, but they canrequest the alteration of that amount. Periodically,the status of allotments is analysed in the regionaloffice and reported to headquarters, where eachallotment is reviewed and such adjustments madeas necessary to assure on the one hand that theamount is adequate for the purpose intended, andon the other that funds are not unnecessarily tiedup if they are not actually required for obligationsduring the financial year. This is necessary tosecure an effective utilization of the funds at theOrganization's disposal.

Completion of the Budget CycleThe budget process, as described above, is neces-

sarily a continuing one, as the original estimates arefrom time to time modified in the light of actualprogramme developments. As soon as possibleafter the end of the financial year, the accountsof each regional office are closed and reported toheadquarters, and the actual budget performanceis reflected in the obligations which were incurred.(The method of final financial reporting on eachyear 's activities is described below.)

Financial Arrangements

Bank Accounts

Primary bank accounts are opened by the Director -General and are drawn upon by a joint panel ofsignatories established by the Director - General andthe regional director concerned. Funds of theOrganization are transferred by headquarters tothe regional accounts. Regional directors are author-ized to open such secondary accounts as are requiredfor the effective functioning of the regional officeunder the authority delegated to them by the Director -General. The regional director advises headquartersof all bank accounts which he opens under thisauthority. He is authorized to transfer funds fromthe primary accounts mentioned above to thesecondary accounts.

Disbursements

Regional offices have the authority to makepayments on the basis of vouchers and supportingdocuments which are designed to ensure that theservices or goods have been received and that pay-ments have not already been made.

Other Financial Arrangements

Arrangements for travel, removals and conferences,and the purchase of administrative supplies aredelegated to regional offices. Operational supplies

and equipment are generally purchased through .

headquarters in order to assure the widest field ofselection, and also the effective use of the variouscurrencies available to the Organization (particularlyunder the Technical Assistance programme, whereit is necessary to make the fullest use of a widevariety of currencies).

Accounting

Accounting has been progressively delegated tothe regional offices and by 1 January 1953 all regionaloffices will be self -accounting in that they will maintaina complete set of accounting records in which willbe reflected all the financial transactions of theregion. Monthly returns are submitted to head-quarters in order that the essential consolidatedaccounts of the whole Organization may be estab-lished and a current control of its financial positionmaintained.

Because a considerable responsibility for account-ing has been delegated to regional directors anddecentralized to the regional offices, it has beennecessary to prescribe detailed accounting andfinancial reporting procedures to be followed byeach of the regional offices. Only by adhering touniform methods is it possible to maintain uni-formity in reporting. This is designed to makepossible the presentation of a single consolidatedfinancial report which will reflect the activities ofthe whole Organization from all sources of fundshandled by it whether at headquarters or regionaloffices.

In view of the fact that internal auditors areexamining the financial transactions to a greatextent locally, the monthly returns are limited to theminimum.

Internal Audit

The Director - General is responsible for establish-ing and maintaining an internal financial controlwhich must provide for an effective current examina-tion and review of financial transactions of theOrganization. To assist in carrying out this res-ponsibility, the internal auditors of the Organizationaudit the financial records and accounts to ensurethat transactions are in accordance with policy,rules and regulations, that the methods of accountingfor obligations and expenditure are being observed,and that the machinery is satisfactory. To facilitatethis examination, internal auditors have been sta-tioned in several of the regional offices, thoughthey remain directly responsible to headquarters.The decentralization of accounts, described above,will result in more work for the internal auditors.


Annual Financial Report

The Director -General is required to submit anannual financial report to the Health Assembly.This report, which is considered a part of the AnnualReport of the Director - General, reflects, in financialterms, the Organization's activities. It providesthe Health Assembly with an account of the financialmanagement of the total resources available tothe Organization, including regional budgets, andincludes in its tables complete financial data whichreflect the various programme activities and regionaland headquarters functions.

Audit Control

Pursuant to the Financial Regulations, the HealthAssembly has appointed an External Auditor whoaudits the accounts of the Organization and reportsthereon to the Health Assembly. The ExternalAuditor is, of course, required to report on accountsmaintained in regional offices as well as those retainedin headquarters, and as a result of visits to regionaloffices, or the audit of the accounting returns sub-mitted by those offices, he is able to advise theOrganization on the efficiency and effectiveness ofthe financial aspects of administration at the variousoffices.

6. PERSONNEL ADMINISTRATION

The Articles of the Constitution of WHO relatingto personnel administration are 30, 35, 36, 37, 51and 53. The Staff Regulations adopted by theHealth Assembly (resolution WHA4.51) governpersonnel administration in the Organization. UnderStaff Regulation 12.2, the Director - General makesstaff rules to implement the Regulations and theseare reported to the Health Assembly after confirma-tion by the Executive Board. The Executive Boardat its second session 23 decided that Staff Regula-tions and Staff Rules apply to the entire Organi-zation, including the regulation (now Regulation 4.2)concerning criteria of selection, particularly indi-vidual competence and geographical representation,and that therefore all vacancies in regional offices(except such lower grades as may be exemptedfrom geographical representation) are to be filledonly after consideration of all applicants.

When regional offices were first established, allstaff procedures were carried out at headquarters.During the intervening years, it has been possible

23 08: Rec. World Hlth Org. 14, 25, item 4.1.1

to delegate increasing responsibility for personnelwork to the regions. The Director- General, pursuantto Article 35 of the Constitution, considering Ar-ticles 51 and 53, and in accordance with Staff Regula-tion 12.3, has delegated to regional directors theauthority to recruit and appoint staff for any postthat can be filled from the regions, except that theselection of senior professional and administrativeofficers in the regional offices is still reserved toheadquarters. The delegation requires, of course,that the Staff Regulations and Rules and the estab-lished procedures shall be followed. To assure co-ordination, headquarters still appoints officers whoare recruited from a region other than that in whichthey are to serve.

The regional director also has the authority,subject to the general regulations, rules and pro-cedures, to change the status and terminate theappointment of any staff whom he appoints. Itis planned to increase the practice of interchanginginternationally recruited staff among regions, andbetween regions and the headquarters office. Inthis way, staff members will acquire a broader andmore complete knowledge of the work of the Organi-zation and a greater understanding of the problemsencountered and the ways of solving them. Suchstaff can make increasingly useful contributions tothe total work of the Organization.

The regional directors have been authorized todecide the proper classification of posts filled bylocal recruitment, and to establish their scales ofpay, subject to the approval of the Director -General.The classification of posts occupied by internationallyrecruited staff is determined by headquarters, inorder to assure that posts with comparable dutiesand responsibilities, regardless of their location,have the same classification, in accordance withStaff Regulation 2.1.

As a result of a recent change in the Staff Rules,regional offices are now setting up regional Boardsof Appeal to deal with appeals that arise within theregions. Regional offices are also dealing with mostof the day -to -day problems of administration thataffect staff members within the regions : for example,they authorize allowances for staff in accordancewith the Staff Rules, travel and reimbursementof travel costs, home leave and other types of leave,and keep all leave records for the staff within theregion. Of more importance is the fact that theyexamine and deal with practically all problems ofstaff relations for the entire region.

To carry out these responsibilities regional per-sonnel officers have been appointed to regionaloffices, except for Africa where the volume of work


has not so far warranted it. The greater part of thedecentralization described above has taken placein the year since these posts were created. As theseofficers gain experience, more and more responsibilitycan be placed on them. It is intended to continueto delegate to each regional director the greatestpossible responsibility for staff operations thataffect the work of his region.

7. CONTINUED AND INCREASINGRESPONSIBILITIES OF HEADQUARTERS

From the earliest stages in the planning for re-gionalization and decentralization it was recognizedthat certain basic functions must be continued asthe responsibility of headquarters. The ExecutiveBoard at its fifth session also emphasized thatcertain basic responsibilities must be retained atheadquarters.24 Since that time, it has becomeincreasingly evident that leadership of a very highorder must be provided by headquarters if WHOis to carry out its constitutional responsibilitiesadequately.

The last few years have brought a vast develop-ment of multilateral and bilateral agencies interestedin international health either directly or as an es-sential part of economic and social improvementwork. This development, which few can haveexpected, either when the Constitution was drawnup or when the First World Health Assembly adoptedits resolution on regionalization, has thrown agreatly increased amount of work on the Organiza-tion, and the functions originally visualized forheadquarters and regional offices in the developmentof regionalization have been considerably expanded.The large amount of work called for in carrying outWHO's constitutional responsibility as co- ordinatingauthority on international health work has throwna heavy additional burden on the Organization andparticularly on headquarters ; the work of regionaloffices is also increased thereby, but to a lesserextent.

The emergence of such work as is supported bythe United Nations Expanded Programme of Tech-nical Assistance for Economic Development and byUNICEF, by such bilateral agencies as the MutualSecurity Agency (MSA) and the Technical Co-operation Administration (TCA) of the United Statesof America, and by such regional arrangements as

24 Of Rec. World Hlth Org. 26, 23, para. 119

the Colombo Plan, the Commission for TechnicalCo- operation in Africa South of the Sahara (CCTA),the Inter -American Economic and Social Council,and the South Pacific Commission, has influencedand extended the responsibility of headquarters forco- ordinating activities undertaken by or in co-operation with such agencies, and for stimulatingthe kinds of activities which can most usefullycontribute to the health of the peoples of the world.The emergence of additional large internationalcampaigns has thrown a new and additional amountof both technical and administrative work, notforeseen in the early stages of the Organization,on the staff of WHO. Headquarters has been activelyconcerned with establishing and maintaining liaisonwith these varied agencies, with technical planningto assure co- ordination, and, for activities financedfrom funds placed at its own disposal (regular,Technical Assistance and UNICEF), with personnelrecruitment, budget management, financial arrange-ments, procurement of supplies and other admi-nistrative and financial services.

Another development, though not so substantialand unforeseen as the above, is the call for WHOheadquarters to deal with special United Nationsresponsibilities. These, though of a regional charac-ter, place heavy responsibilities on headquartersfor planning and negotiation. An example is theassistance required by such organizations as theUnited Nations Relief and Works Agency forPalestine Refugees in the Near East and the UnitedNations Korean Reconstruction Agency.

The headquarters functions of WHO have alsobeen altered by the establishment and developmentof the Organization's regional offices. It is necessarythat clear and complete policy direction be providedfor those offices, that long -range plans be made tomeet changing and emerging health needs, thatregions be given general technical guidance onpolicy, and that they be provided with technicalmaterial -through publications, expert committeereports, special reports, etc. -which they require inthe detailed management of the programme in theregions. There is an increasing responsibility forsupervising and co- ordinating programmes in theregions, to assure that they are compatible with thepolicies of the Organization as well as those ofother organizations participating in combined pro-grammes, such as the Technical Assistance Boardand UNICEF. Headquarters must also acceptresponsibility for assessing the work of regionalorganizations, for assuring that it is executed inaccordance with the instructions of the HealthAssembly and the Executive Board, and for making


the correct technical, scientific and administrativedeductions, from which improved programmes maybe developed and scientific lessons learned.

The freeing of headquarters staff from direct involve-ment in the detailed planning and execution ofprogrammes in the regions has made possible re-newed consideration of some of its other duties inrelation to national administrations and regionaloffices. This has shown the need for headquartersto begin strengthening its world -wide technicalservices. It will be increasingly the source to whichregional organizations, national administrations andtechnical institutions will turn for authoritativeguidance, advice and information on medical andhealth subjects.

8. CONCLUSIONS

The Executive Board believes that the reasonswhich prompted the establishment of a decentralizedorganization are still valid and have been justifiedin practice.

The Board further believes that the general meansadopted in the establishment of such regionaloffices have presented no insurmountable difficultiesof programme planning and operation. It appearsthat the major administrative problems of decen-tralization have been solved or are on the way tosolution.

The Board is satisfied that the organizationalstructures and the functioning of the regional officeshave developed on sound lines. In this connexion,dhe Board concurs in the principle that regional

eeds and problems should be the decisive factor.It is the responsibility of the Director -General toP Y

maintain efficiency in all parts of the Organization,for example, by means of the internal audit andmanagement studies. The Executive Board shouldperiodically request the Director - General to reporton these matters so that the Health Assembly may beassured that decentralization is not an impedimentto the best use of the personnel, financial and otherresources of the Organization.

In addition to the central technical services pro-vided by headquarters to the world as a whole, itsstaff must continue to give guidance to the regionaloffices on specific programmes, assist in long -termplanning and above all control and co- ordinateregional programmes to ensure that they conformto the principles and policies established by theHealth Assembly, the Executive Board and theDirector -General.

The Board recognizes that decentralization mayimpose difficulties on the recruitment and use ofmedical specialists. It is felt however that regionaloffices should not seek to engage such specialistson long or permanent contracts unless importantprogrammes are firmly established. It would appearto be feasible and more economical to plan, wherepossible, for regions to use such personnel in rotationor call on specialists from headquarters or specialistsrecruited by headquarters for short -term assign-ments.

The interchangeability of staff and the co- ordina-tion of programmes between regions are important,not only to further the concept of world health asan entity, but also to ensure the efficiency of decen-tralization.

The Board has been assured that, where countriesare closely related to two or more regions, theutmost in co- operation is maintained between theregional offices concerned. The Board highly com-mends this practice.

It has been shown that the geographical patternof certain regions imposes heavy financial burdenson some countries of the region when called on toparticipate in regional committees. At present, noprovision is made to meet the cost of attendance at

meetings the funds of the Organization.The Board views the consequence of this situationwith concern. It could be dealt with by includingprovision in the annual budget of WHO to pay thetransportation expenses of one representative ofeach Member or Associate Member in the region.

The Board feels that no alterations to the generalpattern of the geographical definitions of the WHOregions should be made at present, but draws theattention of the Health Assembly to Article 44 (a)of the Constitution, which provides for the definitionfrom time to time of the geographical areas. Themajor difficulties of WHO, in this connexion, arisefrom conditions beyond the control of the Organi-zation. The regional offices of WHO must co-operate, in a given territory, with other agencies,some being partially decentralized and otherswholly centralized. Where other agencies havedeéentralized their activities, in one way or another,the areas covered seldom coincide with those ofWHO. The Board believes that there should bea greater degree of uniformity of practice as regardsdecentralization by the United Nations and thespecialized agencies. The Director- General ofWHO should enter into such negotiations in thespirit that the present geographical regional areasof WHO could be altered if this would lead tobetter local and regional co- ordination.


The Board notes with grave concern the effectthat a possible reduction in the funds provided to theOrganization under the United Nations ExpandedProgramme of Technical Assistance would haveon the development of decentralization in WHO.With every assurance that such funds would beavailable for a long period, WHO had devotedmuch time and effort to organizing such an expandedprogramme. Further, even the bilateral agencieswhich make no direct contribution to the financialresources of WHO call on the assistance of WHOas the co- ordinating authority on international

health work. This has placed a new and heavyburden on regional offices and headquarters.

Finally, the Board would observe that the un-doubted advantages of decentralization can beachieved only by mutual confidence and co- operationbetween all those to whom responsibility and author-ity have been delegated by the Constitution, theHealth Assembly and the Director -General. Failingsuch mutual trust and understanding, decentraliza-tion will inevitably lead to a diverse, segmented andconflicting approach to the problems of worldhealth.

Appendix 1

NOTES FOR FUTURE CONSIDERATION

A series of notes are presented here for the informationof the Health Assembly. They include a few only of thematters pertinent to any future comprehensive study ofregionalization as a dynamic device to further the workof WHO.

1. Social and Economic Considerations

This is a time of large and important changes in social,economic and political institutions. Although these changesundoubtedly influence the form and direction of any inter-national scheme for regionalization, discussion of them islargely outside the scope of this report. However, somedevelopments deserve passing reference :

Countries everywhere are today both active and passiveparticipants in social development and economic improvement.These movements for betterment have received immenseimpetus from the many vast international technical andeconomic assistance arrangements, both multilateral andbilateral. The initiation of great new schemes or the rapidexpansion of existing services is inevitably producing stressesand strains in national and local administrations. Applyingand adapting technical knowledge are themselves complicatedprocedures to be evolved anew region by region, countryby country.

There is a serious need for all this growth and change tobe carefully and wisely directed, guided and co- ordinated orit may raise more social, political and administrative problemsthan it will cure.

The interdependence of economic, social and health prob-lems and the need for close co- operation of agencies dealingwith them are now amongst the most significant aspects

of regional planning and administration. Methods of ensuringco- ordination at all levels- headquarters, regional andnational -have yet to be fully evolved and applied.

No attempt at regionalization which overlooks these widersocial, economic and administrative considerations will beefficient or justifiable. A heavy responsibility is thereforeplaced on WHO by the development of regional organizations.

2. Co- ordination

Since the seventh session of the Executive Board, increasedneed for co- ordination with the work of other agencies hasadded to the complexities of the work of the Organizationand has increased the time that officers of WHO must spendin consultation with those of other agencies. These functionsshould be kept to the necessary minimum, but that minimumis necessary to ensure that the funds available for healthwork are spent effectively and are not wasted- whether theycome from the regular budget of the Organization or fromother sources, or are spent by other agencies that depend onWHO for advice on work that has health implications. Thecomplicated interrelation among agencies, and the varioussources of funds and services, the necessary arrangementsfor liaison in planning and execution, the need to securereasonably uniform conditions of work in different agencies,the necessity for controlling, recording and reporting onexpenditure of funds from different sources, and other similarrequirements, are primarily administrative and often involvemuch detailed and intricate discussion before agreement oncommon procedures is secured. It is therefore inevitablethat increasing liaison should mean an increase of adminis-trative and financial work, both in regional offices and atheadquarters, relative to the technical work which it is thepurpose of administrative and financial services to facilitateand advance.


3. Technical Assistance

The wide scope of the Technical Assistance programmemakes very clear the interdependence of economic, socialand health problems, and the need for close co- operation indealing with them at the earliest possible stage before inter-dependent programmes are framed among the several agenciesthat can help countries to meet these needs. In addition,other agencies outside the United Nations family, governmentsand groups of governments are providing assistance whichmust be co- ordinated into a whole.

The recent emphasis upon co- ordination and its pressingneed is due, largely, to the increase in the assistance beingreceived by many countries. Too often the entire blame forthe failure to co- ordinate activities within a country is chargedto the failure of the contributing agencies to co- ordinatetheir programmes and their support. Like most blanketassignments of blame, the conclusion is neat, simple andincorrect.

Thus far, the search of the assisting agencies for a successfulmechanism of co- ordination has met with small success.Progress has been made between the agencies to preventconfusion, overlapping and what appears to be competition.But all assisting agencies agree that successful co- ordinationwithin a country can be achieved only when the countryaccepts that responsibility and acts upon it.

As the various sources of help are developed, it has becomeobvious that collaboration amongst outside agencies isincomplete and ineffective without a corresponding effectiveco- ordination within the country among the ministers anddepartments responsible for various aspects of the country'swelfare. There has been a need to co- ordinate health activitiessupported by existing agencies. Some of the devices usedhave included official national councils or committees tosuggest and review projects. In many instances the agenciesthemselves are represented in the national councils or com-mittees. At the same time, it is essential to develop co -ordi-nation among the agencies working on the various aspectsof the problem. To assure that progress in health keepspace with that in education, food and agriculture, industry,transportation, labour training and utilization, etc., it isessential that the problems in each country should be dealtwith as a whole, and every effort is now being made to assistin internal co- ordination. The appointment of residentTechnical Assistance representatives mentioned above underRelations with other Organizations (page 162) is anotherdevice which has been used to aid governments in buildingup their internal co- ordinating machinery.

All this activity has led to a general realization that newstandards of life are possible, and to a desire to achieve them.There is more widespread knowledge of the resources availablein the world and of the resources yet to be exploited. Thereis an increased consciousness of national needs and, therefore,of national unity. There is an increased consciousness ofthe need for international collaboration. All these elements,on each of which much could be written, are relevant to thefunction of WHO as the directing and co- ordinating authorityon international health work and must, therefore, be bornein mind in any consideration of the problems of regionalization.

The development of these various economic and socialconsiderations, as well as advances in public health, havecreated a situation in which " there is every reason to believethat world health can eventually be raised to a satisfactorylevel, if each of the nations concerned will take the propersteps to apply the knowledge and the procedure now athand... It will require courageous leadership, intelligentpolitical backing, adequate financial support, sound realisticplanning, and vigorous application." 25

4. Programme Planning

The basis of the programme of WHO is the General Pro-gramme of Work covering a Specific Period,86 in whichgeneral principles, criteria for selection and major groupingsare described in relation to this subject. This programmewas adopted by the Fourth World Health Assembly for 1952 -5inclusive, as proposed by the Executive Board at itsseventh session (resolution EB7.R57). The Fifth WorldHealth Assembly extended the period to include 1956 (resolu-tion WHA5.25). Some reference is made in the generalprogramme of work to the question of regionalization, butonly in general terms. It is carefully pointed out that regionali-zation has not changed the general policy of WHO. Thetechnique of working has changed, but WHO still standsfor the same things and pursues the same broad aims as itdid before regionalization began. Account has also to betaken of the criteria included in resolution 222 (IX) of theEconomic and Social Council27 as part of the principlesgoverning collaboration between co- operating agencies ofthe United Nations family, of those in resolution 324 (XI) ofthe Economic and Social Council on concentration of effortand resources and, for work under the Technical Assistanceprogramme, of additional special criteria.

Further, an important part of WHO's work continues to becentralized, since its nature does not lend itself to a fractiona-tion of activities. Parts of the programme which are trulyinternational and cannot readily be divided on a geographicalbasis have remained virtually unchanged by the process ofregionalization.

5. Programme Evaluation

Evaluation of programmes is a two -stage process, involvingthe more detailed evaluation of items which the regionaloffice is best fitted to undertake by reason of its geographicalsituation and closer contact with countries (tactical evaluation)and the long -term (strategic) evaluation which ea quar ei`?;,on the basis of the evidence it receives from all the regionaloffices, can alone undertake. In any programme, there are

25 Simmons, J. S. (1949) Public health in the world today,Cambridge, Mass., p. 10

26 Of Rec. World Hlth Org. 32, 5527 Reproduced in the Handbook of Basic Documents, fifth

edition, p. 145


four periods at which a process which might reasonably betermed evaluation can take place :

(1) the survey period, during which an effort is made todetermine the nature of programmes suitable for a certaincountry (it has not been possible to do this in all cases sofar) ;

(2) the period of screening of requests for suitability ;

(3) the period of operation of a programme, when pro-gress is assessed from time to time ;(4) the period after completion of a programme, whenresults are assessed.The crucial point in evaluation should be at stage (1),

when the decision has to be taken whether a given countryprogramme is suitable to the needs of the country and fitsinto the framework of the general programme.

Appendix 2

COMPOSITE STATEMENT OF FUNCTIONS OF A REGIONAL OFFICE

Office of the Regional Director

The Regional Director(1) acts, on behalf of the Director -General as the directingand co- ordinating authority on international health workin his region ;

(2) is responsible to the Director- General for the planning,implementation and supervision of all WHO activities in hisregion ;

(3) acts, for the Director -General, as secretary to the regionalcommittee and advises it on the formulation of regionalpolicies in line with those laid down by the World HealthAssembly ;

(4) provides liaison between the regional committee andthe Director -General ;

(5) maintains contact with governments and appropriateprofessional groups in his region ;

(6) maintains contact with the local representatives of allagencies (international and other) having common interestsin the region to co- ordinate WHO activities with theirs,thereby obtaining the maximum effective utilization of availableresources ;

(7) submits to the Director -General an annual programmeand budget estimates for his region and any reports or otherinformation which the Director -General may request.

Deputy Regional Director

The Deputy Regional Director(1) advises the Regional Director on the technical aspectsof all health activities throughout the region ;

(2) directs the planning and execution of all health surveysthroughout the region;

(3) co- ordinates individual health projects, including fellow-ships, into country programmes ;

(4) provides, at the request of governments, consultationservices to assist in the planning, implementation and integra-tion into national health services of governmental healthprogrammes ;

(5) provides, at the request of governments, advice on theorganization of their national health administrations ;

(6) formulates, in collaboration with the Office of Administra-tion and Finance, the annual regional programme and budgetestimates for approval by the Regional Director and submissionto the regional committee ;

(7) evaluates projects on the basis of data supplied by theStatistics and Records Unit, specialist advisers and public -health advisers in the field ;

(8) drafts regional operational reports.

WHO Area Representatives

WHO area representatives(1) represent the Regional Director in contacts with thegovernments and representatives of other organizations inthe area in which they serve ;

(2) assist in the development of country programmes atthe request of governments and in consultation and co- opera-tion with their representatives and the appropriate regionaladviser(s) ;

(3) provide liaison between the regional office and all WHOstaff in their area ;

(4) act in a general advisory capacity to WHO staff in theirarea on any of their problems and develop a close mutualassociation among them through conferences, seminars, etc.

Office of Health Services *

Regional Advisers

Regional advisers, under the supervision of the DeputyRegional Director,

(1) plan, advise on, and carry out surveys and investigationsto obtain knowledge and develop techniques related to theirspecial subjects ;

* In some regions this function is exercised by the DeputyRegional Director.


(2) advise on the development of regional programmesin their special subjects, and participate with other regionaladvisers in developing integrated health plans ;(3) advise and assist governments with respect to :

(a) overall planning for their specific subject including,in collaboration with the Deputy Regional Director (Officeof Health Services) and other regional advisers, integrationinto the total public -health programme of the country ;(b) planning of specific projects ;(c) implementation of approved projects ;(d) training of personnel, including fellowships -thelatter in collaboration with the Regional Adviser on Educa-tion and Training ;

(4) prepare analyses and recommendations on specificproposals of governments ;(5) assist the Deputy Regional Director (Office of HealthServices) in the supervision of consultants and field staff ;(6) co- operate with the local representatives of the UnitedNations, specialized agencies and non -governmental organi-zations with regard to the technical development and executionof joint projects in the region ;(7) analyse, in collaboration with the Health Statistics Unit,programme activities and report to the Office of HealthServices ;

(8) advise on the selection of fellowship candidates, on theprovision of medical literature and on the need for, or exchangeof, specific information, together with the Regional Adviseron Education and Training ;(9) visit medical and para- medical educational institutionswithin the region and, by agreement with the authorities ofthese institutions and after consultation with the RegionalAdviser on Education and Training, give special instructionin their special subjects.

Fellowships Unit

The Fellowships Unit, under the supervision of the RegionalAdviser on Education and Training,(1) advises the Deputy Regional Director on all aspectsof the WHO fellowship programme ;(2) provides advice to governments within the region onfellowships, group training and courses ;(3) develops arrangements with governments, organizationsand institutions within the region, to facilitate the implementa-tion of regional fellowship programmes ;(4) administers the regional fellowships programme, whichincludes the review of applications, recommendations as toplacement of Fellows, follow -up, and preparation of reports ;(5) makes the necessary arrangements and prepares reportsfor inter -regional fellowships.

Health Statistics and Records Unit

The Health Statistics and Records Unit, responsible tothe Deputy Regional Director,(1) maintains a statistical consultative service for the useof the regional office ;

(2) provides statistical assistance for projects involving thecollection, processing and analysis of factual data ;

(3) assists and advises, upon requests by governments, onthe establishment and maintenance of health statistics officesin national health administrations and in provincial, districtand local health departments ;

(4) encourages the establishment of national committeeson health and vital statistics for the development of moreadequate statistics in both fields ;

(5) assists the Regional Adviser on Education and Trainingin promoting training programmes for workers on public -health statistics ;

(6) maintains a library of statistical information relatingespecially to countries within the region.

Office of Administration and Finance

The Office of Administration and Finance

(1) advises the Regional Director on all administrative, legaland financial matters regarding WHO within the region ;

(2) formulates, in collaboration with the Deputy RegionalDirector, the budget estimates in connexion with the annualregional programme for approval by the Regional Directorand submission to the Regional Committee ;

(3) directs the operations of the budgetary, financial, per-sonnel, conference and general services of the regional office ;

(4) develops plans and methods for efficient managementof the regional office and field activities ;

(5) examines all agreements, letters of arrangements andother legal documents dealing with WHO's activities withinthe region and negotiates them where appropriate ;

(6) ensures liaison with governments in the region on mattersconcerning staff (privileges, immunities, etc.) ;

(7) prepares all regional budget, financial, personnel andsupply reports for submission by the Regional Director toheadquarters.

Public Information Unit

The Public Information Unit

(1) advises the Regional Director on all aspects of publicinformation ;

(2) plans and carries out informational activities in variousmedia (press, publications, radio and visual media) ;

(3) prepares, develops and executes informational projectsoutlined by the Regional Director ;

(4) covers the sessions of the Regional Committee and othermeetings as instructed by the Regional Director ;

(5) maintains public -information liaison with the regionalrepresentatives of the United Nations and specialized agencies,as well as with governmental and non -governmental organi-zations, newpapers, magazines, radio stations and documen-tary film producers within the region.

Appendix 3

STRUCTURE OF THE REGIONAL ORGANIZATIONS

1. STRUCTURE OF THE REGIONAL ORGANIZATION OF AFRICA

r

OFFICE OF THE REGIONAL DIRECTOR

REGIONAL COMMITTEERegional Director

PUBLIC- HEALTH ADMINISTRATION ADMINISTRATION AND FINANCE

1 Administration and finance officer

MEDICAL SECTION

3 Public -health officers3 Clerk -stenographers

ENVIRONMENTAL SANITATIONSECTION

1 Sanitary engineer1 Public- health technician

CULTURAL ANTHROPOLOGYSECTION

BUDGET AND FINANCE

1 Budget and finance officer

GENERAL SERVICES

1 General services officer

Stenographic Pool

3 Secretaries2 Stenographers1 Clerk- typist

FIELD PROJECTS

rso °.' + o

2. STRUCTURE OF THE REGIONAL ORGANIZATION OF THE AMERICAS 28

r-

Secretary -General

Office of theRegional Director Y9

Conferences Editorial Library

Division ofPublic Health

Health PromotionBranch

EnvironmentalSanitation Branch

CommunicableDiseases Branch

Zone I

Washington, D.C.

Office ofCo- ordination

Office ofPublic Information

r

Division ofAdministration

Legal Office Internal Audit

AdministrativeManagement andPersonnel Branch

AdministrativeManagement

Personnel

I

#

Zone ilMexico City

General

Services

Zone Offices

Regional Committee

Budget andFinance Branch

Finance

1

Division of Educationand Training

i

FellowshipsBranch

Zone IIIGuatemala City

Zone IVLima

Zone VRio de Janeiro

Zone VIBuenos Aires

ProfessionalEducation Branch

28 A list of authorized positions is given below.29 The Office of the Regional Director includes the Regional Director, the Deputy Regional Director and the Secretary -General.

OFFICEOF THE REGIONAL DIRECTOR

*Regional DirectorDeputy Regional Director (PASB)Secretary- General (PASB)1 Consultant (PASB)1 Liaison and reports officer (PASB)3 Secretaries (L /PASB)2 Clerk- stenographers (L/PASB)1 Clerk -typist (L /PASB)

Conference Office1 Chief conference officer (PASB)1 Conference officer (PASB)1 Technical assistant (PASB)1 Administrative assistant (PASE)1 Secretary (L /PASB)2 Clerk -stenographers (L /PASB)

Translating Unit1 Chief translator (PASB)4 Translators (PASB)

*2 Translators*1 Translator (TA)*1 Secretary (L)I Clerk- stenographer (L/PASB)

Editorial Office1 Chief of office (PASE)

*1 EditorS Editors (PASB)1 Clerk (L /PASB)1 Clerk- stenographer (L /PASB)3 Clerk- typists (L /PASB)

LibraryI Chief librarian (PASB)

* I LibrarianI Secretary (L /PASB)3 Clerks (L /PASB)I Clerk- typist (L /PASB)

Office of Co- ordination

*1 Administrative officer1 Administrative assistant (PASE)

*1 Administrative assistant (TA)*1 Secretary (TA)

Office of Public Information

"1 Chief information officer*1 Information officer

1 Secretary (L /PASB)1 Clerk- typist (L /PASB)

DIVISION OF PUBLIC HEALTH

Office of the ChiefChief of division (PASB)1 Secretary (L /PASB)1 Clerk -stenographer (L /PASB)

REGIONAL OFFICE FOR THE AMERICAS

List of authorized positions for 1952

DIVISION OF ADMINISTRATIONHealth Promotion Branch

1 Chief of branch (PASS)*3 Medical officers*1 Public -health nurse*1 Medical officer (TA)1 Secretary (L)

3 Secretaries ( L/PASB)*1 Clerk- typist (L /TA)

Environmental Sanitation Branch

*1 Chief of branch*I Medical officer

1 Medical officer (PASB)*1 Secretary (L)1 Clerk -stenographer (L /PASB)

Communicable Diseases Branch

1 Chief of branch (PASB)*2 Medical officers1 Medical officer (PASB)1 Veterinarian (PASB)

*2 Secretaries (L)2 Secretaries (L /PASB)

*1 Secretary (L /TA)

Epidemiological and Statistical Unit1 Medical officer (PASB)

*1 Statistician4 Statisticians (PASB)1 Technical assistant (PASB)

*2 Secretaries (L)1 Clerk -stenographer (L /PASB)1 Clerk -typist (L /PASB)

DIVISION OF EDUCATIONAND TRAINING

Office of the Chief

*Chief of division*1 Administrative officer

1 Secretary (L /PASB)1 Clerk- stenographer (LIPASE)

Fellowships Branch

1 Chief of branch (PASB)*1 Medical officer (TA)*1 Administrative assistant*1 Secretary (L)*1 Clerk (L)*1 Clerk- stenographer (L)

1 Clerk- typist (L /PASB)

Professional Education Branch

1 Chief of Branch (PASB)*1 Medical officer

I Public- health nurse (PASB)2 Secretaries (L /PASB)

* indicates that staff members are paid from WHO funds (regular or Technical Assistance)L = locally recruited staff

TA = staff members paid from Technical Assistance funds

Office of the Chief

Chief of division (PASB)*1 Administrative assistant (TA)

1 Secretary (L/PASB)

Legal Office

1 Legal officer (PASB)*1 Legal officer (TA)*1 Secretary (L)

1 Clerk- stenographer (L /PASB)

Internal Audit

(no staff in 1952)

General Services 30

1 Chief of section (PASB)1 Technical officer (PASB)

*3 Special services officers2 Special services officers (PASB)

*1 Special services officer (L)1 Visual media officer (PASB)2 Special services officers (L/PASB)

*3 Clerks (L)*1 Clerk (L /TA)10 Clerks (L /PASB)5 Clerk- operators (L /PASB)2 Draughtsmen (L /PASB)1 Secretary (L /PASB)

*1 Clerk -stenographer (L)1 Clerk- stenographer (L /PASB)1 Clerk- typist (L /PASB)3 Telephone operators (L /PASB)3 Messengers (L /PASB)2 Chauffeur- messengers (L/PASB)

Supply

1 Special services officer (PASE)1 Specifications officer (PASB)

*2 Special services officers1 Translator (PASB)

*2 Clerks (L)5 Clerks (L /PASB)

*I Clerk- stenographer (L)*2 Clerk -stenographers (L /TA)2 Clerk- stenographers (L/PASB)

*1 Clerk- typist (L)*1 Clerk- typist (L /TA)

Administrative Management and PersonnelBranch

*1 Chief of branch1 Management officer (PASS)1 Personnel officer (PASB)

*1 Administrative analyst

*1 Personnel technician (TA)1 Personnel assistant (PASE)

*1 Trainee personnel officer (L)*1 Secretary (L /TA)

I Secretary (L /PASB)2 Clerks (L/PASB)

*1 Clerk -stenographer (L)*I Clerk -typist (L /TA)

1 Clerk -typist (L/PASB)

Budget and Finance Branch

1 Chief of branch (PASB)*1 Finance officer*1 Budget officer

2 Budget officers (PASB)5 Accountants (PASB)

*2 Accountants1 Budget analyst (L /PASB)

*1 Accounting assistant (L)1 Accounting assistant (L /PASB)

*1 Accounting clerk (L /TA)*3 Clerks (L)*3 Clerks (LITA)

2 Clerks (L /PASB)*1 Secretary (L /TA)

1 Secretary (L /PASB)I Clerk- stenographer (LIPASE)

*1 Clerk- typist (L /TA)4 Clerk- typists (L /PASB)

REGIONAL ADVISERS

(Regional Advisers and their secretarieshave been shown under the Health Pro-motion, Environmental Sanitation andCommunicable Diseases Branches andunder the Division of Education andTraining, where they are administrativelyassigned.)

ZONE OFFICES

Zone I - Washington, D.C.

Zone II - Mexico City1 Zone representative (PASB)1 Medical officer (PASB)

*1 Public- health engineer1 Public -health nurse (PASB)1 Administrative officer (PASB)1 Office services assistant (L/PASB)1 Accounting clerk (L /PASB)2 Clerk- stenographers (L /PASB)1 Secretary (L /PASB)1 Janitor (L /PASB)

El Paso District Office1 Medical officer (PASB)2 Clerk -stenographers (L /PASB)1 Administrative clerk (L /PASB)

Zone III - Guatemala City1 Zone representative (PASB)

*2 Medical officers*1 Medical officer (TA)2 Medical officers (PASE)

Public- health engineer (PASB)Public- health nurse (PASB)Administrative officer (PASE)Administrative assistant (L/PASB)Accountant (L /PASB)Records and communications clerk(L /PASB)

2 Secretaries (L /PASB)1 Clerk stenographer (L /PASB)

*1 Clerk- stenographer (LITA)1 Senior clerk (L /PASB)1 Junior clerk (L /PASB)1 Janitor messenger (LIPASE)

Zone IV - Lima

Zone representative (PASS)" Medical officer (TA)

Medical officer (PASB)Public- health engineer (PASB)

* Public- health veterinarian (TA)Public- health nurse (PASB)Nursing educator (PASB)Administrative officer (PASB)Accountant (L /PASB)Office services clerk (L /PASB)

5 Secretaries (L /PASB)1 Clerk- stenographer (L /PASB)1 Chauffeur (L /PASB)1 Office- boy /janitor (L /PASB)I Messenger -operator (L /PASB)

Zone V - Rio de Janeiro1 Zone representative (PASB)1 Medical officer (PASB)1 Consultant (PASB)

*1 Public-health engineerI Public- health nurse (PASB)I Administrative officer (PASB)2 Secretaries (L /PASB)2 Clerks (L /PASB)1 Chauffeur (LIPASE)1 Janitor (L /PASB)

Zone VI - Buenos Aires

I Zone representative (PASB)"1 Medical officer

1 Medical officer (PASB)*1 Public -health engineer

1 Public- health nurse (PASB)1 Administrative assistant (PASE)1 Accountant (L /PASB)2 Secretaries (L /PASB)1 Clerk- stenographer (L /PASB)1 Clerk- typist (LIPASE)1 Chauffeur (L /PASB)I Messenger (L /PASB)

PASB = staff members paid from funds of Pan American Sanitary Bureau

3t Includes Travel Unit, Records and Communications Unit, Cartographic and Drafting Unit, and PropertyServices Unit

3. STRUCTURE OF THE REGIONAL ORGANIZATION OF SOUTH -EAST ASIA


Regional Director1 Secretary (L)

PUBLIC INFORMATION UNIT

1 Information officer1 Stenographer (L)

REGIONAL COMMITTEE

OFFICE OF HEALTH SERVICES

Deputy Regional Director(Chief of Health Services)

1 Senior assistant (L)1 Senior assistant (L /TA)1 Secretary (L)1 Stenographer (L /TA)1 Typist (L)

OFFICE OF ADMINISTRATIONAND FINANCE

1 Administration and finance officer1 Secretary (L)1 Briefing secretary (L)

BUDGET AND FINANCE UNIT

from

PERSONNEL UNIT GENERAL SERVICES UNIT

PROJECTS

1 Budget and finance officer1 Chief accountant1 Budget analyst (TA)2 Accountants (L)2 Accountants (L /TA)3 Assistant accountants (L)3 Assistant accountants (L /TA)1 Assistant treasurer (L)1 Stenographer (L)2 Stenographers (L /TA)1 Accounts clerk (L)1 Typist (L)

1 Personnel officer (TA)2 Personnel assistants (L)1 Stenographer (L /TA)1 Filing clerk (L /TA)1 Typist (L)

1 General services officer1 General services clerk (L)1 Stenographer (L)1 Receptionist (L)

Stenographic Pool1 Stenographer (L /TA)2 Typists (L)

Procurement and LibrarySub -Unit

1 Procurement assistant (L)1 Library clerk (L)1 Typist (L /TA)

Registry and DispatchSub -Unit

1 Registry assistant (L)1 Registry clerk (L /TA)1 Sorting clerk (L /TA)1 Dispatch clerk (L)

Travel and Transportation1 Travel clerk (L)1 Typist (LITA)

REGIONAL ADVISERS HEALTH STATISTICSAND RECORDS UNIT

1 for Malaria and insect control1 for Tuberculosis1 for BCG1 for Venereal diseases and treponematoses

1 for Public- health administration2 for Public -health administration (TA)1 for Nursing1 for Maternal and child health1 Maternal and child health officer (TA)1 for Environmental sanitationB Clerk- stenographers (L)3 Clerk- stenographers (L /TA)

1 Medical statistician (TA)1 Statistical assistant (L)1 Stenographer (L /TA)

staffTechnical Assistance funds

FELLOWSHIPS UNIT

1 Regional adviser for education and training (TA)1 Fellowship assistant (L)1 Typist (L)

L = locally recruitedTA = staff paid

FIELD

AREA REPRESENTATIVES

5 Medical officers5 Clerk- stenographers (L)

su 3112

4. STRUCTURE OF THE REGIONAL ORGANIZATION OF EUROPE

PLANNING AND OPERATIONS

Deputy Regional Director1 Administrative assistant1 Secretary (L)1 Clerk -typist (LJTA)


Regional Director1 Secretary (L)

REGIONAL COMMITTEE

REGIONAL HEALTH OFFICERS

1 for Endemo -epidemic diseases (TA)1 for Public- health administration1 for Public -health administration (TA)1 for Social and occupational health1 for Maternal and child health1 for Environmental sanitation1 for Nursing1 for Mental health

Stenographic Pool2 Secretaries (L)2 Secretarios (LITA)

EDUCATION AND TRAINING UNIT

1 Fellowships assistant1 Secretary (L)1 Clerk -typist (L)1 Records clerk (L)

AREA SUPERVISORS

1 for Library organization (TA)1 for Health education of the

public (TA)1 Library clerk (L /TA)

FIELD PROJECTS

ADMINISTRATION AND FINANCE

1 Chief, Administration and Finance1 Secretary (L)1 Clerk (L)1 Registry clerk (L)

PERSONNEL

1 Personnel officer (TA)1 Clerk- stenographer (L /TA)

L= locally recruited staffTA = staff paid from Technical Assistance funds

BUDGET AND FINANCE

1 Accountant1 Clerk- stenographer (L)

*HO 3113 I

5. STRUCTURE OF THE REGIONAL ORGANIZATION OF THE EASTERN MEDITERRANEAN


Regional DirectorDeputy Regional Director

1 Administrative assistant2 Secretaries (L)

PUBLIC INFORMATION

1 Information officer1 Junior information officer1 Secretary (L)

REGIONAL COMMITTEE

EPIDEMIOLOGICAL INTELLIGENCESERVICES

1 Epidemiologist2 Epidemiological clerks (L)

HEALTH SERVICES

1 Director1 Administrative assistant (TA)1 Secretary (L)

IADMINISTRATION AND FINANCE

1 Administration and finance officer1 Secretary (L)1 Clerk -typist (L)

REGIONAL ADVISERS FIELD EPIDEMIOLOGICALUNIT

PLANNING AND OPERATIONS BUDGET AND FINANCE GENERAL SERVICES

1 for Malaria and insect control1 for Tuberculosis1 for BCG1 for Venereal diseases and treponematoses2 for Public- health administration1 for Nursing1 for Maternal and child health1 for Environmental sanitation

Stenographic Pool1 Pool supervisor (L /TA)4 Clerk- stenographers (L /TA)2 Clerk- typists (L /TA)

2 Public- health administrators (TA)2 Secretaries (L /TA)

1 Budget and finance officer1 Accountant1 Budget analyst (TA)2 Accounting assistants (L /TA)1 Accounting clerk (L)1 Accounting clerk (L /TA)1 Secretary (L)1 Clerk (L)

1 General services officer1 Secretary (L /TA)

Registry2 Clerks (L)2 Clerks (LITA)1 Clerk- typist (L /TA)

Translation1 Translator1 Translator (L)

Documents1 Clerk (L)1 Machine operator (L)

Communications1 Telephone operator (L)

1 Field epidemiologist (TA)1 Statistician1 Clerk (L /TA)

FELLOWSHIPS UNIT

1 Regional adviser for educationand training

1 Fellowships assistant (L)1 Secretary (L /TA) SUPPLY OFFICE PERSONNEL

1 Supply officer (TA)1 Supply assistant (L)1 Supply clerk (L /TA)

1 Personnel officer (TA)1 Secretary (L)1 Records clerk (L /TA)

FIELD PROJECTS

L = locally recruited staffTA = staff paid from Technical Assistance funds n'n0 j114

6. STRUCTURE OF THE REGIONAL ORGANIZATION OF THE WESTERN PACIFIC

PUBLIC INFORMATION

1 Information officer1 Information clerk (L /TA)1 Secretary (L)


Regional Director1 Administrative assistant1 Secretary (L)

REGIONAL COMMITTEE

HEALTH SERVICES

Deputy Regional Director1 Public- health administrator1 Public- health administrator (TA)1 Statistician (TA)2 Secretaries (L)1 Secretary (L /TA)1 Clerk- typist (L)

REGIONAL ADVISERS

1 for Malaria and insect control (TA)1 for Tuberculosis1 for Venereal diseases and treponematoses (TA)1 for Nursing1 for Health education of the public1 for Maternal and child health

1 for Environmental sanitation (TA)3 Clerk- stenographers (L)3 Clerk- stenographers (LITA)

EDUCATION AND TRAINING UNIT

t Regional adviser for education and training (TA)1 Fellowships assistant (L)

ser

FIELD PROJECTS

L = locally recruited staffTA = staff paid from Technical Assistance funds

ADMINISTRATION AND FINANCE

1 Administration and finance officer1 Secretary (L)

BUDGET AND FINANCE

1 Budget and finance officer1 Finance officer (TA)1 Budget analyst (TA)1 Accountant (L)1 Cashier (L)1 Assistant accountant (L /TA)1 Budget clerk (L)1 Accounts clerk (L /TA)1 Stenographer (L)

PERSONNEL

1 Personnel officer (TA)1 Records clerk (L)

GENERAL SERVICES

1 General services officer1 Translator (TA)1 Translator (L)1 Clerk -typist (L /TA)

Registry and Library Sub -Unit1 Registrar (L)1 Librarian (L /TA)1 Registry clerk (L /TA)

1 Mailing clerk (L)1 Clerk- typist (L)1 Clerk-typist (L /TA)

Procurement and TravelSub -Unit

1 Procurement clerk (L)1 Travel clerk (L /TA)1 Supply clerk (LITA)1 Clerk- typist (L)

N'n0 3115


Appendix 4

MEETING PLACES OF REGIONAL COMMITTEES

Region 1948 1949 1950 1951 1952 1953 1954

South -East Asia New Delhi New Delhi Kandy Rangoon Bandoeng Bangkok New Delhi(India) (India) (Ceylon) (Burma) (Indonesia) (Thailand) (India)

Americas - Lima Ciudad Washington Havana Washington Not(Peru) Trujillo (USA) (Cuba) (USA) decided

(Dom. Rep.)

Eastern Mediterranean Cairo(Egypt)

Geneva Istanbul(Turkey)

- - Notdecided

Notdecided

Western Pacific - - - Geneva Saigon Manila 81 Manila 81(18 May)and

(Viet Nam) (Philippines) (Philippines)

Manila(Philippines)(18 -21 Sept.)

Europe - - - Geneva Lisbon Copenhagen Yugoslavia(Portugal) (Denmark)

Africa - - - Geneva Monrovia(Liberia)

Kampala(Uganda)

Notdecided

31 Unless an invitation is received to hold the meeting in another country in the region

ANNEXES

Annex 1

LIST OF ATTENDANCES

1. Members, Alternates and Advisers

Dr. M. JAFAR, Director - General of Health, Karachi, Chairman

Professor G. A. CANAPERIA, Chief Medical Officer, Office of the High Commissionerfor Hygiene and Public Health, Rome, Vice - Chairman

Dr. H. B. TURBOTT, Deputy Director -General of Health, Wellington, Vice- Chairman

Alternate :

Mr. W. Wynne MASON, Office of the High Commissioner for New Zealand,London

Dr. S. HAYEK, Director of Technical Services, Ministry of Health and Welfare, Beirut,Rapporteur

Dr. J. N. TOGBA, Director of Public Health and Sanitation, Monrovia, Rapporteur

Dr. G. ALIVISATOS, Professor of Hygiene at the University and Professor of Epide-miology at the School Hygiene, Athens

Dr. J. ALLWOOD -PAREDES, Director - General of Public Health, San Salvador

Dr. O. ANDERSEN, Professor of Paediatrics, University of Copenhagen

Alternate :

Mr. B. SORENSEN, Assistant Chief of Section, Ministry of the Interior, Copen-hagen

Dr. C. VAN DEN BERG, Director- General for International Health Affairs, Ministryof Social Affairs and Public Health of the Netherlands, The Hague

Alternate :

Professeur M. DE LAET, Secrétaire général du Ministère de la Santé publiqueet de la Famille de Belgique, Brussels

Dr. A. L. BRAVO, Chief Medical Officer,Service, Santiago

Dr. S. DAENGSVANG, Deputy Director -General, Department of Health, Bangkok

Dr. M. J. FERREIRA, Professor of Hygiene, State Medical Faculty, Rio de Janeiro

Adviser :

Tuberculosis Department, Public Health

Designated by:

Pakistan

Italy

New Zealand

Lebanon

Liberia

Greece

El Salvador

Denmark

Belgium

Chile

Thailand

Brazil

Mr. C. A. DE SOUZA E SILVA, Brazilian Permanent Delegation to the EuropeanOffice of the United Nations, Geneva

Dr. F. HURTADO, Professor of Paediatrics, School of Medicine, University of Havana Cuba

- 187 -


Dr. W. A. KARUNARATNE, Medical Officer, International Health, Ministry of Health,Colombo

Dr. O. LEROUX, Assistant Director of Health Insurance Studies, Department ofNational Health and Welfare, Ottawa

Alternate :

Mr. B. M. WILLIAMS, Canadian Permanent Delegation to the European Officeof the United Nations, Geneva

Designated by

Ceylon

Canada

Dr. Melville MACKENZIE, Principal Medical Officer, Ministry of Health, London United Kingdom ofGreat Britain and

Alternates : Northern IrelandDr. A. M. W. RAE, Deputy Chief Medical Officer, Colonial Office, London

Mr. W. H. BOUCHER, Assistant Secretary, Ministry of Health, London

Adviser :

Mr. F. A. MELLS, Senior Executive Officer, Ministry of Health, London

Dr. M. A. MALEKI, Professor of Dermato -venereology, Faculty of Medicine, Teheran(Alternate to Dr. S. Farmanfarmaian, absent) Iran

Professeur J. PARISOT, Doyen de la Faculté de Médecine de Nancy FranceAdvisers:

Dr. D. BoID *, Directeur de l'Hygiène publique et des Hôpitaux, Ministère de laSanté publique et de la Population, Paris

Dr. L. BERNARD, Chef du Bureau des Relations extérieures au Ministère de laSanté publique et de la Population, Paris

M. J. FOESSEL, Administrateur civil à la Direction du Budget, Ministère desFinances, Paris

M. B. TOUSSAINT, Représentant permanent de la France auprès de l'Officeeuropéen des Nations Unies, Geneva

Mlle A. LISSAC, Représentant permanent adjoint de la France auprès del'Office européen des Nations Unies, Geneva

2. Representatives of the United Nations and Specialized Agencies

UNITED NATIONS

Mr. A. PELT, Director, European Office, GenevaMr. A. LETHBRIDGE, Chief, Administrative and Financial Services, European Office, GenevaMr. G. MENZIES, Senior Representative, Technical Assistance Administration, GenevaM. M. MILHAUD, Chief, Social Division, Technical Assistance Administration, GenevaMr. B. PICKARD, Liaison Section (Non -Governmental Organizations), European Office, Geneva

TECHNICAL ASSISTANCE BOARD

Mr. D. OWEN, Executive Chairman, Technical Assistance Board, New YorkMr. Ch. WEITZ, Technical Assistance Board, New YorkMr. E. BARGES, Technical Assistance Board, New YorkMr. J. R. SYMONDS, Liaison Officer in Europe of the Technical Assistance Board, Geneva

ANNEX 1 189

INTERNATIONAL LABOUR ORGANISATION

Mr. P. P. FANO, Chief, International Organizations Division

Dr. A. GRUT, Industrial Health Adviser

FOOD AND AGRICULTURE ORGANIZATION

Dr. W. R. AYKROYD, Director, Nutrition Division

Mr. F. WEISL, Director of Administration

Mr. F. L. MCDOUGALL, Special Assistant to the Director- General

Mrs. M. DILLON, Administrative Officer, Geneva

WORLD METEOROLOGICAL ORGANIZATION

Mr. G. SWOBODA, Secretary- General

3. Observers for Non -Governmental Organizations in Relationship with WHO

AMERICAN COLLEGE OF CHEST PHYSICIANS

Dr. M. GILBERT, Governor for Switzerland ; Privat- Docent à la Faculté de Médecine, Geneva

INTERNATIONAL ACADEMY OF FORENSIC AND SOCIAL MEDICINE

Professeur M. DE LAET (Also alternate to the member of the Executive Board designated by Belgium)

INTERNATIONAL ASSOCIATION FOR THE PREVENTION OF BLINDNESS

Professeur A. FRANCESCHETTI, Clinique ophtalmologique, Geneva

INTERNATIONAL COUNCIL OF NURSES

Mme. G. VERNET, Présidente de l'Association suisse des Infirmières et Infirmiers diplômés, Geneva

Mlle Y. HENTSCH, Director, Nursing Bureau, League of Red Cross Societies, Geneva

INTERNATIONAL DENTAL FEDERATION

Dr. C. F. L. NORD, Chairman, External Relations Commission

INTERNATIONAL HOSPITAL FEDERATION

M. E. FAUCON, Secrétaire général de la Fédération hospitalière de France

INTERNATIONAL LEAGUE AGAINST RHEUMATISM

Professor K. M. WALTHARD, Institut de Physiatrie, Hôpital cantonal, Geneva

INTERNATIONAL SOCIETY FOR THE WELFARE OF CRIPPLES

Miss L. FRANKENSTEIN (Also observer for the International Union for Child Welfare)


INTERNATIONAL UNION FOR CHILD WELFARE

Mrs. J. M. SMALL, Deputy Secretary - General

Miss L. FRANKENSTEIN, Assistant Head, Research Department

LEAGUE OF RED CROSS SOCIETIES

Dr. G. ALSTED, Director, Health Bureau

WORLD FEDERATION FOR MENTAL HEALTH

Professor E. E. KRAPF, Chairman, Executive Board

WORLD FEDERATION OF UNITED NATIONS ASSOCIATIONS

Mr. J. A. F. ENNALS, Secretary- General

Mr. B. STEINBERG, Institut de Botanique générale, Université de Genève

WORLD MEDICAL ASSOCIATION

Dr. J. MAYSTRE, Liaison Officer with WHO, Geneva

Annex 2

OFFICERS OF THE EXECUTIVE BOARDAND MEMBERSHIP OF ITS COMMITTEES AND WORKING PARTIES

1. Executive Board and Standing CommitteeAdministration and Finance 1

Chairman: Dr. M. Jafar

on 3. Building CommitteeDr. C. van den Berg, Professor G. A. Canaperia,

M. B. Toussaint (in place of Professor J. Parisot).

Vice-Chairmen: Professor G. A. CanaperiaDr. H. B. Turbott

Rapporteurs : Dr. S. Hayek, Dr. J. N. Togba

Secretary : Dr. Brock Chisholm, Director -General.

2. Léon Bernard Foundation Committee

Dr. M. Jafar (Chairman), Professor G. A. Cana -peria, Dr. H. B. Turbott, Professor O. Andersen,Professor M. J. Ferreira.

1 In accordance with resolution EBIO.R21, the ExecutiveBoard established " the whole Board as the Standing Com-mittee on Administration and Finance, to adopt in the nameof the Board any recommendations, resolutions or reportswithout having to refer its findings to the Executive Boardas such ".

4. Working Party on Regionalization and Assignmentto Regions

Dr. A. L. Bravo (Chairman), Dr. S. Hayek (Rap-porteur), Professor G. A. Canaperia, Dr. W. A.Karunaratne, Dr. A. M. W. Rae (Alternate toDr. Melville Mackenzie), Dr. J. N. Togba, Dr. H. B.Turbott. Secretary: Mr. H. C. Grant.

5. Working Party on the Expanded Programme ofTechnical Assistance

Professor M. J. Ferreira (Chairman), Mr. W. H.Boucher (Rapporteur- Alternate to Dr. Melville Mac-kenzie), Professor J. Parisot (Rapporteur), ProfessorG. Alivisatos, Dr. J. Allwood- Paredes, ProfessorO. Andersen, Dr. C. van den Berg, Dr. S. Daengs-yang, Dr. F. Hurtado, Dr. O. Leroux, Dr. M. A.Maleki, Mr. W. Wynne Mason (Alternate to Dr.H. B. Turbott). Secretary: Dr. P. M. Kaul.

ANNEX 3 191

Annex 3 [EB11 /31j10 December 1952

REPORT OF THE REPRESENTATIVES OF THE EXECUTIVE BOARDAT THE FIFTH WORLD HEALTH ASSEMBLY

1. In accordance with the terms of resolutionEB9.R2, Professor Parisot, Dr. Bravo and Dr. Karu-naratne represented the Executive Board officially atthe Fifth World Health Assembly. Generally,Professor Parisot attended plenary meetings, Dr.Bravo the meetings of the Committee on Adminis-tration, Finance and Legal Matters, and Dr. Karu-naratne the meetings of the Committee on Pro-gramme and Budget. Dr. Bravo and Dr. Karu-naratne were both present at the meetings of theCommittee on Programme and Budget during thediscussions on the budget ceiling, the AppropriationResolution and the Proposed Programme and BudgetEstimates for 1953.2. Following the practice of previous years, therepresentatives of the Executive Board attempted toact in accordance with the principle of participatingin the discussions for only two purposes :

(a) to introduce, as objectively as possible, itemsof the agenda which had been discussed by theExecutive Board and on which the Board hadexpressed opinions or made statements ;(b) to give explanations expressing the point ofview of the Executive Board in answer to questionsraised by delegates.

Conversely, every attempt was made by the repre-sentatives to avoid being drawn into any discussionon subjects on which the Board had expressed noopinion or had made no statement.3. Following the recommendation made by therepresentatives of the Board at the Fourth WorldHealth Assembly,2 Professor Parisot presented tothe Health Assembly, in plenary session, a generalreport of the Executive Board's activities for the pastyear.3

4. In accordance with the principle referred to inparagraph 2(a), Dr. Bravo and Dr. Karunaratnegave ample background information in introducingevery item on the agenda which had been discussedby the Executive Board. They attempted to laybefore the main committees the reasons that had

I See resolution EBII.R1.2 Of Rec. World Hlth Org. 40, 123, para. 4 (4)3 See Off Rec. World Hlth Org. 42, 76.

prompted the Executive Board either to come to acertain decision or to adopt a certain policy. Therepresentatives are of the opinion that this back-ground information was greatly appreciated by thedelegates and was very helpful to them in theirparticipation in discussions.

5. In so far as the principle mentioned in paragraph2(b) is concerned, very few questions were raised bydelegates.

6. It appears to the representatives of the ExecutiveBoard that it is essential for the members appointednot to express personal views but only to act asrepresentatives of the Executive Board corporate andto express only the views of that body as a whole. Itis sometimes difficult to adhere to this principlewhen there has been no precise decision or when adecision has been taken by the Board by a verynarrow majority. However, even in such cases, therepresentatives of the Board found it possible tosubmit the divergent views expressed in the Board onany particular item and then to explain the decisiontaken.

7. The representatives think that the presence ofrepresentatives of the Board in the meetings of theHealth Assembly is of the utmost importance for thepromotion of a better understanding between theBoard and the Assembly. They also consider thatthe participation of such representatives in themeetings is of considerable help to the Secretariat.

8. Conclusions: The representatives recommendthat :

(a) representation of the Executive Board becontinued at future Health Assemblies ;(b) each main committee of the Health Assemblybe attended by a representative ;(c) participation of representatives in HealthAssembly proceedings be limited to matterspreviously acted on by the Board ;(d) a general report of the Board's activities forthe past year be again presented to the HealthAssembly in a plenary meeting ;(e) representatives of the Board should not bedelegates of their own country at the same time.


Annex 4[EB 11 /5]

29 September 1952

HOST AGREEMENT WITH THE GOVERNMENT OF FRANCE 1

The following Agreement, defining the privileges and immunities of the Organization and of its RegionalOffice in Africa, was signed on 1 August 1952 by M. Maurice Schumann, Secretary of State for Foreign Affairs,on behalf of the Government of the French Republic, and on 23 July 1952 by the Director - General of the WorldHealth Organization, subject to approval by the Health Assembly.

The notes exchanged on this occasion are reproduced in the appendix.

AGREEMENT BETWEEN THE GOVERNMENT OF THE FRENCH REPUBLICAND THE WORLD HEALTH ORGANIZATION

THE GOVERNMENT OF THE FRENCH REPUBLIC (hereinafter called " the Government ") of the one part, and

THE WORLD HEALTH ORGANIZATION (hereinafter called " the Organization ") of the other part,

DESIRING to conclude an Agreement for the purpose of determining the privileges, immunities and facilitiesto be granted by the Government to the Organization in respect of the representatives of its Members,its experts and officials in the French territories, or territories administered by France, included in the AfricanRegion as defined by the First World Health Assembly, and

DESIRING to regulate other related matters,

HAVE AGREED AS FOLLOWS :

Article I: DefinitionsSection 1

For the purposes of the present Agreement :(a) the word " territories " shall be deemed to mean theFrench territories or territories administered by Franceincluded in the African Region as defined by the FirstWorld Health Assembly ;

(b) for the purposes of Article IV, the words " propertyand assets ", " funds, currency or specie ", or " assets,income and other property " shall be deemed to includeproperty, assets, and funds administered by the Organizationunder Article 57 of its Constitution and /or in furtheranceof its constitutional functions ;

(c) the word " Member " shall be deemed to includeMember States and Associate Members of the Organizationforming part of the Regional Committee for Africa, aswell as the territories or groups of territories which, withoutbeing Associate Members, are represented and participating

1 See resolution EB11.R3.

in the said committee in accordance with Article 47 of theOrganization's Constitution ;

(d) the words " representatives of Members " shall bedeemed to include all delegates, alternates, consultants,technical experts and secretaries of the delegations ofMember States of the Regional Committee for Africa, aswell as members of the Executive Board of the Organization ;

(e) the words " regional organs " of the Organizationshall be deemed to include the Regional Committee forAfrica, its Regional Office at Brazzaville, and any of thesub -divisions of these organs ;

(f) for the purposes of Sections 4, 6, 16, 17 and 19, thewords " freedom of meeting " or " meeting of the Organi-zation " shall be deemed to include all meetings of theregional organs of the Organization as well as all conferencesor meetings convened by or under the authority or auspicesof the Organization in the territories covered by the presentAgreement ;

(g) the word " communications " shall be deemed toinclude all postal, telegraphic and telephonic correspondenceof the Organization.

ANNEX 4 193

Article II: Juridical PersonalitySection 2

The Organization shall enjoy juridical personality and legalcapacity and, in particular, the capacity :

(a) to contract agreements ;(b) to acquire and dispose of immovable and movable

property ;(c) to institute legal proceedings.

Article III: Freedom of Action and of Meeting

Section 3

The Government shall guarantee to the Organization inthe above -mentioned territories the independence and freedomof action to which it is entitled as an international organization.

Section 4The Organization and its regional organs, as well as its

Members and the representatives of Members in their relationswith the Organization, shall enjoy in the territories concernedabsolute freedom of meeting, including freedom of discussionand decision, within the framework of the normal functionsof the Organization.

Article IV: Property, Funds and Assets

Section 5The Organization and its property and assets located in the

territories concerned shall enjoy immunity from every formof legal process except in so far as in any particular case thisimmunity may be expressly waived by the Director- Generalof the Organization, or by the Regional Director acting ashis duly authorized representative. It shall, however, beunderstood that no waiver of immunity shall extend to ameasure of execution.

Section 6(1) The premises of the Organization in any of the territoriesconcerned, as well as any premises in the territories whichmay be occupied by the Organization for one of its meetings,shall be inviolable.(2) Such premises, as well as the property and assets of theOrganization in the territories, shall enjoy immunity fromsearch, confiscation, expropriation or any other form ofinterference, whether by executive, administrative, judicial orlegislative action.

Section 7The archives of the Organization and, in general, all docu-

ments belonging to or held by the Organization in the territoriesshall be inviolable.

Section 8(1) Without being restricted by financial controls, regulationsor moratoria of any kind, the Organization shall be :

(a) entitled to hold funds, currency or specie of any kindand to operate accounts in any currency ;(b) free to transfer its funds, currency or specie to orfrom the territories or within the territories and convertany currency held by it into any other currency.

(2) The present Section shall also apply to Members in theirrelations with the Organization.

Section 9

The Government shall provide for the Organization itsnational currency to the amount required to meet the expen-diture of the Organization in the territories covered by thepresent Agreement, at the most favourable local official rate.

Section 10

In exercising its rights under Sections 5, 6, 7, 8 and 9, theOrganization shall pay due regard to any representations madeto it by the Government in so far as the Organization considersthat effect may be given to such representations withoutdetriment to its interests.

Section 11

The Organization, its assets, income and other propertyshall be :

(a) exempt from all direct and indirect taxes. It is,nevertheless, to be understood that the Organization willnot claim exemption from taxes which are, in fact, no morethan charges for public utility services ;

(b) exempt from customs duties, prohibitions and restric-tions on imports and exports in respect of medical supplies,and any other articles or goods imported or exported bythe Organization for its official use. It is, nevertheless,to be understood that such medical supplies, articles orgoods imported under such exemption may not be soldor ceded within the territories except under conditionsapproved by the Government ;

(c) exempt from customs duties, prohibitions and restric-tions on imports and exports in respect of the Organization'spublications.

Section 12

While the Organization will not, as a general rule, in thecase of minor purchases, claim exemption from excise dutiesand taxes on the sale of movable and immovable propertywhen such duties and taxes form part of the sale price, never-theless, in the case of important purchases by the Organization,for its official use, of property on which such duties and taxeshave been charged or are chargeable, the Government shallmake appropriate administrative arrangements for the remis-sion or reimbursement of the amount of the said duty or tax.

Article V: Facilities in respect of Communications

Section 13

The Organization shall enjoy, in respect of its official com-munications, in the territories in question, treatment not lessfavourable than that accorded by the Government to anyother government or to the diplomatic mission of any othergovernment in the matter of priorities, rates and taxes onmail, cables, telegrams, radiograms, telephotos, telephone andother communications, and Press rates for informationintended for the Press and radio, on the condition that suchtreatment is not incompatible with the terms of the Inter -nationaI Telecommunication Convention.

Section 14

(1) No censorship shall be applied to the official communica-tions of the Organization.


(2) The Organization shall have the right to use codes andto dispatch and receive correspondence by courier or in sealedbags, which shall have the same immunities and privilegesas diplomatic couriers and bags.

Article VI: Representatives of Members

Section 15

Representatives of Members of the Organization shall,while exercising their functions and during their journeys toand from the place of meeting, enjoy the following privilegesand immunities

(a) immunity from personal arrest or detention and fromseizure of their personal baggage, as well as immunityfrom legal process of any kind in respect of acts performedby them in the exercise of their functions and in theirofficial capacity, including words spoken or written bythem ;(b) inviolability of all papers and documents ;(c) the right to use codes and to dispatch or to receivedocuments or correspondence by courier or in sealed bags ;(d) exemption for themselves and their spouses fromimmigration restrictions, and from aliens' registrationformalities and national service obligations in the territoriesconcerned;(e) the same facilities in respect of currency or exchangerestrictions as are accorded to representatives of foreigngovernments on temporary official missions ;(f) the same immunities and facilities in respect of theirpersonal luggage as are accorded to members of diplomaticmissions of comparable rank.

Section 16In order to secure for representatives of Members of the

Organization at the Organization's meetings complete freedomof speech and independence in the discharge of their duties,the immunity from legal process in respect of words spokenor written and all acts performed by them in the dischargeof their duties shall continue to be accorded to them not-withstanding that the persons concerned may no longer beengaged in the discharge of such duties.

Section 17If the incidence of any form of taxation depends upon

residence in one of the territories concerned, the periodsduring which representatives of Members of the Organizationare present, in the discharge of their duties, at a meeting ofthe Organization in one of the above -mentioned territoriesshall not be considered as periods of residence in the saidterritories.

Section 18Privileges and immunities are not accorded to representatives

of Members of the Organization for their personal benefitbut in order to enable them, in perfect freedom, to exercisetheir functions in connexion with the Organization. Conse-quently, a Member shall not only have the right but it shallbe considered a Member's duty to waive the immunity ofits representatives in any case where, in the opinion of theMember, such immunity would impede the course of justice,and where it could be waived without prejudice to the purposesfor which the immunity is accorded. This same duty shallalso be incumbent upon the Executive Board of the Organi-zation in any case of the same nature in which one of thepersons designated to serve on the said Board is concerned.

Section 19

In so far as possible, the Organization shall communicateto the Government sufficiently in advance a list of represent-atives convened to its conferences or meetings in the territoriesconcerned under this Agreement.

Article VII: Experts on Missions for the Organization

Section 20

Experts and consultants carrying out missions for theOrganization, other than experts and consultants covered bySection 1(d) or those to whom, in their capacity as officials,the provisions of Articles VI and VIII respectively apply,shall enjoy such privileges and immunities as are necessaryfor the free exercise of their functions during the period ofthe mission, including the time spent on journeys in connexionwith such mission. In particular, they shall be accorded :

(a) immunity from personal arrest or detention and fromseizure of their personal baggage, and immunity from legalprocess of any kind in respect of words spoken or writtenand acts performed by them in the discharge of their duties.This immunity from legal process shall continue to beaccorded notwithstanding that the persons concerned mayno longer be employed on a mission for the Organization ;(b) inviolability of all papers and documents ;(c) the right, for the purpose of their communicationswith the Organization, to use codes and to despatch or toreceive documents and correspondence by courier and insealed bags ;

(d) exemption, for themselves and their spouses, fromimmigration restrictions, aliens' registration formalities andnational service obligations in the territories concerned ;(e) the same facilities in respect of currency or exchangerestrictions as are accorded to representatives of foreigngovernments on temporary official missions ;(f) the same immunity and facilities in respect of theirpersonal baggage as are accorded to Members' represent-atives.

Section 21

Privileges and immunities are granted to experts in theinterest of the Organization and not for their personal benefit.The Director -General shall have the right, and it shall behis duty, to waive the immunity of any expert in any casewhere, in his opinion, such immunity would impede the courseof justice and where it could be waived without prejudice tothe interests of the Organization.

Article VIII: OfficialsSection 22

The Director -General, or the Regional Director acting ashis duly authorized representative, shall determine, in con-sultation with the Government :

(a) the various categories of officials benefiting under theprovisions of Section 23 and Article IX ;(b) the extent to which these immunities, privileges andfacilities shall be applicable to each of the said categories.

Furthermore, the Regional Director shall from time totime send to the Government an up -to -date list of the namesof the above -mentioned officials, mentioning the categoriesto which they belong.

ANNEX 4 195

Section 23

Officials of the Organization shall enjoy :(a) immunity from legal process in respect of words spokenor written and acts performed by them in their officialcapacity and within the limits of their functions ;(b) exemption from taxation in respect of salaries andemoluments paid to them by the Organization ;

(c) immunity, for themselves, their spouses and membersof their families dependent upon them, from immigrationrestrictions and aliens' registration formalities ;

(d) the same privileges in respect of exchange facilities asare accorded to officials of comparable rank of diplomaticmissions in France ;

(e) the same facilities for repatriation in case of inter-national crisis for themselves, their spouses and membersof their families dependent upon them, as are accordedto diplomatic mission officials of comparable rank ;

(f) the right to import free of duty their furniture andpersonal effects within six months of definitely taking uptheir posts, as well as certain products intended for personalconsumption (food products, drinks, etc.), in accordancewith a list to be approved by the Government ;

(g) the right to import a motor -car once every three yearsfree of duty, it being understood that duty will becomepayable in the event of the sale or disposal of the said motor-car to a third person not entitled to this exemption withinthree years of its importation.

Section 24In addition to the immunities and privileges specified under

Section 23, the Director -General, the Deputy Director -General,the Assistant Directors -General and the Regional Directorshall enjoy, for themselves, their spouses and minor children,those privileges and immunities, exemptions and facilitiesaccorded to representatives of Members.

Section 25Privileges and immunities shall be granted to officials in

the interest of the Organization and not for their personalbenefit. The Director -General shall have the right, and itshall be his duty, to waive the immunity of any official inany case where, in his opinion, such immunity would impedethe course of justice and where it could be waived withoutprejudice to the interests of the Organization.

Section 26The Organization shall take all the necessary measures to

facilitate the proper administration of justice and the observ-ance of the law and regulations of all kinds and to preventany abuse of the privileges, immunities and facilities accordedto the Organization.

Article IX: Visas, Residence Permits, United NationsLaissez-passer

Section 27(1) The Government shall take all necessary measures tofacilitate the entry into, residence in, and departure from theterritories of all persons called upon to act in an officialcapacity for the Organization, i.e. :

(a) representatives of Members ;

(b) experts and consultants on missions for the Organi-zation, irrespective of nationality ;(c) officials of the Organization ;(d) all other persons, irrespective of nationality, invitedby the Organization.

(2) Police regulations intended to restrict the entry offoreigners into the territories or to regulate the conditionsof their residence shall not apply to persons covered by thepresent section.(3) With the reservation of the preceding provisions, theFrench authorities shall retain their right to decide upon andto control the entry of persons into French territory and theconditions under which such persons may be allowed toremain or to reside in such territory.(4) Furthermore, the persons as mentioned in paragraph (1)shall not be exempt from observance of the regulations withregard to quarantine and public health.(5) The Government shall address, in advance, to its embas-sies, legations and consulates abroad, general instructionsto grant visas with as little delay as possible to any applicanton presentation of a valid identity and travel documentand of a document establishing his status as a representativeof a Member, expert, consultant or official of the Organization,and that without requiring the personal attendance of theapplicant or the payment of any charges.(6) The provisions of the present Section shall apply to thespouse and to the children of the person concerned if theseare living with him and do not exercise any independentprofession or calling.

Section 28The Government shall recognize and accept as a valid

travel document the United Nations laissez -passer issued toofficials of the Organization in accordance with administrativearrangements concluded between the Director -General of theOrganization and the Secretary- General of the United Nations.

Section 29The Director -General, the Deputy Director - General, the

Assistant Directors -General, the Regional Directors and theDirectors of the Organization travelling on its official businessshall enjoy the same facilities as are accorded to representativesof Members.

Article X: Premises and AccommodationSection 30(1) The Government shall give to the Organization and toits personnel all the assistance required in order to procurefor them, on the most favourable conditions, the necessarypremises and accommodation and to facilitate their instal-lation in the said premises and accommodation.(2) The Government shall exercise the police surveillancenecessary for the protection of the Organization's premisesand for the maintenance of order in the immediate neigh-bourhood of such premises. At the request of the RegionalDirector, the Government shall send whatever police forcemay be necessary for the maintenance of order within suchpremises.

Article XI: Security of the GovernmentSection 31(1) Nothing in the present Agreement shall be construed topreclude the adoption by the Government of all appropriateprecautions in the interests of the security of the FrenchUnion and of the maintenance of public order.


(2) In cases where the Government may consider it necessaryto apply the provisions of paragraph (1) of the present section,the Government shall approach the Organization as rapidlyas circumstances allow in order to determine by mutualagreement the measures necessary for the protection of theOrganization's interests.

Article XII: Settlement of DisputesSection 32

The Organization shall decide upon and make provisionfor appropriate modes of settlement of :

(a) disputes arising out of contracts or other disputes ofa private character to which the Organization is a party ;(b) disputes involving an official of the Organization who,by reason of his official position, enjoys immunity, if suchimmunity has not been waived by the Director - General inaccordance with the provisions of Section 25.

Section 33

Any difference between the Organization and the Govern-ment arising out of the interpretation or the application ofthe present Agreement, or of any supplementary agreementor arrangement, and which is not settled by negotiation, shallbe submitted for decision to a Board of three arbitrators.The first of these arbitrators shall be appointed by the Govern-ment, the second by the Director- General of the Organizationand the third, who shall be the presiding arbitrator, by the

President of the International Court of Justice, unless in anyspecific case the parties to the present Agreement agree toresort to a different mode of settlement.

Article XIII: Final ProvisionsSection 34

The present Agreement shall enter into force as soon asit has been signed by the Government and adopted by theWorld Health Assembly.

Section 35On the coming- into -force of the present Agreement, its

text shall be communicated by the Director -General of theOrganization to the Secretary -General of the United Nationsfor registration, in pursuance of Article 1 of the Regulationsadopted by the United Nations General Assembly on14 December 1946 to give effect to Article 102 of the Charterof the United Nations.

Section 36The present Agreement may be revised at the request of

either party. In this event, the two parties shall consulttogether concerning the modifications to be introduced intothe present Agreement ; if negotiations do not lead toagreement within one year, the present Agreement may bedenounced by either party at one year's notice. Notice ofdenunciation of the present Agreement may be given to theGovernment through its representative to the Organizationand to the Organization through its Director -General.

IN FAITH WHEREOF the present Agreement was done and signed at Paris on the 1st day of August 1952 andat Geneva on the 23rd day of July 1952, in two copies in French, one copy being handed to the Government'srepresentative and the other to the Director -General of the World Health Organization.

FOR THE WORLD HEALTH ORGANIZATION

(signed) Brock Chisholm,Director - General

Appendix

FOR THE GOVERNMENT

(signed) Maurice Schumann

NOTES EXCHANGED BETWEEN THE GOVERNMENT OF THE FRENCH REPUBLICAND THE WORLD HEALTH ORGANIZATION REGARDING THE HOST AGREEMENT

1. Letter from the French Government to the WorldHealth Organization, dated 4 August 1952,regarding the interpretation and application ofthe Agreement (translation from the French)

Sir,

With reference to the conclusion between the Governmentof the French Republic and the World Health Organizationof an Agreement for the purpose of defining the privileges,immunities and facilities to be accorded to the said Organi-zation in the French territories, or territories administeredby France, in the African Region, I have the honour to com-municate to you the following details :

(a) Sections 6 and 7 grant certain immunities in respectof the Organization's premises. These provisions referexclusively to the administrative premises occupied by theOrganization.

In the event of there being proof of, or serious reasonsto suspect, the presence on such premises of either personswanted for crimes or offences under common law or foroffences against the security of the State, or illegally intro-duced documents or objects, the Regional Director, actingas your representative, shall consult with the governmentalauthorities for the purpose of waiving the immunity.

(b) The provisions of paragraph (b) of Section 23 shallbe understood with the reservation that a State may tax

ANNEX 4 197

its own nationals unless Member States adopt a systemwhereby the salaries and emoluments in question are taxedby the Organization itself.(c) The Government regrets its inability to exempt inter-national officials who are nationals of the French Unionfrom the military obligations by which all French subjects,without distinction, are bound. The Government will,nevertheless, examine particular cases with every possibleindulgence, bearing in mind the international responsibilitiesof the Organization's officials.

I have the honour, etc.(signed) MAURICE SCHUMANN,

Secrétaire d'Etataux Affaires étrangères

2. Reply of the World Health Organization, dated13 August 1952, to the letter of the FrenchGovernment regarding the interpretation andapplication of the Agreement (translation fromthe French)

Sir,

Pursuant to the conclusion between the Government ofthe French Republic and the World Health Organization ofan Agreement for the purpose of defining the privileges,immunities and facilities to be accorded to the said Organi-zation in the French territories, or territories administeredby France, in the African Region, and replying to your letterdated 4 August 1952 (reference 565 SC), I have the honourto communicate to you the following :

(a) I agree with you that the provisions of Sections 6and 7 apply exclusively to the administrative premisesoccupied by the Organization and that the Regional Directorshall consult with the governmental authorities for thepurpose of waiving the immunities in question in the eventof there being proof of, or serious reasons to suspect, thepresence on such premises of either persons wanted forcrimes or offences under common law or for offencesagainst the security of the State, or illegally introduceddocuments or objects.(b) I note your declaration that the provisions of para-graph (b) of Section 23 shall be understood with the reserva-tion that a State may tax its own nationals unless MemberStates adopt a system whereby the salaries and emolumentsin question are taxed by the Organization itself.(c) I note the assurance given that the French Government,in view of its inability to exempt international officials whoare nationals of the French Union from the militaryobligations by which all French subjects, without distinc-tion, are bound, will examine particular cases with everypossible indulgence, bearing in mind the internationalresponsibilities of the Organization's officials.

I have the honour, etc.For Brock Chisholm, M.D.,

Director -General

(signed) Dr. P. DOROLLE

3. Letter from the French Government, dated4 August 1952, transmitting the signed Agreementto the World Health Organization (translationfrom the French)

Sir,

In sending you herewith, duly signed by me, the Agreementbetween the Government of the French Republic and theWorld Health Organization, I have the honour to informyou that, without waiting for the approval of the WorldHealth Assembly, the French Government, for its part, isready to apply the provisions of the Agreement, particularlyin view of the installation of the Regional Office for Africaat Brazzaville.

With reference to the reservation made in the 'note on theinterpretation of the said Agreement, on the subject of exemp-tion of French nationals from taxation, I would inform youthat the competent authorities will without delay submitthe requests for exemption received by them to the responsibleAssemblies of the territories concerned which alone areentitled to make decisions on this matter. I have no doubtthat these requests will be examined in a spirit of indulgence.

I have the honour, etc.

For the Minister and by authorization(signed) V. BROUSTRA,

Ministre plénipotentiaire,Directeur du Secrétariat

des Conférences

4. Reply of the World Health Organization, dated13 August 1952, to the letter of the FrenchGovernment transmitting the signed Agreement(translation from the French)

Sir,

I have the honour to acknowledge the receipt of your letterdated 4 August 1952 (reference 564 SC) transmitting theAgreement between the Government of the French Republicand the World Health Organization for the purpose ofdetermining the juridical status in the African Region of thisOrganization and of the persons attached to it ; I thank youfor it and am pleased to note that the French Governmentis ready to apply the provisions of the Agreement withoutwaiting for the approval of the said Agreement by the WorldHealth Assembly.

I note also with satisfaction the assurance you give, con-cerning the reservation made in the note on the interpretationof the above -mentioned Agreement on the subject of exemp-tion of French nationals, that the competent authorities willwithout delay submit the requests for exemption received bythem to the responsible Assemblies of the territories concernedwhich alone are entitled to make decisions on this matter.

I have the honour, etc.For Brock Chisholm, M.D.,

Director -General

(signed) Dr. P. DOROLLE


Annex 5[From EB11/49 and Add.l]

22 December 1952 and12 January 1953

RIGHTS AND OBLIGATIONS OF ASSOCIATE MEMBERS 1

Pursuant to the provisions of resolution EB10.R5adopted by the Executive Board at its tenth session,the Director - General addressed the following cir-cular letter (CL.23.1952) to Member States on 16July 1952, requesting their comments, observationsor suggestions concerning possible changes to bemade in the rights and obligations of AssociateMembers, as they emerge from the two resolutionsvoted by the First and Second World Health Assem-blies on that subject.2

CIRCULAR LETTER TO MEMBER STATES

16 July 1952Sir,

In implementation of Article 8 of the Constitution,the First and Second World Health Assembliesadopted two resolutions2 providing for the natureand extent of the rights and obligations of AssociateMembers.

Pursuant to the second resolution (WHA2.103),the Executive Board submitted to the Fifth WorldHealth Assembly a report on the rights and obliga-tions of Associate Members and questions connectedtherewith. For your convenience I am also attachinga copy of the said report.3

After studying this report, the Fifth WorldHealth Assembly adopted the following resolution(WHA5.42) :

The Fifth World Health Assembly,Having considered the rights and obligations of

Associate Members ; and.

Taking into account the admission of twoadditional Associate Members by the Fifth WorldHealth Assembly,

REQUESTS the Executive Board to study thismatter and submit a report to the Sixth WorldHealth Assembly.

1 See resolution EB11.R26.2 Off. Rec. World Hlth Org. 13, 337 and 21, 55 (Handbook

of Resolutions and Decisions, p. 166, resolutions [ WHA1.80]and WHA2.103)

3 See Off Rec. World Hlth Org. 40, 121.

On 29 May 1952 the Executive Board, which metimmediately after the Assembly, adopted the follow-ing resolution (EB10.R5) so as to give immediateeffect to the mandate which it had been given :

The Executive Board,In pursuance of the request of the Fifth World

Health Assembly that the Board study the subjectof the rights and obligations of Associate Membersand submit a report to the Sixth World HealthAssembly,

REQUESTS the Director - General to communicateimmediately with Member States in order thattheir views and suggestions on this subject maybe presented to the Board at its eleventh session.

The new development, which has taken place sincethe attached report was drawn up, is the admissionof two new Associate Members, Morocco (FrenchProtectorate) and Tunisia, to the World HealthOrganization.

I would be grateful if you could let me know, by1 November 1952 at the latest, your comments,observations or suggestions concerning possiblechanges to be made in the rights and obligations ofAssociate Members, as they emerge from the tworesolutions voted by the First and Second WorldHealth Assemblies.

The replies which are received will be examinedby the Executive Board during its eleventh sessionand will enable the Board to prepare the reportwhich the Fifth Health Assembly has requested it tosubmit to the Sixth Health Assembly.

I have the honour to be, etc.

(signed) H. S. Gearfor Brock Chisholm, M.D.,

Director- General

REPLIES TO CIRCULAR LETTER

By 12 January 1953 replies had been received froma total of 27 countries. Replies from the followingeight countries were to the effect that the circularletter was receiving attention :

ANNEX 5 199

Bolivia, Costa Rica, Cuba, El Salvador, Guate-mala, Panama, Philippines, United States of America.

The substance of the other replies is reproducedbelow :

MEMBER STATES

Burma- letter dated 11 December 1952 :... my Government have no comments to makeon the two resolutions. My Government wouldhowever wish to suggest the following change withregard to paragraphs 2 and 3(4) of the resolutionadopted at the Second World Health Assembly :

Under paragraphs 2 and 3(4) of the resolutionadopted at the Second World Health Assembly,those States Members not having their seat ofgovernment within the region but being respon-sible for the conduct of the international relationsof territories or groups of territories within theregion will be entitled to participate as membersof the regional committee and to have one votefor all the territories or groups of territories whichthey represent. The Government of the Unionof Burma are not prepared to accept the idea of theright to vote being given to non -regional MemberStates. It is a known fact that in cases of clash ofinterest between the territories which they arerepresenting and theirmembers always safeguard their own at the expenseof the territories and may not therefore be con-sidered as representing the territories.

Ceylon -letter dated 10 October 1952 :... this Government has no comments to offer.

Denmark -letter dated 18 November 1952 :... for the time being the Danish Government isnot able to set forth any comments, observationsor suggestions concerning possible changes tobe made in the rights and obligations of AssociateMembers, as they emerge from the resolutionsvoted by the First and Second World HealthAssemblies.

Finland -letter dated 11 October 1952 :... Finland has no comments, observations orsuggestions to offer on this subject.

France -letter dated 17 November 1952 (translationfrom the French) :... Government considers that the AssociateMembers' status might be amended so that in thefuture Associate Members, on the regional level,would have the same rights and obligations as fullMembers of the Organization.

Hashemite Kingdom of the Jordan -letter dated17 August 1952 :... do not suggest any specific recommendationson the rights and obligations of Associate Membersto WHO other than those mentioned in resolu-tions adopted in the First and Second World HealthAssemblies.

India -letter dated 19 September 1952 :... the Government of India recommend thatno changes be made in the existing rights andobligations of Associate Members of WHO.

Indonesia -letter dated 18 October 1952 :... Indonesia has no comments or suggestionswith regard to this problem.

Ireland- letter dated 31 October 1952 :The Minister of Health... does not wish to pro-pose any alterations in the rights and obligationsof Associate Members.

Lebanon- letter received on 22 October 1952(translation from the French) :... suggests that Associate Members be accordedthe right to participate in the discussions of otherMember States, in the regional organizations,with the right to vote in the separate committeesand in plenary meetings, except on financial ques-tions and questions of control of the financialactivities of regional offices -other rights andobligations to remain unchanged.

Netherlands -letter dated 22 September 1952 :. have no comments to make on the contents

of this letter.

Letter dated 11 November 1952 :... further to my letter of 22 September, I mayrefer to one point ... The resolution of the SecondWorld Health Assembly gives the AssociateMembers a right to participate with a restrictedvote in the deliberations of the regional committee.

On the other hand, the Second World HealthAssembly decided to give a full vote to the metro-politan countries in the regional committee.Therefore a non -self -governing territory repre-sented by the metropolitan country is in theregional committee in a better position than anAssociate Member.

I merely wanted to draw your attention to thispoint.

Pakistan- letter dated 22 November 1952 :... The Government of Pakistan recommend thatno change should be made in the existing rightsand obligations of the Associate Members. They


have practically all the rights and obligations offull Members except that they cannot vote, andthat distinction must be maintained.

Switzerland -letter dated 24 October 1952 (trans-lation from the French) :... the competent Swiss authorities consider thatexamination of this problem at the present timewould be premature. The World Health Assemblyitself found in 1951 that lack of experience madeit impossible to put forward recommendations,and we do not consider that the admission of twonew Associate Members in 1952 is sufficient tomake it possible to draw conclusions at this date.

Nevertheless, in our opinion, it would be advis-able in the future to envisage the possibility of placingAssociate Members within the regional organiza-tions on an equal footing with full Member States,the only differentiation between the two categoriesto be that Associate Members would not have theright to vote in plenary meetings of the WorldHealth Assembly and in the main committees.

Thailand -letter dated 6 October 1952 :... Thailand, as a Member State, has not changedits mind from the content of the two resolutionsadopted by the First and Second World HealthAssemblies and will not offer any suggestionconcerning possible changes to be made in therights and obligations of Associate Members atthe present time.

Union of South Africa -telegram dated 31 October1952 :

... Union Government do not consider that anychange in position regarding rights and obligationsof Associate Members is necessary since presentarrangements are working satisfactorily.

United Kingdom of Great Britain and NorthernIreland- letter dated 15 November 1952 :

. Having regard to the growth in volume andimportance of the work of the regional committeesof the World Health Organization, it is only tobe expected that there will be an increasing desireon the part of territories which are eligible forassociate membership to become Associate Mem-bers.

With a view to affording Associate Members thefullest possible participation in regional activitieswhich closely concern them, Her Majesty'sGovernment consider that the status of AssociateMembers should be improved to the extent of giving

them full voting rights in all meetings of the regionalcommittees of the World Health Organization.

Viet Nam -letter dated 23 August 1952 (translationfrom the French) :... Government has no observations to makeconcerning the resolutions passed by the Firstand Second World Health Assemblies on thenature and extent of the rights and obligations ofAssociate Members of WHO.

ASSOCIATE MEMBERS

Morocco (French Protectorate) -letter dated 14

November 1952 (translation from the French) :... (1) At a first stage, Associate Members mighthave the same rights and obligations as otherMember States, within the regional assembliesand their sub -divisions.

(2) At a later stage, the date of which it is diffi-cult to fix in the absence of information as to theposition which the Assembly will adopt withregard to the first point, the right within the WorldHealth Assembly (participation with right to votein the discussions of the Assembly and of its maincommittees) might be extended to AssociateMembers.

Tunisia -report dated 29 October 1952 (translationfrom the French) :

I. Concerning the Rights and Obligations ofAssociateMembers in the Regional Organizations

Considering that the nature and extent of therights of Associate Members in regional committeesare at the present time too limited and do not permitthem to participate effectively in the meetings of thesaid committees ;

In view of the fact that during discussion withregard to the principles which should govern therights and obligations of Associate Members in theregional organizations a certain number of membersof the Working Party on Constitutional Mattersset up by the Executive Board at its second sessionexpressed the view that " there would be no obstaclesto the conferment of full rights and obligations onAssociate Members in regions and this solution wouldbe the best method of ensuring the most effectiveregional committee from a health point of view. Itwould also be most valuable in giving to AssociateMembers the opportunity of taking increased res-ponsibility in the management of their affairs "(Official Records No. 14, page 55) ;

ANNEX 5 201

In view of the fact that, in practice, it seems thatregional committees meet only in plenary sessionand that, in particular, there was no division intoseparate committees at the session of the RegionalCommittee for Europe held at Lisbon from 25 to27 September 1952 ;

That therefore the absence of the right to vote inplenary regional committee meetings limits veryconsiderably the powers and action of AssociateMembers ;

Considering that the right to vote in plenarymeetings constitutes a fundamental right not yetaccorded to Associate Members ;

Considering that the participation of AssociateMembers in all sub -divisions concerned with financialor constitutional questions should be made moreeffective by the granting of the right to vote ;

Whereas the text of the draft Rules of Procedureof the Regional Committee for Europe (documentEUR /RC2 /2 of 20 May 1952), adopted in the reportof the second session of the Regional Committee forEurope, allows the word " Member " in Rule 1 tocover delegates of Member States and AssociateMembers ;

In view of Article 47 of the WHO Constitution ;of the various opinions expressed at

the Second World Health Assembly on the inter-pretation to be given to the words " Member Statesand Associate Members in the region concerned "in Article 47 of the Constitution,

It would seem desirable that all " Members " ofregional committees, as defined in Rule 1 of theRules of Procedure of the Regional Committee forEurope, i.e., both Member States and AssociateMembers, should have the same rights and the sameobligations within the regional organizations.

" Whereas it is necessary to have the best possiblerepresentation, with equal responsibilities, of allparts of a region on its regional committee and tohave available the maximum resources in securingthe objectives of the Constitution " (resolution inProposal B, Official Records No. 14, page 56),

It would seem desirable that paragraph 3, sub-paragraphs (2) and (5) of the resolution adopted by theSecond World Health Assembly (WHA2.103, OfficialRecords No. 21) be amended and that the SixthWorld Health Assembly be asked to accord to Asso-ciate Members in regional committees the same rightsand obligations as are accorded to Member States.

II. Concerning the Rights and Obligations of Asso-ciate Members in the World Health Assemblyand the Executive Board

Considering the aims and functions of WHO asdefined in Articles 1 and 2 of its Constitution ;

Considering the functions of the Health Assemblyas defined in Article 18 of the Constitution ;

In view of the anomaly created by the fact that, asfar as Associate Members are concerned, an itemon the agenda of the Assembly may be discussedat meetings of sub -committees with the right ofvote, whereas an Associate Member may not votewhen the same item is discussed in the main com-mittee (which set up the sub -committee) ;

Considering that wider prerogatives within theWorld Health Assembly would enable that body toensure maximum efficiency in its health activities, ifAssociate Members were more effectively and lessnominally " associated " with the work of theAssembly ;

Considering that the participation in the discus-sions of the Assembly without the right to vote, thatthe non -participation in the General Committee, inthe Committee on Credentials and in the Committeeon Nominations, as well as the impossibility ofjoining the Executive Board, already sufficientlydifferentiate the status of Associate Members fromthat of Member States ;

In view of the fact that Associate Members havethe same obligations as Member States except inso far as the determination of their contributionto the budget of the Organization is concerned ;

It would seem desirable to accord AssociateMembers the right to vote in the main committeesand, consequently, to amend paragraph 1, sub-paragraph (i) of the resolution adopted by the FirstWorld Health Assembly (WHA1.80), together withRule 39 of the Rules of Procedure of the HealthAssembly.4

While maintaining the provisions as laid down inparagraph 3 of resolution WHA1.80, the provisionalscale of assessments for Associate Members, asadopted by the Third World Health Assembly(resolution WHA3.86), might be modified in viewof the " improvement " in the status of AssociateMembers.

4 Rule 43 in the Handbook of Basic Documents, fifthedition

Annex 6[From EB11/12]

10 November 1952

REPORT ON THE TUBERCULOSIS RESEARCH OFFICE, COPENHAGEN

September 1952

1. Establishment of the Office, and Authorities

Early in the autumn of 1948, Dr. C. E. Palmer,Medical Director in the US Public Health Service(in charge of the Field Research Branch of theDivision of Chronic Disease and Tuberculosis),came to Europe at the invitation of UNICEF andthe International Tuberculosis Campaign (ITC),and made a survey of the need of and potentialitiesfor medical research in connexion with the massBCG -vaccination programmes being carried out inmany countries. He presented a report on thissurvey to the Joint Committee on Health Policy,UNICEF /WHO, at its second session held on 19 and20 October 1948. Accepting this report, the com-mittee recommended that the attention of the Director -General of WHO be drawn to the importance ofscientific research in the BCG campaigns. The WHOmembers of the committee at the same time reportedthe matter to the Executive Board. In recognizinga unique opportunity to further scientific knowledgein tuberculosis, the Board, at its second session,decided to accept responsibility for promotionof medical research in the BCG programme and tocreate a tuberculosis research office. In February1949, the Tuberculosis Research Office (TRO) wasofficially opened in Copenhagen.

Relevant references in official documents, corre-spondence and agreements concerning the origin ofTRO and its subsequent operations are given inAppendices 1 and 2.

2. Method of Investigation

The work of TRO is essentially one of " operationsresearch ", to borrow a term used during the secondworld war for the application of scientific methodsto military problems. TRO has been, and still is,dealing almost exclusively with technical problems

1 See resolution EB11.R27. This report was prepared inaccordance with resolutions EB7.R85 and WHA4.7

connected with the BCG programme or arising fromits field operations. Its approach is international incharacter. TRO has assisted and co- operated withmany national and international organizations.Special mention should be made of the DanishNational Health Service, Statens Seruminstitut andNational Antituberculosis Association, the FinnishNational Antituberculosis Association, the Tuber-culosis Control Service of the Icelandic Govern-ment, the Union Mission Tuberculosis Sanatoriumin Madanapalle, India, the BCG Pilot Stationin Paris, the International Tuberculosis Campaign,and the WHO Tuberculosis Section, which has takenover the work of ITC.

To obtain reliable results, great care is exercisedin the design and execution of each investigationand in the analysis of observational data. Thisrequires carefully trained technical staff and assistantsto assure uniform techniques, accurate and unbiasedobservation, groups of sufficient numbers andcomparable controls, appropriate statistical conceptsand methods, and, above all, critical judgement indrawing conclusions. What is said is, of course,nothing new, but it cannot be over -emphasized inclinical and publichealth research.

As the WHO /UNICEF BCG programme isextended to many countries where BCG has beenscarcely used, and where reliable information onthe nature and prevalence of tuberculous infectionand disease is lacking, the need for scientific inquirybecomes more apparent and urgent. TRO's experi-ences have repeatedly shown that what is found tobe true in one area frequently fails to hold in anotherarea where people live under different environ-mental, economic, and social conditions. If seriousmistakes are to be avoided in the conduct of large -scale BCG campaigns, preliminary surveys andBCG trials should be made by competent pilotteams in order to determine suitable techniques andcriteria for vaccination and the type of results to beexpected.

- 202 -

ANNEX 6 203

TRO has hitherto put great emphasis on humanfield studies, though the need for basic laboratoryresearch has been recognized for a long time. Arrange-ments have now been completed to undertake aclosely co- ordinated programme of laboratory andfield investigations so that the results and observa-tions from the laboratory and the field can becorrelated, compared and evaluated.

3. Development of Research Activities

When the mass BCG campaign was started, theprocedures and techniques for tuberculin testingand vaccinating were formulated largely on thebasis of previous experiences from the Scandinaviancountries, although it was clearly recognized thatchanges might have to be made as the work wasextended to different parts of the world. Thisactually proved to be the case. The methods andcriteria of tuberculin testing were repeatedly modified,and critical problems were encountered when thevaccination results were found to differ widelyfrom what was expected The research programmedeveloped by TRO therefore involved a variety ofshort -term and long -range investigations whichcomprised almost the whole subject of BCG vaccineand vaccination from the tuberculin test to the efficacyof mass BCG vaccination in the prevention of tuber-culosis. Its object was to place tuberculosis immuni-zation on a rational and scientific foundation.

The first series of the BCG studies was undertakenbecause of the finding of unusually poor results inone of the campaign countries. As the most seriousdeficiencies occurred during the summer, it wasthought that they might be due to a failure to usesufficiently fresh vaccine, to difficulties in keepingthe vaccine cold, or possibly to a reduction in thepotency of the vaccine. In view of these possibilitiesonly empirical and provisional changes could bemade in the production and handling of the vaccineby the Danish Statens Seruminstitut. At the sametime, plans and arrangements were made for intensivestudy by TRO of questions relating to the allergenicpotency of the vaccine and the effects of variousphysical factors, particularly temperature and dura-tion of storage. More questions arose as thestudies progressed. To date 27 projects have beencarried out and approximately 44,000 school childrenhave been tuberculin- tested, and non -reactors vac-cinated and retested. These studies have provided

a wealth of data from which much has been learnedabout BCG vaccine and vaccination.

Concurrently with the vaccine studies, projectswere developed to evaluate the immediate and long -range effects of BCG vaccination. In co- operationwith ITC, specially trained teams were sent toEcuador, Egypt, Greece, India and Syria to retestsamples of the vaccinated populations. It wasobviously necessary to determine whether the earlieruncertain and unsatisfactory results were beingrepeated in other countries. In Denmark and Finlandlong -range projects were designed to study thechanges of tuberculosis morbidity and mortality inrelation to mass BCG- vaccination campaigns. Itshould be noted that neither project is a controlstudy. A national roster of the tested and vaccinatedhas been set up to permit direct matching of currentmorbidity reports in Denmark and death reportsin Finland. Tuberculosis morbidity or mortality ofthe vaccinated can thus be compared with thatof the non -vaccinated (natural reactors to tuberculin)and with the expected trends in the general popu-lation.

As a great deal of the epidemiological and clinicalwork in tuberculosis, as well as BCG vaccination, isbased on the premise that the tuberculin test callsforth a specific reaction, the occurrence of non-specific tuberculin sensitivity raises many problemsand much uncertainty. Material from some of thetropical countries indicates that ordinary tuber-culous infection cannot be the only cause of tuber-culin allergy ; there are most likely other causes,though they have not yet been identified. To clarifythis problem, comparative studies of tuberculinallergy are being conducted on an internationalscale and, recently, groups of tuberculous patientswere tested with uniform techniques in various partsof the world. Such comparative studies are leadingto a better understanding of the usefulness -andlimitations -of the tuberculin test.

Because tuberculosis is an important public- healthproblem -and still the leading cause of death inalmost all the Asian, Eastern Mediterranean andLatin American countries -the importance ofscientific research in tuberculosis need not be stressed.Taking advantage of the excellent facilities availablein a tuberculosis sanatorium in Madanapalle, India,a co- operative field research station has been set upwith the assistance of the Indian Government tostudy the epidemiology of tuberculosis in a rural


Indian population. The work is necessarily limitedin scope, but it is expected that precise knowledgecan be obtained concerning the nature, prevalenceand spread of tuberculosis in that part of India andthe role played by BCG vaccination in affecting thecourse and frequency of the disease.

For organization chart and summary of presentactivities see Appendices 3 and 4.

4. Results so far achieved, and their Significance

What has TRO achieved during the past three anda half years ? It would be absurd even to suggestthat final answers have been found for the complexproblems of BCG and tuberculosis immunization.But it can be said that a good many importantquestions are now clarified and suitable facilities havebeen developed for studies that need to be done.

One of the first responsibilities of TRO was todirect the collection of BCG- campaign statistics andthe preparation of the material for publication. Atthe conclusion of ITC in June 1951, a total of38,000,000 children and adolescents had beentuberculin- tested, and 18,000,000 vaccinated withBCG in 23 countries of the world. This was the firsttime in medical history that mass immunization ofsuch magnitude had been carried out and it offeredan unprecedented opportunity for world -wide collec-tion of information on tuberculin sensitivity. TheMantoux test was given with relatively uniformtechnique and a standard tuberculin produced by asingle laboratory. The record forms were alsostandardized. Up to now, 11 reports documentingthe campaigns by individual country have beenpublished and four more will be completed in 1952.These reports provide a permanent record of thework done and contain statistical information ofgreat epidemiological value for comparison oftuberculin sensitivity between countries and betweenareas within a country, perhaps the best single indexof tuberculosis that can be obtained for manycountries today where morbidity and mortalitystatistics are either not available or unreliable.

During the early ITC campaigns some retestingwas performed in various countries, but no con-clusions could be drawn because of the markedvariability of the methods and results. Since theautumn of 1950, in co- operation with ITC, speciallytrained teams have been sent to several countriesto make systematic surveys of post- vaccinationtuberculin allergy. Analysis of the results revealedsignificant geographic differences, even when the

same batch of BCG vaccine had been used. Sub-sequent studies have shown that exposure of BCGto sunlight has a very damaging effect on the vaccineand this may explain, to a large extent, the low levelof post- vaccination allergy found in some of thetropical and sub -tropical countries.

The results of the BCG studies have proveddifferent in many respects from what was generallyaccepted. For example, it was believed that BCGvaccine had to be kept cold and used within a shorttime after preparation, that large numbers of livingBCG organisms were needed to obtain a satisfactoryallergic response, and that the potency of a givenvaccine could be adjusted simply by minor changes inthe amount of BCG per unit volume. None of thesebeliefs has been confirmed. Instead, it has beenshown that the vaccine can be kept for 10 weeks at2-4° C without significant loss of its allergenicpotency ; and storage at 200C for a month or370C for five days causes only a slight reduction in thelevel of tuberculin allergic response. Vaccine couldbe diluted tenfold, or given in half or twice theusual dose, without causing a significant change inallergy.

On the other hand, the depth of injection ofvaccine was found to have considerable practicalconsequence. Though the level of allergy notaffected, the size of the local lesions at the vaccina-tion site, as well as the frequency of abscesses, in-creased with the depth of the injection. Differencesin technique of injection may well explain why agreater proportion of complications was foundin some of the campaign areas, even though the samevaccine was used.

In seeking an explanation for the levels of post -vaccination allergy found in some southern countries,in contrast to Denmark, exposure of the vaccine tosunlight was naturally considered a possible im-portant cause of a qualitative change in the vaccine.A series of experiments was carried out to determinethe effect of sunlight on BCG. The results showedthat light has a devastating effect on the vaccine.After 30 minutes' exposure, the post- vaccinationMantoux reactions decreased in mean size from20.5 mm to 8.6 mm and the vaccination lesions from9.0 mm to 5.5 mm ; and the colony count of BCGorganisms was reduced approximately a thousand-fold. A substantial decrease in colony count wasseen after exposure of the vaccine to the sun foronly five minutes.

Although it has been common knowledge thatmany biological products are harmed by light and thatundue exposure of BCG vaccine should be avoided,

ANNEX 6 205

the significance of the effect of light was not recognizeduntil the extremely poor results in Egypt promptedthe search for some powerfully destructive agent.Subsequent laboratory studies in the Statens Serum -institut have shown that exposure to ordinarydaylight through the laboratory windows during thecourse of preparation of vaccine causes a largereduction in the number of viable organisms.Vaccines prepared under artificial light, on the otherhand, contain a relatively stable number of liveorganisms. This work has already resulted in modi-fications of the laboratory procedures of preparationand handling of the vaccine, and at the same timeprecautions are being taken in the field to preventexposure of the vaccine to light.

Differences have been observed between vaccinesproduced by different laboratories. Some workersclaim that these are due to variations between strainsof BCG. Field studies have shown that dead bacilliproduce much lower levels of allergy than livingbacilli, and mixtures of the two can produce allergyover a wide range, depending on the relative pro-portion of each component. It is therefore con-ceivable that a great deal of the observed variationsbetween vaccines may be explained by differentproportions of living and dead organisms.

The usual method for assessing the degree of post -vaccination allergy has been to determine thepercentage of persons in the vaccinated group whosereactions are above (or below) a certain size. Thistechnique would work quite well if a definite criterioncould be established to define what is a satisfactorylevel of allergy from BCG vaccination. As a matterof fact, BCG vaccination produces allergy of a broadrange and, at the present time, there is no indicationof what constitutes satisfactory post- vaccinationallergy. Fixing a criterion at some specific point onthe scale is therefore meaningless. It is more rationalto express the results of BCG vaccination in termsof the frequency distribution of the size of thereactions, thus indicating the level of allergy on thespectrum of tuberculin sensitivity. It is expectedthat this improved method of expressing post -vaccination allergy will be widely adopted by criticalworkers.

In applying the Mantoux test in an unvaccinatedpopulation in the Scandinavian countries, thepattern of the distribution of reactions clearly showsthat there are two groups in the general population-one group with little or no reaction and the otherwith strong reactions. Using the same test, the sametuberculin, and with the same person reading thereactions, a different pattern has been found in some

of the campaign countries. Though the distributionagain indicates that there is one group with strongreactions, the other group has a low level of sensi-tivity instead of having no reaction at all. The lattergroup has apparently been infected by some agent thatcauses a tuberculin sensitivity which is not specificfor infection with human tubercle bacilli. Thisdifference in the pattern of the distribution oftuberculin reactions raises a perplexing situationas to the selection of persons for vaccination. Inthe Scandinavian countries the persons who have noreaction can be considered non -infected and may bevaccinated. In these other countries, should thosewith the low -grade sensitivity be vaccinated ? Thereis no answer to this question at the present time. Inthe current BCG campaigns, the criterion which hasworked well in the Scandinavian countries cannotbe used with justification in areas where this low -grade sensitivity is present. For example, using theMantoux 5 TU test in Ecuador, persons selected forvaccination by the 5 mm criterion constitute 55 percent of the group showing a low grade of allergy.The remaining 45 per cent will not be vaccinated.This shows that such a criterion is not applicable.Similar difficulties have been encountered in Egyptand in some parts of India. The tuberculin test mustbe carefully studied in different parts of the worldto determine the pattern of the distribution ofreactions and what criterion can be suitably applied.

5. Future Tuberculosis Research

The work of TRO has perhaps brought forthmore perplexing questions on tuberculosis immuni-zation than it has actually answered or clarified.It may be appropriate, therefore, to examine broadlythe direction of future research which will bestserve the needs of international tuberculosis -controlprogrammes.

Since Koch's discovery of the tubercle bacillus,repeated attempts have been made to vaccinateagainst the disease, but the outcome of most effortshas been disappointing. The protective value ofBCG in man is still a highly controversial subject.The great difficulty is that, with few exceptions,there has been a failure to realize the necessity forusing a comparable group of unvaccinated controlswith which to measure the effect of BCG in thevaccinated. It now becomes imperative that morecontrol studies of this kind be made, in places wherethe prospect of success is good and co- operation isobtainable. WHO, in accepting the responsibility


for technical guidance in mass campaigns conductedin many countries, has an obligation to assess theefficacy of the methods used.

Another pressing problem is the need for muchmore exact knowledge of the basic nature of tuber-culosis immunity. It is of tremendous importanceto improve BCG vaccine or to develop a more potentprophylactic which can be relied upon to preventtuberculosis in man. Only through a clear under-standing of the mechanism of tuberculosis immunityis it likely that this can be achieved. It is basicallya task for the laboratory, to be studied by intensiveanimal experimentation.

For practical BCG work, it is of great importanceto know whether or not vaccinated individualsshowing a high degree of tuberculin allergy arebetter protected than those with a low -grade sensi-tivity. This is a serious question, in view of the factthat retesting surveys have revealed in a number ofcountries an unusually low and possibly unsatisfac-tory level of allergy among the vaccinated population.The same finding may obtain in other countries whereno systematic retesting has been made or whereBCG programmes are being, or will be, performed.Should those below a certain level of allergy berevaccinated ? WHO has a responsibility to provide

an answer to this question for the use of its tubercu-losis technical advisers. The relation between allergyand immunity is as yet obscure, although much workhas been done in recent years. The solution of thisproblem must be worked out jointly by laboratoryand field investigators.

Finally, a conspicuous opportunity to carry outmedical research has arisen in connexion with theintensive efforts against tuberculosis being made byinternational organizations. There are many countriestoday where tuberculosis is the leading public -healthproblem and where reliable knowledge about thedisease is lacking. It is naive to believe that orthodoxmeasures of tuberculosis control, though they mayhave been effective in Western Europe or NorthAmerica, are necessarily applicable in other countrieswhere conditions of life are widely different. Theonly rational approach, perhaps also a more econo-mical one in the end, is to combine the practicalassistance programmes in such countries with asimultaneous programme of scientific research.Undoubtedly the same can be said about otherphases of international public -health work. What ispracticable in one country may fail in another, unlessa sound basis for application has been found, or theresults of preliminary trials support its use.

Appendix 1

EXCERPTS FROM OFFICIAL DOCUMENTS CONCERNING THE ORIGIN

OF THE TUBERCULOSIS RESEARCH OFFICE

The Joint Committee on Health Policy, UNICEF /WHO,adopted at its second session the following resolution (JC2/UNICEF /WHO /3 : Report on second session 2) :

The Joint Committee on Health Policy of UNICEF /WHO

NOTES with interest the medical research aspects of theBCG campaign, and

RECOMMENDS that the attention of the Executive Director[Director -General] of WHO be drawn to the unique opportu-nity that exists in the present BCG campaign for answeringmany questions of basic importance in the control andepidemiology of tuberculosis through intensive and continuingstudy in connexion with these campaigns.

Furthermore, the WHO members of the Joint Committee

2 Reproduced in Off. Rec. World Hlth Org. 22, 41

on Health Policy reported as follows to the Executive Boardconcerning this item (Official Records No. 14, page 49) :

Dr. Carroll Palmer, who has been studying the researchpotentialities of the European BCG programme, presenteda report which indicated certain lines of investigation whichseemed to the WHO members of the committee to presentto WHO a unique opportunity for furthering medicalknowledge in the field of tuberculosis...3 In view of this,Dr. Holm and Dr. Palmer were invited to attend the secondsession of the Executive Board in connexion with its con-sideration of the report of the Expert Committee on Tuber-culosis.

3 See " Outline of Programme presented to the EighthMeeting of the Second Session of the Executive Board byDr. Carroll Palmer, Tuberculosis Research Expert ", repro-duced below.

ANNEX 6 207

The Executive Board, at its second session, accepted thisreport, and adopted a resolution, the relevant part of whichreads as follows (Official Records No. 14, page 18) :

In regard to research in connexion with the currentUNICEF -BCG programme, similar approval of theUNICEF members of the JHPC shall be sought for initiationof a research programme. On receipt of this approval, theDirector -General is authorized to make an allocation notexceeding $100,000. This will further be implementedby the Executive Board upon receiving recommendationfrom the appropriate experts and from the JHPC.

During its third session the Joint Committee on HealthPolicy approved the proposal (JC3/UNICEF/WHO/33).4This initial appropriation for 1949 was later increased to$150,000 by the Executive Board at its fourth session and thefollowing resolution was adopted (Official Records, No. 22,page 2):

The Executive BoardAUTHORIZES the Director- General to allot from the

UNRRA Special Fund an amount not to exceed $150,000to implement the WHO tuberculosis research programme.

OUTLINE OF PROGRAMME PRESENTED TO THE EIGHTH MEETINGOF THE SECOND SESSION OF THE EXECUTIVE BOARD

BY DR. CARROLL PALMER, TUBERCULOSIS RESEARCH EXPERT

Six types of medical research which could be incorporatedin the general BCG programme:

1. Investigation of the criteria for vaccination, and whatcould be considered as a positive tubercular reaction. For

Report on third session, reproduced in Off. Rec. WorldHlth Org. 22, 44

example, would not a single tuberculin test be sufficient forscreening purposes ?

2. Development, testing and use of a preserved vaccine in thelong -range view of immunization against tuberculosis, by thecollection of precise medical scientific information on theefficiency of different vaccines, preserved vaccines and methodsof administration.

3. Revaccination and the value of criteria in the selection ofgroups to be revaccinated. What were the criteria for sayingthat one group or other was completely immunized by BCGvaccination ?

4. Collection of statistical material. The reports of theBCG campaign should be prepared in a uniform way showingthe level of tuberculin sensitivity of adults, and in particularof children, in the various countries.

5. Research to be made on the effectiveness of BCG, as oneof the techniques in the control of tuberculosis. Indirectpresumptive evidence could be obtained on the value of BCGby comparison of the results on vaccinated and non -vaccinatedpersons.

6.1 Miscellaneous studies, such as family and racial differ-ences in susceptibility and resistance to tuberculosis, responseto artificial immunization, and the worldwide prevalence offungus infection in its relation to tuberculosis.

6.2 Preservation of records.

6.3 General evaluation of the effect of the programme andthe possibility of obtaining better morbidity and mortalitystatistics.

Appendix 2

OFFICIAL CORRESPONDENCE AND AGREEMENTS BETWEEN WHO AND THE DANISH GOVERNMENT

1. Excerpts from letter dated 23 October 1950, from the WorldHealth Organization to the Danish Ministry of the Interior,signed by the Acting Director -General

... WHO highly appreciates the co- operation and assistancethat the Danish Government, its Health Department, itsState Serum Institute, the school authorities and schoolphysicians, and the medical profession of the country haveextended to WHO Tuberculosis Research Office in Copenhagenunder the direction of Dr. Carroll Palmer. This collaborationhas proved of great value in carrying out research in the fieldof BCG vaccination at a high scientific level. To make fulluse of the excellent atmosphere created by this collaboration,WHO proposes to retain the Tuberculosis Research Officein Copenhagen, and looks forward to a continuing associationwith the Danish Government and medical profession in

carrying forward and expanding the activities of the Tuber-culosis Research Office.

WHO expresses the sincere hope that the Danish Govern-ment and medical profession will continue to co- operate withthe Tuberculosis Research Office in Copenhagen and with itsfield studies in Denmark so that the research programme maybe developed and expanded. Furthermore, BCG countryprogrammes will thus continue to be closely associated withlaboratory research, with field and statistical studies, andspecialized laboratory facilities will be at all times availablefor the study and comparison of vaccine and tuberculin fromdifferent sources.


2. Excerpt from reply dated 12 January 1951, from the DanishGovernment, signed by the Minister of the Interior :

... The Danish Government notes with satisfaction thatWHO has decided to retain the Tuberculosis Research Officein Copenhagen, and on the basis of this decision, suitablepremises have now been procured which will be placed at thedisposal of the Tuberculosis Research Office, rent free, themaintenance costs to be borne by WHO.

Various Danish institutions and the medical profession ofDenmark are already in close collaboration with the Tuber-culosis Research Office, particularly in connexion with fieldstudies on evaluation of BCG vaccine and the Danish BCGvaccination campaign. The Danish Government will gladlyassist in maintaining and extending this association, and forthis purpose plans connected with laboratory research in thefield of vaccination against tuberculosis are at present underactive consideration.

3. Agreement between the Government of Denmark and theWorld Health Organization for the Establishment of aTuberculosis Immunization Research Centre

Whereas it is recognized that the role of immunizing agentsis of vital importance in the world -wide effort to eradicatetuberculosis,

Whereas the campaigns of mass BCG vaccination haveshown the necessity of further scientific investigation fordetermining the most satisfactory means of immunization,

Whereas the Government of Denmark, recognizing theimportance of such research, has proposed, and the Secretary -General of the United Nations has agreed, that funds of theDanish UNAC collection presently available be used forlaboratory research, and

Whereas the World Health Organization has requested thatspecial emphasis be given to control studies for determiningthe value of BCG vaccination,

Now therefore, the Government of Denmark (hereinaftercalled " the Government ") and the World Health Organi-zation (hereinafter called " the Organization ")


Article 1

Purpose

There is hereby established within the State Serum Institutein Copenhagen a centre for international tuberculosis immuni-zation research (hereinafter called " the Centre ") which shall :

(i) undertake laboratory and related research on tubercu-losis immunization ;(ii) co- operate with the Organization's field researchtuberculosis immunization ;(iii) co- operate with other centres and laboratories.

shall be established composed of four representatives, twonominated by the Government and two nominated by theOrganization.

The Committee shall adopt its own rules of procedure.The Director of the Centre shall be the Secretary of the

Committee.

The duties of the Committee shall also include :(i) the recommendation for the selection of the Directorof the Centre to be designated and appointed in accordancewith the procedure determined in the supplementaryagreement provided for in Article 6 hereof ;(ii) the approval of appointments, on the recommendationof the Director, to the professional and technical staff ofthe Centre ;(iii) the approval of the annual budget estimates to besubmitted by the Director to the Government ;(iv) the transmittal, together with the Committee'scomments, of the annual report of the Director to theGovernment and to the Organization on the progress ofwork ;

(v) such other duties as may be determined in the supple-mentary agreement provided for in Article 6 hereof.

Article 3

Personnel

(1) Subject to the provisions of paragraph (ii) of Article 2of this Agreement, the Director shall appoint the staff of theCentre.

(2) Staff other than officials of the Organization shall beappointed under conditions to be determined in the supple-mentary agreement provided for in Article 6 hereof.

(3) Subject to the availability of funds, officials of the Orga-nization may be assigned to perform duties in the Centre.

Article 4

Establishment of the Laboratory

(1) Suitable premises for the Centre shall be constructedin close proximity to the State Serum Institute by the Govern-ment using the UNAC funds for this purpose upon land beingthe property of the Institute or placed at the disposal of theCentre by the Government gratuitously.

(2) The provision of equipment for the Centre shall be deter-mined in the supplementary agreement provided for in Article 6hereof.

Article 5

Operation of the Centre

on (1) Subject to the availability of funds the Government shallbe responsible for the necessary expenses in connexion withthe operation of the Centre.

(2) Subject to the availability of funds, the Organizationshall assist the Government in the provision of personneland supplies for the Centre.

(3) The implementation of the provisions of this Articleshall be determined in the supplementary agreement providedfor in Article 6 hereof.

Article 2

Organization

For the purpose of co- ordinating laboratory and fieldresearch and general supervision of the Centre, a Committee

ANNEX 6 209

Article 6

Execution of the Agreement

(1) In execution of the provisions of this Agreement, asupplementary agreement (Plan of Operations) shall be con-cluded by the duly authorized representatives of the parties.(2) This supplementary agreement shall also provide forinterim arrangements pending the completion of the newpremises for the Centre.

Article 7

Privileges and Immunities

The privileges, immunities and facilities provided in theConvention on the Privileges and Immunities of the SpecializedAgencies, together with its Annex VII (revised), as acceded toby the Government on 25 January 1950 and on 22 May 1951,shall be accorded to the Organization, its personnel, propertyand assets, in connexion with the performance of this Agree-ment.

Article 8

Entry into Force and Termination

(1) This Agreement shall enter into force upon signature bythe parties.(2) This Agreement may be terminated by either partyupon written notice to the other and shall terminate 6 monthsfrom the receipt of such notice.(3) The termination of this Agreement shall constitutetermination of any supplementary agreement hereto.(4) In the event of such termination the parties shall mutuallydetermine the ultimate utilization of the new premises andthe equipment of the Centre provided from UNAC funds orfrom the funds of the Organization.

IN WITNESS WHEREOF the Government and the Organizationthrough their duly appointed representatives have signed thisAgreement at Copenhagen on 30 November 1951, in fourcopies, two in English and two in Danish, the English textalone being authentic.

For the Government of Denmark : (signed) AKSEL. MOLLER

and at Geneva on 5 December 1951For the World Health Organization : (signed) BROCK CHISHOLM

4. Supplementary Agreement for the Operation of a Tuber-culosis Immunization Research Centre

(Plan of Operations)

The Government of Denmark (hereinafter referred to as" the Government ") and The World Health Organization(hereinafter referred to as " the Organization ").

Acting in pursuance of Article 6 of the Basic Agreementsigned on 5 December 1951 between the Government and theOrganization concerning the establishment and operation ofa Tuberculosis Immunization Research Centre,


(1) Appointment of the Director

In accordance with the provisions of paragraph (i) ofArticle 2 of the Basic Agreement, the Government shall

designate the Director of the Centre upon the recommendationof the Committee from the staff seconded by the Organiza-tion to the Centre.

(2) Functions of the Director of the Centre

The Director shall :

(i) direct the activities of the Centre ;

(ii) select the professional and technical staff for approvalby the Committee and appoint all other staff ;

(iii) prepare the budgets for approval by the Committee ;

(iv) prepare an annual report on the activities of theCentre.

(3) Personnel

(i) The professional and technical staff of the Centre(other than officials of the Organization referred to inArticle 3 (2) of the Basic Agreement) will be appointedafter approval of the Committee under the conditions ofservice of the Institute ;

(ii) All personnel assigned to the Centre shall conform tothe rules and regulations of the Institute.

(4) Establishment of the Laboratory

(i) The building of the laboratory, inclusive of usuallaboratory installations, animal stables, etc., will be paidfor from UNAC funds and from other sources. Until theconstruction of the new laboratory is completed, temporarylaboratory space will be provided by the Institute and paidfor from UNAC funds.

(ii) Capital laboratory equipment and supplies shall beprovided from :

(a) The Organization's funds, but not exceedingUS $20,000 ;

(b) UNAC funds to a maximum of 100,000 Danishkroner ;

(5)

(c) Such additional funds as may be available.

Operation of the Centre

(i) The Government from UNAC or other funds willprovide to the Centre :

(a) such facilities as are part of the general maintenanceof the Institute, e.g., water, heat, electricity, gas, cleaningservices ;

(b) procurement, transportation, accounting and othercommon services of the Institute.

(ii) Within its yearly budgetary allocations and subject tothe availability of funds the Organization will defraypersonnel expenses for the Director and for the personnelseconded by the Organization and for such equipment,supplies and other expenses as must be paid in other thanDanish currency.

This contribution to the Centre shall not exceed US $30,000per annum.

(iii) Operating expenses, not exceeding Danish kroner300,000 per annum, will be defrayed from UNAC funds.


(iv) Such additional funds as may be available may beprovided for further necessary operating expenses.

(6) Accounting and Auditing

(i) Accounting. Accounts for the Government contributionand UNAC funds will be kept by the Institute, and for theOrganization funds by the Organization. The Instituteand the Organization will furnish annual statements ofaccounts to the Director of the Centre for presentation tothe Committee, to the Institute and to the Organizationin the form of a joint statement.

(ii) Auditing. Accounts for the Government contributionand UNAC funds will be audited by the auditors of theState Serum Institute ; accounts for the Organization'sfunds will be audited by the Organization's auditors.

The two auditing bodies should consult each other as neces-sary, it being understood that access by the auditors to theaccounts of both parties is to be provided.

(7) Amendments

This Agreement may be amended from time to time asnecessary by the parties subject to the provisions of the BasicAgreement.

IN WITNESS WHEREOF, the undersigned, being dulyauthorized for that purpose, have signed this Agreement, atCopenhagen, on the 15 December of 1951,

For the Government of Denmark :(signed) ZEUTHEN

and at Washington on 27 December 1951For the World Health Organization :

(signed) CARROLL E. PALMER

Appendix 3

ORGANIZATIONAL CHARTTUBERCULOSIS RESEARCH OFFICE, COPENHAGEN 5

BCG VACCINE STUDIES STUDIES ON TUBERCULIN

3 Medical officers ALLERGY AND TUBERCULINS

1 Statistician 2 Medical officers1 Assistant statistician

1 Statistician2 Research assistants 2 Assistant statisticians2 Technical assistants 2 Clerks3 Clerks1 Driver

OFFICE OF THE DIRECTOR

Medical DirectorAssistant Medical Director

BCG CAMPAIGN STATISTICS

1 Assistant statistician2 Clerks

STATISTICAL PROCESSINGPOOL

1 Head clerk6 Clerks1 Draftsman

ADMINISTRATION (INCLUDINGSECRETARY POOL)

1 Administrative officer1 Assistant admin. officer1 Accounting officer1 Accounting clerk1 Assistant translator2 Secretaries2 Stenographers1 Typist1 Office assistant1 Telephone operator

Joint Projects with National or Local Organizations

BCG EVALUATION STUDIES

1. Denmarkin co- operation with Danish National HealthService and Anti -Tuberculosis Association :

1 Research associate1 Assistant statistician

2. Finlandin co- operation with Finnish National Anti -Tuberculosis Association:1 Assistant statistician

1 Clerk

WHO;DANISHGOVERNMENT COMMITTEE

TUBERCULOSIS IMMUNIZATIONRESEARCH CENTRE (LABORATORY)

TRO staff seconded to Centre :1 Director1 Immunologist1 Bacteriologist

EPIDEMIOLOGICAL STUDIES

1. Madanapalle, IndiaIn co- operation with Union Mission Tubercu-losis Sanatorium assisted. by Indian Govern-ment :1 Consultant (part -time)Local personnel

2. Icelandin co- operation with Icelandic Government

.ne 3116

5 Staff as provided for in the 1953 budget


AppendixSUMMARY OF PRESENT ACTIVITIES OF THE

September

Type of Activity Purpose Organization

I. Statistical documen-tation of mass BCGcampaigns.

To assist the International Tuberculosis Campaign(ITC) in organization of field statistical work andtraining of local statistical personnel ; to compilestatistics and prepare reports on tuberculin testing,vaccination and post- vaccination testing of nationalcampaigns ; to handle WHO /UNICEF campaignstatistics ; to analyse material collected fromvaccination programmes.

Co- operation with the International TuberculosisCampaign (ITC) and participating national organi-zations. Since January 1952, co- operation withWHO Tuberculosis Section and regional officesand national organizations. Assistance and gui-dance to regional BCG statisticians working incountries of the Americas, South -East Asia andEastern Mediterranean.

II. Evaluation studies ofBCG vaccination inprevention of tuber-culosis.

A. Danish antituberculosis mass campaign. Todevelop a national roster of the tuberculin tested,x -rayed and vaccinated for long -range follow -upof tuberculosis morbidity. Special studies ofrelationship of allergy and x -ray findings to incidenceof tuberculosis.

Joint programme with Danish National HealthService and Antituberculosis Association.

B. Finnish mass BCG campaign. To study long -range effect of mass vaccination on tuberculosismortality through setting up national roster of thetested and vaccinated.

Co- operation with Finnish Antituberculosis Asso-ciation and National Office of Vital Statistics.

ANNEX 6 213

4

TUBERCULOSIS RESEARCH OFFICE, COPENHAGEN

1952

Place of Operation Progress Remarks

Central Office in the Tuber-culosis Research Office(TRO), Copenhagen. Before1952, statistics from 23countries in Asia, Europe,the Middle East, LatinAmerica and North Africa.At present, statistics fromAden Colony, Burma,Costa Rica, Egypt, El Sal-vador, Hong Kong, India,Iran, Jamaica, Malaya, Pa-kistan, Philippines, Taiwan,Thailand and Trinidad.

Monthly and annual statistical summaries for theInternational Tuberculosis Campaign (ITC) and,since January 1952, for WHO Tuberculosis Section.Individual reports published for 9 countries, forLebanon and Palestine refugees in ITC secondannual report. Four additional reports to be com-pleted this year. Simplified procedures introducedfor collection of field statistics. Collection and ana-lysis of pre- and post -vaccination testing results onsample basis.

Expenditure for publication of individual countryreports paid by International Tuberculosis Cam-paign (1TC). After 1952, work to be conductedon reduced scale and no budget provision made forpreparing and publishing similar reports for WHO/UNICEF campaigns.

Country -wide in Denmark,except Copenhagen.

Campaign started early in 1950 to cover 1.5 millionpersons 1 -6 and 15 -34 years of age and includingtuberculin testing, vaccination, and x -ray examina-tion of adults. Work on roster begun July 1950.So far punch -card records made for 1.2 millionpersons, half of whom were vaccinated during thecampaign or previously.Special studies conducted to evaluate and improvemethods of tuberculin testing, x -ray examination,and selection of persons for vaccination. Improvedcompulsory national notification of pulmonarytuberculosis. Campaign to be completed December1952 and completion of roster in 1953, after whichcompilation and analysis of statistics, and follow -upwork, will be the main concern.

3.4 million kroner appropriated by Danish Stateand local authorities for the campaign. For deve-loping the roster and research, kr. 400,000 plusannual allocation of kr. 25,000 from the State andkr. 100,000 a year from TRO. In 1954 and suc-ceeding years follow -up work will be based largelyon existing facilities for clinical examination,diagnoses and reporting and research activitiesfinanced through annual allocations from DanishGovernment and TRO.

Operation of a statisticaloffice in Helsinki and ana-lysis of tuberculosis morta-lity statistics in Copenhagen.

Work on roster begun September 1949, includingcopying of some one million cards for population1 -25 years of age. Punch -card records completed for850,000 tested and vaccinated. Matching of tuber-culosis death certificates against roster alreadybegun ; steps being taken to verify tuberculosisdeaths for acute forms of the disease.Study of Finnish tuberculosis mortality with specialreference to BCG vaccination well advanced andmanuscript on results being prepared.

Finland has high tuberculosis mortality and goodvital statistics with strong central leadership andinterest in international collaboration in research.


Type of Activity Purpose Organization

III. BCG vaccine and vac-cination studies.

To investigate basic factors influencing allergenicpotency of BCG vaccine with particular referenceto problems arising in international BCG campaigns.Factors studied include dosage and age of vaccine,exposure to light and heat, qualitative differencesbetween living and dead bacilli, vaccinationtechniques, etc. To compare vaccines prepared bydifferent laboratories.

Studies conducted by TRO under joint auspices ofITC, Danish Statens Seruminstitut and TRO.Programme consists of testing, vaccination andperiodic retesting of school children supplementedby laboratory work (Statens Seruminstitut) onvaccines used. Close co- operation with national andlocal health services and officials, other BCGproduction laboratories, BCG Pilot Station Paris.

IV. Laboratory investiga-tion.

To undertake laboratory research on tuberculosisimmunity and immunization with particular refer-ence to BCG. To co- operate with TRO and otherresearch centres.

A Tuberculosis Immunization Research Centre(TIRC) established by agreement (December 1951)between WHO and the Danish Government.Supervision and co- ordination by a joint committeeof 4 members, two from each of co- operatingparties. 2.3 million kroner allocated by the Govern-ment from its UNAC fund and about $30,000contribution a year from TRO budget.

V. Epidemiologicalstudies of tuberculosisin widely differentcommunities.

To investigate prevalence, nature and spread oftuberculosis and certain methods of control :(1) in Madanapalle, a rural Indian community of

52,000 population ;

Madanapalle Field Station. Co- operation withUnion Mission Tuberculosis Sanatorium, assistedby Indian Government.

(2) in Iceland, an insular country of 140,000population.

Iceland project. Co- operation with IcelandicGovernment.

VI. Studies of tuberculin To study specificity of the tuberculin test withtest and tuberculins. particular reference to selection of non -infected

persons for vaccination in different parts of theworld. To investigate causes of non -specific reac-tions observed in tropical and sub -tropical countries.To develop suitable methods for field standardiza-tion and comparisons of tuberculins.

Work carried out by special teams directed by TROoperating in co- operation with national and localhealth authorities.

VII. Consultation andtraining.

To advise on technical matters of mass BCGvaccination carried out previously by ITC and nowby WHO /UNICEF, and to assist WHO Tuber-culosis Section and regional offices in training anumber of selected doctors, nurses and statisticiansfor BCG work. To acquaint health officers fromMember States and WHO Fellows with TRO workand methods of investigation.

Undertaken by senior staff members on an individualbasis, making use of TRO facilities, including statis-tical evaluation projects, field vaccine studies, andco- operative research programme connected withDanish antituberculosis campaign.

ANNEX 6 215

Place of Operation Progress Remarks

Chiefly in Denmark, alsoin Egypt, Mexico, andSouth India.

Approximately 44,000 school children tested andnon -reactors vaccinated in 27 projects. Retestingafter 6 -12 weeks completed in all projects ; one -yearretesting completed in 17 ; two -year retesting in 7.A monograph being prepared for publication.Plans to continue work in Denmark on reducedscale, and extension to other countries dependingon available facilities and future budget.

Field expenses paid by ITC in 1949 -51, and in 1952by a grant of $40,000 from UNICEF. Future worknecessarily limited unless extra -budgetary supportobtainable.

A special laboratory withinpremises of the DanishStatens Seruminstitut, Co-penhagen.

The committee of the Tuberculosis ImmunizationResearch Centre (TIRC) met in May and July 1952on matters of appointment of staff and commence-ment of work. Director of Centre (temporary) andassistant bacteriologist appointed. Newly construc-ted laboratory of 5 rooms and $20,000 equipmentready for use ; work expected to begin about1 October 1952.

Field studies on BCG have clearly shown need forbasic laboratory investigations. Since 1950 TROhas made repeated efforts to provide a researchlaboratory. Later offer by Danish National HealthService of the balance of Danish UNAC fund madeit possible to establish the Tuberculosis Immuniza-tion Research Centre (TIRC). Use of the UNACcontribution approved by the Secretary -Generalof the United Nations after consultation withUNICEF and WHO.

Madanapalle and 175 sur-rounding villages.

Approximately 42,000 persons tuberculin- testedand x- rayed, including BCG vaccination of 11,000.Retesting and x -ray re- examination of 10,000persons in 1951 -52. 185 tuberculosis patientsdiagnosed and treated. Basic information trans-ferred on to punch cards for individual identificationand annual follow -up. Analysis of material underway.

Madanapalle offers excellent facilities for long -termstudies of tuberculosis occurring under conditionsvery different from those prevailing in Europe andAmerica and for investigations of immediateproblems arising in connexion with mass BCGvaccination being carried on in India.

Country -wide, central officeat Reykjavik.

National roster developed to include informationon tuberculin sensitivity and x -ray findings for thepopulation by household grouping. Plans beingmade for follow -up of tuberculosis morbidityand mortality. Detailed records for many yearsbeing transferred on to punch cards.

Unusual insular nature of the country favourablefor follow -up with excellent facilities for completecoverage of tuberculosis control. Precipitousdecline in tuberculosis mortality in recent yearsdespite very little BCG vaccination.

Denmark, Egypt, Finland,Iceland, India, Mexico,Netherlands, Norway,United States of America.

In addition to children tested in connexion withvaccine studies, approximately 93,000 children andadults and 4,100 tuberculous patients were testedwith standard PPD ; many with duplicate tests usingvarying doses and different antigens.

Work of TRO has demonstrated urgent need forand importance of more precise information ontuberculin sensitivity in different parts of the world.Such data are basic for a rational application ofBCG vaccination and for international comparisonof tuberculin sensitivity as an index of tuberculosisinfection.

Copenhagen as centre, fieldvisits to other places inDenmark.

Increasing number of international and nationalofficials visit TRO for conferences and discussionson technical matters related to BCG vaccination.Requests for training of BCG personnel alsoincreasing. During past year 36 health officers from23 countries and 15 WHO staff members and Fellowshave spent from a day to 2 to 3 months in TRO.Currently, 2 doctors and 4 nurses are being trainedfor BCG work.

The WHO Tuberculosis Section programme ofsending more Fellows to Denmark and increasingrequests for training in TRO make it necessaryto expand this activity on an organized basis. Thiswould require an additional staff of one professionaland one administrative assistant to be providedbeyond present budget.


Annex 7[EB 11 /32]

15 December 1952

REPRESENTATION OF THE WORLD HEALTH ORGANIZATION AT MEETINGS

OF OTHER ORGANIZATIONS 1

The Fifth World Health Assembly, in its resolutionWHA5.67, requested the Executive Board to examinethe question of the representation of the WorldHealth Organization at meetings of other organi-zations in the light of the discussions at the FifthWorld Health Assembly.2 Information on the presentposition is given below, under four headings :

1. Constitutional and other formal provisions ;

2. Practical needs to be met, especially forliaison ;

3. Organizational and secretariat meetings atwhich representation is necessary ;

4. Steps taken for economy and efficiency.

1. Constitutional and Other Formal Provisions

Article 2 of the Constitution provides that " inorder to achieve its objective, the functions of theOrganization shall be :

(a) to act as the directing and co- ordinatingauthority on international health work ;(b) to establish and maintain effective collabo-ration with the United Nations, specializedagencies, governmental health administrations,professional groups and such other organizationsas may be deemed appropriate ;

(r) to assist in developing an informed publicopinion among all peoples on matters of health ".

There are also agreements, into which the Organi-zation has entered with the United Nations, thespecialized agencies, and some intergovernmentalorganizations, which contain provisions in regard torepresentation at meetings. The Agreement betweenthe United Nations and WHO,3 which follows the

1 See resolution EB11.R29.2 Off. Rec. World Hlth Org. 42, 180, 183, 186, 269, 2703 Handbook of Basic Documents, fifth edition, p. 91

same pattern as the Agreements between the UnitedNations and the other specialized agencies, providesin Article II that representatives of WHO shall beinvited to attend certain meetings of the UnitedNations bodies for purposes of consultation onmatters within the scope of its competence and toparticipate, without vote, in the deliberations ofthose bodies with respect to items on their agendarelating to health matters. Article XV of thatAgreement provides also, in paragraph 3(c), thatrepresentatives of the World Health Organizationshall be entitled to participate, without vote, in thedeliberations of the General Assembly or anycommittee thereof, at all times when the budget ofthe World Health Organization or general administra-tive or financial questions affecting the Organizationare under consideration.

The effect of these formal provisions is to place onthe World Health Organization an obligation to berepresented at any meetings of the bodies concernedwhere subjects affecting the work of the Organizationare discussed, in order to carry out its constitutionalresponsibilities and the undertakings embodied inthe agreements.

2. Practical Needs to be met

Since the Constitution and the agreements men-tioned in Section 1 were drawn up it has becomeprogressively clearer that the work_ of the UnitedNations and the specialized agencies cannot befully effective unless their several programmes areco- ordinated by arrangements for joint planning andsometimes for joint execution. Health, social andeconomic problems, for example, are closely inter-dependent. Other intergovernmental organizationsoutside the United Nations family are also interestedin health work directly or indirectly and the scope andamount of their work have greatly increased sincethe formal provisions mentioned above wereestablished. In particular the Expanded Programmeof Technical Assistance for Economic Development,

ANNEX 7 217

and the programmes of many bilateral agencies with thesame purpose of economic assistance, have produceda very considerable increase in the amount of workdone throughout the world for the improvementof health, and therefore in the work that has to bedone by WHO as the " directing and co- ordinatingauthority on international health work ". If theseresponsibilities are not effectively discharged therewill be overlapping in health work, misdirected effort,and waste of time, money and material and humanresources.

This is not a matter that concerns the World HealthOrganization only : the Economic and Social Counciland the General Assembly itself have passed reso-lutions on this question. The most important ofthese are perhaps resolution 324 (XI) of the Economicand Social Council on relations with and co-ordination of specialized agencies, and resolution413 (V) of the General Assembly on Concentrationof Effort and Resources. 4

The increased need for liaison has not only madeit more necessary for WHO to be represented atorganizational meetings of other agencies of theUnited Nations family, but has involved attendanceof WHO staff at the inter -secretariat meetings necessaryto give effect to these resolutions of the Economicand Social Council and of the General Assembly.The machinery which has been built up for imple-menting these resolutions is briefly described inSection 3.

From time to time, the Health Assembly or theExecutive Board requests the Director - General toco- operate in the development of joint programmesor in the preparation of conferences. Such co-operation often requires, among the several organi-zations concerned, exchange of ideas which cannot beeffected by correspondence only. Examples are foundin resolutions of the Executive Board relating to theco- ordinated international programme for rehabili-tation of physically handicapped persons, to co-ordination with the United Nations and specializedagencies on administrative and financial questions,and to the participation of the Organization in theWorld Population Conference or in the First WorldConference on Medical Education.

There is another kind of representation which ispartly in the nature of quasi -diplomatic courtesybetween organizations and partly necessary todischarge the responsibilities of the Organizationunder Article 2 (r) of the Constitution. The Director -General receives many special requests to representthe Organization, or to designate a representative,either to give a public address on behalf of the

4 Reproduced in Off. Rec. World Hlth Org. 32, 48

Organization or to take part in a specific debate.Examples can be found in the public addresses givenby the Directors - General of some specializedagencies at the opening meetings of conferences orassemblies of other specialized agencies. Anotherinstance is the instruction given by the ExecutiveBoard (resolution EB7.R21) to the Director - Generalto represent the Organization at the First Inter -American Congress on Public Health, held at Havana,Cuba, in 1952, to commemorate the fiftieth anniver-sary of the founding of the Pan American SanitaryBureau. In addition, WHO, together with UNESCOand ILO, was specially requested in 1952 to take partin the session of the Commission on Human Rightsdevoted to the establishment of draft covenants onhuman rights. The 1952 session of the Committeeon Information from Non - Self -Governing Territoriesrequired a considerable amount of work from WHOand involved representation at the meeting becausethe session was specially devoted to social and healthquestions.

The Director - General receives also in the courseof each year a great number of invitations fromthe United Nations or its component, subsidiaryor regional bodies, from the specialized agencies,from intergovernmental organizations outside theUnited Nations such as the Council of Europe,the South Pacific Commission, the InternationalCommittee of Military Medicine and Pharmacy, theCommission for Technical Co- operation in AfricaSouth of the Sahara ; from international non-governmental organizations either in formal rela-tions with WHO or not; and, lastly, from a consi-derable number of other bodies such as the AmericanPublic Health Association, the Plenary Assembliesof the World Federation of United Nations Associa-tions, and the International Scientific Committeefor Trypanosomiasis Research.

3. Meetings at which Representation is Necessary

Meetings of the following bodies are coveredby the constitutional and formal provisions referredto in Section 1 above and it is necessary that WHOshould be represented at them whenever healthquestions are being discussed :

(1) the United Nations General Assembly, parti-cularly for the Joint Second (economic) and Third(social) Committees and the Joint Second, Thirdand Fifth (administrative and budgetary) Com-mittees where the work of the specialized agenciesis discussed ;(2) the Economic and Social Council which,inter alia, examines and approves the reportsubmitted to it by WHO, and the Co- ordination


Committee of that Council, which considers withthe specialized agencies ways to improve co-ordination and concentration of effort in theUnited Nations family ;(3) the Technical Assistance Committee of theEconomic and Social Council, which reviews andmakes recommendations on the Technical Assis-tance programme in which the specialized agenciesparticipate ;(4) the United Nations Advisory Committeeon Administrative and Budgetary Questions, atwhich the administrative budget of WHO isreviewed for report to the General Assembly ;(5) the Executive Board and Programme Com-mittee of UNICEF, which participate in manyjoint projects with WHO ;(6) the joint expert committees with FAO andILO ;(7) certain other bodies such as the Social Com-mission and the Population Commission of theEconomic and Social Council, the TrusteeshipCouncil, and bodies dealing with the well -beingand development of peoples of non -self -governingterritories ;(8) the Inter -Agency Regional Co- ordinationCommittee on Migration in Latin America.These are meetings of governmental representa-

tives in which WHO is represented not as a memberof the body itself but in order to provide the meetingwith information and explanations on the work ofWHO.

There are also meetings set up by the Economicand Social Council and the organizations of theUnited Nations family for the purpose of co-ordinating and facilitating their work, in whichWHO takes part as a full member of the meeting andon equal terms with the other bodies represented.These are :

(1) the Administrative Committee on Co -ordi-nation, with its Preparatory Committee and variousworking groups which are set up from time totime to deal with specific matters requiring studyand recommendations -for example, long -rangeactivities for children ;(2) the Technical Assistance Board ;(3) the Consultative Committee on Administra-tive Questions ;(4) the International Civil Service AdvisoryBoard ;(5) the Working Party on Housing and BuildingMaterials of the Economic Commission for Asiaand the Far East ;

(These five bodies have been set up to give effectto the resolutions of the General Assembly and theEconomic and Social Council referred to inSection 2.)

(6) the United Nations Joint Staff PensionBoard. (WHO, as a member organization of theUnited Nations Joint Staff Pension Fund, isrepresented on the Board by three membersdesignated by the WHO Staff Pension Committee.)

4. Steps taken for Economy and Efficiency

Attendance at the meetings included in the firstlist in Section 3 is necessary for the efficient andeconomical conduct of the business of the Organi-zation and the practical point is how that represen-tation can be most economically secured. Thisquestion, as is suggested above, has been examinedby other organizations of the United Nations family.In particular the Advisory Committee on Administra-tive and Budgetary Questions examined the problemin the summer of 1952 and made the following com-ments, to which the Economic and Social Councilhas drawn the attention of all agencies :

The increasingly elaborate process required forthe purposes of inter -agency (including the UnitedNations) consultation in programme matters aswell as constant increase in the number of meetingsdealing with matters of concern to a number ofagencies have tended greatly to increase theexpenditure for travel by international officials.The Advisory Committee suggests that : (a) wheretravel is involved, " representation " should onlybe undertaken if the agenda of a meeting renderssuch representation essential ; (b) inter -secretariatconsultations which cannot be conducted by mailor cable should be held so far as possible throughand at the regular meetings of the ACC and itsPreparatory Committee ; (c) where a specialmeeting for the purpose of inter -agency consul-tation is necessary, it should, as far as possible, besynchronized with key meetings at which repre-sentatives of several agencies must in any case bepresent, for example, sessions of the GeneralAssembly, or the Economic and Social Council,or the agency conferences ; or with the meetingsof the commissions or other bodies dealing withthe particular subject at issue, e.g., statisticalconsultations between secretariats during sessionsof the Statistical Commission ; (d) representationof the United Nations and agencies should bereduced in numbers, possibly by assigning todelegates responsibility in more than one field ;

ANNEX 7 219

(e) the possibility of utilizing field staff locatednear the site of meetings should be carefullyconsidered in each instance.5

WHO has followed these recommendations asclosely as possible.

Meetings of the inter -secretariat bodies mentionedin the second list in Section 3 are normally arrangedso that they can be combined with other meetings.When they are held in New York, WHO is repre-sented by a member of the staff of the New YorkLiaison Office, unless the subject under discussion isof such importance that it requires the presence ofthe Director - General or of another senior memberof the headquarters staff.

When representation is necessary at a meeting ineither of the two groups mentioned in Section 3,ordinarily one staff member is designated to attendthe meeting. A second representative is designatedonly when the agenda of the meeting is of importanceto two or more quite different aspects of the workof the Organization. (This restriction does not neces-sarily apply to meetings held in Geneva, in NewYork, or at the seat of one of the regional offices,where travel is not involved.)

For the more specialized type of meeting referredto in the latter part of Section 2, the Director -General applies the following criteria to determinewhether WHO should be represented :

(1) the constitutional requirements mentionedabove ;(2) agreements with other organizations ;(3) the extent to which the agenda of the meetingconcerned is of importance to the programmeand budget or activities and administration of theOrganization ;(4) the financial outlay required.

5 See Appendix to ECOSOC resolution 451 (XIV).

A considerable number of invitations are refusedbecause they do not meet these criteria. In such acase the inviting body or authority may be asked tosend to the Director -General any report or documen-tation of the meeting.

In consultation with other specialized agenciesWHO has used, wherever possible, a procedure of" reciprocal representation " under which a memberof the secretariat of the agency holding the meetingis asked to watch the interests of WHO and its workduring the meeting, and for this purpose he is givena " brief " prepared in Geneva. This method ofrepresentation has been tried and is still in use, butits application is limited to questions of minorconcern to the Organization which can be adequatelydealt with in a " brief ".

Whenever opportunity offers, one journey is madeto meet as many different obligations as possible.The two most recent examples are : first, the visitof the Deputy Director - General to South Americain 1952, with which he combined representation ofWHO at the Economic and Social Council during thediscussion of the report of WHO and, on his returnjourney, attendance in place of the Director- Generalat the inaugural meeting of the Fourth Council ofthe World Assembly of Youth in Dakar ; secondly,the recent visit of the Director -General to NorthAmerica, during which he attended within a periodof one month the Administrative Committee onCo- ordination, the General Assembly of the UnitedNations, the annual meeting of the Regional Com-mittee for the Americas (together with the DirectingCouncil of PASB), and the First Inter -AmericanCongress on Public Health. He also attended andaddressed a meeting of the directors and staff ofthe International Bank for Reconstruction andDevelopment, and the annual meeting of the Ameri-can Public Health Association.


Annex 8

SCALE OF ASSESSMENTS 1

NOTE BY THE DIRECTOR- GENERAL

This document refers to the following resolutionsof the Fifth World Health Assembly :

(a) WHA5.57, which requested the ExecutiveBoard to study the present scale of assessmentsand report thereon to the Sixth World HealthAssembly ;

(b) WHA5.56, which requested the Board tostudy certain proposals received from the Republicof China and report thereon to the Sixth WorldHealth Assembly.

1. General Review of Present Scale of Assessments

1.1 After considering a request from the Union ofSouth Africa 2 that its assessment be reduced in orderto bring it into line with the assessment of thatGovernment by the United Nations, the Fifth WorldHealth Assembly, in its resolution WHA5.57,requested the Executive Board to study the scaleof assessments in the light of the decisions of theFirst and Third World Health Assemblies and toreport to the Sixth World Health Assembly.

1.2 The pertinent resolutions, or paragraphs ofresolutions, of previous Health Assemblies will befound on pages 181 -2 of the Handbook of Resolutionsand Decisions, first edition ([WHA1.88],3 WHA2.68,and WHA3.91, paragraphs 1 to 4).

1.3 As will be noted, the First World HealthAssembly decided that WHO should assess itsMembers for 1948 and 1949 " according to thecriteria used by the United Nations in assessing itsMembers for the year 1948 ", and the Third WorldHealth Assembly, in resolution WHA3.91, recognizedthat the assessments were made " in accordance withprinciples similar to those on which the contributionsof Members of the United Nations are based... ".

1 See resolutions EB11.R30 and EB11.R34.2 See Of Rec. World Hlth Org. 42, 425.3 Of Rec. World Hlth Org. 13, 316

[EBI 1 /4]22 December 1952

Attention is invited to the fact that some of thevariations revealed by the comparative statement(Appendix 1 to this annex) are due to adjustmentsmade by the United Nations in its scale of assess-ments since the WHO scale was adopted by the FirstWorld Health Assembly.

L4 While WHO has endeavoured to use similardata and criteria, it is extremely difficult to make anydirect comparison with the assessments of the UnitedNations for the following reasons :

(a) the difference in the percentage paid by thelargest contributor ;

(b) the difference in membership ;

(c) the application of the per capita provisionof the WHO assessment resolutions, which, bylimiting the per capita contribution of any countryto the per capita contribution of the Membermaking the highest contribution, provides areduction to certain Members from the amountof their full assessment, and to this extent altersthe basic assessment.

Taking into consideration these difficulties, theDirector- General believes that the best comparisonwould be one between the WHO 1953 assessmentsexpressed in percentages and the United Nations1953 scale adjusted to provide for (a) the assessmentof the United States of America at the same level asin WHO (33 1/3 per cent), and (b) the adjustment ofcertain other Members' United Nations assessmentsby applying the per capita provisions of the WHOresolutions. A statement showing such a comparisonis given as Appendix 1.

1.5 The resolution of the General Assemblyconcerning the United Nations scale of assessmentsfor 1953 will be found in Appendix 2. It should benoted that in 1954 the assessment of the largestcontributor will be reduced to one -third of the totalassessments. In this important respect the UnitedNations scale for 1954 will be the same as the present

ANNEX 8 221

WHO scale. It should also be noted that the UnitedNations Committee on Contributions will reviewthe United Nations scale in 1953 and submit areport to the General Assembly at its next regularsession. The Director - General feels that this reportwould be of value to the Board in making its studyof the WHO scale, and further that it would bedesirable to have the 1954 United Nations scale forpurposes of comparison since, as stated above, theassessment of the largest contributor will be thesame as the present WHO scale.

1.6 In view of these circumstances, the Director -General recommends that the review of the scaleof assessments for WHO be postponed for anotheryear and that it be studied at the thirteenth sessionof the Board, at which time the above informationshould be available. Should the Board consider itdesirable, a recommendation could be made to theSixth World Health Assembly that the Director -General submit the present WHO scale of assessmentsto the United Nations Committee on Contributionsfor their recommendations and advice in accordancewith General Assembly resolution 311 B (IV),such advice and recommendations to be madeavailable to the Board.

2. Assessment of China

2.1 The Director- General received a communica-tion from the Republic of China regarding therenewal of active participation by China in theOrganization. This communication was transmittedto the Fifth World Health Assembly by the Director -General.4

2.2 The delegation of the Philippine Governmentto the Fifth World Health Assembly submitted tothe Committee on Administration, Finance and LegalMatters a proposal which would allow China toresume active participation, and outlined one methodof dealing with the assessment of China and otherrelated financial matters (see Appendix 3 to thisannex).

2.3 Another method which might be followed forthe year 1954, and until such time as the financialcondition of China improves, would be :

(a) that the assessment of China be fixed at14 units for 1954 ;

I Off. Rec. World Hlth Org. 42, 424

(b) that the revised assessment of China beincluded in the assessments of active Members ;

(c) that the Organization accept the offer byChina to make a token payment of US $15,000to be applied against present arrears, and that thisamount be credited to the assessment for 1948.

2.4 To illustrate the effect of the proposal containedin paragraph 2.3 (a) and (b) above, this note includes(Appendix 4) a statement giving the followinginformation

(a) assessments on all Members for 1952 ;

(b) assessments on all Members for 1953 ;

(c) assessments on all Members for 1954 (basedon the Director- General's proposed budget) withno change in the present scale of assessments ;

(d) assessments on all Members for 1954 (basedon the Director -General's proposed budget)showing the effect of removing China from theinactive Members (cancellation of present assess-ment) and reassessment of China as an activeMember at 14 units.

2.5 Should the Executive Board decide to recom-mend that the Sixth World Health Assembly adoptthe proposal of the Government of China, it will benecessary, in addition to dealing with the specificadjustments in the assessment of China, to includerecommendations dealing with certain other relatedfactors.

2.6 Financial Regulation 5.6 reads : " Paymentsmade by a Member State shall be credited firstto the Working Capital Fund and then to the con-tributions due in the order in which the Member wasassessed. " It would therefore be necessary for theBoard to recommend setting aside the provisions ofthis Regulation in order that the payment made byChina in respect of its assessment for 1954 could becredited to 1954 income.

2.7 Should the Board recommend the acceptanceof the token payment of $15,000 offered by China,this payment would under the terms of the aboveRegulation be applied to the Working CapitalFund. However, if the payment could instead beapplied against the 1948 arrears, it would thenrepresent a surplus and be placed in the AssemblySuspense Account. This sum could then be used by


the Health Assembly to help finance future budgetsor for any other purpose voted by the Assembly.The Board may wish to recommend the setting asideof the provisions of the above Regulation in orderthat the token payment can be placed in the AssemblySuspense Account.

2.8 There would then remain the problem of thearrears of China for the years before 1954. The Boardmight wish to recommend the acceptance of theproposal made by the Government of China thatthese arrears should be the subject of future arrange-ments when its financial condition improves.

Appendix 1

COMPARISON BETWEEN THE WHO AND UNITED NATIONS SCALES OF ASSESSMENTS

The following statement shows the comparison in percentage between :

(1) the United Nations scale of assessments for 1953 ;

(2) the United Nations scale adjusted to provide for a reduction of the assessments of the United States of America to 331/3per cent and the application of the per capita provisions of the WHO assessment resolutions ;

(3) the WHO net assessments for 1953 in percentages. These are the actual assessments after the various increases and decreaseshave been effected in accordance with the per capita provisions of WHO's assessment resolutions ;

(4) the WHO assessments for 1953 in units.

Countries UN Scalefor 1953

UN Scaleadjusted

WHO Assessmentsfor 1953

in percentages in units

(1) (2) (3) (4)

A. Active Members of WHO

Afghanistan 0.08 0.08 0.05 6

Argentina 1.45 1.51 1.73 222Australia 1.75 1.77 1.77 236Austria - - 0.13 17Belgium 1.37 1.42 1.26 162Bolivia 0.06 0.06 0.08 10Brazil 1.45 1.51 1.73 222Burma 0.13 0.14 0.05 6Cambodia - - 0.04 5

Canada 3.30 3.03 2.99 384Ceylon - - 0.04 5

Chile 0.33 0.34 0.42 54Colombia5 0.35 0.36 - -Costa Rica 0.04 0.04 0.04 5

Cuba 0.34 0.35 0.27 35Denmark 0.78 0.81 0.74 95Dominican Republic 0.05 0.05 0.05 6

Ecuador 0.04 0.04 0.05 6

Egypt 0.50 0.52 0.74 95El Salvador 0.05 0.05 0.05 6

Ethiopia 0.10 0.10 0.08 10Finland - - 0.13 17France 5.75 5.97 5.61 720Germany, Federal Republic of . . . - - 3.02 387

5 Non - Member of WHO

ANNEX 8 223


UN Scaleadjusted



A. Active Members of WHO (continued)(1) (2) (3) (4)

Greece 0.19 0.20 0.16 20Guatemala 0.06 0.06 0.05 6

Haiti 0.04 0.04 0.04 5

Honduras 0.04 0.04 0.04 5

Iceland 0.04 0.04 0.04 5

India 3.45 3.59 3.04 390Indonesia 0.60 0.63 0.31 40Iran 0.33 0.34 0.42 54Iraq 0.12 0.12 0.16 20Ireland - - 0.33 43Israel 0.17 0.18 0.11 14

Italy - - 1.96 252Japan - - 1.67 214Jordan, Hashemite Kingdom of the . - - 0.04 5

Korea - - 0.04 5

Laos - - 0.04 5

Lebanon 0.05 0.05 0.06 7

Liberia 0.04 0.04 0.04 5

Libya, United Kingdom of - - 0.04 5

Luxembourg 0.05 0.05 0.05 6

Mexico 0.70 0.73 0.59 76

Monaco - - 0.04 5

Morocco (French Protectorate) s. . - - 0.02 3

Netherlands 1.25 1.29 1.31 168New Zealand 0.48 0.42 0.42 60Nicaragua 0.04 0.04 0.04 5

Norway 0.50 0.52 0.47 60Pakistan 0.79 0.82 0.65 84Panama 0.05 0.05 0.05 6

Paraguay 0.04 0.04 0.04 5

Peru 0.18 0.19 0.19 24Philippines 0.39 0.41 0.27 35Portugal - - 0.37 47Saudi Arabia 0.07 0.07 0.08 10

Southern Rhodesia 6 - - 0.02 3

Spain - - 1.03 132Sweden 1.65 1.55 1.55 245Switzerland - - 0.94 120Syria 0.08 0.08 0.11 14

Thailand 0.18 0.19 0.25 32Tunisia 6 - - 0.02 3

Turkey 0.65 0.68 0.85 109

Union of South Africa 0.83 0.86 1.04 134

United Kingdom of Great Britain andNorthern Ireland 10.30 10.68 10.74 1,378

United States of America 35.12 33.33 33.33 4,306Uruguay 0.18 0.19 0.17 22Venezuela 0.35 0.36 0.25 32

Viet Nam - - 0.19 25

Yemen 7 0.04 0.04 - -Yugoslavia 0.44 0.46 0.31 40

Total A 77.41 76.54 85.05 11,000

6 Associate Member of WHO7 Non - Member of WHO



UN Scaleadjusted



(1) (2) (3) (4)

B. Inactive Members of WHOAlbania - - 0.04 5

Bulgaria - - 0.13 17Byelorussian SSR 0.43 0.45 0.20 26China 5.62 5.84 5.61 720Czechoslovakia 1.05 1.09 0.84 108Hungary - - 0.19 24Poland 1.58 1.64 0.89 114Roumania - - 0.33 42Ukrainian SSR 1.63 1.70 0.79 101

Union of Soviet Socialist Republics . 12.28 12.74 5.93 761

Total B 22.59 23.46 14.95 1,918

Grand Total 100.00 100.00 100.00 12,918

Appendix 2

SCALE OF ASSESSMENTS FOR THE APPORTIONMENT OF THE EXPENSES OF THE UNITED NATIONS :

REPORT OF THE COMMITTEE ON CONTRIBUTIONS S

The General Assembly,

Having considered the recommendations of the Committeeon Contributions concerning the proposed adjustments inthe scale of assessments for the financial year 1953,

Notes with satisfaction the action taken by the Committeeon Contributions to implement the recommendations ofGeneral Assembly resolution 582 (VI) by giving additionalrecognition to countries with low per capita income, andurges the Committee to continue to do so in the future ;

Instructs the Committee on Contributions to defer furtheraction on the per capita ceiling until new Members are admittedor substantial improvement in the economic capacity ofexisting Members permits the adjustments to be graduallyabsorbed in the scale ;

Decides that from 1 January 1954 the assessment of thelargest contributor shall not exceed one -third of total assess-ments against Members ;

Resolves

1. That the scale of assessments for the 1953 budget shallbe as follows :

8 UN document A/2286

SCALE OF ASSESSMENTS FOR 1953

Country Per centAfghanistan 0.08Argentina 1.45Australia 1.37Belgium 1.37Bolivia 0.06Brazil 1.45Burma 0.13Byelorussian Soviet Socialist Republic 0.43Canada 3.30Chile 0.33China 0.35Colombia 0.35Costa Rica 0.04Cuba 0.34Czechoslovakia 1.05Denmark 0.78Dominican Republic 0.05Ecuador 0.04Egypt 0.50El Salvador 0.05Ethiopia 0.10France 5.75Greece 0.19Guatemala 0.06Haiti 0.04

ANNEX 8 225

Country Per cent .

Honduras 0.04Iceland 0.04India 3.45Indonesia 0.60Iran 0.33Iraq 0.12Israel 0.17Lebanon 0.05Liberia 0.04Luxembourg 0.05Mexico 0.70Netherlands 1.25New Zealand 0.48Nicaragua 0.04Norway 0.50Pakistan 0.79Panama 0.05Paraguay 0.04Peru 0.18Philippines 0.39Poland 1.58Saudi Arabia 0.07Sweden 1.65Syria 0.08Thailand 0.18Turkey 0.65Ukrainian Soviet Socialist Republic 1.63Union of South Africa 0.83Union of Soviet Socialist Republics 12:28United Kingdom of Great Britain and Northern

Ireland 10.30United States of America 35.12Uruguay 0.18Venezuela 0.35Yemen 0.04Yugoslavia 0.44

100.00

2. That, notwithstanding the provisions of rule 159 of therules of procedure of the General Assembly, the scale ofassessments for the apportionment of the expenses of theUnited Nations shall be reviewed by the Committee on

Contributions in 1953 and a report submitted for the conside-ration of the General Assembly at its next regular session ;

3. That, notwithstanding the terms of financial regulation 5.5,the Secretary- General shall be empowered to accept, at hisdiscretion, and after consultation with the Chairman of theCommittee on Contributions, a portion of the contributionsof Member States for the financial year 1953 in currenciesother than United States dollars ;4. That Switzerland shall contribute 1.50 per cent and thePrincipality of Liechtenstein 0.04 per cent of the expenses ofthe International Court of Justice for the year 1953, theseassessments having been established after consultation withthe respective Governments, in accordance with the terms ofGeneral Assembly resolutions 91 (I) of 11 December 1946and 363 (IV) of 1 December 1949 ;

5. That non -member States which are signatories of interna-tional instruments relating to narcotic drugs shall be calledupon to make contributions towards the annual expenses,commencing with the year 1952, resulting from obligationsplaced on the United Nations by those instruments, in accor-dance with the following rates :

Country Per centAlbania 0.04Austria 0.31Bulgaria 0.19Cambodia 0.04Ceylon 0.13Finland 0.42Federal Republic of Germany 4.22Hashemite Kingdom of Jordan 0.04Hungary 0.48Ireland 0.34Italy 2.20Japan 1.90Laos 0.04Liechtenstein 0.04Monaco 0.04Portugal 0.30Roumania 0.50San Marino 0.04Switzerland 1.26Viet Nam 0.17

Appendix 3

PROPOSAL BY THE DELEGATION OF THE PHILIPPINES TO THE FIFTH WORLD HEALTH ASSEMBLY

The delegation of the Philippines proposes that theCommittee on Administration, Finance and Legal Mattersrecommend the following resolution for adoption by theFifth World Health Assembly ;

The Fifth World Health Assembly,Pursuant to Rule 105 9 of the Rules of Procedure of the

Health Assembly,

SUSPENDS Rule 79 (e),10 of the Rules of Procedure, inorder to consider a proposal from the Republic of Chinaregarding its assessments for 1953.

Subject to the adoption of the above resolution, it is alsoproposed that the Committee on Administration, Finance andLegal Matters recommend the following resolution foradoption by the Fifth World Health Assembly :

° Rule 110 in the Handbook of Basic Documents, fifth 1° Rule 84 (e) in the Handbook of Basic Documents, fifthedition edition


The Fifth World Health Assembly,

I. Having considered a communication from the Republicof China containing proposals which would enable Chinato resume active participation in the Organization,

WELCOMES the return of China to active participation.

II. Taking into account the present situation of the Repub-lic of China, which makes it difficult for that Governmentto fulfil at this time its total financial obligations to theWorld Health Organization,

1. RESOLVES

(1) that for the purpose of establishing the scale ofassessments for 1953 the assessment of China shallremain at 720 units ;(2) that an extraordinary reduced contribution fromChina for 1953 in the amount equivalent to 14 units beaccepted as full payment of the assessment of Chinafor 1953;(3) that, notwithstanding the provisions of FinancialRegulation 5.6, the payment by China of this amount for

1953 shall be credited to the budget year 1953 ratherthan to the arrears of earlier years ;

(4) that the Director - General be authorized to effect anappropriate adjustment in the accounts of the Organiza-tion to reduce the obligations of China for the year 1953from the normal assessment of 720 units to the extra-ordinary reduced assessment of 14 units ;

(5) to request the Executive Board to consider thismatter with respect to 1954 and future years to the extentpracticable and to submit its recommendations to theSixth World Health Assembly ; and

2. DECIDES

(1) to accept the token payment of $15,000 to be appliedto the arrears due to the Organization ;(2) that, notwithstanding the provisions of FinancialRegulation 5.6, this payment shall be credited to theassessment of 1948 ;(3) that the balance of the arrears of China for the yearsprior to 1953 shall be subject to future arrangementswhen its financial condition improves.

Appendix 4

ASSESSMENTS FOR 1952, 1953 AND 1954

The following table shows the assessments for 1952 and 1953 and those which would result for 1954 if a total assessmentfigure (on full membership) were adopted of :

(A) $9,080,000 (effective working budget $8,572,202) ;

(B) $8,618,845 (effective working budget $8,472,202) -China being removed from the group of inactive Members (cancella-tion of China's assessment of 720 units), and reassessed as an active Member at 14 units.

Member States

Assessment

1952 1953 1954

(A) (B)

A. Active Members US $ US $ US $ US $

Afghanistan 4,359 4,201 4,247 4,491Argentina 161,336 155,432 157,159 166,155Australia 152,003 158,723 160,486 152,336Austria 12,355 11,903 12,035 12,724Belgium 117,731 113,423 144,684 121,249Bolivia 7,267 7,002 7,079 7,485Brazil 161,336 155,432 157,159 166,155.Burma 4,359 4,201 4,247 4,491Cambodia 3,634 3,501 3,539 3,742Canada 260,299 268,854 271,843 260,869Ceylon 3,634 3,501 3,539 3,742Chile 39,244 37,807 38,229 40,416China - - - 10,479

ANNEX 8 227

Member States

Assessment

1952 1953 1954

A. Active Members (continued) US $ US $(A)

US $B)

US $

Costa Rica 3,634 3,501 3,539 3,742Cuba 25,436 24,505 24,777 26,196Denmark 69,039 66,513 67,253 71,103Dominican Republic 4,359 4,201 4,247 4,491Ecuador 4,359 4,201 4,247 4,491Egypt 69,039 66,513 67,253 71,103El Salvador 4,359 4,201 4,247 4,491Ethiopia 7,267 7,002 7,079 7,485Finland 12,355 11,903 12,035 12,724France 523,250 504,102 509,705 538,883Germany, Federal Republic of . . (275,285)'1 270,955 273,967 289,650Greece 14,535 14,002 14,159 14,969Guatemala 4,359 4,201 4,247 4,491Haiti 3,634 3,501 3,539 3,742Honduras 3,634 3,501 3,539 3,742Iceland 3,557 3,476 3,514 3,634India 283,427 273,055 276,090 291,895Indonesia 29,069 28,006 28,317 29,938Iran 39,244 37,807 38,229 40,416Iraq 14,535 14,002 14,159 14,969Ireland 31,249 30,106 30,441 32,183Israel 10,175 9,802 9,911 10,479Italy 183,138 176,436 178,397 188,610Japan 139,534 149,830 151,496 160,168Jordan, Hashemite Kingdom of the 3,634 3,501 3,539 3,742Korea 3,634 3,501 3,539 3,742Laos 3,634 3,501 3,539 3,742Lebanon 5,087 4,901 4,955 5,239Liberia 3,634 3,501 3,539 3,742Libya, United Kingdom of (3,557)11 3,501 3,539 3,742Luxembourg 4,359 4,201 4,247 4,491Mexico 55,232 53,211 53,802 56,882Monaco 3,557 3,476 3,514 3,634Morocco (French Protectorate) 12 . (2,134)11 2,101 2,124 2,245Netherlands 122,092 117,623 118,931 125,739New Zealand 36,137 37,735 38,154 36,216Nicaragua 3,634 3,501 3,539 3,742Norway 43,604 42,008 42,476 44,907Pakistan 61,046 58,812 59,465 62,869Panama 4,359 4,201 4,247 4,491Paraguay 3,634 3,501 3,539 3,742Peru 17,442 16,803 16,991 17,963Philippines 25,436 24,505 24,777 26,196Portugal 34,157 32,907 33,272 35,177Saudi Arabia 7,267 7,002 7,079 7,485Southern Rhodesia 12 2,180 2,101 2,124 2,245Spain (93,896)11 92,418 93,446 98,795Sweden 133,675 139,544 141,095 133,929Switzerland 87,209 84,017 84,951 89,337Syria 10,175 9,802 9,911 10,479Thailand 23,256 22,404 22,654 23,951Tunisia 12 (2,134)11 2,101 2,124 2,245

11 The assessments on new Members joining in 1952 (after the date of conclusion of theFourth World Health Assembly) are shown in parenthesis and are not included in the total of$8,600,000. These amounts are available for appropriation for financing the 1954 budget.

12 Associate Member


Member States

Assessment

1952 1953 1954

A. Active Members (continued) US $ US $ U$S úsá$

Turkey 79,214 76,315 77,164 81,581Union of South Africa 97,382 93,819 94,862 100,292United Kingdom of Great Britain and

Northern Ireland 967,556 964,796 975,519 969,677United States of America 2,866,667 2,993,400 3,026,667 2,872,948Uruguay 15,988 15,403 15,575 16,466Venezuela 23,256 22,404 22,654 23,951Viet Nam 18,168 17,504 17,699 18,711Yugoslavia 29,069 28,006 28,317 29,938

Total A 7,206,118 7,637,329 7,722,202 7,722,202

B. Inactive Members

Albania 3,634 3,501 3,539 3,742Bulgaria 12,355 11,903 12,035 12,724Byelorussian SSR 18,896 18,203 18,406 19,459China 523,250 504,102 509,705 -Czechoslovakia 78,488 75,615 76,456 80,833Hungary 17,442 16,803 16,991 17,963Poland 82,848 79,816 80,703 85,324Roumania 30,523 29,406 29,733 31,435Ukrainian SSR 73,401 70,714 71,501 75,593Union of Soviet Socialist Republics . 553,045 532,808 538,729 569,570

Total B 1,393,882 1,342,871 1,357,798 896,643

Grand Total 8,600,000 8,980,200 9,080,000 8,618,845

ANNEX 9 229

Annex 9

SCALE OF ASSESSMENTS : WORKING CAPITAL FUND 1

NOTE BY DR. MELVILLE MACKENZIE

1. The Working Capital Fund was established bythe First World Health Assembly and the followingresolutions relating to assessments thereto have beenad opted.

(i) The First World Health Assembly resolvedthat " Members shall make advances to theWorking Capital Fund in accordance with thescale adopted by the Health Assembly for con-tributions of Members to the budgets of the WorldHealth Organization for the financial years 1948-1949." ([WHA1.93] 2)

(ii) The Second World Health Assembly decidedthat " notwithstanding the amount establishedfrom time to time by the Health Assembly asthe size of the Working Capital Fund, a newMember of the Organization shall, upon itsmembership becoming effective, contribute to theWorking Capital Fund an amount equal to thatwhich it would have been required to contributehad it been a Member of the Organization fromits inception " (resolution WHA2.57).

2. The foregoing resolutions appear to envisage,and provide for, a uniform method of assessment inrespect of contributions to the Working CapitalFund, on the basis of the original budget assessments.The records of the Fund as it now stands show,however, that there is considerable difference in thecontribution assessment in a number of cases.These anomalies arise from the decision of the FirstWorld Health Assembly 2 to transfer to the WorkingCapital Fund the amount of $866,463, representingthe surplus of the 1948 budget appropriation, andthe subsequent decision of the Fourth World HealthAssembly transferring this sum from the WorkingCapital Fund to the Assembly Suspense Account(resolution WHA4.40). Some examples of theexisting differences in the Working Capital Fundassessments are given below :

See resolution EB11.R30.2 Of Rec. World Hlth Org. 13, 318

[EB11 /48]22 December 1952

Member orAssociate Member

BudgetAssessment

Units

WorkingCapital FundAssessment

US $

Cambodia 5 1,602Ceylon 5 1,255Indonesia 40 12,813Yugoslavia 40 10,038Morocco (French Protecto-

rate) 3 757Southern Rhodesia . 3 961

3. The present position is clearly unsatisfactory, andit is suggested that the Executive Board should nowreview the matter with a view to :

(a) bringing all Working Capital Fund assessmentsto a uniform level according to the respectiveunit assessments of Members and AssociateMembers for budgetary purposes ;

(b) adjusting the total amount of the WorkingCapital Fund accordingly ; and

(c) providing a uniform method of assessing newMembers and Associate Members in respect oftheir contributions to the Working Capital Fund.

4. The following comments and proposals areaccordingly submitted for the Board's consideration :

(a) that uniform assessments to the WorkingCapital Fund, on the basis of budgetary unitassessments, was the aim of the resolutions adoptedby the First and Second World Health Assemblies,and that that principle should be maintained ;

(b) that the decision of the Fourth World HealthAssembly to transfer from the Working CapitalFund to the Assembly Suspense Account the1948 budget surplus of $866,463 has resulted inanomalies in the Working Capital Fund con-tributions in certain cases, which should be adjustedas soon as possible ;

(c) that the revision and adjustments should beeffected on the following basis :

2 30 EXECUTIVE BOARD, ELEVENTH SESSION

(i) All existing contributions and assessmentsfor the Working Capital Fund to be revisedon the basis of $250 per budgetary unit assess-ment, subject to the assessment for the UnitedStates of America remaining at 4,787 units,the unit assessment fixed in respect of thatMember for the budgets of 1948 and 1949.(ii) All new Members and Associate Membersto be assessed for contributions to the WorkingCapital Fund on the basis of their substantivebudget unit assessment, at the rate of $250 perunit, or such other rate as may then be applicable,

Working Capital Fund (as at 22 May 1952)Active MembersInactive Members

Total unit assessments for 1953 budgetActive MembersInactive Members

in respect of Working Capital Fund contribu-tions.

(iii) The cash surpluses resulting from therevised Working Capital Fund assessments tobe set off against each Member's and AssociateMember's budget contribution assessment for1954.

5. The adoption of the foregoing proposals wouldsecure the desired uniformity and, on the presentstate of the Fund, the following revised positionwould result :

$2,900,232$ 481,354

$11,000$ 1,918

Deduct Unit assessment of United States of America for 1953. .

Balance :

Add Unit assessment of United States of America for 1948 and 1949

Total :

12,918 units

4,306 units

8,612 units

4,787 units

13,399 ° units

US S

3,381,586

13,399 units at $250 per unit 3,349,750 bActive Members $2,870,250Inactive Members $ 479,500

Difference between totals (1) and (5) 31,836 C

Active Members $29,982Inactive Members $ 1,854

a Representing total units for calculating Working Capital Fund assessmentsb Representing revised total of Working Capital Fundc Representing distributable surplus

Annex 10[EB 11 /461

22 December 1952

TRANSFERS BETWEEN SECTIONS OF THE APPROPRIATION RESOLUTION FOR 19521

Subsequent to the adoption by the Fourth WorldHealth Assembly of the Appropriation Resolutionfor 1952 (resolution WHA4.73), the Executive Boardat its tenth session adopted a resolution (EB10.R9)authorizing the Director -General to transfer, where

' See resolution EB11.R35.

appropriate, credits between sections of the 1952Appropriation Resolution provided that he obtainedthe prior written concurrence of the majority of themembers of the Board, and requesting him to submita report on all such transfers and the circumstancesrelating thereto to the eleventh session of the Board.

ANNEX 10 231

The Director -General invited the attention of theBoard at its tenth session to the anticipated defi-ciencies in Sections 3 and 6 and, in accordance withthe Board's instructions, communicated to theindividual members in August 1952 a request fortheir approval of the following transfers fromsections where savings were available :

(a) $15,000 to Appropriation Section 3

(b) $25,000 to Appropriation Section 6

(c) $15,000 to Appropriation Section 8

These increases were effected by decreasing Appro-priation Section 5 in the amount of $55,000. Sixteenmembers of the Board concurred in this requestwhereas no replies were received from the remainingtwo.

An explanation of the circumstances relating to thedeficiencies in Appropriation Sections 3, 6 and 8 wasgiven at the time and is summarized below :

Appropriation Section 3

The estimates under this section for regionalcommittee meetings in 1952 proved insufficientto cover the costs, owing to the fact that the locationsof individual meetings were not known at the timethe estimates were prepared. The decision to holdmeetings away from regional headquarters in theRegion of the Americas and the South -East Asia,Western Pacific and European Regions resulted inincreased requirements for travel. It was also ex-pected that the Regional Office for Africa would havebeen located in Brazzaville prior to the meeting ofthe Regional Committee, but, as this was not thecase, the meeting in Monrovia had to be servicedfrom headquarters.


In the early part of 1952, certain upward cost -of-living adjustments for internationally recruitedstaff were established in agreement with the UnitedNations and other specialized agencies. In additioncertain local salary scales were revised. As a result,

the salary costs of regional office personnel increasedconsiderably. A transfer of $25,000 requested forthis purpose was expected to be the maximum amountrequired and, as certain economies have beeneffected under other expenditure headings in theregional offices, the whole amount transferred wasnot utilized.


Certain provisions in the estimates for administra-tive services proved inadequate, necessitating atransfer to this section. The additional provisionswere necessitated by the following :

(1) Upward revision of the salary scales of locally -recruited staff at headquarters and at the New YorkLiaison Office.

(2) The curtailment of the facilities made availableto WHO by the United Nations for the developing,printing and enlargement of photographs, forwhich provision had been made, necessitated thepurchase of additional photographic laboratoryequipment to cover this activity. Although thisinvolved additional cost to the Organization in1952, it proved more economical than the alterna-tive of .processing the work through commercialchannels.

(3) Although a small provision had been madefor the costs of normal staff movements at head-quarters during 1952, this was not sufficient tocover the costs of staff movements occasioned bythe redistribution of space in the Palais des Nations,originally planned to take place in 1951 but delayedbecause the new building was not completed.

(4) The estimates for services rendered to WHOby the United Nations, although providing fornormal increases, were insufficient to cover thecost of mailing, mimeographing and distributionservices chargeable to this section. This resultedmainly from an increase in the quantity of workundertaken by the United Nations on behalf ofthe Organization and from certain adjustments inthe 1951 rates on which the estimates were based.


Annex 11[EB11/35]

16 December 1952

AMENDMENTS TO STAFF RULES

The following amendments to the Staff Rules, submitted to the Executive Board bythe Director -General in accordance with the provisions of Staff Regulation 12.2, wereconfirmed by the Executive Board in resolution EB11.R39.

New text Previous text

750 EXTRA COMPENSATION

Staff members officially required to assume tempo-rarily the responsibilities of a vacant established post temporarily assigned to posts of higher grades.of higher grade than that which they normally occupymay be granted extra pay as from the beginning of thefourth consecutive month of such service. The amountof this extra pay will not exceed the difference betweenthe staff member's current salary and the salary hewould receive ifpromoted to the post of higher grade.

Extra cash payments may be made to staff members

Reasons for change. The old rule was so general as to invite claims from staff members under widely varyingcircumstances. The old rule has been applied by the Director - General only in the circumstances described inthe new rule and it therefore seemed preferable to make the rule itself quite specific.

953 EXTENDED ILLNESS

953.1 Staff members incapacitated for work beyond26 calendar weeks as a result of accident orillness covered by the Organization's accidentand sickness insurance policy will have suchabsence after the 26th week charged to specialleave without pay for a period not exceeding26 calendar weeks. Staff members on suchleave will receive the salary benefits payableunder the insurance policy, subject to deductionof their contribution to the Staff Pension Fund.

Staff members incapacitated for work beyond30 days as a result of accident or illness covered by theOrganization's accident and health insurance policy,may elect to have such absence after the 30th daycharged either to sick and annual leave, to the extentthat such leave is accrued or advanced, or to leavewithout pay for a period not exceeding 52 weeks.Staff members on a leavewithout -pay basis, by suchelection will receive insurance benefits, but noallowances.

Reasons for change. The Organization's accident and health insurance policy originally provided a guaranteeof the staff member's full salary during periods of incapacity after the first 30 days and up to 52 weeks. It wasfound that a very considerable part of the premium for the policy (about one -third) resulted from the first26 weeks of this salary guarantee and that the Organization was also giving protection, through its sick leaveprovisions, for about the same period. It seemed preferable therefore to reduce the insurance cover and under-take this risk directly through the sick leave provisions.

ANNEX 12 233

1100 ALLOWANCES BY WAY OF COMPENSATION OR ASSISTANCE

New text (No previous text)1105 As from 1 December 1952 all staff members at

Geneva appointed or in service for six monthsor more shall, subject to the rules of the ILOStaff Sickness Insurance Fund, become membersof that Fund. Staff not eligible to enter theILO Sickness Insurance Fund shall have theprotection against medical expenses providedby the Organization's accident and sicknessinsurance policy. All staff shall have theprotection of this policy with respect todeath and disability benefits.

Reasons for change. The first sentence of this new rule provides for participation by the staff in the ILOStaff Sickness Insurance Fund. At the moment such participation is limited to the staff in Geneva, but inprinciple staff at other duty stations can be granted participation at a later date, subject to certain conditionsstipulated by the Fund.

The Fund covers medical and hospital expenses for staff members, and hospital expenses for dependants.Its provisions for payment of such expenses were considered by the staff in Geneva to be preferable to those ofthe Organization's accident and sickness insurance policy and cost the same. Therefore the Director - Generalagreed to the participation of the Geneva staff in the Fund, and the insurance policy has been amended toexclude such staff from the medical expense provisions of the policy.

Field staff remain fully covered by the commercial insurance policy and all staff remain covered by thepolicy with respect to indemnities for death and temporary or permanent disability.

There is no additional cost to the Organization from this change but it has been necessary to deposit withthe ILO Staff Sickness Insurance Fund, in accordance with the rules of the Fund, a sum of 100 Swiss francs perstaff member in Geneva as a reserve to insure the stability of the Fund.

Annex 12[EB11 /41]

18 December 1952

REPORT ON DISTRIBUTION AND SALE OF WHO PUBLICATIONS 1

The Executive Board agreed at its seventh session that WHO publications should be the subject of oneof the major studies of its Standing Committee on Administration and Finance. This action was endorsed bythe Fourth World Health Assembly (resolution WHA4.55).

In the course of its study, the Standing Committee and the Board at its ninth session considered a " Reporton WHO Publications " 2 submitted by the Director - General, " Publications : Notes submitted by the Director -General ",2 and " WHO Publications Programme : Note submitted by the French Government ".4

1 See resolutions EB11.R42 and EB11.R43.2 Off. Rec. World Huth Org. 40, 932 Unpublished working document4 Off. Rec. World Hlth Org. 40, 109


The Fifth World Health Assembly considered the report of the Executive Board on publications 8 andrequested " the Director -General and the Executive Board to continue their studies on the free distributionand sale of WHO publications, wherever possible in consultation with the United Nations and other specializedagencies " (resolution WHA5.24).

The present report was submitted by the Director -General, as a basis for the further consideration by theBoard at its eleventh session of the distribution and sale of WHO publications. A statement giving numericalinformation on the unpaid distribution of WHO publications appears as Appendix 1, and information on thestatus of the Publications Revolving Fund, which the Board was requested to review (resolution WHA.5.23),is given in Appendix 2.

In resolution EB11.R42 the Board endorsed the general conclusions contained in the report and thepostulates proposed as the basis for the policy of distribution (Appendix 3).

1. WHO AS A PUBLISHER

Like other international organizations, WHOproduces publications for distribution and salesimultaneously in a large number of countries. Someof these publications are such as to be salablethrough ordinary commercial channels. Once thesepublications have been produced in Geneva, it isnecessary to find ways of marketing them throughthe existing trade machinery in each country. Publi-cations which are not of interest to the trade, becauseof their subject matter or their language, cannoteffectively be marketed in this way.

Although there are good reasons for believing thatsales could be considerably developed, due regardshould be paid to the difference in objectives andmethods which distinguish the publishing operationsof WHO from those of a commercial publisher.These differences relate to : (1) the type of publish-ing operation performed ; (2) the type of publicationproduced ; (3) the languages of publication.

1.1 Difference in the Type of Publishing Operation

Commercial publishing normally involves a seriesof operations which start with the decision to accepta manuscript as suitable, commercially and otherwise,for publication. Of this series of operations, theactive measures necessary for the marketing of apublication form a major part.

A commercial publisher is normally workingwithin a framework of established distribution andpublicity channels in a single country. In additionto the press publicity given to a new book by thedispatch of review copies and the purchase ofadvertising space in suitable newspapers and journals,sales are stimulated by the distribution of advancenotices, catalogues, and prospectuses -and often bypersonal visits of representatives (travellers) -to thewholesale and retail book trade.

It is evident that WHO cannot itself carry

5 Off. Rec. World Hlth Org. 40, 54

out the complete publishing operation in a largenumber of different countries or, indeed, in any oneof them. Measures taken at headquarters to promotesales were referred to in the Director- General's" Report on WHO Publications ". They include thepreparation of catalogues, prospectuses, and pressnotices, and the dispatch of review copies.

While adequate publicity material can be preparedat headquarters, its world -wide distribution from acentral point in Geneva would present insuperabledifficulties. It follows, therefore, that for all phases(including sales promotion) of commercial publishingwhich follow the production of the printed volume,WHO must rely largely on such arrangements ascan be established with national publishers or dis-tributors who are appointed as WHO sales agents.When the sales agent is a publisher, he is expectedto " publish " salable WHO publications in his owncountry -that is, to make them known through hisestablished publicity and distribution channels andsell them on the same trade terms as his own publi-cations.

From the commercial point of view, WHO publi-cations suffer from the initial handicap that an extraintermediary is placed between the primary publisherand the bookseller. WHO, the primary publisher,must offer such terms to the national publisher ordistributor as will enable him to pass on the normaldiscounts to the wholesale and retail trade.

1.2 Difference in the Types of Publication produced

Only a small proportion of the total output ofWHO publications is of a type which could be pro-duced and distributed without financial loss by acommercial publisher. In the establishment of theWHO publishing programme, and in the selectionof individual items for publication, the potential salesare not a main consideration.

If, contrary to commercial publishing practice,salability is not to be one of the prime factors indetermining what to publish, the progress of the

ANNEX 12 235

publications programmé cannot be measured by thevolume of sales achieved.

The publications produced by WHO may, inpublishing terms, be classed as (1) periodicals,(2) books, (3) pamphlets and (4) official documents.

1.2.1 Periodicals

If a comparison between WHO periodicals andnational medical journals is to be found, it is notwith the journals of mass circulation to the medicalprofession, but with the special journals devoted tolaboratory, clinical or public -health subjects.6

Most of these are published by professional orscientific associations or societies as a means ofmaintaining contact between members and keepingthem informed of progress in their special fields.Many are financed largely from membership dues,and the revenue from other sources would be insuffi-cient to maintain them, in spite of the considerableamount of voluntary editorial work from which theyoften benefit.

Others are published by national medical asso-ciations, at a considerable financial loss, as a serviceto the profession. For example, the Editor of theJournal of the American Medical Association hasstated :

... the special journals of the American MedicalAssociation (the A.M.A. Archives) are publishedeach year at a loss of many thousands of dollars.?

From the commercial point of view, WHO perio-dicals differ from most other special journals in thatno advertisement revenue is received. They differfrom many in that recipients do not provide apartial subsidy in the form of membership dues.

1.2.2 Books

For the purpose of this report, books are definedas non -serial publications whose subject- matter fallswithin some established class of commercial publi-cations (usually " medical books ") and whosephysical form and price are such as to enable themto be distributed and actively marketed throughthe book trade.

According to this definition, most of the bookspublished by WHO are comprised by the Mono-graph Series 8 and some Supplements to the Bulletin(the Manual of the International Statistical Classi-

6 The Chronicle of the World Health Organization is aspecial case.

? Smith, A. (1952) World med. Ass. Bull. 4, 1188 Some of these might almost as well be classified as " pam-

phlets ".

fi cation of Diseases, Injuries and Causes of Deathand the Pharmacopoea Internationalis).

Extraordinary publications, such as the Inter-national List of Venereal- Disease Treatment Centresat Ports and the Epidemiological Cable Code(CODEPID), cannot be distributed through thebook trade.

1.2.3 Pamphlets

These are non -serial publications whose subject -matter may or may not fall within some establishedclass of commercial publications, but whose physicalform 9 and price are not such as to enable them to beadequately distributed and marketed through thebook trade. The pamphlets so far published byWHO include the Technical Report Series10 and someSupplements to the Bulletin (Medical Certification ofDeath and Comparability of Statistics of Causes ofDeath).

Although pamphlets often contain material of thehighest interest and value, satisfactory trade channelsfor their distribution do not exist." Prices of some60 pamphlets so far published by WHO range from$0.10 to $0.65, with an average of $0.20. WHOpamphlets are not of mass interest, and at theseprice levels there is little or no incentive at any linkin the chain of commercial distribution to marketor even to stock such publications. At the end of thechain, for example, a bookseller who ordered,stocked, and displayed a title in the TechnicalReport Series priced at 10 cents could not expect torecover more than 3 cents from its sale.

The purchase of bulk quantities of pamphlets byinterested organizations is referred to elsewhere (seeSection 2).

It may be added that pamphlets are also the baneof libraries, as not only do they present specialproblems of handling, storage, and classification, but

9 " For the purposes of statistics and method, some librariesset the limit [of a pamphlet] at 80 pages... others considerabout 100 pages sufficient restriction. From the binderypoint of view a pamphlet is any collection of leaves, paper-bound or self- covered, consisting of 64 pages or less." AmericanLibrary Association, A.L.A. Glossary of Library Terms,Chicago, 1943, pp. 96 -7

10 In spite of their series title, each number of the TechnicalReport Series is from the point of view of marketing anddistribution an individual pamphlet. However, as with theOfficial Records series, the series title and numbers are conve-nient for libraries which wish to purchase all issues as theyare published and can give standing orders for all titles in oneor both series.

11 An exception must be made in the case of pamphlets ofmass interest which are taken up by chains of newspaperkiosks, railway bookstalls, etc.


they are often not listed in the standard bibliographi-cal and trade reference works.

1.2.4 Official and Similar Documents

The Official Records of the Organization and itsepidemiological and statistical publications areequivalent to government publications such asannual reports of health departments, parliamentaryreports, annual returns of Registrars- General, sta-tistical bulletins and reviews, budgets, and financialstatements. Like their national equivalents, WHOpublications in this class are part of the machineryof government and administration, and they areissued in printed form as a public service.

Occasionally, a large number of copies of an officialdocument may be sold if there is a current widespreadpublic interest in its subject.

1.3 Languages of Publication

It has been pointed out above that many WHOpublications are, for various reasons, outside therealm of normal publishing and not well adapted toeffective distribution by the ordinary commercialchannels. This applies to English- speaking andFrench- speaking countries, but it applies with evengreater force to those countries in which Englishand French -the only languages in which most WHOpublications are issued -are foreign languages.

In countries where English or French, althoughforeign languages, are widely used for academic andprofessional purposes, possibilities exist for develop-ing the commercial distribution of certain WHOpublications. But in countries where English andFrench are foreign languages, and in which a bodyof similar literature in the mother tongue exists,WHO publications which would otherwise be suitablefor distribution through commercial channels musttake their modest place in the book trade as " foreignbooks ".

A partial solution to the problem of making WHOpublications widely available in countries which areneither English- nor French -speaking is to granttranslation rights to national commercial publishers.Rights of translation and publication of a Germanedition of the Pharmacopoea Internationalis havebeen granted, under certain conditions, to a Germanpublishing firm. Similarly, rights for a Danishedition of Maternal Care and Mental Health havebeen granted to a Danish publisher, and rights forGerman, Swedish, and Italian editions are beingnegotiated.

Two national administrations have assumed theresponsibility of translating into their nationallanguages and publishing in their own countrieseditions of the Manual of the International StatisticalClassification of Diseases, Injuries and Causes ofDeath.

While the translation and publication by commer-cial publishers and national administrations ofWHO publications in other languages furthers theobjectives of the publishing programme and of theOrganization as a whole, the effect on sales of editionspublished by WHO itself must be adverse.

2. TYPES OF SALES OUTLET

The following observations refer principally tobooks and pamphlets. These may be sold througheither (a) purchase in bulk by governments and non-governmental organizations or (b) purchase of singlecopies by libraries and individuals through the normalchannels of the book trade.

2.1 Bulk Sales to Organizations

Special terms are quoted to governments andofficial statistical offices for bulk quantities of theManual of the International Statistical Classificationof Diseases, Injuries and Causes of Death supplieddirect from Geneva and paid for in US dollars,Swiss francs or sterling (see Section 3), and about24,000 copies have been sold in this way. Similarterms are offered for bulk orders of the Pharma-copoea Internationalis.

Bulk orders have also been received for certainnumbers in the Technical Report Series. These havecome from both governmental and non- govern-mental agencies. They are normally channelledthrough the WHO sales agent in the countryconcerned, and the agent is expected to give a specialdiscount of 20 -25 per cent on such orders.

2.2 Single -Copy Sales through the Book Trade

The many variables affecting the feasibility ofselling WHO publications in this way are discussedin Sections 1 and 4. They may be summarized asfollows :

(1) Type of country. In a particular country, doesan effective nation -wide machinery for the commer-cial distribution of books exist ?

(2) Type of subject. Does the subject of the publi-cation place it within a class for which there areestablished channels of commercial distribution ?

ANNEX 12 237

(3) Type of publication. Does the physical formand price of the publication qualify it for effectivedistribution through the book trade ?(4) Language. In a particular country, does acommercial market exist for publications in oneof the languages of WHO publications ?

The answers to all these questions will be affir-mative in relatively few cases, yet it is only in suchcases that distribution through trade channels canbe effective.

In a few countries it has been possible to appointas sales agents publishers who accept the full re-sponsibility of " publishing " WHO publications intheir own countries, thus making them widelyavailable through nation -wide commercial distri-bution channels. In other countries, WHO salesagents are able to give only a much more limitedservice ; in some, they are merely retail booksellersin a principal city.

3. INVOICING, DISPATCH, AND CURRENCIESOF PAYMENT

All clerical operations involved in the sale of WHOpublications and routine dispatch of publications toagents are undertaken as a common service by theSales Section of the European Office of the UnitedNations.

The United Nations accepts payment for publi-cations in US dollars, Swiss francs or pounds sterling,and all invoices are established in one of these threecurrencies. Of agents in 36 countries, 8 are invoicedin dollars, 16 in Swiss francs and 12 in sterling. Theyare normally expected to make payments directlyto the United Nations in any one of these threecurrencies, but, if there are exceptional difficultiesin obtaining one of these currencies, and if there is aUnited Nations Information Centre in the countryconcerned, arrangements are made for payment bythe agent in the local currency to the InformationCentre.

All payments by WHO sales agents are clearedthrough United Nations Headquarters and ultimatelyremitted to WHO by the United Nations EuropeanOffice in Swiss francs.

In countries where official agents have not yetbeen established, purchasers may obtain copies ofWHO publications direct from United Nations Head-quarters or the United Nations European Office bypayment in one of the three currencies mentionedabove. Prices are printed on WHO publications inthese three currencies.

A special arrangement exists for the French Union,for which a French firm of medical publishers hasbeen given the exclusive agency. This agent isinvoiced in Swiss francs, but makes payment inFrench francs at the official conversion rate intoa special United Nations account in Paris. Labelsbearing the price in French francs are added by thisagent to all copies of WHO publications commer-cially distributed in the French Union.

The amount normally invoiced to agents is 60 percent of the list price of publications. Of this, theUnited Nations Sales Section deducts 15 per cent,and WHO therefore receives 51 per cent of the listprice.

Two agents who claimed that they were unable tomarket WHO publications adequately with a 40 percent discount are invoiced for 50 per cent of the listprice. For publications sold through these agents,WHO receives -after the deduction by the UnitedNations Sales Section -42.5 per cent of the listprice.

4. SALES POSSIBILITIES OF DIFFERENT WHOPUBLICATIONS

4.1 Periodicals

With the exception of the Chronicle, WHO periodi-cals are subject to much the same limitations asnational special journals. Subscriptions are to beexpected mainly from libraries and institutions,which would be prompted to subscribe ratherby bibliographical references to WHO periodicalsand requests from library users than by any form ofcommercial publicity.

It is to be expected that the periodicals of WHOwill ultimately find their own level among publica-tions in similar fields, but the rate at which thislevel is reached in some countries might be acce-lerated if more active attempts were made to bringthe existence of the periodicals to the notice of suitablelibraries and institutions. The appointment of asufficient number of suitable agents is necessary inorder to ensure that such libraries and institutionsare able to enter subscriptions for WHO periodicalswithout too much difficulty and by payment in thelocal currency (see Section 3).

The Chronicle is in a class by itself. Its main objectis to provide general information on the work ofWHO and stimulate interest in it. A periodical ofthis type and price might well find a large number ofindividual purchasers. However, only an individualpurchaser who is already interested in WHO wouldwish to subscribe to the Chronicle, and the number


of private subscribers to the Chronicle may thereforebe taken as a rough indication of the degree ofinterest in WHO among the world's health workers.

4.2 Books

The sale of books as defined in Section 1.2.2 hasbeen considerable, both in bulk to governments andin single copies through commercial channels.

The books most readily distributed throughcommercial channels, and those most likely to beof interest to the individual purchaser, are some ofthose included in the Monograph Series, and occa-sionally an exceptional publication such as thePharmacopoea Internationalis.

4.3 Pamphlets

The Technical Report Series constitutes the majo-rity of these. For reasons indicated in Section 1.2.3,individual purchases of pamphlets through normalcommercial channels are never likely to be consider-able. Bulk sales could probably be increasedconsiderably if more effective attempts could be madeto interest appropriate non -governmental organiza-tions in purchasing supplies for their members,or in pooling orders from individual members inorder to take advantage of the special terms availablefor quantities supplied in bulk. In some countries,governmental agencies have given bulk orders fornumbers in the Technical Report Series, and it ispossible that this method of sale could be furtherdeveloped.

4.4 Official and Similar Documents

These are publications which, while not neces-sarily more official than some other WHO publi-cations, are from the point of view of their salespossibilities to be classed with national official orsemi -official publications. They include the OfficialRecords series and most of the epidemiological andstatistical publications.

Sales of such publications must always representa very small part of the total distribution, and, whilethe price charged may be sufficient to cover the cost-including printing, paper and discounts -of asingle copy, the total revenue from sales cannot bemore than a small fraction of the cost of the wholeimpression.

5. DISTRIBUTION OTHER THAN BY SALE

In the " Report on WHO Publications " presentedby the Director - General to the Executive Board at

its ninth session, full details were given of the distri-bution of each WHO publication according to fourcategories : (1) free distribution ; (2) exchanges ;(3) review copies ; (4) sales.

The first of these categories, free distribution, isa very broad one and includes several sub -categories.Distribution in most of these sub -categories is apart of the machinery of the Organization, and couldnot be performed through trade channels.

The sub -categories include :

(1) Governing bodies and Members of the Orga-nization. Specimen copies of all publications are sentregularly to Member countries or their healthadministrations and to members of the ExecutiveBoard. Distribution to Assembly delegates accountsfor a large proportion of the total number of officialprinted documents.

(2) Secretariat, field staff, consultants, and Fellows.The WHO Secretariat both at headquarters and in theregional offices needs to be conversant with WHOpublications. Similarly, the many field staff, short -term consultants, and Fellows must be conversantwith the technical policies and recommendations ofthe Organization as laid down in WHO publications,in so far as their own fields of interest are affected,

(3) Seminars, conferences, etc. At seminars,symposia, and conferences sponsored partially orentirely by WHO, copies of WHO publications mayhave to be provided to all participants as workingpapers for the meeting.

(4) Expert advisory panels. All members of WHOexpert advisory panels receive copies of expertcommittee reports on their own subjects and of theChronicle.

(5) United Nations and specialized agencies. Aspart of the machinery of United Nations inter-agency co- ordination, many copies of the OfficialRecords series and smaller quantities of otherpublications are distributed to the United Nations.Small quantities of both types of publication aresent to other specialized agencies.

(6) Depository Libraries. A list of depositorylibraries, which receive all WHO publicationswithout charge, was included in the Annual Reportof the Director - General for 1951 (page 57).

(7) Individual health workers. With very fewexceptions, the only publications sent on requestwithout charge to individual health workers are theChronicle and individual numbers of the TechnicalReport Series.

ANNEX 12 239

(8) Health libraries and institutions. Apart fromthe institutions and libraries which receive WHOpublications by exchange, a certain number havereceived some WHO publications on request withoutpayment.

It seems improbable that a reduction in the presentscale of unpaid distribution would be justifiable inany of the first five sub -categories enumerated above.Reductions might well be possible -and some havealready been made -in sub -categories (6), (7) and (8).

Depository Libraries (Sub- category 6)

The appointment of depository libraries in somecountries has been on a generous scale, and this hasled to some anomalies. At present some libraries thatwould have no special financial or currency difficultiesto overcome in subscribing to WHO publications arereceiving all of them free of charge because they havebeen nominated depository libraries. Similar librariesin the same country subscribe to some or all WHOpublications.

It is suggested that the policy for appointingdepository libraries might be drastically reviewedand that in future only one or more libraries of trulynational standing should be appointed. This sugges-tion is not intended to preclude the unpaid distri-bution on a more selective basis of certain publi-cations to certain health institutions and libraries(see below under Health Libraries and Institutions).

Individual Health Workers (Sub- category 7)

Because the Chronicle is essentially an organ ofpublicity for WHO, no change has been made in thepolicy of sending it free of charge to certain institu-tions and professional health workers who ask toreceive it regularly. Other publications are notnormally sent free of charge in response to suchrequests. Exceptions are sometimes made for purelypractical reasons : for example, if a professionalhealth worker asks for a single copy of a number inthe Technical Report Series it is sometimes consideredmore economical to send it to him without chargethan, for the sake of a few cents, to set into motionthe train of clerical and accountancy operationsnecessary to supply it through trade channels.

Health Libraries and Institutions (Sub - category 8)

Since the acceptance by the Fifth World HealthAssembly of the report of the Executive Board onthe publications programme of WHO, a number ofhealth libraries and institutions which were formerlyreceiving free copies of certain WHO publications,

and for which there should be no insuperableobstacles to subscribing, have been deleted from themailing lists. However, it is in this sub -category thatthe greatest problems of free distribution arise.

In some Member countries of WHO, medicalfaculties, health institutions, and their libraries arewell or adequately endowed financially, and thenecessary currencies for the purchase of WHOpublications are freely available ; or, where suchcurrencies are not freely available, arrangements canbe made without too much difficulty for obtainingthe necessary currency for the import of learned andscientific books and periodicals. In many Membercountries, however, health institutions are poorlyendowed, and are not even able to offer their staffssuch remuneration as would enable them to workfull -time. The financial resources of the libraries ofsuch institutions are minimal and the cost of sub-scribing to WHO publications could be met onlyby discontinuing existing subscriptions. In addition,there are often currency difficulties involved.

One of the fundamental objectives of WHO is toincrease facilities for the professional and technicaltraining of health workers. But it is in the countrieswhose institutions and libraries have the greatestdifficulty in subscribing to WHO publications thatthe need for WHO assistance of all kinds to educa-tional institutions is greatest.

As a result of its study of publications at its ninthsession, the Executive Board recommended 12 thatthe following should be taken as guiding principlesfor the determination and application of criteria forfree distribution :

(a) Free distribution should be minimal.

(b) In cases where there appear to be good reasonsfor not charging the list price of publications,consideration should be given to the possibilityof making them available at reduced cost insteadof distributing them entirely free of charge.

These principles can be followed without difficultyin the case of countries with adequately endowedinstitutions and libraries that can pay for publica-tions, at the full or a reduced rate, in one of the threecurrencies accepted in Geneva. However, in mostcountries libraries would not find it easy or possibleto obtain these currencies. In many cases, the onlymethod of making payment in a local currency isto place an order through the WHO sales agent inthat country, who normally receives 40 per centdiscount on the subscription or list price of the

12 Of Rec. World HIM Org. 40, 58, para. 119


publication. Of this discount, a substantial propor-tion often has to be passed on to the bookseller fromwhom the order was received.

If substantially lower terms were offered to healthinstitutions and libraries against payment in localcurrency, either the trade discount would have to beconsiderably lowered or the cash received by WHOfrom the sale of a publication would be negligibleor in some cases nil. It is doubtful whether mostagents and booksellers would accept discountsappreciably lower than normal, and in some coun-tries at least the upper limit of special discounts tolibraries is regulated by trade agreements.

In some cases, therefore, free distribution is theonly method of supplying WHO publications tohealth libraries and institutions which need them.

6. UNITED NATTONS INTER -AGENCYCO- ORDINATION

There has been a considerable exchange of infor-mation and ideas between the United Nations andthe specialized agencies on publishing problems, andespecially on problems of sales and distribution. TheWorking Group on Publications established by theAdministrative ordination hasheld three full sessions, the last of which took placein Paris during February 1952. In addition therehave been meetings at Lake Success and in Genevaof the member organizations with headquarters inNorth America and Europe respectively.

In 1949 the United Nations prepared and circulatedto all members of the working group a detailedquestionnaire on a large number of publishingproblems and proceden es. Replies to the question-naire were distributed to all members of the workinggroup, and constitute a considerable body of infor-mation on the publishing practices of the UnitedNations and all specialized agencies.

The third full session of the working group,attended by representatives of the United Nations,ILO, FAO, UNESCO, ICAO, WHO, the Inter-national Bank for Reconstruction and Development,the International Monetary Fund, and ITU, wasdevoted almost entirely to problems of sales anddistribution. Some pertinent extracts from the reporton this session submitted by the working groupto the ACC are reproduced in Section 7 below.

In addition to these formal exchanges of infor-mation, there have been informal inter -secretariatdiscussions on different occasions with representa-

tives of the publishing services of the United Nations,ILO, FAO, UNESCO and ICAO. Such informaldiscussions have been particularly frequent withUNESCO, and they culminated in a formal requestto the Director- General of UNESCO that WHOshould receive a visit of consultation and advicefrom the Head of the Sales and Distribution Divisionof UNESCO's Documents and Publications Service.During this visit, which took place in July 1952,problems encountered by WHO in the distributionand sale of publications were thoroughly examinedand discussed with the UNESCO representative,who afterwards submitted written recommendations.

7. THE FUNCTION OF SALES IN RELATIONTO DISTRIBUTION POLICY

The sale of United Nations and specializedagency publications is primarily another form ofdistribution of these publications, incidental tothe basic official or mandatory free distributionand differing from the latter only in that it is asfar as possible a self -liquidating enterprise.

The above extract is from the report to the ACCof the third session of its Working Group on Publi-cations. The working group, consisting of repre-sentatives of the publishing services of the UnitedNations and the specialized agencies, added :

In addition, the sale of a publication is awarranty of the purchaser's interest in it andprovides a means, therefore, of eliminatingwasteful free distribution. Nevertheless, thefundamental publishing aim of the memberorganizations remains that of having their publi-cations read rather than merely paid for. In thisconnexion it must be borne in mind that most ofthe publications involved would require publishing,even if there were no purchasers for them, andthat, on the other hand, they are not written inorder to appeal to the general reading public. It isfundamentally untenable, therefore, to comparethe total costs of publication with sales revenues.

The function of sales cannot be dissociated fromthe functions of the publications themselves. Thedecision to print and distribute a publication restson the assumption that WHO wishes to bring to theattention of health workers in Member countriescertain information or recommendations. Theinformation or recommendations contained in WHO

ANNEX 12 241

publications have often been obtained or formulatedat considerable effort and expense, and the publishingof a document in printed form may be the finaloutcome of the work of years. This work can beeffective only if its results are brought to the attentionof a sufficient number of readers.

It follows, therefore, that the main objective ofpublication cannot be achieved unless distributionis adequate. The distribution of each group of WHOpublications presents a different problem.

For reasons outlined in Section 1, commercialdistribution through the normal trade channels isin many cases not an effective method. If a publi-cation cannot be effectively distributed by sales, andif free distribution is severely restricted, the objectivefor which it was published may not be attained. Ifthe Organization were to adopt the policy that salesshould in all cases be the main method of distri-bution, this policy should logically first be appliedin the determination of what to publish. In otherwords, editorial policy would, as in commercialpublishing, be influenced strongly by the estimatedsalability of the product.

A very important element determining the functionof sales is the varying ability to pay of recipients,whether libraries or individual purchasers, in differentcountries. To this barrier to sales may be addednon -availability in a country of currencies in whichpayment may be accepted.

From the foregoing, the following general con-clusions may be drawn :

(1) Sale is a method of distribution whoseeffectiveness varies according to the type of publi-cation.

(2) No single distribution policy is applicableto all WHO publications.

(3) The distribution policy determined for eachpublication may have to be adapted to the varyingconditions in each country.

(4) If a publication is to achieve its objective,distribution without reimbursement may be ne-cessary to a varying degree, according to the typeof publication and the recipient country.

8. DEVELOPMENT OF SALES AND DISTRIBUTION

In the United Nations, and in other specializedagencies with a publishing programme comparableto that of WHO, distribution and sale of publicationsis the responsibility of a special organizational unitwithin the publishing service.

The mechanical or passive side of sales operationsis undertaken for WHO as a common service by theSales Section of the European Office of the UnitedNations, which arranges for the routine dispatch ofpublications to WHO sales agents, prepares invoices,and keeps accounts and all essential records. Inreturn for these services, the United Nations deductsa commission of 15 per cent on receipts.

As was pointed out in the Director -General'sreport to the Executive Board on WHO publications,no staff is available for the appraisal of the salespossibilities of the various publications of WHO indifferent countries, nor for the stimulation of salesin suitable cases.

The question of sales and distribution was firstformally raised during the Second World HealthAssembly in the Committee on Programme. Indiscussing the proposed publications programmeand budget estimates for 1950, the chief delegate ofthe United States of America commented that,while much information was given on the number ofpages and the number of personnel involved, therewas " no mention of the ways in which these publi-cations were to be utilized or distributed ", nor anyreference to the amount of revenue expected fromsales.13 Apart from this, however, discussion ofpublications in the Health Assembly and the Exe-cutive Board has centred largely on the need toachieve a complete and regular publishing pro-gramme. In the execution of the programme ofpublications, there has been a corresponding em-phasis on production and the resources devoted todistribution have been minimal.

In the initial preparation of the Proposed Pro-gramme and Budget Estimates for 1951, provisionwas made for a small staff unit to handle sales anddistribution, but it was later decided for financialreasons that these posts should be deleted from thebudget as presented to the Executive Board for itscomments. However, in the Proposed Programmeand Budget Estimates for 1951 reference was madeto " the absence of effective sales arrangements " 14and in the report on its fifth session the ExecutiveBoard noted " that WHO staff do not engage in thepromotion of sales activities, nor is any provisionmade for such activity in the 1951 estimates ".15

This matter was again brought to the attentionof the Board in the Director -General's " Report onWHO Publications " submitted at its ninth session.In its report to the Assembly, the Board noted

13 Of Rec. World Hlth Org. 21, 16514 Off. Rec. World Hlth Org. 23, 8715 Of Rec. World Hlth Org. 26, 13


" that there is at present no staff employed forthe promotion of sales of WHO publications ... "and it recommended to the Health Assembly(resolution EB9.R72) that certain sums from thePublications Revolving Fund should be used forgiving better publicity to WHO publications. Thisresolution was endorsed by the Health Assembly(resolution WHA5.23). In the part of its reportrelating to this subject, the Board refers to theimprovement which might be achieved " if morefunds were available for the printing of prospectuses,for the insertion, in suitable cases, of advertisementsin the technical press, and possibly for temporarystaff services." 16

In its resolution WHA5.24, the Health Assemblyrequested the Director - General to continue " studieson the distribution and sale of WHO publications,wherever possible in consultation with the UnitedNations and other specialized agencies ".

As a result of this continued study, and of consul-tations with other specialized agencies, especiallyUNESCO, the Director -General has reached theopinion that the rational world -wide distribution, bysales or other means, of WHO publications is animportant and specialized function which cannot besatisfactorily undertaken without a specialist full -time staff.

The main concern of such a staff would be withthe shaping of sales and distribution policy, and theadaptation of that policy to the individual publi-cations of WHO in the different countries in whichthey are to be made available. With each publicationit is necessary to determine what distribution shouldbe achieved if the publication is to attain its objective,what the desirable ratio is between free and paiddistribution, and what modifying factors exist(including linguistic and currency difficulties) in eachof the Member countries of WHO. Associatedwith these functions are : the determination of thesize of the impression of each publication ; thepreparation of publicity material (catalogues, infor-mation sheets, brochures) ; the selection of agents,and correspondence with agents otherwise than onmatters of routine ; the devising and carrying outof plans to secure the greater co- operation of suitablegovernmental and non -governmental health agencies

16 Off Rec. World Hlth Org. 40, 58, para. 122

in developing an adequate distribution of WHOpublications.

Such a staff would also maintain and analyse suchrecords as were necessary for appraising the per-formance of WHO sales agents in different countriesand for estimating the results achieved by differentmethods of promoting sales.

At present there is one distribution officer (P1)within the Office of the Director, Division of Editorialand Reference Services. This officer's principal dutyis to control the maintenance and revision of themailing lists for the distribution of free copies(including review copies) of WHO publications. Inthe opinion of the Director -General, an additionalstaff of one sales and distribution officer (P2) andone sales and distribution officer (P1), with appro-priate secretarial and clerical assistance, would benecessary in order to constitute an adequate unitfor the distribution and sale of WHO publications.

However, no proposals for extra headquartersstaff have been made in the Proposed Programmeand Budget Estimates to be submitted to the SixthWorld Health Assembly. It is, nevertheless, proposedthat, as an interim measure, the appointment of adistribution and sales officer (P2) early in 1953 shouldbe authorized as a charge against an extra -budgetarysource -the Publications Revolving Fund -fromwhich the expenditure of up to $10,000 in 1953 wasauthorized by the Fifth World Health Assemblyfor the promotion of the sale of WHO publications.This officer, together with the present distributionofficer (P1), would form an interim distribution andsales unit within the Office of the Director, Divisionof Editorial and Reference Services. It is proposedthat his initial appointment should be for two years,and that his salary for 1953 should be found fromthe $10,000 which the Health Assembly authorizedas expenditure from the Publications RevolvingFund.

It is suggested that the Executive Board may wishto recommend that the Sixth World Health Assemblyauthorize a similar expenditure from the PublicationsRevolving Fund in 1954.

For 1955 and subsequent years, the Director -

General would consider at the appropriate timewhether to recommend that such an arrangementbe continued.

ANNEX 12 243

Appendix 1

ANALYSIS OF UNPAID DISTRIBUTION

In the table below, an analysis is made by nine sub -categoriesof the regular unpaid distribution of periodicals and otherserial publications of WHO. These sub -categories do notexactly correspond with those listed in Section 5 of the Reporton Distribution and Sale of WHO Publications, as theavailable records have not been kept in such a way as topermit analysis in this form.

The data in the table refer only to the number of addresseson the regular mailing lists. In addition, single copies of allpublications included in the table are sometimes distributedwithout payment : for example, a health administration mayrequest one or more extra copies of a publication which isof special interest to it.

Technical Report Series

The data on the Technical Report Series refer only to regularrecipients of the complete series. In addition, expert com-mittee reports published in the Technical Report Series areautomatically sent to all members of the panels from whichthe members of the committees were drawn. The numberof copies of different numbers of the Technical Report Seriesdistributed in this way varies considerably according to thenumber of members on the panel concerned.

Published expert committee reports are also sent auto-matically to certain addresses on the mailing lists of those who

[EB11 /41 Add.1]10 January 1953

regularly receive roneographed working papers of expertcommittees but are not panel members. For most subjects,the number of addresses on such mailing lists is very small ;however, in one subject they exceed 300, and in two othersmore than 400.

Review copies of all numbers in the Technical ReportSeries are sent to some 200 general medical journals. Inaddition, special journals receive review copies of appropriatenumbers.

Official Records

As with the Technical Report Series, the data in the tablerefer only to regular recipients of the complete Official Recordsseries. In addition, copies of certain numbers are distributedin large quantities to delegations and other participants atthe Health Assembly, and to the United Nations for distribu-tion to the Economic and Social Council.

Mislaid or lost copies are sometimes replaced from thestocks available in conference rooms during sessions of theExecutive Board and the Health Assembly.

Non -Serial and Annual Publications

For non -serial publications, such as the PharmacopoeaInternationalis, there is no automatic free distribution exceptto the Executive Board, Member governments, and WHO

Analysis of regular unpaid distribution of WHO periodicals and other serial publications

Bulletin ChronicleInternational

Digest ofHealth

Legislation

Epidemic-icaland Vital

StatisticsReport

WeeklyEpidemic-

logicalRecord

MonographSeries

nicaTReport 1

SeriesOfficialRecords

Executive Board 18 18 18 18 - 18 18 18National and local administrations 17 492 1,900 362 919 328 302 372 633United Nations, specialized agencies,

non -governmental organizations . 65 85 82 65 13 45 64 104Secretariat, including regional of-

fices and field personnel . . . 225 467 238 240 137 104 377 247Panel members - 697 - - 96 - - -Depository libraries 135 135 135 135 - 135 135 135Libraries, institutes, health workers 55 1,000 20 279 12 24 37 15WHO Fellows 18 - 180 - - - - - -Exchanges 263 625 20 65 4 - 2 12

1,253 5,107 875 1,721 560 628 1,005 1,164

17 Including administrations of non -self- governing territories18 Holders of fellowships of six months' duration or more receive the Chronicle for a year.


depository libraries. Unpaid distribution to the Secretariat(at headquarters and in the regions), to the United Nationsand its agencies, and to other recipients varies considerablyaccording to the type of publication, and no typical figurescan be given, but it is normally small.

The regular unpaid distribution of Annual Epidemiological

and Vital Statistics is at present as for non -serial publications,but additional copies of some volumes have been distributedon a considerable scale to national administrations andstatistical offices.

Review copies of non -serial publications are sent toappropriate general or special journals.

Appendix 2[EBII /41 Add.2]13 January 1953

PUBLICATIONS REVOLVING FUND

The Fifth World Health Assembly in resolution WHA5.23requested the Executive Board at its first session in 1953 toreview the status of the Publications Revolving Fund inorder to determine the purposes for which any accumulatedsums should be used. In this same resolution the HealthAssembly authorized the Director -General :

(a) To continue to use such sums from the Fund as wererequired to finance the cost of printing additional copiesof World Health Organization publications for sale, and

(b) To draw on the Fund amounts not to exceed $6,000 in1952 and $10,000 in 1953 to be used to give publicity toWorld Health Organization publications and to improvethe sale of publications.

During 1952 approximately $2,000 was used as authorizedunder (b). In his Report on Distribution and Sales of WHOPublications the Director -General makes a proposal forusing part of the sum authorized for use in 1953, and suggeststhat a similar expenditure be authorized from the Fund in1954.

The following two statements show the status of the Fund(1) for the years 1948 -51, and (2) as at 31 December 1952.

Most of the income from the sale of publications shownfor the years 1949 and 1950 represents receipts from bulk salesof the Manual of the International Statistical Classification ofDiseases, Injuries, and Causes of Death. In these years theregular programme of publications was not fully developed,and revenue from publications other than the Manual wasstill very small.

Most of the income from sale of publications shown forthe years 1951 and 1952 represents receipts from sales ofpublications other than the Manual.

For the year 1952, a total deduction of $15,483 has beenshown in respect of unliquidated obligations, incurred forreprinting for sale of international certificates of vaccinationand certain other publications. Receipts from these salesare expected to restore an equivalent amount to the Fund.

Similarly, no account has been taken of the stocks of publi-cations printed in 1952 and preceding years, for which thereis a continuing sale. While such stocks represent an inventoryasset, it is not possible to estimate the quantities which mayultimately be sold.

1. PUBLICATIONS REVOLVING FUNDfor the years 1948 -1951

(Expressed in US dollars)1948

Taken over from Interim Commission .

Income :

Sale of International Certificates of

2,135.65

Vaccination 501.59 2,637.24

Expenditure :

Printing of International Certificatesof Vaccination 1,070.13

Balance :Carried forward to 1949 1,567.11

1949

Brought forward from 1948 1,567.11

Income :

Sale of publications 25,995.90Sale of International Certificates of

Vaccination 2,040.71 29,603.72

Expenditure :Printing of International Certificates

of Vaccination 2,143.70

Balance :

Carried forward to 1950 27,460.02

1950

Brought forward from 1949 27,460.02

Income :

Sale of publications 24,770.14Sale of International Certificates of

Vaccination 2,920.07 55,150.23

Expenditure:Printing of International Certificates

of Vaccination 3,064.82Various reprints for sale 239.01 3,303.83

BalanceCarried forward to 1951 51,846.40

ANNEX 12 245

1951

Brought forward from 1950

Income:Sale of publicationsSale of International Certificates of

51,846.40

10,527.82

Vaccination and various reprints . 6,731.96 69,106.18

Expenditure :Printing of International Certificates

of Vaccination 5,011.64Various reprints for sale 4,729.19Purchase of paper for reprints . . . 3,205.82 12,946.65

Balance :Carried forward to 1952 56,159.53

2. PUBLICATIONS REVOLVING FUNDas at 31 December 1952(Expressed in US dollars)

Balance brought forward from 1951. .

Income:(a) Sale of International Certificates

of Vaccination, various reprints

56,159.53

and publications sold directly toGovernments on special terms. 13,792.99

(b) Sale of publications (throughordinary channels) 20,840.00

Total 90,792.52Expenditure :

Printing of International Certificatesof Vaccination

Various reprints for salePurchase of paper for reprints . .

Costs of catalogues and prospectusesfor sales promotion

9,677.236,026.408,575.24

1,873.02 26,151.89

Balance of Account 64,640.63

Deduct :

Unliquidated obligations :Printing of International Certificates

of VaccinationVarious reprints for salePurchase of paper for reprints . .

Appendix 3

POLICY OF DISTRIBUTION

The Director -General proposes that the policy of distributionof WHO publications should be based on the followingpostulates, which are either stated or implicit in the Reporton Distribution and Sale of WHO Publications :

1. The objectives of publication cannot be fully attainedwithout effective distribution.

2. World -wide distribution of WHO publications, whetherby sale or otherwise, can be most effectively developed bythe use of established national channels.

3. The determination of the most effective national chan-nels of distribution, the appraisal of the sales possibilitiesof each publication in each country, and the promotionof distribution, whether by sale or otherwise, of WHOpublications, are important elements of the publishingprogramme for which the necessary staff services and fundsshould be available.

4. The main purpose of sales is to increase distributionwithout additional cost to the Organization.

5. Sale is a method of distribution whose effectivenessvaries according to :

(a) the degree of organization of the book trade ineach country ;

3,446. -6,037. -6,000.- 15,483.-

Net available balance 49,157.63

[EB11 /41 Add.3]16 January 1953

(b) the subject of the publication ;

(c) the physical form and price of the publication ;

(d) the market which exists in each country for publica-tions in the languages in which WHO publications areavailable ;

(e) the financial resources of health institutions andlibraries in each country ;

(f) the extent to which purchases can be made withlocally available currencies.

6. It follows from point 5 that no single formula is applic-able to the distribution of all WHO publications, or ofany one publication in all countries.

7. When, because of any factor or combination of factorsin point 5, a publication cannot be effectively distributedby sale, free distribution may be necessary to a varyingdegree in different countries in order that the publicationmay attain its objective.

8. Where effective distribution of WHO publications inthe languages in which they are normally available is, forlinguistic reasons, impossible, encouragement should begiven to national commercial or non -commercial publishersto undertake the responsibility of producing editions inother languages.


Annex 13

CONTRACT OF THE DIRECTOR -GENERAL 1

DRAFT AGREEMENT

THIS AGREEMENT is made this day ofbetween the World Health

Organization (hereinafter called the Organization)of the one part and (hereinaftercalled the Director -General) of the other part.

WHEREAS

(1) It is provided by Article 31 of the Constitu-tion of the Organization that the Director - Generalof the Organization shall be appointed by theWorld Health Assembly (hereinafter called theHealth Assembly) on the nomination of the ExecutiveBoard (hereinafter called the Board) on such termsas the Health Assembly may decide ; and

(2) The Director - General has been duly nomi-nated by the Board and appointed by the HealthAssembly at its meeting held onfor a period of five years.

Now THIS AGREEMENT WITNESSETH and it ishereby agreed as follows,

I. (1) The Director - General shall serve from thetwenty -first day of July, one thousand nine hundredand fifty- three, until the twentieth day of July, onethousand nine hundred and fifty -eight, on whichdate his appointment and this Agreement shallterminate. This Agreement may be renewed bydecision of the Health Assembly on such terms as theHealth Assembly may decide.

(2) Subject to the authority of the Board, theDirector -General shall exercise the functions ofchief technical and administrative officer of theOrganization and shall perform such duties as maybe specified in the Constitution and in the rules ofthe Organization and /or as may be assigned to himby the Health Assembly or the Board.

(3) The Director - General shall be subject to theStaff Regulations of the Organization in so far asthey may be applicable to him. In particular heshall not hold any other administrative post andshall not receive emoluments from any outside sourcesin respect of activities relating to the Organization.He shall not engage in business or in any employ-ment or activity which would interfere with his dutiesin the Organization.

1 See resolution EB11,R49.

[From EB11 /71, amended]14 January 1953

(4) The Director -General, during the term of hisappointment, shall enjoy all the privileges and immu-nities in keeping with his office by virtue of theConstitution of the Organization and any relevantarrangements already in force or to be concluded inthe future.

(5) The Director - General may at any time givesix months' notice of resignation in writing to theBoard, which is authorized to accept his resignationon behalf of the Health Assembly ; in which case,upon the expiration of the said period of notice, theDirector -General shall cease to hold the appoint-ment and this Agreement shall terminate.

(6) The Health Assembly shall have the right, onthe proposal of the Board and after hearing theDirector - General and subject to at least six months'notice in writing, to terminate this Agreement forreasons of exceptional gravity likely to prejudicethe interests of the Organization.

II. (1) The Director - General shall receive fromthe Organization an annual salary, to be paidmonthly, commencing onof twenty thousand United States dollars or itsequivalent in such other currency as may be mutuallyagreed between the parties to this Agreement.

(2) In addition to the normal allowances autho-rized to staff members under the Staff Rules, he shallreceive an annual representation allowance of sixthousand five hundred United States dollars or itsequivalent in such other currency as may be mutuallyagreed between the parties to this Agreement, to bepaid monthly, commencing onThe representation allowance shall be used at hisdiscretion entirely in respect of representation inconnexion with his official duties. He shall be entitledto such reimbursable allowances as travel allowancesand removal costs on appointment, on subsequentchange of official station, on termination of appoint-ment, or on official travel and home leave travel.

III. The terms of the present contract relating torates of salary and representation allowance aresubject to review and adjustment by the HealthAssembly on the proposal of the Board, and afterconsultation with the Director- General, to bring

ANNEX 14 247

them into conformity with any provision regardingthe conditions of employment of staff members year first above written.which the Assembly may decide to apply to staffmembers already in the service.

WHEREUNTO we have set our hands the day and

IV. If any question of interpretation or any disputearises concerning this Agreement, which is not settledby negotiation or agreement, the matter shall bereferred for final decision to the competent bodyprovided for in the Staff Regulations.

Annex 14

President of the Health Assemblyof the World Health Organization

Director -General

[From EB11 /50 and Add. 1, Add. 2 and Add. 3]22 December 1952 and 9, 13 and 27 January 1953

ASSIGNMENT TO REGIONS 1

In compliance with the provisions of resolution EB10.R7, adopted by the Executive Board at its tenthsession, the Director - General addressed a circular letter (CL.22.1952) to Member States on 16 July 1952,requesting their opinions and comments on the rules and criteria for determining the assignment of any territoryto a geographical area. In order to assist governments in giving their opinions, they were asked to considercertain factors, in accordance with the plan drawn up by the Executive Board at its tenth session.

The circular letter was also transmitted to the United Nations and to certain specialized agencies, theirattention being drawn to point (f) of the plan and their comments thereon requested.

1. CIRCULAR LETTER TO MEMBER STATES

16 July 1952Sir,

As you are no doubt already aware, the FifthWorld Health Assembly approved the followingresolution (WHA5.43), on 21 May 1952 :

With regard to Articles 44 (a) and 47 of theConstitution,

The Fifth World Health Assembly,Considering the necessity of determining rules

and criteria which permit the assignment of Mem-ber States, Associate Members and territories orgroups of territories to the geographical areasdetermined in conformity with Article 44 of theConstitution,1. REQUESTS the Executive Board, in close colla-boration with the Director -General, to undertakea thorough study of the rules and criteria fordetermining the assignment of any territory to ageographical area ;2. DECLARES that this study should specificallytake the form of inquiries to be carried out among

1 See resolution EB11.R51.

the interested Member States, in which opinionsshould be collected from duly qualified nationalauthorities ;

3. DECLARES that the Executive Board, afterconsidering the information collected in this way,should make a report to the Sixth World HealthAssembly ; and

4. AUTHORIZES the Director - General, in themeantime, to take the necessary steps to provideservices to territories not yet assigned to regionsthrough the headquarters of the Organizationunder the title " Region undesignated ". However,Member States, Associate Members and terri-tories or groups of territories for which a requestfor assignment to a region has been presentedwill be provisionally assigned to the regionalorganization of their choice, pending the results ofthe study mentioned above.

Pursuant to this resolution the Executive Boardadopted the resolution given below (EB10.R7) on30 May 1952



Noting resolution WHA5.43, on assignment toregions, adopted by the Fifth World HealthAssembly,

DECIDES to undertake at its eleventh session therequested study of the rules and criteria fordetermining the assignment of any territory to ageographical area, when the results of the inquiriesto be carried out among interested Member Stateshave become known.

In implementation of the two above resolutionsI have the honour to request you to send me, by1 November 1952 at latest, any comments, obser-vations or suggestions which you may wish to makeconcerning the rules and criteria which shouldgovern the assignment of any territory to a geogra-phical area, defined under the provisions of Article 44of the WHO Constitution.

In this connexion, I would remind you that thedefinition of geographical areas provided for in theabove article of the Constitution was carried out bythe First World Health Assembly, which establishedthe following regions : I. Africa ; II. Americas ;III. South -East Asia ; IV. Europe ; V. EasternMediterranean ; VI. Western Pacific.

This arrangement was embodied in resolutionWHA1.72, included in the Handbook of Resolutionsand Decisions of the World Health Assembly andExecutive Board (first edition, page 153).2 Thisdivision of the world into six regions was accom-panied by a territorial and political description ofeach region.

The method employed for the definition of eachregion was not uniform. Thus the American andEuropean regions were defined as including thewhole of the continents concerned ; on the otherhand, the definition of the African region was basedpartly on the selection of certain political frontiersand partly on that of purely geographical frontiers ;as concerns the Regions of the Eastern Mediterranean,South -East Asia and Western Pacific, the methodemployed was to enumerate the States and terri-tories they were to comprise.

During subsequent World Health Assembliesthere were assigned to regions certain States andterritories which had not been expressly designatedas being assigned to one of the regions given above,or which were not included therein by definition,their stated preference having been taken intoconsideration ; others, on the other hand, weretransferred at their request from the region to which

2 See also Off Rec. World filth Org. 13, 330.

they had originally been assigned to another region.This was established by various resolutions whichare reproduced in the Handbook of Resolutions andDecisions, pages 153 to 155, as well as by recentresolutions approved by the Fifth Health Assembly.3

On examining these texts it can be seen that preced-ing Health Assemblies defined the geographical areaswithout precisely delimiting their correspondingterritorial extent, and without an exhaustive enume-ration of the States or territories which were to formpart of each region.

In dealing with certain special cases it appearedthat the Fifth Health Assembly wished to replacethe empirical procedure so far employed by a rationalmethod, which still remains to be found. This hasgiven rise to the study now being undertaken, towhich all the Member States of the Organization arerequested to contribute.

In order to find criteria and rules making it possibleto establish a satisfactory system, it will be necessaryto take numerous and important factors into conside-ration ; but the bringing together and the comparisonof the various points of view expressed concerningthe different aspects of the problem will only bepossible and of value if all the governments ap-proached agree, for their mutual benefit, to followan identical plan in giving their opinions. This plan,as drawn up by the Executive Board at its tenthsession, is indicated below :

(a) health and technical aspects ;(b) economic aspects, including both financialones and those relating to problems of communi-cation ;(c) social aspects ;(d) geographical aspects ;(e) administrative considerations ;(f) relations between the various regions of WHOand regional agreements concluded by otherinternational organizations ;(g) any other considerations ;(h) conclusions and recommendations.

Replies which reach me in good time will becommunicated to the Executive Board and willenable the latter to submit its report as requestedto the Sixth Health Assembly.

I have the honour to be, etc.

(signed) H. S. GEAR

for Brock CH1sxoLM, M.D.Director - General

3 Resolutions WHA5.44 and WHA5.46

ANNEX 14 249

2. REPLIES TO CIRCULAR LETTER

By 27 January 1953 replies had been received from29 countries. Replies from the following five coun-tries were to the effect that the circular letter wasreceiving attention :

Cuba, Dominican Republic, El Salvador, Guate-mala, Panama.

The substance of the other replies is reproducedbelow.

MEMBER STATES

Australia - letter dated 23 December 1952 :

... The Commonwealth Government is of theopinion that the only criterion which should deter-mine such assignment should be the wishes of theGovernment of the territory concerned, or, in thecase of a territory not having responsibility for itsinternational relations, of the country responsible forthose relations, provided only that the desired assign-ment is administratively practicable from the point ofview of WHO.

Burma - letter dated 5 December 1952 :

(a) Health and technical aspects: It would bebeneficial for a country or a territory to be groupedwith those having more or less the same standard ofhealth, more or less the same problems and wheremethod of approach to those problems, technicalor otherwise, is similar if not the same.(b) Economic aspects, including both financial onesand those relating to problems of communications :The last two factors mentioned in (a) above dependso much on the economy and the social aspects ofthe community that it will not be an easy matter toconsider them separately. In so far as communicationis concerned, the vastly improved facilities in travel,transport and communications of the present day,appreciable reduction in the time factor and theenforcement of International Sanitary Regulationsshould lead to a change or modification in every-one's perspective and it may not be considered vital,except perhaps in exceptional circumstances wherecommunication, transport, etc., with adjacent coun-tries are considered to be difficult or uneconomicaland where such a country could be assigned toanother region with advantage both to itself and tothe region so assigned.

(c) Social aspects: It cannot be disputed thatadjacent countries as a rule have a certain amount of

influence on one another in matters social, ethical,and ethnological, and consequently these pointsshould be given priority wherever assignment of aterritory to a region is considered.

(d) Geographical aspects: Regions which have sofar been defined by the World Health Organizationseem to be fair, and national countries which are onthe borderline may have the option of joining oneor the other of the two adjacent regions and not anyother region which is geographically far and remote.

(e) Administrative considerations: It is presumedthat the administration contemplated is by a regionaloffice, particularly with regard to the projects spon-sored by the World Health Organization and otherspecialized agencies of the United Nations. Admi-nistration by the metropolitan government does notdeserve any serious consideration.

(f) Relations between the various regions of theWorld Health Organization and regional agreementsconcluded by other international organizations: Thereis not much to comment on or make any other sug-gestion regarding the relations between the variousregions of the World Health Organization as, sofar, such relations have been quite happy. Shouldthere be any shortcomings, the Director -Generalcould rectify them without any difficulty.

(g) Any other considerations: Nil.

(h) Conclusions and recommendations: There is nospecial recommendation to be made.

Canada - letter dated 13 November 1952 :

Although the Canadian authorities recognize theimportance of the points included in the plan setout on page 3 of your circular letter, I have thehonour to suggest that these matters are betterjudged by the government of the country concernedor, in the case of a territory not having responsibilityfor its international relations, by the government ofthe country responsible for those relations. It is theview of the Canadian authorities, therefore, that thepreference of the government of a country, or thegovernment responsible for the international relationsof a territory, taken in the light of the criteria suggestedin categories (a) to (g) in the closing portion of yourletter, should be the determining factor when acountry or territory is assigned to a region. It is


understood, however, that any assignment to a regionwill be subject to the over -riding consideration thatsuch assignment is administratively practicable fromthe point of view of WHO.

Ceylon - letter dated 10 October 1952 :

... this Government has no comments to offer.

Denmark - letter dated 14 January 1953

. in the opinion of the Danish Government, itshould be a general rule that particular considerationbe given to the desires of the State having theresponsibility for the foreign affairs of the territoryin question.

Regarding the various aspects enumerated in yourletter I beg to make the following remarks :

(a) Health and technical aspects: The healthproblems, including the question of improvinghygiene and especially the combating of infectiousdisease, should be more or less the same in the parti-cular territory as in the region to which it desiresto be assigned, or at any rate should not be unfamiliarto all or the majority of the lands within the region.Especially with regard to epidemic diseases it issuggested that, as help from WHO for fighting asudden epidemic must come through the region towhich the territory is assigned, it will be natural thatthis region is in fact that which comprises the coun-tries to which the spreading of the epidemic isparticularly to be feared. It must naturally be realizedthat in this as well as in the other " aspects " thereis only question of a factor which must be consideredalong with and determined in conjunction with theother factors that may present themselves forconsideration.

(b) Economic aspects, including both financial onesand those relating to problems of communication:It should be correct to give serious considerationto whether the territory exclusively or predominantlyhas its communications -the movement of bothgoods and persons -with the one or the other of theregions that may come into question. If this is thecase it constitutes an association that makes itnatural for the population and the administrationwithin that territory to feel particularly attached tothe region with which the connexion is especiallyclose, which again makes a co- operation throughWHO with this region desirable.

(c) Social aspects and (d) Geographical aspects : Itis extremely difficult quite theoretically to set upcertain criteria here, the economic, social and geo-graphical aspects being closely connected. Normally,a given territory will feel especially attached to theregion with which it has particularly easy geographicalcommunication and with the populations of whosecountries it is of the same standing by being of thesame race, descent, social development, etc. Natu-rally, all these factors need not point in the samedirection ; the same race and religion of course neednot mean the same social development, and evenif this should be the case, geographical and adminis-trative considerations may have to be taken intoaccount.

However, it will be reasonable to urge that aterritory should not be assigned to a region wherethere are geographical conditions making communi-cation between the territory and the region and thelatter's regional office particularly difficult.

(e) Administrative considerations: The DanishGovernment cannot but regard it as being of greatimportance that, when assigning a territory to ageographical area, suitable consideration be givento the administrative aspect. It will therefore beregarded as particularly practical to the greatestpossible extent to assign a territory to the sameregion as the country which has the care of theforeign affairs of that territory. This viewpointwill often lead to the same result as those referred tounder (b) to (d).

(f) Relations between the various regions of WHOand regional agreements concluded by other inter-national organizations : It will undoubtedly facilitategreatly the collaboration between the United Nationsfamily if, within the United Nations special organi-zations and other intergovernmental organizationsin which a regional system has been evolved, a systemcould be devised whereby the regions coincide as faras possible ; it will often happen that WHO col-laborates with other intergovernmental organizationson seminars, health demonstration projects, etc.

(g) Any other considerations and (h) Conclusions andrecommendations : The Danish Government hasbeen unable on a theoretical basis to submit othercriteria or to draw any conclusions or make sugges-tions. As already stated, each of the various aspectshas its signification ; they will often in concrete casespoint in the same direction, and sometimes each in

ANNEX 14 251

its own direction ; but it seems natural to point outin advance that on practical grounds as far as possiblethe preponderant consideration must be to delimitthe regions in such a manner as to form an adminis-trative and communicative whole, and that the mainhealth problems presenting themselves are of a moreor less homogeneous character.

Egypt - letter received on 12 January 1953

(translation from the French) :

.. the Egyptian Government is of the opinion thatthe rules and criteria in question should be :1. Similarity of social conditions. These are deter-mined mainly by the financial and cultural level ofthe majority of the population and by the predomi-nant occupation, i.e., either agricultural, industrialor commercial. In fact, social conditions are similarin territories where the position of most of the people,from these points of view, is nearly identical, sinceliving standards, as reflected in housing, nutritionand clothing, are almost the same in such territories.

In view of the close relationship between thesefactors and the health of a people, the health prob-lems in such territories will be similar.2. Similarity of climate, on condition that countriesare geographical neighbours, seeing that territorieswith similar climates are affected by the same epide-mic and endemic diseases. Nevertheless, apart ft omsimilarity of climate, it is only reasonable to consideralso whether such territories are geographicalneighbours.

3. Natural harmony between members of the sameregional office. This harmony, which is a prerequisitefor close co- operation between members of the sameOffice in the solution of health problems, must bebased above all on unity of race, religion and languageas well as of customs and traditions.

Finland - letter dated 11 October 1952 :

... Finland has no comments, observations orsuggestions to offer on this subject.

France - letter received on 6 November 1952(translation from the French) :

... in the opinion of the French Government,the determining factor in assignment of a territoryto one of the regions of the Organization shouldremain that which has so far been accepted by theWorld Health Assembly with satisfactory results,namely, the desire expressed by the Member Stateor Associate Member or, in the case of territories not

responsible for the conduct of their internationalrelations, by the responsible State.

It seems to us that the authorities of the interestedState are the best judges of which solution to thisproblem is likely to facilitate the most completeapplication of WHO programmes. It may also beassumed that such authorities will contribute allthe more readily to the implementation of the saidprogrammes if their wishes with regard to assign-ment to region have been respected.

It is to be understood, of course, that in exercisingits right to choose the region to which it desires toadhere, a State must bear in mind the exigencies ofeffective administration by WHO in the region inquestion.

Hashemite Kingdom of the Jordan - letter dated17 August 1952:

I feel that this matter should be discussed againby the Sixth World Health Assembly.

India - letter dated 29 September 1952 :

. the Government of India agree that the WHOshould lay down rational criteria for determiningassignment of countries to WHO regions. Untilnow ad hoc decisions have been given by differentAssemblies, sometimes resulting in assignment ofcountries to regions outside their geographical areas.However, to avoid old arguments being revived,it is suggested that no changes need be made in theexisting assignment of countries to the WHO regionsunless a country requests reassignment under cri-teria now to be laid down for deciding questions ofassignment to regions. In regard to new applicantsfor assignment to regions, the comments of theGovernment of India according to the plan suggestedin the penultimate paragraph of your letter mentionedabove are as follows :(a) When a country applies for assignment to aregion, identity or similarity of the health and techni-cal aspects of its problems with those of othercountries of its geographical area should be consi-dered to be a very important factor in deciding itsassignment to the region.(b) Economic aspects, including both financial onesand those relating to problems of communications,should be given due consideration when decidingassignment of countries to a region.(c) Social customs and habits of people have agreat bearing on public -health practice in a country.This aspect therefore should be given due considera-tion when deciding assignment of countries to aregion.


(d) Geographical aspects demand primary conside-ration. More often than not, geographical nearnessof countries determines the pattern of social, healthand economic development in those countries.Similarity of problems is usually the rule in neigh-bouring countries. Therefore, unless other moreweighty reasons require different action, geogra-phically near countries should be assigned to thesame region.(e) Administrative considerations should be givendue weight. Wherever administratively convenient,countries should be assigned to a common region.This would make for efficient working of programmesat lower costs. However, observance of this criterionshould not violate the criteria (a), (b), (c) and (d).

(f) As regards this item (relation between the variousregions of WHO and regional agreements concludedby other international organizations), if it is intendedto fit the composition of WHO regions with theregional pattern of other international organizations,there need be no objection to laying this down as oneof the criteria, provided it does not clash with thecriteria (a) to (e).

(g) WHO being primarily a technical organization,political considerations should find no place in thedecisions on applications from countries for assign-ment to regions.(h) The criteria mentioned above should be consi-dered of importance in the order indicated belowwhen deciding questions of assignment of countriesto regions :

(d) geographical aspects ;(a) health and technical aspects ;(c) social aspects ;(b) economic aspects, including both financialones and those of communications ;(e) administrative considerations ;(f) relations between the various regions of WHOand regional agreements concluded by otherinternational organizations.

Iraq - letter dated 14 August 1952 :

... the Government of Iraq supports the plandrawn up by the Executive Board at its tenth session.

Ireland - letter dated 18 December 1952 :

... it is considered that in the case of those regionalareas which are based on continents which can bereasonably well defined or indicated by physicalfeatures, it would seem most practicable and expe-

dient that the WHO region should be identical withthe corresponding geographical region. Where,however, there are physical features which mightjustify the sub -division of a continent it is not easyto have regional assignments on clear -cut principlesand it would not seem to be feasible to go furtherthan drawing attention to the following points whichmight be taken into account in determining theregion to which any country in a continent should beassigned.

(1) The health problems of the countries whichit is proposed to assign to a regional area shouldbe similar. In so far as such problems are deter-mined by natural factors such as climate, topo-graphy, etc., these factors should be of assistancein arriving at a decision on an application forassignment to a region.(2) Full weight should be given to ethnic conside-rations since solutions propounded to healthproblems which exist in more than one countrymust have regard to the manners and customs ofall the nationals concerned. It is clear that it iseasier to arrive at such general solutions where theinhabitants of a region are racially homogenousand share the same culture.

It is considered that the Executive Board's reviewof the existing regional arrangements should be basedon health, technical, ethnic, geographical and admi-nistrative considerations, but in the final analysisassignments to regions must have regard to facilitat-ing the work of the Organization as a whole and theyshould, as far as possible, be based on such conside-rations as the general interest and efficiency of theOrganization which has certain specified tasks tofulfil.

Israel - letter dated 10 December 1952 :

... The Government of Israel is of the opinionthat the method adopted for the assignment of newMember States, Associate Members and territoriesmust be consistent with the general principles laiddown in the Constitution of the World HealthOrganization. Therefore, the basic criterion for theassignment of a Member or an Associate Memberto a region should be the best interests of the healthof the people of that country. This clearly excludesany considerations of a political nature.

On examination of the various aspects outlinedin the questionnaire, the Government of Israel is ofthe opinion that those relating to geographical andhealth conditions are of primary importance.

Since a region is primarily a geographical concep-tion, it should clearly include all Member States

ANNEX 14 253

situated within its geographical boundaries. In thecase of a territory situated on the border of twogeographical areas, the wish of that country to joinone region or the other should determine its assign-ment.

Moreover, since it may be assumed that the healthconditions in any particular territory are dependenton and influenced by the prevalence of similarfactors in other territories of the geographical areain which it is situated, the consideration of healthaspects should be of equal importance in establishingthe criteria for the assignment of territories to aregion. The control and prevention of disease in agiven area can best be undertaken by the co- ordinatedefforts of countries faced with similar problems whichderive from similar ecological conditions. Further-more, in a region formed on a geographical basis, thefull utilization of research and training institutionsin the area will be facilitated.

In the view of the Government of Israel, considera-tion of any other factors would lead to the creationof artificial aggregations of countries joined togetherby common factors which have little concern withhealth. The countries in such aggregations mightwell be geographically distant from one another andpossessed of totally different health conditions.Rather than have the regional principle distorted bythe artificial creation of regions formed on the basisof political, cultural, economic, social, religious orethnic criteria, the Government of Israel wouldprefer to see it abandoned altogether.

Italy - letter dated 4 December 1952 (translationfrom the French) :

... The Italian Government is of the opinion thatit is not desirable to attempt to establish too rigidrules and criteria.

Above all, the expressed desires of Member Statesshould be borne in mind, if there is no counter -indication from the health point of view, i.e., ifepidemiological, social and economic conditions aresimilar to those existing in the region in question,and if communications with the regional officeheadquarters do not present serious difficulties.

Lebanon - letter dated 18 December 1952 (transla-tion from the French) :

... a preparatory meeting was held under theauspices of this Department to determine rules andcriteria permitting the assignment of Member States,Associate Members and territories or groups ofterritories to the geographical areas determined inconformity with Article 44 of the Constitution. The

unanimous opinion was that in doing this, maximumimportance should be attached to the followingfactors :

(a)

(b)

(c)

health and technical aspects ;economic aspects ;social aspect ;

(d) geographical aspect;in the order in which they are given on the lastpage of the above -mentioned circular letter, onlysubsidiary attention being paid to the remainingfactors (e), (f) and (g).

After considering these aspects it should be possibleto decide on the policy to be followed ; however,if the position remains undecided even after conside-ration of these points, the three remaining factorsshould then be examined.

Luxembourg - letter dated 21 November 1952(translation from the French) :

... the Government of the Grand Duchy isof opinion that, for the purpose of applying theprovisions of Article 44 of the Constitution of WHO,a State or a territory should be assigned to the regiondesignated by its Government or by the Governmentresponsible for the conduct of its internationalrelations, on condition that the State or territory inquestion be adjacent to the region in which it wishes tobe included.

Netherlands - letter dated 11 November 1952 :

... To my mind there should not be questions of" assignment " of countries to regions.

Basing myself on Article 44 of the Constitution-" The Health Assembly shall from time to timedefine the geographical areas in which it is desirableto establish a regional organization " -I feel that itis for the World Health Organization to definegeographical areas with a view to establishingregions. Formally speaking, no countries are" assigned " to belong to a certain region, but theformal act is to modify the delineation of a region,if a country wants to join another region than thatto which it used or was supposed to belong.

On these grounds the Netherlands have raised noobjection when Pakistan, Indonesia, Greece andTurkey expressed their wishes as to their regions :they all could be considered as belonging either tothe one or to the other region and the only criterionfor the decision was their own wish to belong to aspecific region. I therefore regret that in the reso-lutions of the World Health Assemblies and of theExecutive Board the word " assignment " is being

254 EXEÇUTIVE BOARD, ELEVENTH SESSION

used, which is liable to endanger the principle laiddown in Article 44 of the Constitution which aimsat the establishment of regions on geographicalconsiderations.

Concluding I feel that WHO should not proceedto determining a territory to a region on the basisof the points set out on page 3 of your letter. Bytaking into account the points (a) to (h) each " assign-ment " might be subject to difficult and dangerousdiscussions. It should be left to the discretion of theterritory in question to choose the region to whichit wishes to belong if it is responsible for its inter-national relations, respectively to the discretion ofthe country which is responsible for the internationalrelations of the territory in question.

New Zealand -- letter dated 29 December 1952 :

... It appears to the New Zealand Governmentthat there are three basic criteria to which referencemight appropriately be made in determining theregions to which territories should belong, namely :

(a) geographical position ;(b) community of health problems ;

wishes of the State concerned.(c)

It is appreciated that these considerations do notfall within the list of factors outlined in your letterof 16 July.

Switzerland - letter dated 24 October 1952 (trans-lation from the French) :

... After careful examination of all aspects of theproblems, we have arrived at the conclusion thatit is extremely difficult to analyse the technicalfactors involved in automatic assignment so long asthere exist no precise regulations with regard todelineation of the World Health Organization'sregions. In fact, such delineation, fixed by the firstWorld Health Assembly on the basis of political(Europe /America) or geographical (Africa /Asia) con-siderations, or even by simple enumeration of coun-tries and territories (Mediterranean), is in iteifsubject to change (cases of Greece, Indonesia andTurkey).

Furthermore, it seems to us impossible to laydown strict rules concerning countries on the bordersof two regions, on the basis only of the circumstancesmentioned by the Executive Board, since in factspecial conditions exist in each case. If, however, theAssembly admits the necessity for taking variouscriteria into account, there can be no progress beyondthe present system in the case of territories which, onaccount of their situation, may with equal justifi-

cation be assigned to one geographical region oranother.

Under these circumstances, we consider that theproblem of assignment to existing regions should besolved once and for all by accepting as the deter-mining factor the free choice registered by theauthority competent -according to the Constitutionor to standing agreements -to express an opinionon behalf of the country or territory concerned, oncondition that the choice made is reasonable anddoes not prejudice the interests of the Organization.

Union of South Africa - letter dated 6 December1952 :

... the Union is of the opinion that the pointsenumerated on page 3 thereof do not provide asuitable basis for determining, through the machineryof the World Health Organization, the assignmentof Member States, Associate Members or territoriesor groups of territories to a region of the Organiza-tion. In this connexion it is considered that the onlycriterion which should determine such assignmentshould be the wishes of the Government of theterritory concerned, or, in the case of a territory nothaving responsibility for the conduct of its inter-national relations, of the country responsible forthose relations, provided only that the desiredassignment is administratively practicable from thepoint of view of the World Health Organization.

United Kingdom of Great Britain and NorthernIreland - letter dated 16 October 1952 :

... After careful consideration of the contents ofyour letter Her Majesty's Government are of theopinion that the points enumerated on page 3 ofyour letter do not provide a suitable basis for deter-mining, through the machinery of the World HealthAssembly, the assignment of a territory to a regionof the Organization. Her Majesty's Governmentconsider that the only criterion which should deter-mine such assignment should be the wishes of theGovernment of the territory concerned, or, in thecase of a territory not having responsibility for itsinternational relations, of the country responsiblefor these relations, provided only that the desiredassignment is administratively practicable from thepoint of view of the World Health Organization.

Her Majesty's Government would point out thatthe criterion suggested above would appear to havebeen followed in the general delineation of the regionsof the Organization with results which have provedgenerally satisfactory.

ANNEX 14 255

United States of America - letter dated 16 January1953 :

... At the outset it would seem reasonable toassume that, except for deviations which were madeto meet special conditions and needs, general prin-ciples relating to geographic contiguity, the expec-tation that similar health conditions and problemswould exist in given areas because of such contiguity,and similar factors were applied in the originaldelineation of the geographic areas, even where theywere not explicitly enumerated. Similar considera-tions were undoubtedly taken into account in assign-ing, to regional organizations, countries or territorieswhich entered the Organization after the originalassignments had been made. As was noted above,however, the application of these principles hasalways been extremely flexible, a major considerationat all times being the wishes or preference of thecountry involved. It would appear highly undesirablethat any rigid set of criteria should be adopted whichwould remove this flexibility.

It seems reasonable to assume that these samefactors will continue to be applied in the future evenif they are not enumerated. There would, therefore,appear to be no need to define the criteria which theAssembly should apply in determining the assign-ment of territories to geographic areas for purposesof regional organization. Should it be the view of theExecutive Board, however, that criteria should beestablished for this purpose, the list contained inyour letter of 16 July 1952 would appear to include,in general terms, the factors which have been appliedin the past. Two somewhat more specific factorswhich, although they are undoubtedly covered withinthe general items listed, seem to this Governmentto be worthy of individual mention, and which theBoard might wish to consider including in any listingof criteria, relate to the similarity of health conditionsand the availability of transportation and communi-cations facilities. It is this Government's view,however, that no set of criteria should be adoptedwhich would remove the flexibility mentioned above.

ASSOCIATE MEMBERS

Morocco (French Protectorate) - letter dated 14November 1952 (translation from the French) :

... in my opinion, the main determining factor forassignment to a region should be the expressed wishof the Member State or Associate Member concerned.

In fact, each separate State concerned is alone ableto assess the various technical, health, economic,geographic and social factors involved in its desireto be assigned to a particular regional office. More-

over, the application of WHO's various programmeswill be facilitated by being carried out in each regionby States which have the same problems to solve.

Tunisia - letter dated 3 November 1952 (translationfrom the French) :

... It may be assumed that, when the governmentof a Member State expresses its choice of assignmentto a particular region, that government will havethoroughly examined all the questions involved insuch a choice, i.e., health, economic, geographic,social, financial, administrative factors, etc. Con-sequently, the best and simplest rule to apply in theassignment to regions would be that of compliancewith the wishes of the Member State concerned, oncondition that they were not incompatible with thenormal functioning of a particular regional organiza-tion, as defined in Article 50 of the WHO Constitu-tion.

UNITED NATIONS AND SPECIALIZED AGENCIES

United Nations - letter dated 20 August 1952 :

... The following information concerning theexperience of the Economic and Social Council asregards the definition of the geographical scope ofregional economic commissions may be of some useto you in making your study.

As the general definition of " Europe " is non-controversial, the terms of reference of the EconomicCommission for Europe, as established by the Coun-cil, do not go beyond stating that " the membersof the Commission are the European Members of theUnited Nations and the United States of America "(E/2152, p. 98, para. 7). Turkey is included in thisdefinition.

The terms of reference of the Economic Commis-sion for Latin America stipulate that " the geo-graphical scope of the Commission's work is thetwenty Latin American States Members of the UnitedNations, participating territories in Central andSouth America which have frontiers adjoining anyof these States, and participating territories in theCaribbean areas " (E/2152, p. 102, para. 4).

The territories of Asia and the Far East are referredto in ECAFE's terms of reference as " Brunei, Burma,Cambodia, Ceylon, China, Federation of Malaya,Hong Kong, India, Indonesia, Japan, Korea, Laos,Nepal, North Borneo, Pakistan, the Philippines,Sarawak, Singapore, Thailand and Viet Nam "(E /CN/ 11 /Rev. 4, p. 2, para. 2).

Membership in the regional economic commissionsas laid down by the Council, however, includescountries outside the geographical scope of their


work : thus the USA is a member of ECE ; member-ship in ECLA is open not only to Members of theUnited Nations in North, Central and South Ame-rica and in the Caribbean area but also to France,the Netherlands and the United Kingdom ; andAustralia, France, the Netherlands, New Zealand,the USSR, the United Kingdom and the USA aremembers of ECAFE.

In 1948, the Council established an Ad Hoc Com-mittee to consider the factors bearing upon theestablishment of an Economic Commission for theMiddle East which in turn established a sub-com-mittee on the geographical delineation of the area.In the course of the sub -committee's discussions, itbecame evident that its members thought it was notpossible to draw up a definition of the area basedpurely on geographical criteria ; all agreed that theeconomic factors should be taken into account, andcertain members emphasized the historical, culturaland social factors. The report of this sub -committeeis contained as an annex to the report of the Ad HocCommittee on the Proposed Economic Commissionfor the Middle East to the ninth session of theCouncil (E/1360).

The Ad Hoc Committee recommended that thegeographical scope of the proposed Commission'swork " shall be the territories of the membersof the Commission as well as the Non -Self - GoverningTerritories and the territories of States in the ArabianPeninsula, the Eastern Mediterranean and NorthEast Africa, admitted by the Commission as associatemembers or in a consultative capacity... The mem-bers of the Commission shall in the first instance bethe following members of the United Nations :Afghanistan, Egypt, Ethiopia, Greece, Iran, Iraq,Lebanon, Saudi Arabia, Syria, Turkey and Yemen ".(See E/1360, page 21, para. 6 and page 20, para. 3.)

International Labour Organisation - letter dated31 July 1952 :

... In reply, I am to inform you that the Director -General does not at the present time consider thatthere is any comment or suggestion relating to thissubject which he could usefully make on behalf ofthe International Labour Organisation.

Food and Agriculture Organization - letter dated8 August 1952 :

... The Food and Agriculture Organization hasbeen led to set up regional offices for the purposeof serving the main geographical areas of the worldwhere FAO is active. The assignment of our variousStates Members to these regional offices has beendone on an ad hoc basis and so far we have not been

requested by our Conference to apply definite rulesand criteria: in defining the areas of competenceof our regional offices.

I do not believe that such a request is likely to beformulated. Our regional offices are merely adminis-trative outposts, established to facilitate liaisonbetween headquarters and the various regions. Theyare being used increasingly as convenient centresfrom which to conduct our activities of a regionalcharacter, and the heads of these offices have theresponsibility of watching developments within theirrespective regions and of establishing contacts withGovernments. However, because of the technicalnature of these activities, it has not been foundnecessary to use detailed criteria in determining theexact delimitations of the areas of competence ofour regional offices. In reality, we have ratherendeavoured to adapt our network of offices andsub -offices to appropriate groups of countries, notmerely from geographical considerations but alsowith regard to agricultural conditions, social back-grounds and cultural traditions.

Close contact is maintained between these officeswhich overlap in most areas. At least in two caseswe have had countries assigned to more than oneregional office.

Even when convening regional meetings of govern-ment representatives, ad hoc arrangements arerequired since the purpose of each meeting alwaysinfluences the selection of the countries to beinvited.

Should we ever be faced with a request that ourregional areas of competence be carefully delimitedon rational principles, I confess that I would beextremely embarrassed. Political factors wouldundoubtedly loom large in the solution of theproblem, although these would, of course, be pre-sented under cover of economic and technicalconsiderations. The solution of conflicting viewsbetween our Member Nations might lead to thebreaking up of large regions into smaller geographicalareas which, I believe, would be unfortunate.

I fully realize that the above comments will notbe of much use to you in reporting to the ExecutiveBoard of WHO, but our experience is not such thatI can offer any more valuable suggestions.

United Nations Educational, Scientific and CulturalOrganization - letter dated 29 August 1952 :

... UNESCO is, for various reasons, far fromhaving reached the degree of decentralization attainedby the World Health Organization.

At its Sixth Session (Paris 1951), the GeneralConference considered a "Report by the Director-

ANNEX 14 2 57

General on the means and degree of decentralizationdeemed most advisable in the field of the Organiza-tion's activities ". It then adopted a resolution(30.31) by which it approved in principle " theprogressive establishment of an efficient network ofoffices adapted to the specific needs of regionsdistant from Headquarters ". It also requested theDirector -General to study the problems involved inthe creation of such offices, to consult MemberStates on financial and practical questions related toit and to report to the Seventh Session in 1953.

Furthermore, a Working Party was set up tostudy the question specifically mentioned in yourletter, that is, the grouping of Member States inregions. In its report, which was approved by theGeneral Conference, and which appears in doc.6C /PRG /32 enclosed herewith for your information,5it recommended the grouping of Member Statesin six main geographic regions and outlined theprinciples which should guide the Secretariat in thedevelopment of regional activities.

FIRST REPORT OF THE JOINT WORKING PARTY OFTHE PROGRAMME COMMISSION AND OF THE OFFICIALAND EXTERNAL RELATIONS COMMISSION ON THE

GROUPING OF MEMBER STATES BY REGIONS(UNESCO Document 6C /PRG /32)

The Working Parties set up by the Programme andthe Official and External Relations Commissions,to consider certain questions concerning UNESCO'swork in the different regions of the world, held twojoint meetings on Saturday, 30 June, at 3.30 p.m.,and on Monday, 2 July at 9.30 a.m., under the chair-manship of the representative of France, Mr. CharlesLucet.

In order to help the Commission to draw up thelists of States that were to be invited to take part inactivities contemplated for 1952 which are of interestto regional groups, the Working Party defined, ona geographical basis, the six main regions in whichUNESCO's work was being done, namely, Africa,Southern Asia and the South Pacific, Eastern Asia,Europe, the Western Hemisphere, and the MiddleEast.

The list of Member States which, on a geographicalbasis, it seemed should be included in the six regionsproposed is contained in the annex to this report.

The Working Party wishes, in this connexion, todraw the attention of the Programme and the Officialand External Relations Commissions to the followingpoints :

5 Reproduced below

(1) While the geographical criterion should beusefully adopted for the purpose of grouping MemberStates when it is a question of defining the actionareas of regional offices and field science co- operationoffices, or of deciding on the way in which fieldprojects are to be carried out, it should not be theonly operative one so far as UNESCO's work in thefield of education, science and culture is concerned.When the list of States to be invited to take part inany given action is drawn up, it may be useful andnecessary to take into account also such factors ascommon cultural traditions, common language, andsimilarity of economic and social conditions. There-fore, Member States should be consulted before anyfinal decisions on the subject are taken.(2) The Commission recognized that certain States,in virtue of their geographical position and theirspecial situation, should be enabled to take partin activities in two or more different regions when itis ,a question of carrying out the Programme.(3) The Working Party considers that when partof the national territory of a Member State or aterritory administered by it is in a region other thanthat in which the metropolitan territory is situated,such Member State should be enabled to take partin activities in that other region.(4) Following decisions which the General Con-ference would probably take regarding the admissionof Associate Members, the composition of the variousregions would probably subsequently be changed.(5) As a general rule, the Working Party considersthat the development of regional activities whichmight have an exclusive character would be contraryto the principles and objectives of Unesco. Repre-sentatives of other regions should, on request, begiven the opportunity of taking part in such activities.(6) Owing to the short time available to it, theWorking Party was unable to specify, in the light ofthe above considerations, which States should beinvited to take part in each of the regional activitiesand meetings planned in the 1952 programme.

It hopes, nevertheless, that this first report willfacilitate the Programme Commission's task in thisrespect.

ANNEX I TO UNESCO DOCUMENT 6C /PRG /32

Suggestions of the Working Partyas regards the Grouping of Member States

Western HemisphereArgentine, Bolivia, Brazil, Canada, Colombia, CostaRica, Cuba, Dominican Republic, Ecuador, Guate-mala, Haiti, Honduras, Mexico, Panama, Peru,Salvador, United States, Uruguay, Venezuela.


Southern Asia and South PacificAfghanistan, Australia, Cambodia, Ceylon, India,Indonesia, Laos, New Zealand, Pakistan, Philippines,Thailand, Union of Burma, Viet Nam.Eastern AsiaChina, Japan, Republic of Korea.Middle EastEgypt, Hashemite Jordan, Iraq, Iran, Israel, Leba-non, Saudi Arabia, Syria, Turkey.AfricaLiberia, South Africa.EuropeAustria, Belgium, Czechoslovakia, Denmark, France,German Federal Republic, Greece, Hungary, Italy,Luxembourg, Monaco, Netherlands, Norway,Poland, Sweden, Switzerland, United Kingdom,Yugoslavia.

International Monetary Fund - letter dated 6 August1952 :

. This matter has been given some thought here,but we have no specific comments to offer at thistime. It is, of course, probable that a grouping ofcountries which would be suitable for, say, agricul-tural or health purposes would not necessarily be thegrouping most suitable for political or financialpurposes. Accordingly uniformity in these mattersas amongst the specialized agencies does not appearabsolutely necessary.

However, for the sake of convenience, it would beuseful to have as great a uniformity of terminologyin this respect as is practicable and we should bepleased to learn more of the results of World HealthOrganization consideration of this problem.

Annex 15 [EBil/WP /7]28 January 1953

RELATIONS WITH NON -GOVERNMENTAL ORGANIZATIONS

REPORT BY THE EXECUTIVE BOARD TO THE WORLD HEALTH ASSEMBLY

The Executive Board at its eleventh sessionconsidered the Director- General's study on theproblem of official relations with non -governmentalorganizations, which had been requested by theBoard at its ninth session (resolution EB9.R42). Thisstudy indicated the experience of both the UnitedNations and certain specialized agencies (ILO,FAO and UNESCO) in relationship with non-governmental organizations. It also pointed outthat there were four main possibilities for action inthis matter, each compatible with Article 71 of theConstitution of WHO. These were :

(1) to abolish official relationship ;

(2) to continue official relationship under thesame policy as has ruled up to date ;

(3) to amend the present working principles 2or their interpretation ;

1 See resolution EBI1.R54.2 Reproduced in the Handbook of Basic Documents, fifth

edition, p. 117

(4) to establish two categories of relationshipwith non -governmental organizations.

Early in its discussions the Executive Board agreednot to accept suggestions (1) and (4), and it reachedno final conclusion after prolonged debate on (2)and (3). The draft resolutions and proposals putforward are reproduced in the appendix to thisannex. A draft resolution (see appendix, item 5)in which it was proposed to modify neither thecriteria to be fulfilled before a non -governmentalorganization became eligible to be considered forrelationship with WHO, nor the procedure foradmitting such organizations into this relationship,but permitting plurality of relationships in specialcases, was rejected (8 votes to 8). Seventeen memberswere present, but the Chairman did not vote.

It was then proposed and unanimously agreedthat, in view of the amount of time the Board hadspent discussing the question, and the impossibility

ANNEX 15 259

of arriving at a decision by a clear majority, the wholematter should be referred to the Health Assembly.

It was clear that the point at issue was whetherthere should be only one non -governmental organiza-tion admitted into relationship in each field of activity,or whether it would be advisable to have a numberof them. Varying points of view on this subjectwere brought out in the draft resolutions submitted.

Those members in favour of having only oneorganization in each field of work admitted intorelationship contended that it would be impossibleto co- ordinate international health work if theadvice of two or more different organizations was tobe accepted, or if their activities could not be co-ordinated. They also pointed out that any inter-national non -governmental organization which didnot admit to membership all persons engaged inits field of work was in fact guilty of being exclusive,and this was not compatible with the Constitution,which states that there shall be no " distinction ofrace, religion, political belief, economic or socialcondition ". It was further suggested that if morethan one organization working in any given field ofhealth were admitted into relationship it might bemore difficult to resolve differences of opinionbetween such organizations than would be the caseif such differences remained matters for discussionoutside WHO.

On the other hand, those who were in favour ofinterpreting principles in the sense of plurality inspecial cases contended that any complete or rigid

adherence to the point of view taken by the opposinggroup would lead to bad public relations and un-necessary tensions deleterious to the interests ofWHO. This opinion was endorsed to a limitedextent by the Director -General. It was believedthat a better solution to the problem would be toadmit all reputable organizations which requestedrelationship rather than make invidious distinctions,provided always that the organization requestingrelationship came within the criteria contained in theworking principles.

During the debate, questions were also raisedconcerning the obligations of non -governmentalorganizations brought into relationship with WHO.The principles governing the admission of suchorganizations into relations with WHO refer toprivileges granted to these organizations but do notrefer to duties or obligations which they might beexpected to assume. However, when the proposalwas made for amendment of this part of the princi-ples it was rejected by 8 votes to 6 with 2 abstentions.(See appendix, paragraph 3 of the draft resolutionunder item 5.)

The foregoing statement covers substantiallythe difficulties experienced by the Executive Boardon this controversial question, which remainsunsolved. The Board therefore passes it on to theSixth World Health Assembly with the Request thatthe Director -General prepare any further documen-tation he may think necessary for the use of theHealth Assembly.

Appendix

PROPOSALS MADE BUT NOT ADOPTED

The following proposals were made during the debate onthe Director -General's study of the relationship of non-governmental organizations with the World Health Organiza-tion which took place at the tenth, eleventh and twelfthmeetings :

1. A proposal by Dr. van den Berg to set up a workingparty in the early stages of discussion -rejected by 12 votesto 4.

2. Draft resolution proposed by Professor Canaperia :

The Executive Board,After having examined the document presented by the

Director -General on the question of relations with non-governmental organizations,

1. Is OF THE OPINION that there is no need to modify theprinciples governing the admission of non -governmental

organizations to relations with WHO, as approved by theThird World Health Assembly ;2. CONSIDERS that, in accordance with these principles,there is nothing against the plurality of representation ofnon -governmental organizations active in the same fieldand that, consequently, this solution could be adopted inspecial cases, when the organizations concerned satisfy theconditions laid down for their admission.

This resolution was discussed but not put to the vote.

3. Draft resolution proposed by Dr. Allwood- Paredes andDr. Togba (who later withdrew his sponsorship) :

The Executive Board1. RECOMMENDS that the criteria to be fulfilled by a non-governmental organization for admission into relationswith WHO remain as at present ;


2. RECOMMENDS, nevertheless, that the procedure foradmitting such organizations into relationship, as well asthe privileges conferred by such relationship, be revised ;3. REQUESTS the Director -General and a committee onnon -governmental organizations jointly to submit to thethirteenth session of the Executive Board a . study on thisquestion and a complete set of rules governing relationships.

This resolution was discussed but not put to the vote.

4. A proposal by Mr. Mason that " the Board adopt thesecond possibility suggested by the Director -General tocontinue official relationship as it now stands "- rejectedby 8 votes to 8 with 1 abstention.

5. Draft resolution proposed by Dr. Allwood -Paredes'Dr. van den Berg, Professor Canaperia and Dr. Hurtado(a combination of 2 and 3) :

The Executive Board,After having examined the document presented by the

Director - General on the question of relations with non-governmental organizations and the working principlesgoverning the admission of non -governmental organizationsinto relations with WHO,

1. Is OF THE OPINION that there is no need to modify thecriteria to be fulfilled before a non -governmental organiza-tion becomes eligible to be considered for relationshipwith the World Health Organization nor the procedure foradmitting organizations into relationship with WHO ;

2. CONSIDERS that, in accordance with these criteria, thereis nothing against the plurality of representation of non-governmental organizations active in the same field andthat, consequently, this solution could be adopted in specialcases, when the organizations concerned satisfy the condi-tions laid down for their admission ;

3. RECOMMENDS that the question of privileges and obliga-tions conferred on non -governmental organizations byrelationship with WHO be examined ; and

4. REQUESTS the Standing Committee on Non- Govern-mental Organizations and the Director -General jointlyto submit to the thirteenth session of the Executive Board astudy of this question and a draft set of rules governingrelationship.

The voting on this resolution was taken paragraph byparagraph:

Paragraph I was adopted unanimously;

Paragraph 2 was rejected by 8 votes to 8;

Paragraph 3 was rejected by 8 votes to 6 with 2 abstentions;

Paragraph 4 was not voted upon, since paragraph 3, fromwhich it followed, was rejected.

The Chairman then put to the vote the draft resolution asa whole, as amended by the previous votes. This was rejectedby 8 votes to 8.

Accounts for 1952, examination,Administrative and Budgetary Ques-

tions, Advisory Committee on,

INDEX TO RESOLUTIONS

Resolution No.

EB11.R33

EB11.R29EB11.R57.8

Administrative Committee on Co -ordi-nation, Working Group on Publica-tions, EB 11. R42

AfricaRegional Committee, report on

second session, EB11.R9Regional Director, appointment, EB11.R4Regional Office, host agreement

with France, EB11.R3Agenda for Sixth World Health As-

sembly,Allowances, lodging, travel, etc.,

for national training courses,for Technical Assistance projects,for attendance at regional com-

mittee meetings, EB11.R50Americas

Regional Committee, report onfourth meeting, EB11.R9

Regional Director, confirmationof appointment, EB11.R5

Annual Report of the Director -General, EB11.R44Appropriation resolutions, transfers

between sections1952, EB 11. R351953, EB11.R36

Areas, see RegionsAssessments

China, EB11.R34scale, EB11.R30

for Associate Members, EB11.R26See also Contributions

Associate Membersposition in regional committees, EB11.R26proposed amendment of procedure

for admission, EB11.R24scale of assessments, EB11.R26

Auditor, see External AuditorAuxiliary personnel, training,

expert committee report,

EB11.R66EB11.R60EB11.R61EB11.R57.5

BCG vaccination,Biennial Health Assemblies,

EB11.R57.6EB11.R52

EB11.R27EB11.R69

Bilharziasis, Expert Committee on,first report,

Biological Standardization, ExpertCommittee on, sixth report,

Brucellosis, Joint FAO /WHO ExpertCommittee on, second report,

Budget, see Appropriation Resolutions ;Programme and Budget Estimates

Building Committee,

China, assessment,Chronicle of the World Health Organi-

zation,Committee reports, proposed amend-

ment of procedure,Communicable diseases in Technical

Assistance programme,Constitution of WHO, amendments in

case of biennial Assemblies,Contributions

collection of,to Office International d'Hygiène

Publique, arrears,United Nations Committee on,See also Assessments

Co- ordination, Administrative Com-mittee on, Working Group on Publi-cations,

Costsof attending national training

courses,of attending regional committee

meetings,local, participation of Member

States,in Technical Assistance pro-

jects,

Demonstration projects in TechnicalAssistance programme,

Dental hygiene and preventive dent-istry,

Director - GeneralAnnual Report,contract,nomination,

procedure,

- 261 -

Resolution No.

EB11.R11

EB1L.R17

EB11.R12

EB11.R56

EB I 1. R34

EB11.R44

EB11.R24

EB11.R57.6

EB11.R69

EB11.R30

EB11.R38EB11.R30

EB11.R42

EB11.R61

EB11.R50

EB11.R60

EB11.R57.5

EB11.R57.6

EB11.R59

EB11.R44EB11.R49EB11.R48EB11.R47


Eastern MediterraneanRegional Committee,Regional Director, confirmation

of appointment,Economic and Social Council, deci-

sions affecting WHO,

concerning Technical Assistance,Education and training

cost of attending national courses,expert committee report,study by Board,Technical Assistance programmes,See also Fellowships

Environmental sanitation in TechnicalAssistance programme,

Epidemiological information,Europe, Regional Committee

report on second session,request regarding fellowships,See also International Anti -Vene-

real -Disease Commission of theRhine

Executive Boarddate and place of twelfth session,examination of External Auditor's

report,for 1952,

method of work,representation at Sixth Health

Assembly and report of repre-sentatives at Fifth,

Rules of Procedure, amendment,See also Organizational studies

Expert advisory panels and commit-tees, appointments,

Expert committee reports,Bilharziasis, first report,Biological Standardization, sixth

report,Brucellosis (FAO /WHO), second

report,Hepatitis, first report,Influenza, first report,International Pharmacopoeia,

eleventh session,Non -Proprietary Names, fifth ses-

sion,Occupational Health (ILO /WHO),

second session,Professional and Technical Educa-

tion of Medical and AuxiliaryPersonnel, second report,

Resolution No.

EB11.R8

EB11.R6

EB11.R40EB11.R55EB11.R57

EB11.R61EB11.R52EB11.R53EB 11. R57.6

EB11.R57.6EB11.R22

EB11.R9EB11.R64

EB 11. R70

EB11.R32EB11.R33EB11.R2

EB11.R1EB11.R25

EB11.R19

EB11.R11

EB11.R17

EB11.R12EB11.R14EB11.R13

EB11.R18

EB11.R18

EB11.R16

EB11.R52

Expert committee reports (cont.)Venereal Infections and Trepone-

matoses, fourth report,Experts, Technical Assistance, condi-

tions of service,External Auditor's report, examination

by Board,for 1952,

FAO /WHO Joint Expert Committeeon Brucellosis, second report,

Fellowshipspriorities,under Technical Assistance pro-

gramme,costs,

Field projects, participation of MemberStates in certain costs,

under Technical Assistance,Financial Report, examination by

Board,France, host agreement with WHO,Fund, see Publications ; Working

Capital Fund ; Seals, WHO

General Assembly, decisions of concernto WHO,

Gift to WHO,

Headquarters accommodation,Health aspects of Technical Assistance

programme, criteria for developing,Health Assembly, see World Health

AssemblyHepatitis, Expert Committee on, first

report,Host agreement with France,

ILO /WHO Joint Committee on Oc-cupational Health, report on secondsession,

Influenza, Expert Committee on, firstreport,

Insecticides, toxic hazards,International Anti -Venereal- Disease

Commission of the Rhine,International Dental Federation,International Pharmacopoeia, Expert

Committee on the, report on eleventhsession,

International Sanitary Regulationsepidemiological information,international certificates of vaccina-

tion,

Resolution No.

EB11.R15

EB11.R57.7

EB11.R32EB11.R33

EB11.R12

EB11.R64

EB11.R57.6EB11.R57.5

EB11.R60EB11.R57.5

EB11.R32EB11.R3

.EB 11. R40EB11.R55EB11.R46

EB11.R56

EB11.R57.6

EB11.R14EB11.R3

EB11.R16

EB11.R13EB11.R21

EB11.R10EB11.R59

EB11.R18

EB11.R22

EB11.R23


International Sanitary Regulations(cont.)reservations in respect of overseas

and outlying territories,

Joint FAO /WHO Expert Committeeon Brucellosis, second report,

Joint ILO /WHO Committee on Oc-cupational Health, report on secondsession,

Local costs to be borne by govern-ments,

in Technical Assistance projects,Lodging costs, see Allowances, lodging,

travel, etc.

Maternal and child health in TechnicalAssistance projects,

Meetings of other organizations, re-presentation of WHO,

Member States, participation in certaincosts,

in Technical Assistance projects,Members, Associate, see Associate

MembersMonograph Series,

National training courses, assistancein financing,

Non -governmental organizations, rela-tions with WHO,

Non -Proprietary Names, Sub- commit-tee on, report on fifth session,

Non -Self- Governing Territories, Com-mittee on Information from,

Nurse training in Technical Assistanceprogramme,

Nutrition in Technical Assistance pro-gramme,

Occupational Health, Joint ILO /WHOCommittee on, report on secondsession,

Office International d'Hygiène Publi-que, arrears of contributions,

Organizational studieson education and training,on programme analysis and evalua-

tion,on regionalization,

Palais des Nations, extension,Pan American Sanitary Organization,

report on sixth meeting of DirectingCouncil,

Resolution No.

EB11.R20

EB11.R12

EB11.R16

EB11.R60EB11.R57.5

EB11.R57.6

EB 11. R29

EB11.R60EB11.R57.5

EB11.R21

EB11.R61

EB11.R54

EB11.R18

EB11.R41

EB11.R57.6

EB11.R57.6

EB11.R16

EB11.R38

EB11.R53

EB11.R63EB11.R50

EB11.R56

EB11.R9

Pension Committee, Staff,Pharmacopoeia, International, Expert

Committee on the, report on eleventhsession,

Preventive medicine in Technical As-sistance programme,

Procedure, see Rules of ProcedureProfessional and Technical Education

of Medical and Auxiliary Personnel,Expert Committee on, second report,

Programme analysis and evaluation,study by Board,

Programme and budget estimatesfor 1954,

procedure for considerationby Sixth Health Assembly,

provisions in case of biennialAssemblies,

Projects, periodical reports,Public- health administration in Tech-

nical Assistance programme,Publications

ACC working group,distribution and sales,

Revolving Fund,See also titles of individual publica-

tions

Regional committeesEastern Mediterranean,Europe,

request concerning fellow-ships,

place of meetings,position of Associate Members,preparation of technical discus-

sions,reports,South -East Asia, proposal con-

cerning costs of national courses,travel costs of representatives,

reimbursement,Regional Directors

Africa,Americas,Eastern Mediterranean,South -East Asia,

Regional offices,Africa, host agreement with France,

Regionalization, study by Board,Regions

allocation of resources between,assignment to,

263

Resolution No.

EB11.R69

EB11.R18

EB11.R57.6

EB11.R52

EB11.R63

EB11.R62

EB11.R65

EB11.R69EB11.R44

EB 11. R57.6

EB 11. R42EB11.R42EB11.R43EB11.R43

EB11.R8EB11.R10

EB11.R64EB11.R50EB11.R26

EB11.R67EB11.R9

EB11.R61

EB11.R50

EB11.R4EB11.R5EB11.R6EB11.R7EB11.R50EB11.R3EB11.R50

EB11.R71EB11.R51


Regulations, see International SanitaryRegulations

Representation at meetings of otherorganizations,

Rhine boatmen,Rules of Procedure, amendments,

Executive Board,World Health Assembly,

Rules, Staff, amendments,

Sanitary Regulations, see InternationalSanitary Regulations

Sanitation, environmental, in TechnicalAssistance programme,

Seals, WHO,Secret ballot, proposed amendment to

procedure,Smallpox, worldwide campaign,Social and occupational health in Tech-

nical Assistance programme,Social field, development and con-

centration of efforts,South -East Asia

Regional Committeeproposal concerning costs of

national courses,report on fifth session,

Regional Director, extension ofappointment,

Staff, exemption from taxes,Staff Pension Committee,Staff Rules, amendments,Studies by Executive Board, see Organi-

zational studies

Tax reimbursement,Technical Assistance programme,

activities proposed for 1954,administrative structure and costs,conditions of service for experts,co- ordination of assistance,criteria for developing health as-

pects,definition adopted by TAB of

types of costs,financial resources available in

1953,long -term planning and continued

financing,participation of Member States in

certain costs,policy regarding national training

courses,

Resolution No.

EB11.R29EB11.R10

EB11.R25EB11.R24EB11.R39

EB11.R57.6EB11.R37

EB11.R24EB11.R58

EB 11.R57.6

EB11.R40

EB11.R61EB11.R9

EB11.R7EB11.R45EB11.R69EB11.R39

EB11.R45EB11.R57EB11.R62EB 11. R57.2EB11.R57.7EB11.R57.3

EB11.R57.6

EB11.R57.8

EB 11. R57.4

EB11.R57.9

EB11.R57.5

EB11.R61

Technical Assistance programme (cont.)reorganization of TAB and

appointment of Executive Chair-man,

resident representatives,resolutions concerning,responsibility for review and

approval,WHO participation,

Technical discussions at future HealthAssemblies,

Training, see Education and trainingTravel costs, see Allowances, lodging,

travel, etc.Treponematoses, see Venereal diseasesTuberculosis Research Office,

UNICEF /WHO health programmes,United Nations

efforts in the social field,place of meetings,scale of assessments,See also Administrative and

Budgetary Questions, AdvisoryCommittee on ; Contributions,Committee on ; Non -Self-Governing Territories, Commit-tee on Information from ; Eco-nomic and Social Council ;General Assembly ; TechnicalAssistance programme

Vaccination,approval of yellow -fever vaccine

for international certificates,BCG,

Venereal diseasesExpert Committee on Venereal

Infections and Treponematoses,fourth report,

International Anti- Venereal -Dis-ease Commission of the Rhine,

Weekly Epidemiological Record,Wellcome Research Laboratories,Western Pacific Regional Committee,

report on third session,Women's Society of Christian Service,Working Capital Fund

assessment for advances,collection of advances,

Resolution No.

EB11.R57.1EB11.R57.3EB11.R57

EB11.R57.1EB11.R57

EB11.R67

EB11.R27

EB11.R28

EB11.R40EB11.R29EB11.R30

EB 11. R58

EB11.R23EB11.R27

EB11.R15

EB11.R10

EB11.R22EB11.R23

EB11.R9EB11.R46

EB11.R30EB11.R31


Resolution No.

World Health Assemblyduration of sessions, EB11.R68Fifth, report of Executive Board

representatives, EB11.R1frequency of sessions, EB11.R69Rules of procedure, amendments, EB11.R24Sixth

procedure for consideringprogramme and budgetestimates, EB 11. R65

World Health AssemblySixth (cont.)

provisional agenda,representation of Executive

Board,technical discussions at future

sessions,

Yellow -fever vaccine, approval,

265

Resolution No.

EB11.R66

EB11.R1

EB11.R67

EB11.R23