PROCEEDINGS. (Washington, D. C., 9-21 September 1955)

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1 PROCEEDINGS of the VIII MEETING OF THE DIRECTING COUNCIL OF THE PAN AMERICAN SANITARY ORGANIZATION and VII MEETING OF THE REGIONAL COMMITTEE OF THE WORLD HEALTH ORGANIZATION FOR THE AMERICAS (Washington, D. C., 9-21 September 1955) Official Documents No. 13 December, 1955 PAN AMERICAN SANITARY BUREAU Regional Office of the World Health Organization 1501 New Hampshire Avenue, N.W. Washington 6, D. C., U.S.A.

2 TABLE OF CONTENTS PART I FINAL REPORT Page Participants... 3 Election of officers... 4 Committee on Credentials... 5 General Committee... 5 Secretariat Agenda... 5 Working parties... 6 Reports on the malaria eradication programs in the Americas... 7 Technical discussions... 7 Sessions... 7 Resolutions approved: I. Annual report of the Chairman of the Executive Committee... 7 II. Status of the collection of quota contributions... 8 III. Fellowship program IV. Annual report of the Director of the Pan American Sanitary Bureau... 8 V. Financial report of the Director and report of the External Auditor for VI. Meetings of the governing bodies of the Pan American Sanitary Organization held away from headquarters... 9 VII. Pan American Zoonosis Center... 9 VIII. Election of three Member Countries to the Executive Committee... 9 IX. Vote of thanks to the Representatives of Brazil, Haiti, and Panama X. Program and budget of the Pan American Sanitary Organization for XI. Local programs within countries XII. Emergency Revolving Fund XIII. Proportionate program distribution of budget funds XIV. Utilization of available funds XV. Proposed program and budget of the Pan American Sanitary Organization and the World Health Organization for the Region of the Americas for the year XVI. Regional programs to be financed with funds of the United Nations Expanded Program of Technical Assistance XVII. Conditions of employment of personnel XVIII. General program of work during the period XIX. Rules for technical discussions at Directing Council meetings XX. Rules of procedure of the Directing Council XXI. Topic for technical discussions during the IX Meeting of the Directing Council XXII. Resolutions of the WHO Assembly and Executive Board of interest to the Regional Committee for the Americas XXIII. Place of the 29th and 30th Meetings of the Executive Committee and the IX Meeting of the Directing Council XXIV. Technical discussions XXV. Vote of thanks Signatures Plenary Sessions FIRST PLENARY SESSION PART II PRÉCIS MINUTES Topic 1: Opening by the Temporary Chairman of the Council Topic 2: Establishment of the Committee on Credentials iii

3 iv CONTENTS Page Topic 3: Election of Chairman and two Vice-Chairmen Welcome to the Representative of the Council of the Organization of American States. 20 Topic 4: Adoption of the agenda Topic 5: Adoption of the program of sessions Topic 6: Establishment of the General Committee Topic 7: Annual report of the Chairman of the Executive Committee SECOND PLENARY SESSION First report of the Committee on Credentials Topic 12: Report on the collection of quota contributions Topic 17: Fellowship stipends Topic 18: Rules for technical discussions at Directing Council meetings Topic 17: Fellowship stipends (conclusion) THIRD PLENARY SESSION Topic 8: Annual report of the Director of the Pan American Sanitary Bureau FoURTH PLENARY SESSION Topic 8: Annual report of the Director of the Pan American Sanitary Bureau (conclusion) Inclusion of a new topic on the agenda of the meeting (Topic 26: Conditions of employment of regular and project personnel in the PASB/WHO) Topic 11: Financial report of the Director and report of the External Auditor for Motion of the Representative of Cuba (Presence of the External Auditor at Directing Council meetings) Topic 18: Rules for technical discussions at Directing Council meetings (continuation) Establishment of a working party Topic 20: Meetings of the governing bodies of the Pan American Sanitary Organization held away from headquarters FIFTH PLENARY SESSION Topic 9: Proposed program and budget of the Pan American Sanitary Bureau for SIXTH PLENARY SESSION Topic 9: Proposed program and budget of the Pan American Sanitary Bureau for 1956 (continuation) Election of the moderators and rapporteurs for the technical discussions Authorization for the distribution of Document CSP14/34 (Unification of action in public health programs in the Region of the Americas) Topic 9: Proposed program and budget of the Pan American Sanitary Bureau for 1956 (continuation) Motion of the Representative of Brazil (Pan American Zoonosis Center) Motion of the Representative of El Salvador (Local programs within countries) Motion of the Representative of Ecuador (Local programs within countries) SEVENTH PLENARY SESSION Expression of gratitude from the United States-Mexico Border Public Health Association Topic 21: Election of three Member Countries to fill the vacancies on the Executive Committee created by the termination of the periods of office of Brazil, Haiti, and Panama Motion of the Representative of Colombia (Vote of thanks to the Representatives of Brazil, Haiti, and Panama) Topic 9: Proposed program and budget of the Pan American Sanitary Bureau for 1956 (conclusion)... 63

4 CONTENTS V Page Motion of the Representative of Ecuador (Local programs within countries) (continuation) Malaria eradication Motions of the Representatives of Ecuador and El Salvador (Local programs within countries) (continuation) Appropriations resolution Text of Resolution on the Pan American Zoonosis Center Motions of the Representatives of Ecuador and El Salvador (Local programs within countries) (conclusion) EIGHTH PLENARY SESSION Topic 15: Emergency Revolving Fund Topic 13: Proportionate program distribution of budget funds, Motion of the Representative of Colombia (Proportionate distribution of funds for field activities, by countries) Topic 15: Emergency Revolving Fund (conclusion) Topic 14: Utilization of available funds (Building reserve fund; installations at headquarters; antimalaria campaign) NINTH PLENARY SESSION Second report of the Committee on Credentials Topic 10: Proposed program and budget of the PASO and proposed program and budget of the WHO for the Region of the Americas for Topic 16: General program of work in the Region of the Americas during the period Topic 10: Proposed program and budget of the PASO and proposed program and budget of the WHO for the Region of the Americas for 1957 (conclusion) Topic 25: Regional programs to be financed with funds of the United Nations Expanded Program of Technical Assistance Motion with respect to Article 25 of the Rules of Procedure TENTH PLENARY SESSION Topic 23: Presentation of reports on the malaria eradication programs in the Americas Statement of the Representative of the Netherlands Report of the Representative of Venezuela Report of the Representative of the United States Report on the British Caribbean Territories Report of the Representative of Paraguay Report of the Representative of Panama Report of the Representative of Nicaragua Report on Surinam Report of the Representative of Mexico Report of the Representative of Honduras Report of the Representative of Haiti Report of the Representative of Guatemala Report on the French Departments Report of the Representative of El Salvador Report of the Representative of Ecuador Report of the Representative of the Dominican Republic Report of the Representative of Cuba ELEVENTH PLENARY SESSION Topic 23: Presentation of reports on the malaria eradication programs in the Americas (conclusion) Report of the Representative of Colombia Report of the Representative of Brazil Report of the Representative of Bolivia... 90

5 vi CONTENTS Page Report of the Representative of Argentina Statement by the Chief of the Coordination Office of the Malaria Eradication Program (COMEP) Statement by the Representative of UNICEF TWELrTH PLENARY SESSION Topic 26: Conditions of employment of regular and project personnel in the PASB/ WHO Invitations from the Governments of Guatemala and Ecuador regarding the IX Meeting of the Directing Council Topic 16: General program of work in the Region of the Americas during the period (conclusion) Motion of the Representative of El Salvador (General program of work) Motion of the Representative of Brazil (Economic impact of health programs) THIRTEENTH PLENARY SESSION Topic 18: Rules for technical discussions at Directing Council meetings (concluson) Motion of the Representative of Cuba (Rules of procedure of the Directing Council) Resolution on the rules for technical discussions Vote on the motion of the Representative of Cuba (Rules of procedure of the Directing Council) Topic 19: Selection of topic for technical discussions during the IX Meeting of the Directing Council, VIII Meeting of the Regional Committee of the WHO (1956) Topic 24: Resolutions of the WHO Assembly and Executive Board of interest to the Regional Committee for the Americas Topic 22: Place of the IX Meeting of the Directing Council Motion of the Representative of Argentina (Selection of the seat of meetings) FOURTEENTH PLENARY SESSION Presentation of the reports of the rapporteurs of the technical discussions Methods of improving the education of public health personnel Medical care in rural areas Vote of thanks Statement of the Representative of El Salvador Statement by the Observer for the United Nations and United Nations Technical Assistance Board Reading, approval, and signing of the Final Report Closure of the VIII Meeting of the Directing Council GENERAL COMMrrrEE First session Second session Third session Fourth session Fifth session Sixth session Seventh session Eighth session Ninth session ANNEXES 1. General program of work in the Region of the Americas during the period Financial Report of the Director and Report of the External Auditor for Financial report of the Director for the year 1 January-31 December Financial statements for Report of the External Auditor for

6 PART I FINAL REPORT

VIII MEETING OF THE DIRECTING COUNCIL OF THE PAN AMERICAN SANITARY ORGANIZATION and VII MEETING OF THE REGIONAL COMMITTEE OF THE WORLD HEALTH ORGANIZATION FINAL REPORT The VIII Meeting of the

8 VIII MEETING OF THE DIRECTING COUNCIL OF THE PAN AMERICAN SANITARY ORGANIZATION and VII MEETING OF THE REGIONAL COMMITTEE OF THE WORLD HEALTH ORGANIZATION FINAL REPORT The VIII Meeting of the Directing Council of the Pan American Sanitary Organization and the VII Meeting of the Regional Committee of the World Health Organization were held at Washington, D. C., in the International Conference Suite of the Department of State of the United States of America, from 9 to 21 September 1955, inclusive, as convoked by the Director of the Pan American Sanitary Bureau, in compliance with Resolution X adopted by the Executive Committee at its 25th Meeting. PARTICIPANTS At the first plenary session of the VIII Meeting, which opened under the temporary chairmanship of Dr. Héctor A. Coll, Representative of Argentina, in the absence of the Representative of Chile, Chairman of the VII Meeting, the Representatives of Brazil, Cuba, and Panama were designated as the Committee on Credentials. The following representatives, alternates, advisers, and observers presented their credentials to the Committee and were present at the meeting: GOVERNMENTS ARGENTINA Dr. Héctor A. Coll, Representative Dr. Julio C. Blaksley, Alternate BOLIVIA Mr. Hugo de la Rocha, Representative BRAzIL Dr. Manoel Ferreira, Representative Dr. Bichat Rodrigues, Adviser CHILE Mr. José Miguel Barros, Representative COLOMBIA Dr. Bernardo Henao Mejía, Representative Dr. Jorge Jiménez Gandica, Alternate Dr. José A. Concha Venegas, Alternate CUBA Dr. Félix Hurtado, Representative DOMINICAN REPUBLIC Dr. Ramón Bergés Santana, Representative Dr. Marco de Peña, Alternate ECUADOR Dr. Emilio Romero Menéndez, Representative Dr. Juan Montalván Cornejo, Alternate EL SALVADOR Dr. Juan Allwood Paredes, Representative FRANCE Dr. R. G. Hyronimus, Representative Mr. Jacques Leprette, Adviser 3 GUATEMALA Mr. Humberto Olivero, Representative Dr. Orlando Aguilar, Alternate Adviser Mr. Francisco Anguiano, Adviser HAITI Dr. Jean-Baptiste Durand, Representative HoNDURAs Dr. Ramón Alcerro-Castro, Representative MEXIco Dr. Manuel E. Pesqueira, Representative NETHERLANDS Dr. Nicolaas H. Swellengrebel, Representative Dr. Alphonsus I. Faverey, Alternate Dr. Hugo M. Waszink, Alternate NICARAGUA Dr. Leonardo Somarriba, Representative Dr. Manuel Antonio Sánchez Vigil, Alternate Dr. Rodrigo Quesada, Alternate PANAMA Dr. Alberto Bissot, Jr., Representative PARAGUAY Dr. Rubén Acosta Fleytas, Representative PERU Mr. Gonzalo Pizarro, Representative Mr. Jorge W. Nicholson, Alternate UNITED KINGDOM Dr. J. W. P. Harkness, Representative Dr. Charles C. Wedderburn, Adviser Dr. H. P. S. Gillette, Adviser

9 4 P.A.B.O. DIRECTING COUNCIL UNITED STATES OF AMERICA Dr. Leonard A. Scheele, Representative Dr. Frederick J. Brady, Alternate Mr. Howard B. Calderwood, Alternate Dr. H. van Zile Hyde, Alternate Mr. Godfrey H. Summ, Adviser Dr. C. L. Williams, Jr., Adviser Mr. Simon N. Wilson, Adviser VENEZUELA Dr. Daniel Orellana, Representative CANADA Mr. D'Iberville Fortier, Observer PAN AMERICAN SANITARY BUREAU Dr. Fred L. Soper, Director, Member ex officio of the Directing Council OBSERVERS Organization of American States Dr. Charles G. Fenwick Mr. O. H. Salzman, Jr. Mr. Isidoro Zanotti United Nations and Specialized Agencies United Nations and United Nations Technical Assistance Board Mr. Gustavo Durán International Labor Organization Mr. R. Peter Straus United Nations International Children's Fund Mr. Robert L. Davée Nongovernmental Organizations American College of Chest Physicians Dr. Roy G. Klepser International Blood Transfusion Society Dr. Sam T. Gibson International Committee of Catholic Nurses and Medico-Social Workers Miss Anne V. Houck International Council of Nurses Miss Virginia Arnold International Dental Federation Dr. Norman Gerrie International Hospital Federation Dr. V. M. Hoge International Hydatidological Association Dr. Julio C. Blaksley International Leprosy Association Dr. James A. Doull International Union against Cancer Dr. O. M. Ray International Union against the Venereal Diseases and the Treponematoses Mrs. Josephine V. Tuller League of Red Cross Societies Miss Madge Crouch Medical Women's International Association Dr. Ada Chree Reid Mrs. Elizabeth Kittredge The World Medical Association Dr. Frank E. Wilson Dr. Joseph Lawrence ELECTION OF OFFICERS The election of the Chairman and two Vice- Chairmen of the Council took place pursuant to Article 3 of the Rules of Procedure, the new officers being: Chairman: Dr. Héctor A. Coll, Argentina Vice-Chairmen: Dr. Juan Allwood Paredes, El Salvador Dr. Bernardo Henao Mejía, Colombia COMMITTEE ON CREDENTIALS The members of the Committee on Credentials were the following: Chairman: Dr. Félix Hurtado, Cuba

10 W.H.O. REGIONAL COMMITTEE 5 Rapporteur: Dr. Alberto Bissot, Jr., Panama Member: Dr. Manoel Ferreira, Brazil GENERAL COMMITTEE Upon election of the Representatives of Cuba and Venezuela, the General Committee was composed of the following members: Dr. Héctor A. Coll Chairman of the Council Argentina Dr. Juan Allwood Paredes Vice-Chairman of the Council El Salvador Dr. Bernardo Henao Mejía Vice-Chairman of the Council Colombia Dr. Félix Hurtado Representative Cuba Dr. Daniel Orellana Representative Venezuela Dr. Fred L. Soper (ez oficio) Pan American Sanitary Bureau Dr. Miguel E. Bustamante Secretary Pan American Sanitary Bureau Secretary General: SECRETARIAT Dr. Miguel E. Bustamante Advisers to the Director: Dr. Carlos L. González Assistant Director Mr. Harry A. Hinderer Chief, Division of Administration Dr. Gustavo Molina Chief, Division of Public Health Dr. Myron E. Wegman Chief, Division of Education and Training Chief, Conference Services: Mr. Guillermo A. Suro Public Infornation: Mr. Harold Ballou AGENDA Pursuant to Articles 10-B and 12-B of the Constitution of the Pan American Sanitary Organization, the Director submitted the draft agenda of the VIII Meeting of the Directing Council to the Executive Committee for approval. The agenda, after being duly approved, was presented, with the documents necessary to expedite the discussions, to the Directing Council for consideration. AGENDA AND RELATED DOCUMENTS Topic Number Title 1 Opening by the Provisional Chairman 2 Establishment of Committee on Credentials 3 Election of Chairman and two Vice-Chairmen 4 Adoption of the Agenda 5 Adoption of the Program of Sessions 6 Establishment of the General Committee 7 Annual Report of the Chairman of the Executive Committee 8 Annual Report of the Director of the Pan American Sanitary Bureau 9 Proposed Program and Budget of the Pan American Sanitary Bureau for 1956 CD8/1, Rev. 3 CD8/2 CD8/17 Document Number Official Documents, No. 11 CD8/7, CD8/37, CD8/51

11 6 P.A.B.O. DIRECTING COUNCIL 10 Proposed Program and Budget of the Pan American Sanitary Organization and Proposed Program and Budget of the World Health Organization for the Region of the Americas for the Year 1 January through 31 December Financial Report of the Director and Report of the External Auditor for Report on the Collection of Quota Contributions 13 Proportionate Program Distribution of Budget Funds 14 Utilization of Available Funds 15 Emergency Revolving Fund 16 General Program of Work in the Region of the Americas during the Period Fellowship Stipends 18 Rules for Technical Discussions at Directing Council Meetings 19 Selection of Topic for Technical Discussions during the IX Meeting of the Directing Council, VIII Meeting of the Regional Committee of the WHO (1956) 20 Meetings of the Governing Bodies of the Pan American Sanitary Organization Held away from Headquarters 21 Election of three Member Countries to Fill the Vacancies on the Executive Committee Created by the Termination of the Periods of Office of Brazil, Haiti, and Panama 22 Place of the IX Meeting of the Directing Council 23 Reports on the Malaria Eradication Programs in the Americas 24 Resolutions of the WHO Assembly and Executive Board of Interest to the Regional Committee for the Americas 25 Regional Programs to be Financed with Funds of the United Nations Expanded Program of Technical Assistance Official Documents, No. 12, and CD8/19 CD8/6 CD8/16 CD8/5 CD8/4 CD8/3 CD8/12 CD8/15 CD8/8, CD8/42, CD8/85 CD8/13 CD8/14, Rev. 1 CD8/9 CD8/10 CD8/25, CD8/26, CD8/27 and Corr., CD8/28, CD8/31, CD8/ 34, CD8/35, CD8/55, CD8/ 56 and Corr., CD8/57, CD8/60 and Corr., CD8/61 and Corr., CD8/62, CD8/72, CD8/73, CD8/79, CD8/91, CD8/92, CD8/94, CD8/101 CD8/11 CD8/18 At the fourth plenary session the following topic was added to the agenda at the proposal of the Director of the Bureau: Topic 26, Conditions of Employment of Regular and Project Personnel in the Pan American Sanitary Bureau/World Health Organization (Document CD8/36). The General Committee, in accordance with Article 25-b of the Rules of Procedure, determined the order in which the topics on the agenda were submitted to the Directing Council for consideration in plenary session. WORKING PARTIES A working party was appointed to draft a new proposed resolution on Topic 17, "Fellowship Stipends," the members being the Representative of Ecuador, Dr. Juan Montalván Cornejo; the Representative of El Salvador, Dr. Juan Allwood Paredes; and the Representative of Venezuela, Dr. Daniel Orellana. Another working party was appointed for the study of Topic 18, "Rules for Technical Discussions

W.H.O. REGIONAL COMMITTEE 7 at Directing Council Meetings;" it was composed of the Representative of the Dominican Republic, Dr. Ramón Bergés Santana; the Representative of Ecuador, Dr.

12 W.H.O. REGIONAL COMMITTEE 7 at Directing Council Meetings;" it was composed of the Representative of the Dominican Republic, Dr. Ramón Bergés Santana; the Representative of Ecuador, Dr. Juan Montalván Cornejo; the Representative of Guatemala, Mr. Humberto Olivero; and the Representative of Panama, Dr. Alberto Bissot, Jr. REPORTS ON THE MALARIA ERADICATION PROGRAMS IN THE AMERICAS During the tenth and eleventh plenary sessions, the following representatives presented oral reports on the malaria eradication programs in their respective countries: Dr. Swellengrebel (Netherlands), Dr. Orellana (Venezuela), Dr. Brady (United States), Dr. Harkness (United Kingdom), Dr. Acosta Fleytas (Paraguay), Dr. Bissot (Panama), Dr. Quesada (Nicaragua), Dr. Faverey (Surinam), Dr. Pesqueira (Mexico), Dr. Alcerro-Castro (Honduras), Dr. Durand (Haiti), Dr. Aguilar (Guatemala), Dr. Hyronimus (France), Dr. Allwood Paredes (El Salvador), Dr. Montalván Cornejo (Ecuador), Dr. Bergés Santana (Dominican Republic), Dr. Hurtado (Cuba), Dr. Concha Venegas (Colombia), Dr. Ferreira (Brazil), Mr. de la Rocha (Bolivia), and Dr. Coll (Argentina). The discussion closed with a statement by Dr. C. A. Alvarado, Chief of the Coordination Office of the Malaria Eradication Program (COMEP) and another statement by Mr. Robert L. Davée, Regional Director for the Americas, United Nations International Children's Fund (UNICEF). The Secretariat reproduced and distributed to the representatives the malaria reports submitted by the following countries: Brazil (CD8/25), Venezuela (CD8/26), El Salvador (CD8/27 and Corr.), Ecuador (CD8/28), United States (CD8/31), Panama (CD8/34), Honduras (CD8/35), Mexico (CD8/55), United Kingdom (CD8/56 and Corr.), Guatemala (CD8/57), Netherlands (CD8/60 and Corr.), Colombia (CD8/61 and Corr.), Dominican Republic (CD8/62), Nicaragua (CD8/72), Argentina (CD8/73), Bolivia (CD8/79), and Paraguay (CD8/91). TECHNICAL DISCUSSIONS The Directing Council devoted Monday, 19 September and Tuesday, 20 September, to the technical discussions. The first topic examined was "Methods of Improving the Education of Public Health Personnel," for which the introductory statement was prepared by Dr. José Bustos, who was invited to serve as expert by the Director of the Pan American Sanitary Bureau. The Moderator for this topic was Dr. Manoel Ferreira (Brazil), assisted by the Rapporteur, Dr. Juan Montalván Cornejo (Ecuador), and the Technical Secretary, Dr. Myron E. Wegman (Pan American Sanitary Bureau). The second topic studied was "Medical Care in Rural Areas," for which the introductory statement was prepared by Dr. J. A. Díaz Guzmán, the expert designated by the Director of the Bureau. For this topic Dr. Daniel Orellana (Venezuela) served as Moderator, Dr. Alberto Bissot, Jr. (Panama), as Rapporteur, and Dr. Gustavo Molina (Pan American Sanitary Bureau), as the Technical Secretary. SESSIONS The Directing Council held fourteen plenary sessions, the Committee on Credentials, two sessions, and the General Committee, nine sessions. RESOLUTIONS APPROVED As the result of its deliberations, the Directing Council approved the following resolutions: THE DIRECTING COUNCIL, Resolution I Annual Report of the Chairman of the Executive Committee Having examined the Annual Report (Document CD8/17)' presented by Dr. Alberto Bissot, Jr., Representative of Panama, on behalf of the Chairmen of the 24th and 26th Meetings of the Executive Committee and on his own behalf, as Chairman of the 25th Meeting of the Committee, 'For text, see p. 22.

13 8 P.A.S.O. DIRECTING COUNCIL RESOLVES: To approve the Annual Report of the Executive Committee and to express its satisfaction at the work accomplished, extending its congratulations to the Representative of Panama. (Approved at the first plenary session, 9 September 1955) THE DIRECTING COUNCIL, Resolution II Status of the Collection of Quota Contributions Having examined the report on the collection of quota contributions (Document CD8/16), reflecting the status of the outstanding contributions as of 7 September 1955; and Bearing in mind Resolution X of the XIV Pan American Sanitary Conference, which states that delays in the receipt of quota contributions limit the development of long-range programs to be undertaken in the Americas, RESOLVES: To take note of the report on the collection of quota contributions (Document CD8/16). (Approved at Ihe second plenary session, 9 September 1955) THE DIRECTING COUNCIL, Resolution III Fellowship Program Having examined Document CD8/15 presented by the Director of the Pan American Sanitary Bureau and considering the suggestions made on the Fellowship Program by several of the Member Government as well as the views expressed during the discussion on this topic, RESOLVES: 1. To take note of aforesaid document. 2. T o recommend to the Director that he continue to study the comments made by the Member Governments on the Fellowship Program of the Pan American Sanitary Bureau, giving special attention to those on: (a) fellowship stipends; (b) the need for allowing a period of preliminary study and orientation for fellowship recipients who do not have a command of the language in which they are to pursue their studies; and (c) the need for establishing more definitely the commitments of the Member Governments with respect to utilization of the services of the fellowship recipients upon completion of their studies. 3. To request the Director to report on this matter to the Directing Council at its next meeting. 4. To recommend to the Member Governments the advisability of making provision for officers in their employ who are studying under fellowships to retain the salaries and privileges pertaining to the positions they occupy. (Approved at the second plenary session, 9 September 1955) THE DIRECTING COUNCIL, Resolution IV Annual Report of the Director of the Pan American Sanitary Bureau Having examined the Annual Report of the Director of the Pan American Sanitary Bureau, Regional Office of the World Health Organization for the Americas, for 1954 (Official Document No. 11), RESOLVES: To approve the Report of the Director and express its congratulations to him and to the staff of the Pan American Sanitary Bureau. (Approved at the fourth plenary session, 12 September 1955)

14 W.H.O. REGIONAL COMMliTEE 9 Resolution V Financial Report of the Director and Report of the External Auditor for 1954 THE DIRECTING COUNCIL, Having examined the Financial Report of the Director and Report of the External Auditor for 1954 (Document CE25/4);' and Noting that the Executive Committee approved the aforesaid reports at its 25th Meeting, RESOLVES: 1. To approve the Financial Report of the Director and Report of the External Auditor for To congratulate the Director of the Pan American Sanitary Bureau and his associates on the financial policies reflected in his Report. (Approved at the fourth plenary session, 12 September 1955) Resolution VI Meetings of the Governing Bodies of the Pan American Sanitary Organization Held Away from Headquarters THE DIRECTING COUNCIL, Having examined Resolution III adopted at the 26th Meeting of the Executive Committee with respect to meetings of the governing bodies of the Pan American Sanitary Organization held away from Headquarters, 2 RESOLVES: To take note of Resolution III approved by the 26th Meeting of the Executive Committee with respect to meetings of the governing bodies of the Pan American Sanitary Organization held away from Headquarters. (Approved at the fourth plenary session, 12 September 1955) THE DIRECTING COUNCIL, Resolution VII Pan American Zoonosis Center Considering the importance of establishing a Pan American Zoonosis Center, RESOLVES: To authorize the Director of the Pan American Sanitary Bureau to take appropriate measures so that the Pan American Zoonosis Center may receive, at the earliest possible date, the funds required for its operation. (Approved at the sixth plenary session, 13 September 1955) THE DIRECTING COUNCIL, Resolution VIII Election of Three Member Countries to the Executive Committee Considering that the election of three Member Governments to membership on the Executive Committee took place pursuant to Article 13-A of the Constitution of the Pan American Sanitary Organization; and For text, see p See p. 47.

15 10 P.A.S.O. DIRECTING COUNCIL Considering that the Governments of Bolivia, Cuba, and Nicaragua were duly elected at the seventh plenary session, in accordance with Articles 32 and 34 of the Rules of Procedure, RESOLVES: To declare elected the Governments of Bolivia, Cuba, and Nicaragua to membership, for a period of three years, on the Executive Committee of the Pan American Sanitary Organization. (Approved at the seventh plenary session, 14 September 1955) THE DIRECTING COUNCIL, Resolution IX Vote of Thanks to the Representatives of Brazil, Haiti, and Panama Considering that, by virtue of Article 13-A of the Constitution of the Pan American Sanitary Organization, the terms of office of the Governments of Brazil, Haiti, and Panama on the Executive Committee have expired, RESOLVES: To extend its thanks and congratulations to the Representatives of Brazil, Haiti, and Panama for their collaboration in the Executive Committee and for their valuable contribution to the programming and success of the work of the Pan American Sanitary Organization. (Approved at the seventh plenary session, 14 September 1955) THE DIRECTING COUNCIL, Resolution X Program and Budget of the Pan American Sanitary Organization for 1956 Having examined and discussed Documents CE25/2 and Corrigendum and CE25/27, Rev. 1, together with Official Document No. 12, RESOLVES: 1. To approve the Program and Budget of the Pan American Sanitary Organization for 1956 contained in Documents CE25/2 and Corrigendum and CE25/27, Rev. 1, and in Official Document No To appropriate for the financial year 1956 an amount of $2,200,000 as follows: Purpose of Appropriation Part I: Pan American Sanitary Organization... $168,839 Part II: Pan American Sanitary Bureau Headquarters ,990 Part III: Pan American Sanitary Bureau field and other programs... 1,067,171 Total-All Parts... $2,200,000 Less: Contributions on behalf of the territories of France, the Netherlands, and the United Kingdom... $22,532 Estimated miscellaneous income... 77,468 Total ,000 Total for assessment $2,100, Amounts not exceeding the appropriations noted under paragraph 2 shall be available for the payment of obligations in accordance with the Financial Regulations of the Bureau incurred during the period 1 January to 31 December 1956, inclusive.

16 W.H.O. REGIONAL COMMITTEE The appropriations as noted above shall be financed by contributions from Member Governments according to Article 60 of the Pan American Sanitary Code; from contributions on behalf of the territories of France, the Netherlands, and the United Kingdom according to Resolutions XV and XL of the V Meeting of the Directing Council, and miscellaneous income accruing to the Pan American Sanitary Bureau. 5. The Director is authorized to transfer credits between parts of the budget, provided that such transfers of credits between parts as are made do not exceed 10% of the part from which the credit is transferred. Transfers of credits between parts of the budget in excess of 10 % may be made with the concurrence of the Executive Committee. All transfers of budget credits shall be reported to the Directing Council. (Approved at the seventh plenary session, 14 September 1955) THE DIRECTING COUNCIL, Resolution XI Local Programs within Countries Considering the fact that many countries still need direct international aid so that they may organize and strengthen their health administrations and assume their own responsibilities in the execution of continental programs, RESOLVES: To recommend to the Director of the Bureau, Regional Director of the WHO, and to the Executive Committee that, in the preparation of the proposed programs and budgets of the Organization, they continue to bear in mind the advisability of carrying out local programs in the countries that need and desire such programs. (Approved at the seventh plenary session, 14 September 1955) THE DIRECTING COUNCIL, Resolution XII Emergency Revolving Fund Having examined the report on the use of the Emergency Revolving Fund in 1954, presented by the Director of the Pan American Sanitary Bureau to the 25th Meeting of the Executive Committee (Document CE25/22), RESOLVES: To take note of the fact that the Emergency Revolving Fund has been restored to the authorized level of $50,000 through the reimbursement of the cost of the emergency assistance. (Approved at the eighth plenary session, 14 September 1955) THE DIRECTING COUNCIL, Resolution XIII Proportionate Program Distribution of Budget Funds Taking into account the report presented by the Director of the Pan American Sanitary Bureau on the proportionate program distribution of budget funds, (Document CE25/10 and Corrigendum); and Considering that the afore-mentioned report fully complies with Resolution I adopted at the 24th Meeting of the Executive Committee, RESOLVES: To take note of the report on proportionate program distribution of budget funds, (Document CE25/10 and Corrigendum), and to congratulate the Director of the Pan American Sanitary Bureau on the presentation and contents of the report. (Approved at the eighth plenary session, 14 September 1955)

17 12 P.A.S.0. DIRECTING COUNCIL Resolution XIV Utilization of Available Funds THE DIRECTING COUNCIL, Having studied the report of the Director regarding the total available funds of the Bureau as of 31 December 1954, amounting to $273,593.75, an unusual surplus that cannot be expected in the future, owing to the low amount of outstanding quota arrearages; Taking into account the proposals of the Director to the effect that, of the aforesaid amount, $173, be utilized for the establishment of a Building Reserve Fund, for the installation of a new elevator at Headquarters, and for an increase in the allocation for the antimalaria campaign; Bearing in mind Resolution XLIII of the XIV Pan American Sanitary Conference, which authorized the Director to apply $100,000 of the existing surplus to antimalaria activities, and the fact that the malaria problem, whose definitive solution demands concerted action on the part of all agencies and organizations interested in the welfare of the Hemisphere, merits prior attention over the other public health problems; and Noting the recommendations contained in Resolution V adopted by the Executive Committee at its 25th Meeting, RESOLVES: 1. To approve the recommendations of the Director, concurred in by the Executive Committee at its 25th Meeting, regarding: the establishment of a Building Reserve Fund in an initial amount of $100,000; the installation of a new elevator in one of the Headquarters buildings at a cost of $19,000; and an increase in the allocation for the antimalaria campaign in the amount of $54,593.75, plus any savings that may be realized from the installation of the elevator. 2. To authorize the Director to utilize as much of the Building Reserve Fund referred to in the foregoing paragraph as may be required in the event that additional funds should be necessary for the intensification of the malaria eradication program. (Approved at the eighth plenary session, 14 September 1955) Resolution XV Proposed Program and Budget of the Pan American Sanitary Organization and the World Health Organization for the Region of the Americas for the Year 1957 THE DIRECTING COUNCIL, Having examined Official Document No. 12, submitted by the Director of the Pan American Sanitary Bureau and containing the Proposed Program and Budget of the Pan American Sanitary Organization and the World Health Organization for the Region of the Americas for the Year 1957; Bearing in mind that the Proposed Program and Budget for the Region of the Americas is submitted to the Directing Council, as Regional Committee of the World Health Organization, for review and submittal to the Director-General of the World Health Organization for consideration in drafting his budget for 1957; and Taking into account the fact that the Proposed Program and Budget of the Pan American Sanitary Organization for 1957 is a provisional draft that will serve as the basis for the preparation of the Proposed Program and Budget to be submitted by the Director to the 28th Meeting of the Executive Committee for review and revision, and to the IX Meeting of the Directing Council of the Pan American Sanitary Organization in 1956 for approval, RESOLVES: 1. To approve the transmittal of the Proposed Program and Budget of the World Health Organization for the Region of the Americas for 1957, and to request the Regional Director to transmit it to the Director-General of the World Health Organization, so that he may take it into consideration when preparing the WHO budget for 1957.

18 W.H.O. REGIONAL COMMITTEE To take note of the preliminary draft of the Proposed Program and Budget of the Pan American Sanitary Organization for To express to the Director of the Pan American Sanitary Bureau its satisfaction at the new format of the document. (Approved at the ninth plenary session, 15 September 1955) Resolution XVI Regional Programs to be Financed with Funds of the United Nations Expanded Program of Technical Assistance THE DIRECTING COUNCIL, Having studied the Proposed Program and Budget of the World Health Organization for the Region of the Americas for 1957 (Official Document No. 12), including those activities that it is proposed to carry out with funds of the United Nations Expanded Program of Technical Assistance; and Having noted that the proposed program includes certain projects of a regional character that will require a regional request to support their submittal to the Technical Assistance Board, RESOLVES: To endorse the regional projects shown in Official Document No. 12 of the Pan American Sanitary Organization and to authorize the Director to submit these projects to be financed under the United Nations Expanded Program of Technical Assistance in the years 1956 and/or (Approved at the ninth plenary session, 15 September 1955) THE DIRECTING COUNCIL, Resolution XVII Conditions of Employment of Personnel Having examined Document CD8/36, "Conditions of Employment of Regular and Project Personnel in the Pan American Sanitary Organization/World Health Organization;" and Considering the provisions of Article 030 of the Staff Rules, RESOLVES: To take note of Document CD8/36 and to transmit it to the 27th Meeting of the Executive Committee for study, with the express recommendation that the Committee give it special attention and consider the advisability of establishing a subcommittee charged with examining the conditions of employment of regular and project personnel. (Approved at the twelfth plenary session, 16 September 1955) THE DIRECTING COUNCIL, Resolution XVIII General Program of Work during the Period Considering that paragraph 1 of Resolution III approved by the Council at its VII Meeting sets forth guiding principles and suitable methods for the development of a plan of long-range public health programs; Taking into account Resolution I of the XIII Pan American Sanitary Conference, which requires that the Pan American Sanitary Bureau consider itself responsible only for those programs or recommendations that are supported by budgetary funds; Having in mind the recommendation adopted by the Eighth World Health Assembly in Resolution 10, paragraph 2; and Having examined Document CD8/12' presented by the Pan American Sanitary Bureau, 1For text, see p. 125.

19 14 P.A.S.O. DIRECTING COUNCIL RESOLVES: 1. To adopt the Program of Work indicated in Document CD8/12, which sets forth the general standards for the preparation of the detailed annual programs for the Region of the Americas during the period To reaffirm the principles and methods approved in Resolution III, paragraph 1, of the VII Meeting of the Directing Council, with respect to the plan of long-range public health programs. 3. To recommend to the Member Countries that have not yet done so, that they prepare, during the year 1956 if possible, national plans for public health work for the period , informing the Director of the Pan American Sanitary Bureau of such plans so that he may prepare suitable proposed annual programs and budgets for the period (Approved at the twelfth plenary session, 16 September 1955) THE DIRECTING COUNCIL, Resolution XIX Rules for Technical Discussions at Directing Council Meetings Taking into account Resolution XI approved at the 25th Meeting of the Executive Committee, RESOLVES: To approve the Rules for Technical Discussions (Document CD8/85). (Approved at the thirteenth plenary session, 17 September 1955) THE DIRECTING COUNCIL, Resolution XX Rules of Procedure of the Directing Council Considering that diverse interpretations as to the scope of certain articles in its Rules of Procedure have arisen during the meeting, RESOLVES: 1. To recommend to the Director that he request the opinion of a legal adviser on the problem of the two-thirds majority, with the count of abstentions, as well as on the question of a quorum and that of the instances in which the two-thirds majority is required; and that he present this opinion to the Executive Committee for study. 2. That the Executive Committee submit to the IX Meeting of the Directing Council such recommendations with respect to these problems as it deems pertinent. (Approved at the thirteenth plenary session, 17 September 1955) Resolution XXI Topic for Technical Discussions during the IX Meeting of the Directing Council THE DIRECTING COUNCIL, Taking into account the provisions of Articles 1, 2, and 3 of the Rules for Technical Discussions at Directing Council Meetings, RESOLVES: To select for the technical discussions to be held during the IX Meeting of the Directing Council, VIII Meeting of the Regional Committee of the World Health Organization, the topic: Methods for the Preparation of National Public Health Plans. (Approved at the thirteenth plenary session, 17 September 1955)

20 W.H.O. REGIONAL COMMITTEE 15 Resolution XXII Resolutions of the WHO Assembly and Executive Board of Interest to the Regional Committee for the Americas THE DIRECTING COUNCIL, Having seen Document CD8/11 in which the Director of the Bureau, at the request of the Director- General of the World Health Organization, brought Resolutions WHA8.10, WHA8.12, WHA8.13, WHA8.20, WHA8.30, WHA8.32, WHA8.38, and EB16.R16 to the attention of the Regional Committee for the Americas, RESOLVES: To take note of Document CD8/11 and its Annex. (Approved at the thirteenth plenary session, 17 September 1955) Resolution XXIII Place of the 29th and 30th Meetings of the Executive Committee and the IX Meeting of the Directing Council THE DIRECTING COUNCIL, Taking into account Resolution IX of the XIII Pan American Sanitary Conference, RESOLVES: To select Guatemala as the place of the 29th and 30th Meetings of the Executive Committee and the IX Meeting of the Directing Council, VIII Meeting of the Regional Committee of the World Health Organization for the Americas. (Approved at the thirteenth plenary session, 17 September 1955) THE DIRECTING COUNCIL, Resolution XXIV Technical Discussions Having examined the reports presented by the Rapporteurs of the Technical Discussions held at this meeting, RESOLVES: 1. To take note of the reports on the Technical Discussions, expressing its satisfaction at the manner in which the discussions were conducted and on the accuracy with which the reports have interpreted them, and to transmit these reports to the Executive Committee for whatever action it may deem advisable. 2. To recommend to the Director of the Bureau that he give the above-mentioned reports the widest possible distribution. (Approved at the fourteenth plenary session, 21 September 1955) Resolution XXV Vote of Thanks The Directing Council wishes to express its appreciation to the Secretariat staff of the Pan American Sanitary Bureau for the efficiency and conscientiousness it has shown in the performance of its duties, thus contributing in large measure to the great success of this meeting. (Approved at the fourteenth plenary session, 21 September 1955) IN WITNESS WHEREOF, the Members of the Council and the Secretary sign the present Final Report in the English and Spanish languages, both texts being equally authentic.

21 16 P.A.B.O. DIRECTING COUNCIL DONE in Washington, D. C., this twenty-first day of September The Secretary shall deposit the original texts in the archives of the Pan American Sanitary Bureau, and shall send copies thereof to the Member Governments. ARGENTINA: H. A. Coll BOLIVIA: Hugo de la Rocha BRAzIL: Manoel Ferreira CHILE: José Miguel Barros COLOMBIA: Jorge Jiménez CUBA: F. Hurtado DOMINICAN REPUBLIC: Ramón Bergés S. ECUADOR: E. Romero Menéndez EL SALVADOR: J. Allwood P. FRANCE: R. G. Hyronimus GUATEMALA: Humberto Olivero, hijo HAMIq: J.-Baptiste Durand HONDURAS: Ramón Alcerro-Castro MEXIco: Manuel E. Pesqueira NETHERLANDS: A. I. Faverey NICARAGUA: A. S. Vigil PANAMA: A. Bissot, Jr. PARAGUAY: R. Acosta Fleytas PERU: Gonzalo Pizarro UNITED KINGDOM: J. W. P. Harkness UNITED STATES OF AMERICA: Frederick J. Brady VENEZUELA: D. Orellana Fred L. Soper Director Member ex offio of the Directing Council PAN AMERICAN SANITARY BUREAU REGIONAL OFFICE OF THE WORLD HEALTH ORGANIZATION M. E. Bustamante Secretary General Secretary of the Directing Council

22 PART II PRECIS MINUTES

24 PLENARY SESSIONS' FIRST PLENARY SESSION Friday, 9 September 1955, at 10:15 a.m. Temporary Chairman: DR. HÉCTOR A. COLL (Argentina) Chairman: DR. HÉCTOR A. COLL (Argentina) Topic 1: Opening by the Temporary Chairman of the Council The TEMPORARY CHAIRMAN, Dr. Coll (Argentina) opened the VIII Meeting of the Directing Council of the Pan American Sanitary Organization, VII Meeting of the Regional Committee of the World Health Organization for the Americas. He stated that he occupied the Chair as Vice-Chairman of the previous meeting of the Directing Council in the absence of the Representative of Chile, Chairman of the previous meeting. He expressed his satisfaction at the presence of so many distinguished representatives at the opening session and hoped that now, as before, success would crown their efforts. The SECRETARY explained various general facts to be kept in mind in order to facilitate the proceedings. He said that the documents had been prepared in the form familiar to those who had attended previous meetings, and had been distributed in two volumes, as usual. The Annual Report of the Director and the Proposed Program and Budget for 1957 had been issued as Official Documents Nos. 11 and 12, respectively. He said that the Secretariat would at all times be ready to give the representatives any information needed. Topic 2: Establishment of the Committee on Credentials The TEMPORARY CHAIRMAN announced that, pursuant to Article 22 of the Rules of Procedure, the Council would proceed to establish the Committee on Credentials. He called for the nomination of three members. Dr. BIssoT (Panama) nominated the Representative of Cuba. Dr. FERREIRA (Brazil) seconded this motion and nominated the Representative of Panama. Dr. BERGS SANTANA (Dominican Republic) seconded the two proposals. ' The original text of the précis minutes is in Spanish. 19 Dr. HURTADO (Cuba) nominated the Representative of Brazil. Dr. ALLWOOD PAREDES (El Salvador) seconded the proposal. Decision: The Representatives of Brazil, Cuba, and Panama were unanimously elected to the Committee on Credentials. Topic 3: Election of Chairman and Two Vice-Chairmen The SECRETARY read Article 32 of the Rules of Procedure regarding elections. The TEMPORARY CHAIRMAN called for nominations for Chairman of the VIII Meeting of the Directing Council. Dr. HENAO MEJÍA (Colombia) nominated the Representative of the United States. Dr. FERREIRA (Brazil) stated that he would support the proposal of the Representative of Colombia with great pleasure, but felt that the fact that the United States is host to this meeting should be taken into consideration. Moreover, the Temporary Chairman had shown considerable skill in presiding over the meeting, and he therefore proposed that the Representative of Argentina continue as Chairman. Dr. BRADY (United States) seconded the nomination made by the Representative of Brazil and requested that the candidacy of the United States be withdrawn. He explained that the chief of his delegation, Dr. Leonard A. Scheele, was out of the country, and, although he was expected to return within a week, it was preferable that a representative who was able to attend all sessions serve as Chairman of the Council meeting. Dr. HENAO MEJfA (Colombia) withdrew his proposal, in view of the statement of the Representative of the United States. He supported Brazil's motion in favor of the Representative of Argentina. Dr. BISSOT (Panama) proposed that the nomination for Chairman be approved unanimously. Dr. JIMÉNEZ GANDICA proposal. (Colombia) seconded this

25 20 P.A.8.0. DIRECTING COUNCIL Decision: Dr. Héctor A. Coll, Representative of Argentina, was unanimously elected Chairman of the VIII Meeting of the Directing Council. Dr. COLL (Argentina) expressed his appreciation at being elected, considering it an honor both to his country and to himself, and declared that he would perform his duties to the best of his ability. He then called for the election of the two Vice-Chairmen. Dr. BISSOT (Panama) nominated the Representative of El Salvador as first Vice-Chairman. Dr. ORELLANA (Venezuela) proposed the Representative of Colombia as second Vice-Chairman. Mr. OLIVERO (Guatemala) and Dr. BERGÉS SANTANA (Dominican Republic) supported both these proposals. Dr. FERREIRA (Brazil) proposed that the Vice- Chairmen also be elected unanimously. Decision: The Representatives of El Salvador and Colombia were unanimously elected Vice-Chairmen of the meeting. Welcome to the Representative of the Chairman of the Council of the Organization of American States The CHAIRMAN welcomed His Excellency, Mr. Love O. Léger, Ambassador of Haiti, Vice-Chairman of the Council of the Organization of American States, who was present as representative of the Chairman of the Council, His Excellency, Dr. José A. Mora, Ambassador of Uruguay. Ambassador LÉGER (OAS), congratulating the Chairman of the Directing Council on his election, stated that he was present as representative of the Chairman of the Council of the OAS, who, because of the pressure of work, was unable to attend. The Council of the OAS wished to convey its best wishes for the success of the present meeting of the Directing Council of the Pan American Sanitary Organization. The CHAIRMAN thanked Ambassador Léger for his remarks. Topic 4: Adoption of the Agenda (Document CD8/1, Rev. 2) The SECRETARY read the agenda. Decision: The agenda appearing in Document CD8/1, Rev. 2, was unanimously approved.' See Final Report, p. 5. Topic 5: Adoption of the Program of Sessions (Document CD8/2) The SECRETARY read the program of sessions. Dr. SOPER (Director, PASB) explained that no meeting was scheduled for Saturday, 10 September, so that the representatives could take advantage of the weekend to study the documents they had just received. He announced that, at the end of the Council meeting, the Jefferson Medical College, in Philadelphia, planned to commemorate the centennial of Carlos Finlay's graduation. The representatives would receive invitations for the celebration, which would be held in Philadelphia on 22 and 23 September. Decision: The program of sessions (Document CD8/2) was unanimously adopted. Topic 6: Establishment of the General Committee The SECRETARY read Article 24 of the Rules of Procedure of the Council and explained that there was a disparity between the Spanish and the English texts, since the latter stipulates that there are to be two additional representatives on the General Committee, and the former, by error, does not specify the number. He added that, at the present meeting, the main committees mentioned in Article 23 would not be established but that working parties could be established as agreed upon by the Council. The CHAIRMAN called for nominations for the two additional representatives who were to serve on the General Committee. He added that, pursuant to Article 24 just read, only two persons were to be elected, as the other members were the Chairman and the two Vice-Chairmen of the Council, the Director of the Pan American Sanitary Bureau, who serves as member ex officio, and the Secretary of the Council. Dr. HURTADO (Cuba) pointed out that, in accordance with Article 23 of the Rules of Procedure, in addition to the General Committee, main committees should be established and that the decision to dispense with them was highly debatable, inasmuch as their establishment is contemplated in a basic provision whose suspension would imply a change in the Rules. He agreed that there were advantages in working in plenary session whenever possible, but felt that it was one thing to follow

W.R.O. REGIONAL COMMITTEE 21 this procedure for practical reasons and quite another to abolish the main committees entirely. The Council is not competent to do this.

26 W.R.O. REGIONAL COMMITTEE 21 this procedure for practical reasons and quite another to abolish the main committees entirely. The Council is not competent to do this. He added that he would not insist on the matter, although the point was most debatable and he would be willing to pursue it further. He felt that a practical formula for settling the difficulties, without prejudice to the provisions set forth in the Rules, would be to appoint four additional members to the General Committee, two of them as Chairmen of the main committees. Thus, these committees would be virtually established, although in practice they would not function. Dr. ALLWOOD PAREDES (El Salvador) felt that the Directing Council is indeed authorized to change its own Rules of Procedure and suggested that, in order to overcome the difficulty that had arisen, an amendment to the Rules be officially proposed. This would avoid injury to the legal sensibility of some of the representatives. Dr. ALCERRO-CASTRO (Honduras) asked the Secretary to explain whether, according to the Rules of Procedure, the establishment of the main committees is compulsory or elective. If the latter is the case, the Council would not be violating the provisions in force if it did not establish the committees because it considered them unnecessary. The SECRETARY stated that, pursuant to Article 11 of the Constitution of the Pan American Sanitary Organization, the Council "shall adopt its own rules of procedure." At its VI Meeting, the Directing Council decided to follow the same regulations at all its meetings, unless there were sufficient cause for changing them. At the VII Meeting held in 1953, it was decided not to establish the main committees. It is the Council, then, that should decide in each case whether it wishes to establish the committees. Dr. ALCERRO-CASTRO (Honduras) acknowledged the explanation given by the Secretary. Mr. OLIVERO (Guatemala) felt that the statement by the Representative of Cuba was based on the latter's interpretation of Article 23 of the Rules of Procedure of the Council, the text of which clearly shows that there is no absolute need to establish the committees. The difficulty arises in relating Article 23 to Article 24, since the latter provides that the chairmen of the main committees shall serve on the General Committee. Hence, it would perhaps be advisable to add, in Article 24, the clarifying phrase "if any" after "the chairmen of the main committees." Dr. SOPER (Director, PASB) said that he would refer only to the practical aspect of the problem that had arisen. Formerly there were two main committees, but when one of them was in session it was difficult for the other to meet, owing to the lack of a quorum. In practice, it was necessary to refer all problems to the plenary sessions. Those who attended the 1953 meeting would recall that the work was carried out with no main committees and that the results were effective and satisfactory. Therefore, from a practical viewpoint, the possibility should be considered of deliberating in plenary session only, except when the establishment of working parties is deemed advisable. Dr. FERREIRA (Brazil) said that he shared the opinion of the Representative of Honduras, believing the matter to be merely one of procedure. Therefore, if it were agreed not to establish the two committees, the problem would be solved. Dr. HURTADO (Cuba) agreed with the observations and comments that had been made and considered it appropriate to name two additional members to serve on the General Committee. Dr. ALLWOOD PAREDES (El Salvador) felt it advisable to add another topic to the agenda, regarding the approval of the Council's Rules of Procedure, since changes had been made in the Rules, invalidating some of their provisions. He favored the approval of Rules of Procedure worded in the same way as the present ones, except for the deletion of the words "the chairmen of the main committees" in Article 24. Mr. OLIVERO (Guatemala) said that he was not entirely in agreement with the suggestion of the Representative of El Salvador, since if at some future time the main committees were to be established, it would be advisable, in the interests of better coordination of the work, for their chairmen to serve on the General Committee. The SECRETARY read Articles 48 and 49 of the Rules of Procedure of the Council, which state that the Directing Council may resolve directly all matters not provided for in the Rules and that proposals for amendments to the Rules must be presented on 24-hour notice or by a two-thirds majority vote. Dr. HURTADO (Cuba) said that the discussion was being unnecessarily prolonged. Apparently all the representatives were in agreement not to establish the two main committees. Therefore, what should be done is to elect the two additional members of

22 P.A.8.O. DIRECTING COUNCIL the General Committee and to correct the erratum in the Spanish text, which fails to specify that the number of additional members is two.

27 22 P.A.8.O. DIRECTING COUNCIL the General Committee and to correct the erratum in the Spanish text, which fails to specify that the number of additional members is two. The SECRETARY explained that the error was typographical, since the original Spanish text specified that the number of elected members is two. Dr. FERREIRA (Brazil) agreed with the Representative of Cuba, adding that Article 49 of the Rules of Procedure really solves the problem that had arisen, because it establishes that all matters not provided for in the Rules may be resolved directly by the Council. The CHAIRMAN called for nominations for the two additional members of the General Committee. Dr. JIMÉNEZ GANDICA (Colombia) nominated the Representatives of Cuba and Venezuela. Decision: The Representatives of Cuba and Venezuela were unanimously elected members of the General Committee, in accordance with Article 24 of the Rules of Procedure. The session was recessed at 11:25 a.m. and resumed at 12:15 p.m. Topic 7: Annual Report of the Chairman of the Executive Committee Dr. BISsoT (Panama) presented the Annual Report on behalf of the Chairmen of the Executive Committee meetings in , representing Panama, Paraguay, and the United States, respectively. The report was as follows: Pursuant to Article 8-C of the Constitution of the Pan American Sanitary Organization, I have the honor of submitting the Annual Report of the Executive Committee to the Directing Council for consideration. The report covers the activities carried out from October 1954 to September of this year. A. 24TH MEETING OF THE COMMITTEE At the close of the XIV Pan American Sanitary Conference, the 24th Meeting of the Executive Committee was held in Santiago, Chile, on 22 October 1954, at which time two new Members, Colombia and Paraguay, were elected to the Committee to replace Ecuador and Mexico, whose terms of office had expired. The principal topics discussed at that meeting were the following: 1. Measures to Facilitate Analysis of Budgets With a view to facilitating the presentation and study of the budget, the Director of the Pan American Sanitary Bureau was requested to submit to the Executive Committee at its next meeting, all available data concerning the proportionate distribution of funds administered by the Bureau for the various technical and administrative activities, in such manner that this analysis would show a comparison of the expenditures of the last four years with those proposed for future programs. 2. Measures Designed to Stren~then National Public Health Administrations Since this was a matter of special interest to all the countries, its discussion was postponed, it being recommended that the Director include this topic on the agenda of the VIII Meeting of the Directing Council. 3. Attendance of Zone Representatives at Meetings of the Executive Committee After hearing the explanations and recommendations made by the Director of the Bureau and various delegates on the advisability of requiring the presence of the Zone Representatives at all meetings and on the need to effect economies, the Committee authorized the Director to decide which Zone Representatives should attend future meetings of the Executive Committee. After expressing its appreciation to the authorities and to the people of Chile for their generosity and hospitality, the Committee closed its meeting, agreeing to meet again in the capital of Mexico from 25 April to 2 May B. 25TH MEETING OF THE COMMITTEE In a cordial atmosphere, the 25th Meeting of the Executive Committee took place in Mexico's attractive University City, built on the site of an ancient and highly advanced Indian culture, this land having been covered for many centuries by the lava from a nearby volcano, forming the famous Pedregal de San Angel. That meeting, over which we had the honor of presiding, was, in the opinion of persons widely experienced in public health matters, one of the most interesting and most fruitful of our meetings. I shall touch briefly on the topics taken up at that meeting. 1. Proportionate Program Distribution of Budget Funds ( ) Pursuant to the recommendations made in Chile by the Pan American Sanitary Conference and the Executive Committee, the Director of the Bureau presented a new type of report that permits an easy comparison between the expenditures effected from 1952 to 1954 and the budget allotments for 1955 and 1956, with respect to the various financial sources in a given year, according to the various types of activities. 2. Method of Preparation of Budgets The presentation of proposed budgets has always been the subject of active discussion. The new form of presenta-

28 W.H.O. REGIONAL COMITTEE 23 tion suggested by the Bureau was to show in a single document the proposed budgets of the Pan American Sanitary Bureau and of the World Health Organization for the Region of the Americas. The Committee recognized that the recommendations would permit the Bureau to effect new economies, since the number of hours spent in preparing the document would be decreased and the cost of printing and shipping reduced. 3. Financial Report of the Director and Report of the External Auditor for 1954 The Financial Report of the Director was approved after having been discussed in detail, especially the section on the Working Capital Fund. Both reports were approved by the Committee and referred to the Directing Council for study, and the Director and his associates were congratulated on the sound financial policies of the Bureau. 4. Status of Quota Contributions The desire of various countries to pay their outstanding quota balances was made evident, thus underscoring the interest and confidence of all countries in the successful operation of the Bureau. 5. Utilization of Available Funds This topic was also the subject of active debate, since at the end of 1954 there was a surplus of $273, It was finally agreed to establish a Building Reserve Fund of $100,000, to install a new elevator at Headquarters at a cost of $19,000, and to increase the allocation for the antimalaria campaign by S54,593.75, with the request that the Directing Council authorize the Director to utilize part of the Building Reserve Fund in the event that additional funds should be required for the malaria eradication program. 6. Study on Public Information Several countries expressed agreement on the need to give wider publicity to the work of the Pan American Sanitary Bureau, with a view to providing more information, especially to the general public of the Americas. In order to determine specifically what these activities should be, the Committee referred the problem to the Director for study, with a view to taking up this topic at a future meeting. 7. Fellowship Stipends In line with the discussion on this topic at the XIV Pan American Sanitary Conference, and following the recommendations made in Chile, the Director presented a report that clarified many of the questions that had been raised. The "Fellowship Program of the Pan American Sanitary Bureau" was received with great interest, inasmuch as it will serve as a guide both for the public health administrations and for the recipients of fellowships. 8. Production of Biologicals for Central America and Panama In view of the interest of all countries of this area in the establishment of an Institute of Biological Products for Central America and Panama, organized along the same lines as the Institute of Nutrition of Central America and Panama (INCAP), it was recommended that the Director collaborate in the joint action of the governments interested in this matter. 9. Regionalization of Vaccine Production This problem remained pending, since, before taking a decision, the Committee deemed it advisable to make a prior geographic study on the production of vaccines. It is also essential to be acquainted with the needs of each country and to recommend a vaccine-distribution policy. 10. Method of Work of the Directing Council The recommendation that the Secretariat services be organized on the basis that the main committees would not be established and that all agenda topics would be discussed in plenary session, after receipt of a report of a working party, was not approved, as it limited simultaneous interpretation to Spanish and English. It was unanimously agreed that French and Portuguese be accorded equal standing with the other two languages and be used freely at PASO meetings. 11. Rules for Technical Discussions at Directing Council Meetings These rules were deemed suitable and were referred, with some modifications, to the Directing Council for final approval. 12. Meetings of the Governing Bodies of PASO Held away from Headquarters As several delegates had not seen the document on this topic before leaving their countries and therefore had no specific instructions from their governments, discussion of this matter was postponed. 13. Emergency Revolving Fund The Committee was informed as to how this fund had been used in the past year. 14. Technical Assistance In this respect, the need was stressed for the Director of the Bureau to remind the governments of the importance that public health programs have within the total country program of Technical Assistance, since, if steps are not taken in due time, there is the danger that certain projects under way will not be adequately financed.

29 24 P.A.BS.. DIRECTING COUNCIL 15. Proposed Program and Budget of the Pan American Sanitary Bureau for 1956 A working party, composed of the Representatives of Colombia, Haiti, Paraguay, and the United States, was established to make a thorough study of this important document. After examining the budget item by item, the working party recommended its approval. The Executive Committee accordingly approved the Proposed Program and Budget and transmitted it to the Directing Council for final action. C. 26TH MEETING OF THE COMMITTEE This body resumed its work at the 26th Meeting on the 6th of this month here in Washington, to settle pending matters and to prepare for this meeting of the Directing Council. It devoted special attention to the study of the WHO Proposed Program and Budget for the Americas for May I note that the Director and the entire staff of the Bureau collaborated to the fullest extent possible to make all these meetings a success. To conclude, I should like publicly to express, in my own name and on behalf of the two other Chairmen, our sincere appreciation to our colleagues on the Executive Committee, whose experience, graciousness, understanding, and interest in the work and in the solution of the public health problems of all the countries have permitted significant studies to be made and important decisions to be taken for the improvement of public health in the Region of the Americas. The CHAIRMAN congratulated the Executive Committee on its work during the period October 1954 to September 1955, as described in the report, and submitted the document to the Council for consideration. Dr. SWELLENGREBEL (Netherlands) requested additional information on one of the points mentioned in the report: the regionalization of vaccine production and distribution, which he considered of great importance. Dr. SOPER (Director, PASB) stated that the problem of the regionalization of vaccine production and distribution is extremely complicated, requiring a thorough survey and more information than has yet been received from the countries concerned. The matter is under consideration, but the presentation of a special report to this meeting of the Directing Council was not anticipated. The varied aspects of the problem make it necessary to obtain more specific information, both as to the availability of vaccines and the general policies of the various countries with respect to this matter. Dr. HURTADO (Cuba) did not believe that the question raised by the Representative of the Netherlands should be discussed at this time, since it could be taken up when the Annual Report of the Director was considered. He thought it advisable to approve the Annual Report of the Chairman of the Executive Committee, presented by the Representative of Panama, and to congratulate the Chairman on the excellent work accomplished. Dr. SWELLENGREBEL (Netherlands) thanked the Director of the Bureau for his explanation concerning the problem of vaccine production and distribution. Decision: The Directing Council unanimously approved the Annual Report of the Chairman of the Executive Committee, covering the 24th, 25th, and 26th Meetings; expressed its satisfaction at the work accomplished; and congratulated the representative of Panama.' The session was adjourned at 12:35 p.m. Resolution I, p. 7. SECOND PLENARY SESSION Friday, 9 September 1955, at 3:00 p.m. Chairman: DR. HÉCTOR A. COLL (Argentina) the Directing Council had been designated and were expected to arrive in Washington on Monday. With respect to Topic 23, Reports on the Malaria Eradication Programs in the Americas, the Secre- tary stated that, because of their connection with the topic, reference should be made to Annexes IV The CHAIRMAN opened the meeting and stated that the Secretary had a few announcements to make. The SECRETARY said that cables had been received from the Governments of Haiti and Peru announcing that their representatives to the present meeting of

W.H.O. REGIONAL COMMITrEE 25 and V of Document CE25/12, containing a statement of the Director on malaria eradication and a report on antimalaria activities in the Americas.

30 W.H.O. REGIONAL COMMITrEE 25 and V of Document CE25/12, containing a statement of the Director on malaria eradication and a report on antimalaria activities in the Americas. Document CE25/12 appeared as an annex to CD8/4 (Utilization of Available Funds), in Volume I of the working documents. First Report of the Committee on Credentials Dr. BIssoT (Panama), Rapporteur of the Committee on Credentials, presented the following report: A meeting was held by the Committee on Credentials, composed of Dr. Félix Hurtado (Cuba), Chairman; Dr. Alberto Bissot, Jr. (Panama), Rapporteur; and Dr. Manoel Ferreira (Brazil), member. The credentials of the members of the Committee were first examined and, being found to be in good and due form, were accepted. The credentials of the representatives, alternates, and advisers of the following countries were examined and declared accepted: Argentina, Bolivia, Brazil, Colombia, Cuba, Dominican Republic, Ecuador, El Salvador, France, Guatemala, Honduras, Mexico, Netherlands, Nicaragua, Panama, Paraguay, United Kingdom, United States of America, and Venezuela. Dr. ALLWOOD PAREDES (El Salvador) asked whether the Committee on Credentials should report also on the observers attending the VIII Meeting of the Directing Council on behalf of various international organizations, or whether the Secretariat could report on this matter. The SECRETARY explained that, since the observers do not present credentials, they are not included in the report of the Committee. The observers were attending the meeting at the invitation of the Director-General of the World Health Organization. He said that, at the next session, the Secretariat would submit the requested report on the observers present at the meeting. The CHAIRMAN submitted the report for approval. Decision: The first report of the Committee on Credentials was approved unanimously without change. Topic 12: Report on the Collection of Quota Contributions (Document CD8/16) The SECRETARY read the report reflecting the status of outstanding quota contributions to the budget of the Pan American Sanitary Organization. The CHAIRMAN said that, if the representatives had no comments, note would be taken of the report. Decision: It was unanimously agreed to take note of the report on the collection of quota contributions (Document CD8/16).' Topic 17: Fellowship Stipends (Document CD8/15) The SECRETARY read the document on this topic, containing an analysis of the governments' comments on the Fellowship Program of the PASB, received in reply to an inquiry sent to them by the Director in compliance with Resolution VII of the 25th Executive Committee Meeting, and setting forth also a proposed resolution on this topic. Dr. ALLWOOD PAREDES (El Salvador) brought up some points concerning the present system of granting fellowships. He noted particularly, as a factor complicating the utilization of the fellowships granted by the World Health Organization and the Pan American Sanitary Bureau, that a specific agreement is not reached as regards the interested government's commitment to use the services of the fellowship recipient in the public health field in which he has specialized, if he is not already working in that field when he receives the grant. Dr. Allwood Paredes felt that this point should be formalized in a special agreement between the government and the Organization, if fruitful results are to be obtained. Dr. ORELLANA (Venezuela) said that some governments had pointed out the necessity of allowing the fellowship recipient a pre-study period of orientation, especially if he is to pursue his studies in a country where the language is not his mother tongue. The student should be given time to learn the language in which the courses will be given, and concerning this point Dr. Orellana spoke of the value of English as a tool in the field of public health. He believed that, although the proposed resolution contained in Document CD8/15 refers only to fellowship stipends, the comments made by the governments on other related aspects of the fellowship program are also of interest and that the study of these suggestions should be continued. Mr. OLIVERO (Guatemala) expressed interest in the proposal of the Representative of El Salvador. He suggested that a recommendation could be included in the resolution concerning the desirability of 'Resolution II, p. 8.

26 P.A.S.0. DIRECTING COUNCIL assigning the recipient, upon return to his country, to public health services related to his specialized training. Dr.

31 26 P.A.S.0. DIRECTING COUNCIL assigning the recipient, upon return to his country, to public health services related to his specialized training. Dr. MONTALVÁN (Ecuador) recalled that, at the Executive Committee meeting held prior to the XIV Pan American Sanitary Conference, suggestions similar to those made by the Representatives of El Salvador and Venezuela had been put forth. The proposed resolution under consideration refers only to the financial aspects of the Fellowship Program and does not reflect the recommendations and suggestions made at various times by the governments. It is now suggested that the Director of the Bureau inform the Directing Council, "when appropriate," as to the amount of the stipends. The speaker felt that it would be well to be more precise and that conclusions should now be reached. He was of the opinion that the Director could present a report at the next meeting of the Directing Council. Dr. SOPER (Director, PASB), when invited by the Chairman to explain his point of view, asked Dr. Wegman to report on the subject. Dr. WEGMAN (Chief, Division of Education and Training, PASB) explained that, although there was no mention of the fact in the document, the fellowship application does contain a paragraph in which the public health ministry of the interested country promises to use the services of the fellowship recipient; this commitment refers both to fellowship recipients who are already in the public health service and to those who are not. He believed there was no objection to making this commitment more precise, which would be a great advantage. As to the language difficulty, Dr. Wegman stated that the Bureau is convinced of the importance of a period of orientation. The orientation now given the student is divided into two stages: a period at the Pan American Sanitary Bureau and a training course in the university in which he is going to study. The same procedure is followed in the countries where there are Zone Offices. Dr. Wegman then drew attention to the prerequisites established by certain public health schools and universities. For instance,the public health schools in California and Minnesota require that the student arrive six weeks before the beginning of the course; it is now requested that the students have a certain knowledge of the language in which courses will be given. He said that the Executive Committee resolution that gave rise to the present report referred only to the fellowship stipends and for that reason the report deals only with this point, but the study of all aspects of the problem should be continued. When it was recommended that the Director report "when appropriate," it was understood that he should do so as soon as there is anything new to report, and there is no objection to requesting a report for the next meeting of the Directing Council. The CHAIRMAN summarized the debate, which showed agreement on the advisability of including certain recommendations in the proposed resolution, but he thought it appropriate to entrust the final drafting of the resolution to a working party composed of the Representatives of Ecuador, El Salvador, and Venezuela. Decision: It was agreed to appoint the abovementioned working party to draft a new text of the proposed resolution. While the new resolution was being drafted, the next topic on the agenda was examined. Topic 18: Rules for Technical Discussions at Directing Council Meetings (Document CD8/8) The SECRETARY read Document CD8/8 transmitting a set of rules, recommended by the 25th Meeting of the Executive Committee (Resolution XI), to serve as a guide for conducting Technical Discussions at meetings of the Directing Council. The CHAIRMAN inquired whether Document CE25/32, containing the text of the Rules, should also be read. Dr. ALLWOOD PAREDES (El Salvador) did not think it necessary to read the Rules, as all the representatives were already familiar with them. He pointed out that Article 3 stipulates that the Technical Discussions shall be limited to one topic, yet two topics were to be taken up in the Technical Discussions at this meeting of the Directing Council. Dr. HURTADO (Cuba), agreeing with the Representative of El Salvador, said that if Article 3 were approved the VIII Meeting of the Directing Council would start off by violating the Rules. This difficulty could be avoided if it were stated that the Rules would become effective beginning with the next meeting of the Council. With respect to the problem of the Technical Discussions themselves, Dr. Hurtado recalled the views he had expressed on other occasions and pointed out the need for defining the scope, limitation, and interpretation of the word "technical." In

W.H.O. REGIONAL COMMITITEE 27 public health administration, "technical" refers not only to measures of application but also to their scientific basis.

32 W.H.O. REGIONAL COMMITITEE 27 public health administration, "technical" refers not only to measures of application but also to their scientific basis. The speaker described what, in some countries, constitutes the organization of public health administration; what public health studies are; and what the scientific or technical basis is for all public health work. A public health organization needs a scientific forum on the pure science of public health, and to meet this need the First Inter- American Congress of Public Health was held at Havana, but its work has not been continued and it is not known when the Second Congress will be held. Dr. Hurtado recalled that he had stressed this general point at the last World Health Assembly. It is incomprehensible that public health officers should meet and not take up a topic of such great importance as, for example, the effectiveness of the Salk vaccine, or the case of a hospital that for four years has not utilized a single cubic centimeter of diphtheria antitoxin for curing diphtheria because it believed that the cure is obtained with penicillin. The speaker pointed out the urgent need for the public health officers of the Americas to meet again so as to bring themselves up to date on the latest technical advances in public health science. He felt that some of the Technical Discussions held up to this time have not been on a very high level. As to the Rules for Technical Discussions, in his opinion they contain some general provisions that are useful and set forth a guide to be followed. Mr. OLIVERO (Guatemala) said that, in his opinion, Article 21, which states that "the Directing Council shall not meet on the day the Technical Discussions are held," is intended to prevent the meetings of the Directing Council and the Technical Discussions from being held simultaneously but that the wording of the article does not clearly express this purpose. He proposed that the wording be changed to read "while the Technical Discussions are being held..." Dr. ALLWOOD PAREDES (El Salvador) disagreed with some of the ideas expressed by the Representative of Cuba that could be considered as disparaging to the public health profession. He said that persons who work in public health administration have a professional, emotional, and even a civic interest in that subject. He could by no means accept the idea that public health administration is not a science. On the contrary, it is both a science and an art. He felt that the knowledge necessary for public health administration is derived from all branches of science including the purest science, and directly improves the health of the peoples. Public health administration requires scientific knowledge and it comes closer than any other applied science to what is defined as a "scientific discipline." Public health administration interprets the technical knowledge originating in the laboratory and applies it to satisfy the needs and hopes of mankind in the sphere of health. He praised public health administration and mentioned the humble attitude of the public health worker in comparison with that of workers in professions commonly considered to be more glamorous. Any topic that permits progress in public health knowledge that benefits the people is worthy of consideration by the Directing Council. Dr. BIssoT (Panama) considered the new wording proposed by the Representative of Guatemala for Article 21 to be acceptable. As to the statements of the Representative of El Salvador on Article 3, he said that the Executive Committee understood that the Rules would be applied beginning with the IX Meeting of the Directing Council and not the VIII Meeting, as the topics for the Technical Discussions at the present meeting were selected by the XIV Pan American Sanitary Conference. Dr. HURTADO (Cuba) wanted to leave no possibility of an erroneous interpretation of his remarks. He supported the statements of the Representative of El Salvador in defense of the public health worker, as he held the same sentiments. He added that his efforts, his comments, were made precisely to raise the general level of the public health worker. He recalled that in Geneva he had had the opportunity to make a defense of the public health worker when a report presented by a group of technical experts was discussed. He stated that in Article 15 of the Rules the wording reflects timidity, since it leaves the Technical Discussions with no official character and states that they do not form a part of the business of the Directing Council proper. Dr. MONTALVÁN (Ecuador) said that, as a public health worker, he could not but feel pleased with the statements of the Representative of El Salvador. He wished, however, to record his disagreement with the statements of the Representative of Cuba. It is the public health administrators who, on the basis of the latest scientific advances, are the ones who have to find the solution that appears most favorable for public health problems. Nevertheless, he supported the objections expressed by Dr Hurtado concerning Article 15, as he believed that

28 P.A.S.O. DIRECTING COUNCIL the Technical Discussions on public health administration should form a part of the activities of the Directing Council. MR.

33 28 P.A.S.O. DIRECTING COUNCIL the Technical Discussions on public health administration should form a part of the activities of the Directing Council. MR. ANGUIANO (Guatemala) said that, in his opinion, the only disagreement concerned Articles 15 and 21. He requested a clarification of the matter by the Chair. The CHAIRMAN indicated that there was, in fact, a firm proposal by the Representative of Ecuador to the effect that the Technical Discussions should form a part of the business of the Council. As to Article 21, he felt that there was general agreement on the modification that had been suggested by the Representative of Guatemala. Dr. ALCERRO-CASTRO (Honduras) felt that there was no disagreement concerning Article 3, in view of Panama's explanation that the Rules would be in force beginning with the next meeting of the Council. Dr. BRADY (United States) defended the text of Article 15 proposed by the Executive Committee, which assures the technician of all the latitude necessary for discussions of this type. If the Technical Discussions were to form part of the meetings of the Council, the technician would have to act as the representative of his government and in conformity with its instructions. If the Technical Discussions remained outside the Council meetings, the technician would be entirely free to express his personal opinion as an expert in the field. Dr. Brady also reminded the participants of an element of danger involved in incorporating the discussions within the Council's activities. He recalled that, on a certain occasion, he had attended a technical discussion at which, in examining the problem of potable water supply, a delegate explained a curious practice that was followed in his country and that could have no application in any other. In such cases it would not be appropriate to record certain data in the proceedings of the Directing Council. He felt that Article 15 should be approved as worded in the Rules. Dr. MONTALVÁN (Ecuador) was in favor of eliminating Article 15 entirely. With respect to the statements of the Representative of the United States, he said that if the representatives sent by a government are technicians they should be qualified and authorized to consider technical subjects. In matters of public health administration, he felt, the expression of opinion by the representatives should form a part of the activities of the Council. Dr. HURTADO (Cuba) reiterated that the Technical Discussions constitute the core of public health administration. He could see no incompatibility between the technical function and the political representation. As technicians, the representatives of the governments, in these Discussions, will examine technical questions. He felt that Article 15 was wholly unnecessary and asked that it be deleted. Dr. BIssoT (Panama) noted that two basic proposals had been made: one to eliminate Article 15 entirely and the other to modify it. Adopting either of the two, he said, would require changing Articles 16, 19, 22, and 25 of the Rules as well. The session was recessed at 4:50 p.m. and resumed at 5:15 p.m. The CHAIRMAN summarized the discussion on Article 15 of the Rules under study, which states: "The Technical Discussions are not of an official character and do not form part of the business of the Directing Council proper." He enumerated the proposal of Ecuador to change the wording; that of Cuba to eliminate the article; and that of Panama to modify other articles if it were decided to change or eliminate Article 15. Dr. BIssOT (Panama) maintained that Article 15 should remain unchanged, since it was based on the principle that in the Technical Discussions the experts do not speak for their governments and, indeed, their opinions may differ from the official views. If the Technical Discussions were given an official character, as an activity of the Directing Council, the experts who are not members of the Council would have to take part in them as guests. If, despite his opinion that this article should be retained, it were decided to change it, he proposed the following compromise text: During the meeting of the Directing Council, Technical Discussions shall be held on a previously selected topic of regional interest. Dr. PESQUEIRA (Mexico), agreeing with the Representative of Panama that the article should remain unchanged, felt that the Technical Discussions should not have an official character. Dr. ALCERRO-CASTRO (Honduras) supported the views of Panama and Mexico. He felt that in this way the Technical Discussions would have a more scientific character, as the experts, not being subject to instructions from their governments, would enjoy greater freedom in expressing their scientific views. The representatives are the governments'

34 W.H;O. REGIONAL COMMITTEE ; 29 most highly qualified technical. personnel, but there.might be some among them who would not be in a position to resolve scientific questions such as might be brought up at these Technical Discussions. He therefore proposed that the present wording of the article be retained. Dr. MONTALVÁN (Ecuador) reiterated his point of view, feeling that the Technical Discussions on public health administration should be included- in the activities of the Council. However, since it had been stated that the experts' views on scientific matters are not necessarily those of their governments, a reservation could be made to the effect that it is the resolutions or conclusions resulting from the Technical Discussions that have no official character, unless the Directing Council decides otherwise; yet the Technical Discussions would be included in the Council's activities. He stressed the point that the article should be retained, but amended as he had just proposed. Dr. SOPER (Director, PASB), expressing much interest in the discussion, wished to clarify the following point: The difference should be borne in mind between the technical problems that the Council discusses in order to find solutions and take measures, and those other technical matters that can be taken up for study and information but that do not require the adoption of immediate measures. If one of these questions requires such action, it is included on the agenda of the Directing Council, as was done at the Santiago meeting in the case of malaria because it was felt that the Conference should adopt new measures regarding that problem. In addition to these problems, there are others of a technical and scientific character that are of interest but that need not be the object of a resolution on the part of the Council. Dr. Soper added that, for the Technical Discussions, the Bureau does not present its own documents or budget of expenditures, nor are special regulations required for the study of those topics. If a topic falls within the sphere of action of the Council, it is included in the order of business. Other topics are considered for informational purposes. Dr. HURTADO (Cuba) said that the difficulty arises from the meaning given to various words in the text and he stressed the importance of the adjectives "official" and "proper" in this case. What is serious, he felt, is the interpretation of these words. He asked how it could be said that the Technical Discussions are not the business of the Council "proper" and objected to the use of the term. As for the adjective' "official"': hethought that if it is taken to mean "governmental" the :concept.becomes confusing. A discussion may not result in executive agreements or. conclusions, but that does not mean that it is not official. In referring to an activity of the Council, the word "official" cannot be used in a negative sense. Dr. Hurtado then stated that reconimendations made to the governments by the Counci] are not imperative, and the same would be true of the results of the Technical Discussions. If the Council is to be considered a. technical: body, its activities must include the Technical Discussions, since they are a normal function of the Council. Dr. Hurtado therefore opposed having Article 15 appear in the Rules, as he felt it out of keeping with the spirit of the Organization. He said that he would not accept the proposal of Panama and, only as a last resort, would he accept that of Ecuador. He disagreed with the view expressed by the Director as to what is of an official character. All the conclusions resulting from the Technical Discussions would have to go to the Council, he said, but this does not affect the nature of the Council. He maintained that, in any case, the experts would be free to express their opinions on technical and scientific matters, for only in political matters would they be subject to instructions from their governments. In the field of science an expert is free to give his opinion; it is then up to a government to decide whether to accept it. The CHAIRMAN, considering that the matter had been discussed sufficiently, proposed that a vote be taken, first on whether Article 15 should be modified, and, if it were agreed to modify it, on how the change should be made, whether according to the amendment proposed by Ecuador or that of Panama. Dr. HURTADO (Cuba) believed that it should first be decided whether to eliminate the article, as he had proposed, since that amendment was furthest removed from the original proposal. The SECRETARY read Article 36 of the Rules of Procedure, which was pertinent to the case. The CHAIRMAN announced that, in accordance with the said article, the proposal of the Representative of Cuba to eliminate the article would be put to a vote first. Mr. DE LA ROCHA (Bolivia) warned that, in that case, Article 19 would also have to be revised. The CHAIRMAN declared that only if it were decided to eliminate the article would the other articles

35 30 P.A.B.O. DIRECTING COUNCIL that relate to it have to be examined, and he put the proposal of Cuba to a vote. Decision: It was agreed by 10 votes to 4, with no abstentions, not to eliminate Article 15. The CHAIRMAN announced that the following amendments would be put to a vote: first that of Ecuador, and then, if required, that of Panama with its compromise text. Dr. HURTADO (Cuba) considered that the proposal of the Representative of Ecuador constituted a new draft replacing the original text, rather than an amendment. Dr. PESQUEIRA (Mexico) said that it might be well to decide on whether Article 15 should stand as drafted or be modified. Dr. HURTADO (Cuba) maintained that, since amendments had been proposed, they should be acted on according to regulation. Dr. MONTALVÁN (Ecuador) confirmed the fact that his proposal to modify the text constituted an amendment. He upheld his position but admitted that his amendment might be worded in another way. Dr. JIMÉNEZ GANDICA (Colombia) said that the article might perhaps state that the conclusions of the Technical Discussions have no official character, even though the discussions may form part of the business of the Directing Council. Dr. MONTALVÁN (Ecuador) said that, taking into consideration Colombia's suggestion, the new text of Article 15 might be as follows: The Technical Discussions form part of the business of the Directing Council proper, but the conclusions reached during the Discussions shall not be of an official character unless the Directing Council so expressly resolves. The CHAIRMAN inquired whether it was desired to suspend the discussion at this point, resuming it on Monday. Dr. PESQUEIRA (Mexico) believed it possible to come to an agreement quickly on the new wording presented by Ecuador. Dr. GONZÁLEZ (Assistant Director, PASB), on behalf of the Director, called attention to the fact that at present no minutes are kept of the Technical Discussions. However, if the Discussions were to be given an official character, minutes would presumably have to be kept, a procedure requiring secretariat personnel and related services, with the resulting financial implications. Dr. MONTALVÁN (Ecuador) again read the new text of Article 15, which he and the Representative of Colombia proposed as an amendment. Dr. BISSOT (Panama) inquired whether the amendment might not have been presented after closure of the debate. Dr. MONTALVÁN (Ecuador), in reply, recalled that the amendment had been presented before closure. The CHAIRMAN submitted the amendment presented by Ecuador and Colombia to a vote. Decision: The amendment was approved by 9 votes to 7, with 1 abstention, as the new text of Article 15 of the Rules for Technical Discussions. The CHAIRMAN announced that consideration of the Rules would be resumed on Monday. Topic 17: Fellowship Stipends (Document CD8/15) (conclusion) Dr. ORELLANA (Venezuela), on behalf of the working party assigned to draft a new proposed resolution on Topic 17, presented the draft text, by virtue of which the Directing Council, after taking note of Document CD8/15 submitted by the Director of the Bureau, recommended to the Director that he continue to study the comments made by the Member Governments on the PASB fellowship program, particularly those that refer to: (a) fellowship stipends; (b) the need for a prior period of instruction and orientation for those fellowship students who do not have a command of the language in which they are to pursue their studies; and (c) the need to establish more firmly the commitments of the Member Governments with respect to utilization of the services of the fellowship recipients upon completion of their studies. The same text requests the Director to report on the matter to the Directing Council at its next meeting and recommends to the Member Governments the advisability of making provision for officers in their employ who are studying under fellowships to retain the salaries and privileges pertaining to the positions they occupy. Decision: The proposed resolution presented by the working party on Topic 17, Fellowship Stipends, was approved.' 'Resolution III, p. 8, also General Committee, p. 119.

W.H.O. REGIONAL COMMITTEE 31 The SECRETARY said that the General Committee had agreed that the Annual Report of the Director would be examined at the Monday morning session.

36 W.H.O. REGIONAL COMMITTEE 31 The SECRETARY said that the General Committee had agreed that the Annual Report of the Director would be examined at the Monday morning session. At its noon meeting on Monday, the General Committee would decide when the consideration of Topic 18, Rules for Technical Discussions, would be continued. The session toas adjourned at 6:10 p.m. The SECRETARY enumerated the documents distributed to the representatives, including a secretariat notice on the decisions taken at the previous sessions and a list of the intergovernmental and nongovernmental organizations represented at the meeting by observers, this last document issued at the request of the Representative of El Salvador. Topic 8: Annual Report of the Director of the Pan American Sanitary Bureau (Official Documents, No. 11) The CHAIRMAN invited the Director of the Bureau to comment on the Annual Report for 1954, the first topic on the order of business. Dr. SOPER (Director, PASB) explained that he would make only an introductory statement and would ask his associates in the Bureau to give any additional information requested by the representatives. He said that, inasmuch as everyone was familiar with the Annual Report, he would merely make a few supplementary remarks. He recalled that the Bureau does not have its own public health programs, since its function is to collaborate with the national public health services, and the results of such collaboration are apparent only in the public health progress achieved in the countries themselves. The Bureau can present a report on the activities carried out, but it is up to the public health authorities of the various countries to evaluate this work. The activities undertaken in 1954, he said, fall into three groups: the fight against communicable diseases, general public health services, and education and training. Three words may be used to describe these three kinds of activities: eradication, integration, and education. With respect to the eradication activities, Dr. Soper called attention to the fight against the Aedes aegypti, smallpox, yaws, and malaria. The Bureau THIRD PLENARY SESSION Monday, 12 September 1955, at 9:35 a.m. Chairman: Dr. HÉCTOR A. COLL (Argentina) has been cooperating with the governments in the eradication of the mosquito since 1947, when the Directing Council adopted a specific resolution on the subject. He pointed out that two graphs on pages 40 and 41 of the Annual Report describe the status of the yellow fever campaign in the various countries. In September 1954, the Bureau signed an agreement with the Government of Argentina with a view to reorganizing and expanding the A. aegypti campaign in that country. This campaign is being carried out in As these graphs show, there are no known aegypti foci in Bolivia, Brazil, Chile, Costa Rica, Ecuador, Nicaragua, Panama, Paraguay, Uruguay, French Guiana, and Bermuda. This does not mean that no foci exist, but that their existence is not known. In Bolivia, the existence of A. aegypti has not been reported in the last seven years. In Brazil, the fight against this vector has been waged for years. He pointed out that in the Americas there is only one important country in which no eradication activities are being carried out. The resistance to DDT acquired by the mosquito has been proven in Trinidad. The Director of the PASB stressed the danger that this fact presents to the other countries, since it is always possible that a mosquito, having developed a resistance to DDT, will emigrate to other regions. It is a serious problem and one that must be solved before this area of resistance spreads. The known distribution of yellow fever in 1954 is shown on page 35 of the Director's Report. During 1954, cases of the jungle type were reported in Brazil, Colombia, Honduras, Peru, Trinidad, and Venezuela. In Trinidad, cases of yellow fever had not been reported since The Rockefeller Foundation Laboratory isolated the virus obtained in a case of jungle yellow fever in April 1954, although it is

32 P.A.S.O. DIRECTING COUNCIIL thought that the virus existed in that'territory since January.' In August, several cases of urban yellow fever transmitted by the A'des aegypti were diagnosed.

37 32 P.A.S.O. DIRECTING COUNCIIL thought that the virus existed in that'territory since January.' In August, several cases of urban yellow fever transmitted by the A'des aegypti were diagnosed. This is the first.. time in the past twenty-five years that a seaport in the Americas has been infected. Mortality among monkeys in Trinidad continued until January It took one year for the virus to spread across the island and disappear. Reinfection was reported in the northeastern area of Venezuela, where no case of the disease had been recorded in twenty years. In Caracas, also, diagnosis was made of an infective case transmitted by airplane, a fact that caused grave concern. In Colombia, there has always been yellow fever. In 1954, it was present in the valley of the Magdalena. During that year, and following two years of calm, cases were reported in San Vicente de Chucuri and in Muzo, where, over the last twenty-year period, the presence of the disease has been confirmed by viscerotomy in thirteen different years and in all months of the year, except March and April. He recalled that jungle yellow fever should be considered an occupational disease, since it attacks almost solely young men working in the forests, to the exclusion of women and children. In Peru, yellow fever appeared at two widely separated points in the Amazon region. On the Pacific coast, no cases have been reported since In Brazil, after four years of an intense epizootic in the southern part of the country, with extensive invasion and a large number of human cases, the infection disappeared completely in 1954 and there were no further cases in The reason for this is unknown, but it is attributed to the intense drought in this region late in In Central America, the yellow fever virus penetrated into Honduras. After high mortality among monkeys during the months September to December 1953, a six-month period of apparent calm was observed. Later, dead monkeys were found more-to the north and the west of the country, and one human case was reported in San Pedro Sula. In an entire year, therefore, only one human case was recorded in Honduras; this fact could be attributed to the intense vaccination campaign carried out in the country. The field investigation has been continued in 1955, and there is no indication that there is any yellow fever in this area. Although the disease seems to'have disappeared, observation must be continued. The wave that came from Panama apparently has subsided without penetrating Guatemala and Mexico, but only time will tell the entire story. The Director called attention to the fact that yellow fever has been present in this region for seven years without creating international quarantine problems or disrupting commerce between the countries. He went on to say that, in theory at least, yellow fever should no longer exist in man, when one considers that the vector can be eradicated and that the yellow fever vaccine offers sure and permanent protection. When a case appears, it serves to demonstrate the discrepancy between what is being done and what could be done. The problem of yellow fever was one of the most difficult that arose in the preparation of the International Sanitary Regulations. In the World Health Assembly last May, a proposal of the Quarantine Committee was not accepted, and a very important change in the Regulations was passed. Instead of limiting endemic zones, the new Regulations will consider yellow fever on the same basis as any other communicable disease. However, in the notification of cases, whether urban or jungle, local infected zones will be established. According to the new Regulations, a period of three months must elapse before an infected zone can be considered free of the disease. A case, however, sometimes occurs in a place so remote that it may take three months for the government to make the necessary notification, so that both this notification and the declaration that the zone is free from infection are simultaneous. In reality, the cases diagnosed by viscerotomy are so isolated that they constitute no danger to the rest of the world. The Director of the Bureau called attention to the desirability of having the proper authorities study the Regulations and said that the Bureau had sponsored a seminar for Central America and the Caribbean Area on the application of the International Sanitary Regulations, which was held in San José, Costa Rica, from 22 to 26 August 1955 and attended by representatives of nine countries. With regard to yaws, Dr. Soper said that the campaign in Haiti is progressing according to plan and that no technical difficulties have arisen. The dose of 600,000-units of penicillin continues to be used for the mass application. March 1954 saw the end of the first campaign for the mass treatment of the rural population and the beginning of the search for individual cases. The experience gained in Haiti in the treatment of yaws shows that yaws and syphilis are eradicable diseases and they exist only where there is willingness to endure them. Dr. Soper announced that he had recently learned, to his surprise, that in certain parts of the Americas penicillin has not yet been adopted as treatment for

38 W.B.O. BEGIONAI; COMMITTrEE 33 syphilis and that 'bismuth and heavy miinerals are still being used. As for smallpox eradication, Dr. Soper said that the Pan American Sanitary Bureau is collaborating in improving vaccine production and in developing vaccination programs. Inasmuch as a special topic of the agenda is devoted to malaria eradication, he refrained from discussing it for the moment. He then spoke of the importance of poliomyelitis and the interest shown in this disease, and announced that the Poliomyelitis Unit at Yale University has been designated as the WHO Regional Poliomyelitis Center for the Americas. Its director, Dr. Paul, collaborated in the epidemiological study of poliomyelitis that was carried out in Jamaica. Then, too, the Bureau assisted the Government of Costa Rica in the training of personnel for the rehabilitation of paralytic cases. The Bureau has also followed with great interest the steps taken in connection with the Salk vaccine, keeping the authorities of each country apprised of the situation. The Bureau was represented at the recent meeting held in Ann Arbor, at which Dr. Francis presented a report on the tests made in Dr. Francis pointed out in his study that in 1954 it was necessary to vaccinate 100,000 persons in the United States in order to prevent from 30 to 35 cases of polio. Such a program is extremely expensive, considering the price of the new Salk vaccine and the cost of its application, yet several countries have expressed a willingness to pay this price in order to reduce the number of cases. If proportionate amounts could be spent in the fight against yellow fever, malaria, etc., there would be no difficulty in eradicating these diseases. In closing, the Director pointed out that several publications related to the Bureau's activities are worthy of note. He mentioned particularly a report prepared by Dr. H. T. Dalmat on his work in connection with onchocerciasis in Guatemala. This study, published by the Smithsonian Institution with the financial aid of the Bureau and entitled The Black Flies (Diptera, Simuliidae) of Guatemala and Their Role as Vectors of Onchocerciasis (Smithsonian Misc. Col]., Vol. 125, No. 1, Pub. 4173, Apr. 5, 1955), summarizes the seven years of work done in Guatemala. Dr. Soper also mentioned a report by Dr. Fox on his experiments with the live avirulent vaccine used against typhus fever in Peru. The CHAIRMAN thanked the Director of the Bureau for introducing the document under consideration. Dr. SWELLENGREBEL (Netherlands) said that, except for last year, when they did not give him the chance, he had always made some comment on the Director's Report, for the simple reason that he had always greatly admired his reports and read them with consummate interest. In his opinion, the study and the discussion of the Report constitute one of the principal objects of this meeting. This time he proposed to criticize a certain part of the Report, touching upon the fundamentals of public health administration. His criticism started with the sentence on page 12 that states that the Bureau "is especially anxious to support activities that bring better health into the home." The speaker recognized that the home and the family are the center of all public health activities. But he said that after this statement, which pleased him so much, the Report ceased to deal with the domestic center of health activities and made mention of a more impersonal and less appealing concept, a figment spawned in an evil hour by the human mind: the public. In the third paragraph on page 13, the Report says: "The public and the public health officials alike are in the same army, waging the same battles against the same diseases." And the next paragraph contains the statement that the program of health education "is of direct concern to the public." In other words, the report no longer speaks of the home, but of the public; it ignores the person around whom all public health activities revolve: the housewife. She is the intermediary between the officers and the privates of the public health armies. The frontispiece of the Report is a very beautiful and very touching photograph, but it does not indicate that the combination of doctor and baby is possible only by virtue of the housewife, who is not in the picture. The Representative of the Netherlands believed that the collaboration of the people will never be brought about without the support of the housewife. Once she has been won, her children and her husband will follow her. Dr. Swellengrebel proposed that although the Report had been printed, the word "public" be deleted and the phrase "the housewives commanding their families" be inserted instead. He closed by saying that his criticism of this point did not indicate any less admiration for the Report and he offered the Director his heartfelt congratulations on the splendid work he had done. Dr. ORELLANA (Venezuela) thought that the Director's Report was a faithful summary of the multiple activities of the PASB and that it showed how the Bureau is solving many problems with its very limited funds. The Report contains a wealth

34 P.A.B.O. DIRECTING COUNCIL of theoretical principles and techniques, which makes it a valuable public health document. It is optimistic and stimulating in tone, not without strong overtones.

39 34 P.A.B.O. DIRECTING COUNCIL of theoretical principles and techniques, which makes it a valuable public health document. It is optimistic and stimulating in tone, not without strong overtones. It examines the great continental problems and mentions successes and failures. Its pages provide information on the work accomplished by the Bureau, based on knowledge accumulated during fifty years of public health experience in the Americas for the achievement of its ultimate goal, namely, the orientation of national public health administrations. Dr. Orellana thought the Report to be an excellent document, one that is proof of the high authoritative position attained by the Pan American Sanitary Bureau. The speaker went on to say that this document shows the importance the Bureau attaches to two fundamental phases of public health, namely, eradication programs and the strengthening of national public health services. True, he added, the Bureau has no eradication programs of its own, but it gives the needed guidance to national programs. The Report points out the advantages of eradication programs, which, once their goal has been reached, become vigilance campaigns. It is the governments that make the final choice between eradication and disease-control programs. The second point that comes to the fore in the Report is the building up of national health departments, so indispensable if eradication campaigns are to be carried out. The speaker then referred to various problems that will increasingly attract the attention of the international public health agencies. Among such problems are the change in the demographic picture, due to the lowering of the mortality rate and to the change in the population, with the predomination of new age groups. Consequently, new problems arise, having nothing to do with either control or eradication. These problems include cancer, cardiovascular diseases, mental hygiene; they extend to industry and hence embrace occupational medicine, medical care, and social security. The public health agencies must join this new movement or else be left behind. In conclusion, the Representative of Venezuela congratulated the Director and his colleagues on the valuable document submitted. Dr. HYRONIMUS (France) remarked that he had found the Director's Report very interesting, especially in its description of the insect resistance to DDT observed in Trinidad. He said that in the French territories, particularly Martinique, this same phenomenon has been observed. Laboratory work has proved that the insects either survive or are not killed off as rapidly as in areas that have never been treated with DDT. From his experience, he found that BHC acts more rapidly. He added that, in order to ensure the success of Aedes aegypti eradication campaigns, it is necessary to coordinate control activities in the various Caribbean islands. He also pointed out the advisability of holding frequent meetings designed to effect such coordination and said that he would like to have additional reports on other phases of public health work. Dr. FERREIRA (Brazil) considered the Director's Report to be something more than an annual report of a regional director. It was, as the Representative of Venezuela had said, a document rich in guidance on techniques and in theoretical principles that merit speeial attention. In the introductory section, Dr. Soper points out that the Bureau published three volumes during 1954 that fully describe its recent activities. The Bureau had grown from an agency with 32 employees and a budget of $522,000 in 1947 into one that had over 400 workers and a $4,099,000 budget in The Representative of Brazil thought that this unequivocal demonstration of progress was largely due to the persistent efforts of Dr. Soper. That progress, he added, cannot be separated from Dr. Soper's remarkable personality. To him is due the progress achieved in public health in the Americas. The speaker then referred to the three terms used to summarize the Bureau's work: eradication, integration, and education. He supported the earlier statements of Dr. Orellana, but added that the Bureau's achievements have not led to an increase in public health funds. Speaking of malaria, which has been defined as a phenomenon of "good earth and sick people," he cited the case of Ceylon, where the eradication of this disease brought about a fifty percent increase in rice production. The public health workers, he said, are helping to increase production, and public health services can demand more funds for their work because they give results for the money spent. The services of economists who appreciate the economic value of public health work would be useful in presenting, alongside the humanitarian aspect, the economic side of the achievements of public health work. Another problem that the Representative of Brazil took up was the difficulty of recruiting public health workers: doctors, engineers, nurses, and health educators. The salaries such personnel receive in their respective countries make other offers very tempting, creating the problem of the national and

W.H.O. REGIONAL COMMITTEE 35 international labor market for professional public health workers and the turnover that takes place in such staff every five years.

40 W.H.O. REGIONAL COMMITTEE 35 international labor market for professional public health workers and the turnover that takes place in such staff every five years. It would be worth while for the Director of PASB to investigate this matter so as to find out, both on the national and the international levels, how many public health officers have to be recruited to carry out public health programs, a field in which the possibility of paying good salaries is diminishing. This is a real crisis, because we are not successful in interesting young workers, those whose place it is to continue the present work and to whom inducements must be offered. He also pointed out the possible conflict between the programs of eradication and those of integration of public health work and referred to new problems arising in this connection, such as, for instance, the consequences of the development of atomic energy. In conclusion, Dr. Ferreira spoke of the value of the work of coordination and expressed his satisfaction with the progress being made. He trusted, finally, that the governments understand the necessity of preparing budgets adequate to accomplish the great public health tasks that remain to be done. The session was recessed at 11:00 a.m. and resumed at 11:40 a.m. Dr. ALLWOOD PAREDES (El Salvador) said that he had read the Director's Annual Report very carefully and was impressed by the new style, which is lively and optimistic and augurs well for future work, after the difficult times through which the Bureau has passed. He took up the priorities established for the various activities, which reflect the opinion of the Bureau concerning the problems of eradication, integration, and education and training. He felt, however, that for various reasons it is difficult or even impossible to establish priorities for such problems and activities, one of the reasons being that it is not possible to generalize to any great extent on these problems because of the diversity of the countries of the Americas, in spite of the long tradition of solidarity among them. America presents a varied picture with respect to the stage of progress in each of the nations, and the program priorities would have to be established on an individual basis, for it is not always easy to determine the order in which each task should be undertaken. Dr. Allwood Paredes recalled that, at the World Health Assembly, a European representative had expressed an opinion in opposition to the Regional Office for the Americas because of the heterogeneity of the American countries but had failed to take into consideration other characteristics that give them a homogeneous character. Pointing out the primary importance ascribed by the Bureau in the Report and in the budget to the eradication of communicable diseases, the speaker stated that he would make pertinent comments on the programs when they are taken up. However, he said, his country had entrusted him with formulating a sound skepticism-which is not to be confused with defeatism-concerning the eradication of diseases transmitted by insects, a skepticism born of reality itself, because of the variety of factors involved. He pointed out, among other considerations, the fact that conditions in the tropics favor insects and oppose man. In the face of so many adverse factors, the resources of the countries and the Bureau's contribution are so insufficient that there is doubt as to the success of the undertaking, particularly when action is urgently required, as in the case of malaria. The speaker then stressed the fact that the program priorities, which cannot be the same in all countries, must be changed according to circumstances. In some nations, eradication will come first, and in others, integration or education. The planning of the work must be based on actual conditions in the countries themselves. He said that the delegation of El Salvador will make firm proposals on the subject when the program and budget are discussed. Dr. HENAO MEJfA (Colombia) congratulated the Director on the Report and on the manner in which the accomplishments and working principles were described. He agreed with the statements of the Representative of Venezuela, which reflected his own views. He acknowledged the statements of the Director of the Bureau concerning the health work carried out in Colombia and said that he would yield the floor to the National Director of Public Health of his country, who would discuss the subject in greater detail. With reference to the yaws campaign, he pointed out that the incidence of this disease, which was formerly 45 %, has been reduced to 0.4 % as the result of the campaign, so that yaws can now be considered practically eradicated. Dr. JIMÉNEZ GANDICA (Colombia) corroborated the remarks made by the Minister of Public Health of his country, stressing the interest of the section of the Report dealing with public health problems. Concerning yellow fever, he voiced the concern that is felt over the fact that, so far this year,

41 36 P:A.SO..DIRECTING COUNCIL' more than twice as many cases have been recorded as during the entire preceding year. He then spoke of the conditions in some areas, such as San Vicente de Chucurí, of 'the investigations carried out by the Carlos Finlay Institute, and of the epidemiological studies undertaken to detect the presence of yellow fever and to examine individual cases. He explained the mass vaccination programs that are carried out when highway construction work is begun, but reiterated his concern at the frequency of cases recorded this year. With regard to yaws, he reported that of the 300,- 000 persons living along the Pacific coast, 200,000 had been treated, as had many contacts, and he confirmed the marked decrease in incidence mentioned by the Minister of Public Health. As to smallpox, the incidence of which is alarming, Dr. Jiménez Gandica pointed out that the increased incidence recorded is due to the improvement made in the reporting of that disease. Organization of rural medical services in very remote localities has helped in the compilation of more complete data. He announced that a smallpox eradication program will be initiated within three or four days, with the collaboration of the PASB and UNICEF. He agreed with the statements of the Representative of Venezuela on communicable diseases in rural areas, saying that he would comment at greater length on this aspect of the program when the paper on medical care in rural areas is studied. Dr. HURTADO (Cuba), adding his enthusiastic compliments to the unanimous praise of Dr. Soper's Report, was led to speak of the accomplishments of the past eight years, since the time of the Conference in Caracas. With all due admiration for Dr. Soper's predecessors in the Pan American Sanitary Organization, he felt that, historically, the work of the Bureau should be divided into two periods: the one preceding and the one following the Conference at Caracas, which was where Dr. Soper assumed the direction of the Bureau. It has been under his stimulus and with the assistance of the associates he has selected that the excellent achievements with which all are familiar have been realized. With reference to the three phases of the activities pointed out by Dr. Soper-eradication, integration, and education-dr. Hurtado agreed with the Representative of El Salvador that no set priorities should be established for them, since at times preference will have to be given to one activity over another, and there will be cases in which all of them will have to be carried out simultaneously, for which reason coordination of the three phases will be essential. Although he was limiting himself to general comments, he wished to mention a few points that had been raised by the Representative of Venezuela, whose views he shared, and by the Representative of Brazil, concerning the economic value of public health activities. The Council should look further into this matter at the proper time and seek means by which to demonstrate the contribution of public health to the national and international economy. And it should try to find a formula whereby this economic contribution would be recognized and translated into greater intensification of programs and better remuneration for the public health personnel, so as to resolve the crisis that had been mentioned. Dr. Hurtado then examined the points that Dr. Soper had brought out more precisely in his statement. He referred to public health work on yellow fever and pointed out that in general the results are satisfactory. Dr. Soper's Report summarizes the two aspects of the activities as being the fight against the Aédes aegypti, until its total eradication, and vaccination, which are the two great weapons in the yellow fever campaign. The eradication of A. aegypti, then, is the objective that is being pursued in all countries of the Americas, through their control and eradication programs, and in Cuba the present index is zero, demonstrating that the aegypti has been eradicated. He mentioned several other statements on different subjects made by Dr. Soper in his Report, such as the incidence of yaws in Haiti, and added that, from the point of view of public health, penicillin has made it possible to eliminate syphilis. Anyone still having doubts about the effect of penicillin in the treatment of this disease should be informed of the facts. He agreed with Dr. Soper about the possibility of eradicating other contagious diseases. Dr. Hurtado then referred to poliomyelitis, a disease that presents a public health paradox because it takes its toll in the most advanced countries, a paradox that must be done away with. He requested the Director to give close attention to poliomyelitis, keeping up with the scientific developments, in order to bring the benefit of the latest findings to the health authorities of the different countries. He discussed scientific aspects and details of the Salk vaccine and its application, and the prophylaxis of the disease, pointing out the great interest of this subject from the public health viewpoint.

42 W.H.O. REGIONAL COMMrITEE 37~ He went on to discuss typhus fever and ántityphus vaccine, malaria, and the resistance of vectors to insecticides, the latter problem calling for intensified research on the part of technicians to find substitutes for the insecticides, just as oceurred with antibiotics when their effectivenessl changed. In this respect he recalled that. there are many new insecticides awaiting the official approval of the WHO and that DDT might be deposed.. In conclusion, Dr. Hurtado said that these comments gave a general outline of his views, which he would discuss in greater detail when the separate chapters of the Report were reviewed. Dr. WILLIAMS (United States) added the congratulations of his delegation to those extended to the Director on his Report, which he considered the best of the reports presented in the last several years during which he had had the opportunity to study them. He considered it an outstanding job and one well worth studying. Part II, having to do with the description of programs and activities, is of considerable interest, he said, and contains a wealth of valuable information on American and inter-american public health problems. However, he wished to refer particularly to Part I with its excellent philosophy of solid thinking, stressing two specific points. One of them, already brought up by Dr. Orellana, was the question of the balance between the emphasis placed on specific-disease control and that placed on the activities designed to integrate general health services. This balance is brought into excellent focus in the Report, and it is desirable that it be maintained in the activities of the Organization. The second point he wished to make dealt with the cultural patterns. He felt that the discussion of this point shows an implicit recognition of the importance of cultural patterns in public health work and it also shows that public health in itself is an applied social science directed basically at the alteration of culture, at the alteration of behavior in such a way as to protect health and to prevent disease. This is a matter of fundamental importance to all and for that reason the Representative of the United States repeated his congratulations on the Report. Dr. HARKNESS (United Kingdom) stated that he, too, had read the Report with great interest and he congratulated the Director and his staff on the able and comprehensive survey of so many aspects of public health. He wished to say a few words on the part played by the Haemagogus in the transmission of yellow fever in Trinidad, not from the point of view of an expert, but from that of a public health administrator. He stated that, when present studies were completed,. new light would be shed on the activities of this sylvatic mosquito in certain types of terrain, especially where, as in Trinidad, the forest merges with the wooded suburbs of a town such as Port-of-Spain. It is sufficient to say that in Trinidad there was found in 1954 an intense degree of infection of Haemagogus with yellow fever virus, that the insects attacked persons on the ground, and that the Haemagogus mosquitoes were recovered from houses in Port-of-Spain. He called attention to the parallel between the situation in Trinidad and the monkey infections in Honduras described by the Director on pages 37 and 38 of the Report. He believed that the studies now being pursued would throw new light on this problem. After affirming the appropriateness of the measures taken iii Trinidad for the control of yellow fever, the Representative of the United Kingdom expressed his gratitude for the great assistance given by the Director and the Bureau to that island in coping with the yellow fever problem. He also welcomed the arrangements made to hold seminars on the application of the International Sanitary Regulations so as to eliminate the unnecessary imposition of restrictions on international traffic. He further stated, with respect to Aedes aegypti control, that steady progress is being made in the majority of the British territories on a regional basis and he commended the assistance given by UNICEF in the form of supplies. He also referred to the campaigns for the eradication of yaws and for the control of syphilis, which are commencing in the Leeward Islands. Finally, he thanked the Director on behalf of Trinidad for the assistance given in investigating the bat rabies problem in that territory and repeated his congratulations to the Director on his excellent Report. Mr. OLIVERO (Guatemala) expressed his appreciation for the assistance rendered to his country in public health programs and added his congratulations to the Director on his Annual Report. But he pointed out that, although in the text of the Report the territory of Belize is referred to under that name, which is the correct one, it appears wrongly under a different name on the chart and map shown on page 37. He had no other exception to make and again expressed his appreciation of the Report, which he felt sure would be helpful in the work of the Council. The session was adjourned at 12:35 p.m.

38 P.A.S.O. DIRECTING COUNCIL The CHAInMAN called the meeting to order and announced that the Secretary would report on the decisions reached by the General Committee at its session that day.

43 38 P.A.S.O. DIRECTING COUNCIL The CHAInMAN called the meeting to order and announced that the Secretary would report on the decisions reached by the General Committee at its session that day. The SECRETARY reported on the topics assigned by the General Committee to the plenary sessions. With respect to Topic 23, Reports on the Malaria Eradication Programs in the Americas, it had decided to invite all the representatives desiring to present papers to deliver them to the Secretariat as soon as possible, so as to permit their reproduction and distribution sufficiently in advance. Topic 8: Annual Report of the Director of the Pan American Sanitary Bureau (Official Documents, No. 11) (conclusion) Dr. GONZÁLEZ (Assistant Director, PASB), continuing the explanation begun by the Director at the morning session concerning the part of the Annual Report relating to communicable diseases, said that mention should be made of the schistosomiasis project under way in Brazil, a project in which the Brazilian Ministry of Health, the Pan American Sanitary Bureau, and the U. S. Public Health Service are cooperating. The objective of the project is to study the ecology of the intermediary snail hosts, to test the various molluscacides, and to select those that offer the best possibilities for practical application. Schistosomiasis is a public health problem of tropical areas, a problem that, because of its increasing importance, merits greater attention. He mentioned also that during 1954 in Bolivia a viral disease spread among a colony of persons of Japanese origin, an event that was of interest to the PASB and to certain other organizations, especially the Institute of Inter-American Affairs, which gave close attention to the matter. The discovery by the Rockefeller Foundation Laboratories of various types of virus in Trinidad and Brazil and the recent movement of the yellow fever virus, described by the Director, point out the need for intensifying the study of viruses. With regard to communicable diseases, he spoke of the collaboration of the Pan American Sanitary Bureau in the leprosy campaign. The Government of Paraguay requested the collaboration of WHO and UNICEF to combat that disease, and this was FOURTH PLENARY SESSION Monday, 12 September 1955, at 2:50 p.m. Chairman: Dr. HÉCTOR A. COLL (Argentina) the first time that UNICEF's international cooperation extended to this aspect of public health. In 1955 a control program based primarily on the use of sulfones was initiated, special attention being given to early diagnosis and treatment of cases and to periodic surveillance of contacts. By these means it is hoped to reduce the number of patients requiring hospitalization. The next chapter of the Annual Report, he said, dealt with what has been summarized as "integration of public health activities," the essential purpose of which is to develop over-all, well-balanced programs as the basis for developing and strengthening the national public health services. He said that it is most satisfactory to record that in 1954 steps were taken toward the integration of public health services in several countries of the Region, recalling that planning committees had been set up in various public health departments. For satisfactory integration of health services in a country, it is essential to be aware not only of the needs and problems but also of existing resources. The Pan American Sanitary Bureau is therefore especially interested in collaborating with the governments to improve statistics. On the occasion of the XIV Pan American Sanitary Conference, the reports presented by the Member States on their public health conditions during the period 1950 to 1953 were summarized in a single volume. Dr. González went on to say that collaboration is being continued in the strengthening of local public health services, especially in rural areas. Referring to maternal and child health, he said that the benefits achieved are due not only to the activities carried on directly in that field but also to the progress made in other spheres, such as the control and eradication of diseases and environmental sanitation. Another chapter of the Annual Report is devoted to education and training, and the Bureau's activities in this field are reviewed under the headings: professional education; nursing; fellowship program; health education of the public; and conferences, publications, and exhibits. In 1952 it was decided to set up in the Bureau a Medical Education Information Center for the compilation of information on the activities of official and private agencies and foundations in the development of medical education and fellowship programs in Latin America.

W.H.O. REGIONAL CONMMrlIEE 39 The Center receives, compares, and distributes data on medical schools, plans for collaboration, and fellowship grants. Dr.

44 W.H.O. REGIONAL CONMMrlIEE 39 The Center receives, compares, and distributes data on medical schools, plans for collaboration, and fellowship grants. Dr. González recalled that in recent years travel grants have been planned for professors of public health schools in the Continent for the purpose of acquainting them with the economic, social, and health conditions facing students from other countries who receive training in their schools. In this way, professors can adapt their instruction to conditions existing in the home countries of the students. He added that one of the fields of greatest interest is nursing education, owing to the scarcity of nurses in many parts of the Region of the Americas. In an attempt to correct the situation, the Organization is collaborating with various countries in programs designed to develop and improve schools of nursing. The results to date are most encouraging and open promising vistas for the future. Dr. González called attention to the fact that the total fellowship awards in 1954 were 319, distributed among all countries of the Americas. He recalled that the fellowships, the usefulness of which is recognized by all, are granted to professional personnel at the request of the governments, which agree to offer the fellowship recipients a post compatible with the knowledge acquired. He then referred to the technical information activities carried out by the Pan American Sanitary Bureau through its Bulletin and its nonperiodical publications. The 1954 publications in Spanish included the Spanish translations of the book Principles of Public Health Administration, by John J. Hanlon, of various studies in the WHO monograph series, such as Psychiatric Aspects of Juvenile Delinquency and Maternal Care and Mental Health, and of reports of the WHO Expert Committees. Finally, he referred to the sources of the funds expended in 1954, amounting to a total of $4,305,075, derived as follows: Pan American Sanitary Bureau, $2,099,424; World Health Organization, $925,586; United Nations Technical Assistance, $685,093; OAS Technical Cooperation, $205,326; and other extrabudgetary funds, $389,646. UNICEF allotted approximately $500,000 for supplies and equipment for international public health programs given technical approval by the Organization. He explained that he had attempted to summarize the most important aspects of the Annual Report, adding that there were other problems of an administrative and personnel nature to which he would refer in the course of the meeting. Dr. HYRONIMUS (France) said that he had examined with great interest the part of the Annual Report referring to communicable diseases and to the activities carried out by the Pan American Sanitary Bureau in He declared that the attention being given to the leprosy campaign had pleased him very much, saying that this is a disease that greatly concerns his delegation because it constitutes one of the principal scourges to be combated in the Caribbean area. France has put forth considerable effort in the leprosy campaign. In Martinique there is a modern service in which the leprosy patients, or persons suspected of having the disease, are subjected to observation and treatment. Through a systematic campaign to discover the presence of the disease, it has been found that leprosy is much more prevalent than was thought. During recent years, leprosy has been confirmed in children of four, five, and six months of age, as well as in numerous adults. At least 25 % of the leprosy patients are now hospitalized. The delegation of France attributes great importance to the problem of leprosy because it constitutes perhaps the principal or at least the second most important public health problem faced by France in its American territories. He stressed the fact that a systematic observation campaign would lead to the discovery of many more cases than it is believed exist and said that his country would be very gratified to obtain the collaboration of all the countries in combating the disease and achieving its eradication in the Americas. It is most important, he said, that cases be diagnosed early, and no effort should be spared to this end. In the French Departments patients are treated, among other things, with sulfones and cortisone, and in using these products it is preferred to hospitalize the patients. It has been possible to achieve cures quite rapidly and, in many cases, to eliminate speedily the danger of contagion. Therefore, patients who have received early treatment and are rendered noncontagious, usually after a period of seven or eight months of hospitalization under treatment by specialists, do not have to remain isolated. The leprosy problem does not affect the French territories alone, and he felt that there should be international collaboration to achieve a suitable solution. As to the other diseases, yaws has become relatively rare in the French territories. There are no rabies cases, and foot-and-mouth disease is unknown. The principal problems in the French territories are tuberculosis and leprosy. Of course, there are other diseases which, although less prevalent, still require

.40 :.P:A;A.S.O. DIRECTING 'COUNCIIL atten.tion.. Thus it is with. schistosomiasis, against which. iron and copper sulfates have been tried as molluscacides, without much success to date.

45 .40 :.P:A;A.S.O. DIRECTING 'COUNCIIL atten.tion.. Thus it is with. schistosomiasis, against which. iron and copper sulfates have been tried as molluscacides, without much success to date. There is also considerable uncertainty as to the best therapeutic means of combating the disease. Intestinal parasitoses are the cause of concern in the West Indies; the best way to combat them is by environmental sanitation, through which they can be eradicated or at.least radically reduced in extent. Dr. Hyronimus congratulated the Director of the Pan American Sanitary Bureau on his. excellent report, saying that, while his own remarks on various subjects had been rather extensive, he had wished only to point up the problems of particular interest to the Caribbean islands. Dr. HURTADO '(Cuba) said that it was impossible to expect a report such as the one under consideration to cover all problems in detail. He had hoped, however, that greater attention would be given to the problem of tuberculosis, especially to the application of BCG vaccination. He admitted that the latter was mentioned, but it had not been given the importance that its effectiveness as a preventive agent deserves. The use of BCG has already passed the experimental stage, and it is now possible to harbor high hopes for it. However, the application of BCG cannot follow any exact rules. A distinction has to be made between different cases. BCG has a protective vaccination effect and produces an allergic reaction. Of course, no more can be expected of this vaccine than of any other. When a person is not infected BCG produces a state of allergy, and its use is important with respect not only to tuberculosis but also to leprosy. In this connection it is interesting to note the work accomplished in Brazil. It is true that all the beneficial effects of BCG are well known to everyone, but it is not enough to speak of its existence; full support should be given to its use and its application should be recommended officially. BCG has already proven itself a producer of protective allergy. The systematic use of hydrazid and of modern therapeutic methods plays a very important role in the campaign against tuberculosis today. Hydrazid, because of its capacity to penetrate the meninges, has reduced tubercular meningitis. It is undoubtedly thanks to these drugs that tuberculosis morbidity has decreased considerably. The systematic application of BCG has also made it possible to reduce the number of beds in tuberculosis wards or hospitals and has increased outpatient treatment. Dr. Hurtado recognized that the Annual Report made some mention of BCG but he reiterated his opinion- :that',it does not give it the importance he would have wished.: Dr. SÁNCHEZ VIGIL (Nicaragua) praised the Annual Report of the Director as being one of the best reports presented, both as to content and to general form. The document could be understood not.only by technicians but also by the general public: It will undoubtedly help call the problems of public health to the attention of the public of the Americas. -He added that, in discussing the Annual Report, all the factors that bear on the development of PASB activities should be taken into account. It is only just to recognize the noble spirit that inspires the report, one that has as its highest aim the improvement of the health of an entire hemisphere. One must keep in mind the development that every próblem, every technical process, undergoes from year to year. Ideas are constantly changing, and to meet the problems that arise one must first be cognizant of true conditions in the Continent. The report accomplishes much toward this end. On behalf of the Minister of Public Health of Nicaragua and of the delegation of that country, the speaker congratulated Dr. Soper and his collaborators on the splendid document presented. Dr. GONZÁLEZ (Assistant Director, PASB) said that the comments on the Annual Report had given great satisfaction to the Director and the staff of PASB. The criticisms and observations made by the representatives will be profited by in the future, since only through such observations can the staff of the Bureau judge whether its work is effective. The activities of the Bureau can only reflect the views and opinions of its governing bodies. As the Director had said, the Bureau's progress can be measured only by the progress achieved by each of the national administrations. The speaker referred to the remarks of the Representative of Venezuela on the new problems that have and will continue to appear with the reduction in infant mortality and incidence of infectious diseases and the consequent change in population balance. Thus as yesterday's problems are overcome, new ones will arise, such as cancer and cardiovascular diseases. Latin American countries, moreover, are undergoing rapid industrialization and face new problems of industrial hygiene. All these comments of the Representative of Venezuela are of the greatest interest, he said, intimately related as they are to public health planning in every country, an aspect in which the Bureau has a special interest in collaborating.

46 W.H.O;: REIONAL. COMMITTEE 41 Dr. González then referred to the comments of the Representative of Brazil on the shortage of personnel, a problem that is observed not only on the national but also on the international level. One of the concerns of PASB is to cooperate with the governments in equipping the national health services with well-trained, full-time, and adequately paid staff. The PASB aids in the training of personnel and encourages the governments to create a public health career service that will meet presentday requirements. He recalled the statement of the Representative of El Salvador that the Annual Report was bold and optimistic in tone and that eradication was apparently considered more important than integration, and the latter more important than education. Dr. González said that it was difficult to make distinctions in this matter and to establish an order of priority. Some would say that without eradication no integration is possible, and others that without integration there can be no eradication; there were also those who would very logically insist that without education neither integration nor eradication is possible. These three words represent fundamental concepts upon which the Bureau's activities are based and they are principles that have been approved by the governing bodies of the Organization. In this connection he cited the case of Haiti as an example. In that country yaws was the main health problem until a few years ago, and it might logically be stated that the public health services could not have been developed until this disease had been eliminated. In a country undermined by malaria, the organization of a good public health system cannot be considered. The Representative of El Salvador, he recalled, had pointed out that broad generalizations could not be made. This fact is recognized by everyone, but there are certain principles of a general nature, established by the governing bodies, which are applicable to the whole Continent. The principle of eradication has been accepted, and this acceptance implies a continent-wide campaign. Eradication should not be undertaken in isolated "islands" but should constitute a regional program. The progress of eradication stimulates international cooperation, and the countries contribute to it because they know that it is beneficial to all. The speaker added that he would comment on the financial aspects of this subject during the discussion on the budget. The budget figures will show that the Bureau is attempting to divide its attention as equally as possible among integration, eradication, and education. Dr. González then referred to the comments of teie Representative of Cuba concerning the apparently little attention paid to tuberculosis. However, more than three pages of the Annual Report are devoted to describing the activities concerned with this disease. It should be remembered that several countries, jointly with UNICEF and the Organization,. have conducted mass BCG-vaccination campaigns, it being understood that the countries will continue them and integrate them within their national services after termination of the international collaboration. In the campaign against tuberculosis the fundamental epidemiological principles concerning early diagnosis, isolation of open cases, and health education cannot be put aside. Finally, Dr. González reiterated his appreciation of the praise expressed by the representatives to the Director and his staff on the Annual Report, and of the comments made by the representatives on the Bureau's activities. Dr. SOPER (Director, PASB) stated that it had not been his intention to enter into the debate, but the comments of the Representative of Cuba induced him to say a few words. The PASB is much more optimistic than is shown in the Annual Report. There are many countries in which the morbidity and the mortality due to tuberculosis have experienced a marked decrease. In the United States, where for twenty years mortality decreased by 3 % annually, in 1949 it decreased by 13%. This curve has continued to drop very rapidly. Tuberculosis mortality, which was 26 per 100,000 some years ago, is only 10 or 11 per 100,000 today. This result has been obtained in the United States without the use of BCG. The traditional sanatoria are disappearing in this country. In Canada there are already more beds than patients, and in Puerto Rico, a tropical country with poor economic conditions, there are also more beds than patients. It can be said with almost complete certainty that within a few years tuberculosis will take its place on the list of diseases to which the methods of eradication can be applied. Today we are in the initial phase, he said, and experiments are being made with new methods; the present status of tuberculosis can be compared with that of malaria at the time DDT was discovered. The PASB is following with great interest the progress being made in the campaign against tuberculosis and is confident that within a few years this problem will have been definitely eliminated.

42 P.A.S.O. DIRECTING COUNCIL Dr. HURTADO (Cuba) stated that the observations he made previously were not of an absolute nature and were not meant to imply neglect or omission.

47 42 P.A.S.O. DIRECTING COUNCIL Dr. HURTADO (Cuba) stated that the observations he made previously were not of an absolute nature and were not meant to imply neglect or omission. But the Annual Report did not devote to the problem of tuberculosis the attention that he felt should have been devoted to it. He said that Dr. Soper, a great public health expert, took as his point of departure the fact that this is a disease that has been thoroughly studied and based his arguments on the North American experience. However, the example given was not well chosen. Although it is true that the disease has shown the decrease mentioned, it is also true that the real defense against it is found in the index of susceptibility. As long as the people of the United States remain within their own country they will be practically free of the disease, but it will be different if they leave the United States and go to other countries where the disease exists. It should be remembered that the hygienic system does not immunize against tuberculosis. The only thing to date that provides immunity against tuberculosis is BCG. This fact is corroborated by the conclusions of the National Tuberculosis Association and by the International Congress on BCG. The CHAIRMAN, sharing the appreciation expressed by the representatives, congratulated the Director and the staff of the Pan American Sanitary Bureau on the Annual Report, which he felt initiated a new stage in this aspect of the work of the Organization. He asked that the statements made be included in the record. He then put the Annual Report to the vote. Decision: It was unanimously decided to approve the Annual Report of the Director and to congratulate the Director and the staff of the Pan American Sanitary Bureau.' Inclusion of a New Topic on the Agenda of the Meeting (Topic 26: Conditions of Employment of Regular and Project Personnel in the PASB/WHO) Dr. GONZÁLEZ (Assistant Director, PASB) said that, during his explanation of the second part of the Annual Report, he had announced that he would comment later on certain administrative and personnel problems. He therefore requested inclusion on the agenda of a new topic under the title, "Conditions of Employment of Regular and Project Personnel in the PASB/WHO." ' Resolution IV, p. 8, also General Committee, p The CHAIRMAN, before putting the proposal to the vote, asked Dr. González whether a document would be circulated on the subject. Dr. GONZÁLEZ (Assistant Director, PASB) announced that, in addition to the presentation of an oral statement, a document would be distributed. Dr. FERREIRA (Brazil) expressed satisfaction at the proposal presented by Dr. González. The SECRETARY read Article 15 of the Council's Rules of Procedure, which provides that a new topic may be added to the agenda if approved by two thirds of the representatives present and voting. Dr. ALLWOOD PAREDES (El Salvador) wanted to know what implications the proposal, if approved by the Directing Council, would have on the integration of the administrative practices of the PASB and the WHO. He asked whether this topic concerns only the PASB or in some way affects the standards established by the WHO. Dr. GONZXLEZ (Assistant Director, PASB) indicated that the implementation of personnel policy now in force has presented a series of problems on which it would be desirable to have the opinion of the Directing Council. The question does not really concern the PASB alone. It affects the Organization as a whole and concerns certain appointment problems that have been giving rise to administrative difficulties. Decision: The inclusion on the agenda of a new topic entitled, "Conditions of Employment of Regular and Project Personnel in the PASB/ WHO," was approved by a vote of 17 to 0, with 2 abstentions. The session was recessed at 4:20 p.m. and resumed at 4:55 p.m. Topic 11: Financial Report of the Director and Report of the External Auditor for 1954 (Document CE25/4) The SECRETARY explained Document CE25/4,' containing the Financial Report of the Director and Report of the External Auditor for Dr. ALLWOOD PAREDES (El Salvador) requested clarification as to the amount of the purchases made by the Bureau for the Member Governments, since Document CE25/4 shows that the purchases amounted to $1,500,461 in 1954 and $1,404,476 in 1953, whereas in Document CE25/10, on Pro- ' See Annex 2, p. 129.

W.H.O. REGIONAL COMMITTEE 43 portionate Program Distribution of Budget Funds, the same figure is given for 1954 but for 1953 the amount is $1,365,199.

48 W.H.O. REGIONAL COMMITTEE 43 portionate Program Distribution of Budget Funds, the same figure is given for 1954 but for 1953 the amount is $1,365,199. He wished to know which were the correct figures for the purchases made exclusively for the account of the governments. Mr. HINDERER (Chief, Division of Administration, PASB) explained that the correct figure for purchases made for the governments is found on Schedule E of Document CE25/4 and that the amount for 1954 was $992, The difference mentioned by the Representative of El Salvador is due to the fact that the figures he quoted include purchases for the governments and for the PASB and WHO field programs. Dr. ALLWOOD PAREDES (El Salvador) asked whether the Bureau makes the same 3% service charge on purchases for extracontinental countries as it does for the American countries. Mr. HINDERER (Chief, Division of Administration, PASB) replied that, in 1954, the Bureau made no purchases for countries outside the Western Hemisphere. Purchases outside the Hemisphere are made through the WHO and for projects of that Organization. Dr. ALLWOOD PAREDES (El Salvador) said that he had raised the question because, in comparing the figures for purchases made by the Bureau with the 1953 and 1954 receipts from the 3 % procurement service charge to the governments, it could be seen that these receipts were lower than they should be, and therefore it would be advisable to request that the External Auditor indicate in his report the exact origin of the funds received from the procurement service charge to the governments. Moreover, if the Bureau makes purchases for extracontinental countries, it might well apply the 3% service charge, as authorized by the Directing Council. He recalled that at the pertinent time he had defended the procedure of having this service charge made on all purchases for the account of the governments. Mr. HINDERER (Chief, Division of Administration, PASB) confirmed the fact that the receipts from the 3 % service charge do not agree with the figures for the total amount of purchases mentioned in the Report of the External Auditor, since the latter figures cover purchases and shipments in general, while the receipts for the 3 % service charge are considered actual income within a year, and often the commissions on purchases are computed the year following that in which the purchases are made, when the letter of credit is negotiated. As for purchases for the account of extracontinental countries, he pointed out that the Bureau has made no such purchases during the past two years and that, furthermore, the WHO has also established a 3% service charge and helps maintain the Supply Office in the Bureau by paying the salaries of various staff members. Therefore, if the 3% is collected for purchases made for countries outside the Western Hemisphere, the amount collected would be credited to the World Health Organization. Dr. BRADY (United States) recalled that the Executive Committee, at its 25th Meeting, reviewed the Financial Report of the Director and the Report of the External Auditor and resolved to congratulate the Director of the Bureau and his associates on the financial policies reflected in his report. The External Auditor had also congratulated the Director on the fact that, of the amount of $2,100,000 budgeted for 1954, only $ remained unobligated. Dr. Brady considered both reports to be excellent. The Auditor had brought out each subject very clearly, suggesting studies and recommendations. The speaker felt that the resolution to be adopted should record the satisfaction of the Council at the financial policies followed by the Bureau. He then mentioned that item 15 of the Auditor's Report, under accounts receivable,' shows the amounts that were still outstanding because of purchases made for the governments, and he asked whether payment of these amounts was made at a later date. Then, too, the Auditor had called attention to the amount of $41,411 set aside for fellowship awards but not expended in 1953, and Dr. Brady inquired whether better methods had been adopted to prevent the accumulation of such surplus. Finally, he referred to the fact that the preparation of the pro-forma invoices provided to the governments entails considerable work, since specifications must be obtained, etc., all this being a service to the governments but sometimes not resulting in purchases and, hence, not being subject to the 3 % service charge. He suggested that the representatives of the countries that make use of this service comment on its usefulness. Mr. HINDERER (Chief, Division of Administration, PASB) pointed out, with regard to accounts receivable for purchases made for the governments, that the Director would appreciate the advice of the Directing Council in this matter. Most of these obligations were incurred before the adoption of Resolution XXIX by the V Meeting of the Direct- ' See p. 146.

44 P.A.S.O. DIRECTING COUNCIL ing Council, providing that the Member Governments shall deposit funds prior to any purchase action by the Bureau. Mr.

49 44 P.A.S.O. DIRECTING COUNCIL ing Council, providing that the Member Governments shall deposit funds prior to any purchase action by the Bureau. Mr. Hinderer pointed out that about a week ago these accounts were still outstanding. In some of these cases, from 25 to 30 different contacts have been made with the governments concerned, but because of changes in governments, ministers, or national directors of public health, it was impossible to make collection. The Directing Council might wish to determine what action should be taken with regard to these outstanding accounts, even perhaps writing them off if it were considered advisable. Referring to the surplus in the allotment for fellowships, mentioned by the Representative of the United States, Mr. Hinderer explained that in 1954 it was noted that for the previous year more funds than necessary had been reserved for this purpose, inasmuch as it had been anticipated that the fellowship recipients would take nine-month courses in the United States and then spend a month or two traveling, but in many cases the fellows were anxious to return to their countries as soon as possible and therefore did not make those trips. As a result, the above-mentioned surplus was accumulated. As to the pro-forma invoices provided to the governments, he pointed out that their volume, amounting to $2,672,166 for the year 1954, was increasing and for the first six months of 1955 amounted to $2,997,000. The purchases made for the first six months of 1955 amounted to over $900,000. Dr. ORELLANA (Venezuela) said that the External Auditor, in item 16 of his report,' objected to the fact that the Bureau extended credit to the Government of Venezuela without charging the amount to the Emergency Revolving Fund and that payment had been delayed for some time because of the administrative steps that had to be taken. Venezuela had been in urgent need of a vaccine; it was obtained and, because payment was not made in advance, the Auditor had raised objection. The speaker inquired whether a method could not be found whereby, in the future, the Auditor would not object to the Bureau's providing services that are so necessary and useful to the governments in times of emergency. Dr. SOPER (Director, PASB) said that, in the case cited by the Representative of Venezuela, the Bureau should have considered the situation an emergency and charged the purchase to the fund established 'See p for that purpose. If this had been done, the Auditor would have raised no objection. Dr. HURTADO (Cuba) pointed out that the Auditor had indicated that the purchase was not an emergency one, for, judging by the accounting, there appeared to be no real emergency to justify charging the payment to the Emergency Revolving Fund, since the transactions were not recorded as being of an emergency nature. It was the Bureau itself that did not show, in its accounting, that Venezuela's request was of an emergency nature. Dr. GONZÁLEZ (Assistant Director, PASB) stressed the explanation given by Dr. Soper. It was an error on the Bureau's part to have included this transaction under current purchases for governments. He recalled that the Director, at the April meeting of the Executive Committee, had explained that the said purchase was of yellow fever vaccine to meet a most urgent need of the Government of Venezuela, which, realizing that its rural population was very much exposed to jungle yellow fever, lacked this biological to protect its population. Therefore, it was through error that the Bureau did not charge this purchase to the Emergency Revolving Fund. Dr. ORELLANA (Venezuela) said he was satisfied with the explanations given by the Director and the Assistant Director of the PASB. Dr. ALLWOOD PAREDES (El Salvador) declared that the Supply Office of the Bureau had rendered his country excellent and efficient services by making available quotations on bids from the United States, where equipment and supplies are almost always bought. He was pleased with the way all such requests are handled. He mentioned that not all purchases are made through the Bureau, because the law in his country provides that government purchases shall be made through public bids; however, the quotations provided by the Bureau serve as a basis for the bidding, thus enabling the Government to effect considerable savings. He felt that, unless it implied great sacrifice, the Bureau's procurement service should continue for the benefit of those countries that make use of it. The CHAIRMAN submitted for approval the Financial Report and Report of the External Auditor. The SECRETARY read the proposed resolution on this topic. Dr. BRADY (United States) proposed that the Director and his associates be congratulated on the financial policies reflected in his report.

50 W.H.O. REGIONAL COMMITTEE 45 Dr. ALLWOOD PAREDES (El Salvador) suggested that a paragraph be added to the resolution, requesting that the External Auditor, in future reports, present in greater detail the sources of budgetary funds derived from the 3% charge on purchases made for the account of governments. Dr. HURTADO (Cuba) concurred in extending congratulations to the Director and his associates, as proposed by the Representative of the United States, but he felt that the motion presented by the Representative of El Salvador should not be included in the resolution. Instead, he thought it should be made a separate motion to be submitted to the Directing Council, recommending that the Director invite the External Auditor to attend the meeting on the day the Council examines his report. Dr. ALLWOOD PAREDES (El Salvador) withdrew his motion. Decision: It was unanimously agreed to approve the Financial Report of the Director and the Report of the External Auditor for 1954 and to congratulate the Director of the Pan American Sanitary Bureau and his associates on the financial policies reflected in his report.' Motion of the Representative of Cuba (Presence of the External Auditor at Directing Council Meetings) The CHAIRMAN said that there remained the matter raised by the Representative of Cuba on the presence of the External Auditor at the meetings in which the Council examines the Auditor's report. Dr. ALLWOOD PAREDES (El Salvador) pointed out that in the past the External Auditor had been appointed annually. If the same were true now, there would be no need for his request regarding the source of budgetary funds derived from the 3 % service charge on purchases for the account of governments, but if Mr. Uno Brunskog continued as External Auditor the manner of apprising him of the comments made during these discussions would have to be studied. Dr. GONZÁLEZ (Assistant Director, PASB) explained that Mr. Brunskog was appointed by virtue of Resolution XXVIII of the V Meeting of the Directing Council and that, in accordance with the Financial Regulations, only the Directing Council may remove the Auditor. Therefore, Mr. Brunskog's appointment is indefinite, unless the Directing Council decides otherwise. ' Resolution V, p. 9. Dr. HURTADO (Cuba) said that, without going into personalities, he would like his motion to state specifically that the Council requests the Director to invite the External Auditor to attend the Council meeting on the day his report is examined, so that he may reply directly to any request for information. Dr. GONZÁLEZ (Assistant Director, PASB) pointed out that the Report of the External Auditor is submitted to the Executive Committee at its April meeting. The Auditor, in order to prepare his report, comes from Europe and, in addition to working in Washington, he also visits the Zone Offices. Therefore, if he were to attend the meetings of both the Executive Committee and the Directing Council, he would have to make three trips to this Hemisphere, a fact worthy of note because of its possible financial implications. This does not mean that the Bureau is opposed to having the External Auditor present at the meetings of the governing bodies, since he is, after all, directly employed by the Directing Council, which can take any action it deems advisable. Dr. HURTADO (Cuba) stated that the Directing Council is the organ that approves the budget, which is prepared by the Executive Committee on consultation with the Director. The Assistant Director just said that the External Auditor is in the employ of the Directing Council, and the speaker therefore saw no reason why the Auditor should not attend the Council meetings. One reason put forth for his not attending was the fact that he resides in Europe; however, Dr. Hurtado did not see why the Directing Council of the Pan American Sanitary Organization should be dependent for its audit on an employee who resides abroad, when there are so many good auditors in the Americas. He therefore upheld his own motion that the External Auditor be at the disposal of the Council when it examines his report. The CHAIRMAN submitted the motion of the Representative of Cuba for consideration and requested the Secretary to read the pertinent articles of the Financial Regulations. The SECRETARY read Articles 13.1 and 13.2 of the Financial Regulations, which prescribe that neither the Pan American Sanitary Conference, nor the Directing Council, nor the Executive Committee shall make decisions involving expenditures unless they have received a report from the Director on the administrative and financial implications of the proposal, and that where, in the opinion of the Director, the proposed expenditure cannot be made from the existing appropriations

46 P.A.S.O. DIRECTING COUNCIL it shall not be incurred until the Pan American Sanitary Conference or the Directing Council has made the necessary appropriations. Dr.

51 46 P.A.S.O. DIRECTING COUNCIL it shall not be incurred until the Pan American Sanitary Conference or the Directing Council has made the necessary appropriations. Dr. HURTADO (Cuba) said that the regulation just read would not interfere with any decision the Council might take. If the Council were to decide that the Auditor should be present at its meetings, the Director would take note of this decision and include the pertinent financial appropriations in the draft budget to be approved by the Council or Conference. Moreover, there is no reason for considering whether the Auditor resides in Europe or not. Either he would attend the meeting at his own expense or another auditor would be found in the Americas. Dr. FERREIRA (Brazil) pointed out that this question had arisen as the result of a request made by the Representative of El Salvador to which the Secretary had given a satisfactory answer. He felt that the administrative staff of the Bureau should be able to give any desired explanation on financial policy, without the presence of the External Auditor being required, since the latter bases his report on the data supplied by the Bureau itself. He recalled that WHO's External Auditor does not attend either the meetings of the Executive Board of that Organization or the World Health Assemblies. He saw no reason to replace an employee like the Auditor merely because he resides in Europe. Therefore, the delegation of Brazil proposed that matters be allowed to stand as they are. Dr. BRADY (United States) reviewed the circumstances under which Mr. Brunskog had been employed. He recalled that at one time the auditing firm for the Organization was Price Waterhouse, a very eminent firm in the field. Its annual reports consisted of from two to four pages, which meant that they were insufficient. At a meeting of the Directing Council the advisability of changing the auditor was debated, and the name of Mr. Brunskog was suggested. In addition to being the official auditor for Sweden, Mr. Brunskog is also the auditor for the WHO, the ILO, and, in part, for the United Nations. He therefore is widely experienced in the operation of international organizations and the auditing of their accounts. For these reasons Mr. Brunskog was employed at the time, and as far as the United States delegation is concerned, it is quite satisfied with the audits presented by him. This does not mean, however, that additional information in such a report might not be desirable. Mr. Brunskog arranges his trips to this Hemisphere so that the auditing of accounts at Headquarters and his visits to the Zone Offices usually coincide with his duties at the United Nations, and, as the result, the expenses to the Organization for his travel 1:ive been kept down to a minimum. The speaker felt it would not be advisable to request Mr. Brunskog's presence at Directing Council meetings; however, it could be suggested to him that in the future he try to arrange his trips to this Continent so that they would coincide with Council meetings, in order that he might answer questions. Yet, if Mr. Brunskog were to do tbis, he would be unable to attend the April meetings of the Executive Committee at which the report of the Auditor is examined in more detail. It might be well, then, to consider whether it would not be of greater benefit to the Organization if the Auditor were to attend those Executive Committee meetings instead of the Directing Council. In any case, the speaker thought it inappropriate to demand that Mr. Brunskog appear at these meetings. It was the feeling of the United States delegation that nowhere could a better auditor for an international organization than Mr. Brunskog be found. The CHAIRMAN put the proposal of the Representative of Cuba to a vote. Decision: The proposal of the Representative of Cuba, to the effect that the presence of the External Auditor be required at meetings of the Directing Council at which his reports are examined, was rejected by 3 votes in favor, 12 against, and 3 abstentions. Dr. ALLWOOD PAREDES (El Salvador) requested that there be placed on the record the interest expressed by his delegation in having the External Auditor show in greater detail, in his future reports, the budget funds derived from the 3% service charge for purchases made for the account of Member Governments. He thought that the Secretariat might do this by means of a letter to the External Auditor, for the benefit of the Bureau and the satisfaction of all the governments. Dr. GONZÁLEZ (Assistant Director, PASB) assured the Representative of El Salvador that the Director of the Bureau would inform the External Auditor of the comments made during the meeting, and especially of the desire expressed by that Representative. Topic 18: Rules for Technical Discussions at Directing Council Meetings (Document CD8/8) (continuation) The SECRETARY stated that, during the discussion on this topic at the second plenary session, the re-

W.H.O. REGIONAL COMMITTEE 47 vised text of Article 15 of the Rules for Technical Discussions had been approved. Establishment of a Working Party Dr.

52 W.H.O. REGIONAL COMMITTEE 47 vised text of Article 15 of the Rules for Technical Discussions had been approved. Establishment of a Working Party Dr. ALLWOOD PAREDES (El Salvador) pointed out that, owing to the change made in Article 15 and the change in Article 21 suggested by the Representative of Guatemala, it would be advisable to entrust the revision of the draft Rules and the drafting of a proposed resolution to a working party composed of three members, in order that the Rules would be applicable to the Technical Discussions held at Pan American Sanitary Conferences, should the Conference wish to adopt them. He proposed that the working party be composed of the Representatives of the Dominican Republic, Ecuador, and Guatemala. Dr. HURTADO (Cuba), Dr. FERREIRA (Brazil), and Dr. SÁNCHEZ VIGIL (Nicaragua) supported the proposal of the Representative of El Salvador. Mr. OLIVERO (Guatemala) expressed his appreciation at being nominated and suggested that another Executive Committee member who had studied the draft Rules be added to the working party, proposing the Representative of Panama. Dr. HURTADO (Cuba) supported the proposal and asked the Chair to clarify the duties of the working party. The CHAIRMAN stated that the working party would be in charge of adapting the articles in accordance with the changes already approved by the Council, taking into account also the points of view expressed during the previous discussion. Decision: It was unanimously agreed to establish a working party composed of the Representatives of the Dominican Republic, Ecuador, Guatemala, and Panama, to revise the draft Rules for Technical Discussions and draw up the appropriate proposed resolution. Topic 20: Meetings of the Governing Bodies of the Pan American Sanitary Organization Held Away from Headquarters (Document CD8/14, Rev. 1) The SECRETARY read the document on this topic. The CHAIRMAN recalled that the Executive Committee, at its 26th Meeting, discussed this topic in detail and adopted Resolution III, which it transmitted to the Directing Council, as follows: The Executive Committee, Taking into account the terms of Resolution IX of the XIII Pan American Sanitary Conference concerning the date and place of meetings of the Directing Council and of the Pan American Sanitary Conference; Bearing in mind that, after acceptance of the invitation of a Member Government to have one of the Organization's governing bodies meet in its territory, it has been necessary to reach agreements concerning the premises, equipment, services, installations, and personnel required for the successful conduct of the meeting; and Considering the authorization given to the Executive Committee in paragraph 2 of Resolution XXXI adopted by the XIV Pan American Sanitary Conference, Resolves: (1) To approve the model agreement appended to this resolution, concerning the obligations of the Host Government and of the Bureau in the organization and conduct of meetings of the governing bodies of the Pan American Sanitary Organization to be held outside Washington, D. C., without prejudice to such changes in details as may be required in each case. (2) To recommend that the Director endeavor to secure signature of the respective agreement within sixty days from the date on which the competent governing body accepts the invitation of the Host Government. (3) To bring this resolution to the attention of the VIII Meeting of the Directing Council. Dr. HURTADO (Cuba) agreed in principle with the resolution adopted by the Executive Committee. In examining the model agreement, he noted that the original text of Article 9, later modified by the Committee, provided that the government would deposit with the Bureau a fixed sum for the payment of the rental of simultaneous interpretation equipment and other expenditures incurred for material, transportation, etc., that are chargeable to the government and must be paid in the United States. The present text is less definite, since it states that the government "accepts the responsibility for the payment." Dr. Hurtado would have preferred that the condition providing for a deposit from the government be retained since it is more conclusive and since, when the time came to sign the agreement, the Bureau would know the amount required for such expenditures. Finally, with regard to Article 11 of the model agreement, he proposed that in the Spanish text the word privilegios be replaced by prerrogativas, in conformity with the decision taken at the Pan American Sanitary Conference held in Ciudad Trujillo. Dr. RODRIGUES (Brazil) recalled that, at the Executive Committee meeting held in Mexico City, it was pointed out that the necessity for the

53 48 P.A.S.O. DIRECTING COUNCIL governments to deposit a sum for the payment of the rental of simultaneous interpretation equipment and other expenditures incurred for material and transportation might prove embarrassing to the governments. When this question was discussed at the 26th Meeting, Article 9 was intentionally drafted in less specific terms in order to avoid such difficulties and, also, because the model agreement is of a very general nature. The first operative paragraph of the Executive Committee resolution states that the model agreement was approved "without prejudice to such changes in details as may be required in each case." Mr. CALDERWOOD (United States) pointed out that the Directing Council could take note of the resolution adopted by the Executive Committee. He observed, however, that the phrase "respective agreement" contained in paragraph 2 of the operative part refers to the specific agreement to be concluded in each case between the host government and the Bureau, and not to the model agreement attached to the resolution, which serves as a model for drawing up the specific agreement. Dr. HURTADO (Cuba) said that the proposed resolution to be adopted by the Council should make no mention of the model agreement, but merely state that an agreement will be concluded between the host government and the Bureau, setting forth their respective obligations. The model could be attached as a note, for informational purposes, but not as a model agreement. The CHAIRMAN thought it appropriate, as suggested by the Representative of the United States, that note be taken of the resolution adopted by the Executive Committee by virtue of Resolution XXXI of the XIV Pan American Sanitary Conference, and that the comments made by the representatives during the discussion be recorded in the minutes of the session. Dr. HURTADO (Cuba) remarked that all decisions taken by the Executive Committee are subject to review and amendment by the Council, if this superior body deems such action advisable. The CHAIRMAN asked the Representative of Cuba if he wished to present a formal motion to the effect that the Council amend the resolution presented by the Executive Committee, or whether he felt that note should be taken of the resolution, with the statements of the representatives being included in the minutes. Dr. HURTADO (Cuba) said that he did not wish to present a motion, since when an agreement is concluded both the host government and the Bureau will stipulate whatever conditions they deem suitable. Dr. JIMÉNEZ GANDICA (Colombia) did not think that the approval of the model agreement would create serious difficulties, inasmuch as it does no more than establish the minimum requirements to be fulfilled both by the host government and the Bureau. Should it become necessary, the terms of the agreement could be broadened, for the first operative paragraph of the resolution provides that the model agreement will be subject to such changes in details as may be required in each case. Decision: It was unanimously agreed to take note of Resolution III, approved at the 26th Meeting of the Executive Committee, regarding the meetings of the governing bodies of the Pan American Sanitary Organization held away from Headquarters.' The session was adjourned at 7:00 p.m. Resolution VI, p. 9, also General Committee, p. 119.

54 W.H.O. REGIONAL COMMITTEE 49 FIFTH PLENARY SESSION Tuesday, 13 September 1955, at 9:30 a.m. Chairman: Dr. HÉCTOR A. CoLL (Argentina) Later: Dr. BERNARDO HENAO MEJfA (Colombia) The CHAIRMAN called the session to order. The SECRETARY listed the documents that had been distributed, among them a secretariat notice containing a summary of the decisions taken at the fourth plenary session of the Council. At the invitation of the Chairman, Dr. Henao Mejia (Colombia), Vice-Chairman, took the chair Topic 9: Proposed Program and Budget of the Pan American Sanitary Bureau for 1956 (Documents CD8/7, CE25/2 and Corr., CE25/27, Rev. 1) The SECRETARY read Document CD8/7, citing the resolution in which the 25th Meeting of the Executive Committee approved the 1956 budget and transmitted it to the Council; he explained the contents of Document CE25/2 and Corrigendum, containing the 1956 budget, and Document CE25/ 27, Rev. 1, the report of the working party approved by the Executive Committee. The CHAIRMAN called for discussion on the proposed program and budget of the PASB for Dr. GONZÁLEZ (Assistant Director, PASB) believed that, before starting the debate, a few general remarks would be in order. He called attention to the fact that, pursuant to the Financial Regulations of the Organization, the 1956 budget was presented by the Director to the Executive Committee at the April 1955 meeting in Mexico City. Once the proposed budget has been considered and approved by the Executive Committee, it is the Executive Committee's budget, prepared in collaboration with the Director in accordance with the Constitution. This document presents budget estimates of an informational nature relative to funds from WHO, from the United Nations Technical Assistance Program, and from the OAS Technical Cooperation Program, as well as possible allotments from UNICEF for field programs. Such funds fluctuate constantly, a fact that explains the difference in the amounts shown in Document CE25/2, the 1956 budget, and PASB Official Document No. 12, the 1957 estimates for PASB and the Regional Office. In fact, the situation may well have changed since the latter document was published. Such changes are due to the necessity of meeting changing circumstances and to the impossibility of foreseeing two years in advance the total contributions that agencies outside the PASO will allocate to the international health programs in the Americas. In the preparation of the 1956 budget, an effort was made to comply as far as possible with the wishes expressed by the Member Governments regarding the activities to be undertaken by the PASB. National public health authorities were consulted through the Zone Offices; the national authorities made their proposals, which were studied by the Bureau, for inclusion in the general program set forth in the document. He concluded by saying that he would be glad to give the representatives any further explanations they considered necessary. Dr. ALLWOOD PAREDES (El Salvador) wished to know the reason for the differences in the budget documents for 1956 and for 1957 with regard both to the number of programs provided for and the funds expected. If the figures for 1956 in the green document' and in the gray document 2 are compared, differences can be noted that do not seem to be entirely due to the variations in the funds allocated by UNICEF. The green document mentions twelve country programs of the Pan American Sanitary Organization, whereas the gray document provides for fifteen. As to the WHO, the green document mentions sixteen country programs, whereas there are twenty in the gray document. He had also noticed certain differences in the columns headed "Other Extrabudgetary Funds." Dr. GONZÁLEZ (Assistant Director, PASB) explained that in an organization like the Pan American Sanitary Bureau, which administers funds from different sources, it was natural that the fluctuations in any of these funds would affect the program as a whole. Moreover, as time goes on, the programs that are worked out in collaboration with the governments have to be adapted to new circumstances or modified at the request of those governments. Sometimes, programs agreed upon for a specific year have to be changed at the request of the government con- 'CE25/2, 1956 PASB Budget. 2 Official Documents, No. 12, 1957 PASO and WHO Regional Budget.

55 50 P.A.B.O. DIRECTING COUNCIL cerned or by decision of the Bureau itself, because they are no longer in accord with the prevailing circumstances. This is probably the reason for the differences noted by the Representative of El Salvador, and it is even possible that today the situation is different from that pictured in the gray document. Moreover, an attempt has been made to effect economies, and this fact might explain other differences. With respect to the WHO funds, the Assistant Director of the Bureau pointed out that the last Assembly of the World Health Organization adopted resolutions that have affected the program for In the interval between the preparation of the two documents the situation has also changed radically with respect to the funds of the U.N. Expanded Technical Assistance Program, as he had already had occasion to report at the last meeting of the Executive Committee. For instance, the sum of $720,000 had been allocated to PASB, as Regional Office of the WHO, at the beginning of 1955 from those funds; this figure was increased to $987,685 in April, and in July to $1,078,346. According to information received from the Technical Assistance Board, it is believed that this favorable state of affairs may continue in 1956 and 1957, and the Bureau was requested to draw up its plans on the basis of a higher figure than that used in preparing the green document. In brief, the Bureau has tried to present the situation more up to the moment, more in keeping with present facts, and that is the reason for the differences in the figures. Dr. ALCERRO-CASTRO (Honduras) said that in the green document his country had only one project, Honduras-4 (Rural Public Health Services). In the gray document, however, there is another project, Honduras-5 (BCG Vaccination). He would like to know whether this was one of the new projects mentioned by the Assistant Director. Moreover, according to information given him by the Representative of Guatemala, the Seminar on Sanitary Engigeering will be held in Honduras in Dr. GONZÁLEZ (Assistant Director, PASB) observed that it is intended to carry out the program Honduras-4 with United Nations Technical Assistance funds. The program Honduras-5, which has to do with BCG vaccination, will be carried out through collaboration provided by the Bureau and UNICEF. This program was requested by the Government of Honduras, and a financial contribution to implement it is under consideration by the Executive Board of UNICEF at the meeting that is now being held. The funds are charged to the year in which their allocation is approved by the Executive Board of UNICEF, even if they are not all spent in that same year. With respect to the Seminar on Sanitary Engineering, the Assistant Director declared that it was an intercountry program whose expenses would, it is hoped, be defrayed with Technical Assistance funds. Mr. OLIVERO (Guatemala) observed that mention is made in the budget of the Seminars on Sanitary Engineering held in Managua and Caracas but that no mention is made of that which took place in San José, Costa Rica, in He added that these meetings of Central American sanitary engineers offer a splendid opportunity for the exchange of ideas, and the Bureau has therefore been requested to have these periodic meetings repeated frequently, since their success depends on their continuity. He expressed the desire that another meeting of the sanitary engineers be held in 1956 in some Central American country. Dr. COLL (Argentina) said that project AMRO-81, relating to the Pan American Zoonosis Center, is listed in the green document and also appears in the gray document. The allocations in the columns for the OAS Program of Technical Cooperation amount to $76,091 in 1955 and $109,401 in 1956, although recent information is that there are no funds available. He asked that an explanation be given of the status of this program and of the possible ways of putting it into effect, in view of the great significance of the Zoonosis Center for agricultural countries. Dr. GONZÁLEZ (Assistant Director, PASB) acknowledged the interest in the matter raised by the Representative of Argentina, both in this concrete case and in general. He said that the Bureau faces the problem of preparing and submitting for the technical approval of its governing bodies programs that it believes can be financed out of funds from other sources. In the specific case of the Pan American Zoonosis Center, in 1953 the Economic and Social Council of the OAS approved its establishment at the request of the Government of Argentina. The project was then submitted to the OAS Coordinating Committee on Technical Assistance, on which the PASB is represented. The Director of the Bureau proposed to the Directing Council the implementation of this project, and the latter deemed it worth while. Since then the Bureau has tried to obtain the necessary appropriations to carry out the project. Unfortunately, the necessary funds have not been placed at the disposal of the Bureau. In January 1955 the Coordinating Committee on Tech-

W.H.O. REGIONAL COMMITIEE 51 nical Assistance requested the Director of the PASB to consult the governments to see whether they were still interested in the project.

56 W.H.O. REGIONAL COMMITIEE 51 nical Assistance requested the Director of the PASB to consult the governments to see whether they were still interested in the project. By June 1955 a number of countries had advised that they were indeed interested, and the Bureau notified the Committee and the Inter-American Economic and Social Council, again requesting that the necessary funds be allocated. The Assistant Director believed that the chances of carrying out this project in 1955 or 1956 were slight. He repeated that the PASB had done everything possible to obtain the funds, but, unfortunately, control of those funds is not in the hands of the governing bodies of the Pan American Sanitary Organization. Dr. COLL (Argentina) concluded that there is no hope that the OAS Technical Cooperation Program will appropriate the necessary funds either in 1955 or 1956 and he reviewed the alternatives that had been suggested for financing this program, either by an increase in the regular PASB budget quotas or through an agreement among those countries that are interested in supporting the proposed Center. On the other hand, there is an unexpected increase of $400,000 in the funds from the United Nations Technical Assistance Program. The Representative of Argentina asked whether AMRO-81 could be implemented by using these funds, which had not been expected in Dr. GONZÁLEZ (Assistant Director, PASB) pointed out that, in his personal opinion, this matter has high-level international policy implications. It is a matter of a program that originated in the Inter- American Economic and Social Council and was later adopted by the OAS Committee on Technical Cooperation for execution by the PASB. He stated that, although the assigned funds had not been forthcoming, the program was officially included among the projects to be carried out. Aside from this reason, the Assistant Director pointed out the difficulties created for the Bureau in financing longterm projects that are dependent on funds subject to such fluctuation. He recalled the crisis that the Technical Assistance Program underwent two years ago, at which time the WHO had to take emergency measures to continue the operation of the programs financed with such funds. In concluding, he stated that, as the Director's Report said, the stability of the Technical Assistance Program depends on the equilibrium between three factors: the contributions promised by the governments, the funds collected and made available for disbursement, and the number of programs planned. Dr. SOPER (Director, PASB) said that what is happening in the case of the Pan American Zoonosis Center is a good example of the difficulties that arise in considering projects to be paid for with funds that are not in the regular program of the Bureau. American governments contribute to international public health programs through various agencies, such as the United Nations Technical Assistance Program, the OAS Technical Cooperation Program, UNICEF, WHO, and the Pan American Sanitary Organization. As regards the PASB and the WHO, certain arrangements had been made and, except for differences with respect to the payment of personnel, there are no difficulties. But as regards the other funds, neither the Directing Council nor the Pan American Sanitary Conference has any voice in the matter of appropriations or the use thereof. All the funds have the same origin, for they are contributed by the governments, but they reach the programs through different channels, namely, the various international agencies. Dr. Soper felt that the present system is wasteful of both money and effort. He spoke of the interest shown by the governments in concrete programs of eradication, childhood protection, nutrition, tuberculosis, poliomyelitis, etc., but added that it is difficult to interest the governments in general programs. The Director thought that, in contemplating the future, it would be well to consider the basic functions of the Directing Council and the Conference, leaving aside specific programs. According to the Pan American Sanitary Code and the Constitutions of the PASO and the WHO, the governing bodies of these organizations are composed of technical representatives who are to direct the execution of international public health programs. But in reality this happens only to a certain extent, since almost everything depends on administrative bodies of other nontechnical agencies. He observed that the countries of the Americas gain certain advantages in contributing to the Technical Assistance Program and to the OAS, as they can make their contributions in their own currencies, while they must pay their quotas to WHO and PASO in dollars. This possibility of using national currencies is due to the fact that the United States Government, which gives such great financial support to the Technical Assistance Program, contributes in proportion to the allocations of the countries interested in the programs, allowing them to make their contributions in their respective currencies. Dr. Soper said that, neither as a hygienist nor as Director of the Bureau, could he conceive of public

57 52 P.A.S.O. DIRECTING COUNCIL health programs being dependent on the Technical Assistance Program for Economic Development. Certainly there is no public health program that does not produce economic benefits for the country concerned, and it may even be stated there can be no economic improvement in a country if public health is unsatisfactory. However, it would be well to consider public health problems independently of Technical Assistance funds and economic development; that is, they should be examined solely as technical public health problems. Under the present system, when there is a discussion of the allocation of Technical Assistance funds among heads of governments and their ministers, it is difficult for ministries of public health to defend their programs against the demands of other ministries. Reverting to the Pan American Zoonosis Center, the Director recalled that Argentina had proposed this international sanitary project through ECOSOC, not through the PASB. Once the project had been accepted, ECOSOC proposed it to the OAS Committee on Technical Cooperation, which in turn insisted that PASB present it. The Directing Council approved it in 1954, the Director being thus authorized to enter into negotiations with the Committee on Technical Cooperation. At the June meeting of that Committee, it was found that there were 1,200,000 Argentine pesos that it was not known how to utilize. The Bureau thought that with this sum and about $40,000 more, in addition to the equipment and buildings offered by the Government of Argentina, the program could be carried out in Dr. Soper stated, however, that the OAS Committee on Technical Cooperation is composed of representatives of the organizations interested in Technical Assistance funds, so that it is the representatives of institutes of statistics, geography, history, agricultural sciences, etc., who make the decisions, including decisions on public health programs, and therefore the amount that had been available was used for another program, so that the 1,200,000 Argentine pesos brought the corresponding payment of $700,000 by the United States Government on the basis of its $1,500,000 contribution to the Technical Assistance Program. The program of the Zoonosis Center has appeared in PASB documents since Yet no such Center exists or will exist in either 1955 or Dr. Soper added that the documents referring to future budgets reflect an absolutely uncertain situation, except as regards the funds of the Bureau itself. There has recently been distributed to the Member Governments a document in which the case of the Zoonosis Center is thoroughly examined. That document took up precisely the possibility of financing programs of this sort either by increasing the PASB budget and consequently the country quotas, by special contributions of the governments interested in financing the program, or in a manner similar to that under which INCAP operates. The session was recessed at 11:10 a.m. and resumed at 11 :45 a.m. Dr. COLL (Argentina), referring to the comments on the presentation of the project for the Zoonosis Center, said that this project was presented in 1953 in what was at that time a logical manner, and the difficulties that arose later on were not foreseen. He considered the argument set forth by the Assistant Director of the PASB with regard to the high-level international policy aspect of this question to be a valid one, but not so the argument regarding the difficulties encountered in utilizing Technical Assistance funds, since this argument might be applied to almost all the programs, and the possibility must be studied of utilizing all sources of income, with no need to reduce funds derived from regular contributions. Referring specifically to the Zoonosis Center, he examined the two possible ways the Director had mentioned of organizing it, either with special funds from the interested countries or through a general increase in quotas. He mentioned a third possibility, namely, that there may be funds in the Bureau's budget for starting this work until such time as the governments can appropriate the necessary funds to continue it. Dr. Coll thought that a recommendation might be approved to the effect that the Bureau should submit the various possible solutions to the governments, so that at a meeting in the near future it could be decided how this project could be converted into a program of the PASB itself. Dr. FERREIRA (Brazil) expressed his interest in the detailed explanations given, which not only clarified the particular point being examined but threw light on the multiple technical and financial facets of such matters. He recalled that the problem of zoonosis has held the interest of the American States and is a field that merits attention. For Brazil, with its range and livestock resources, it is a matter of great importance. He thought that the proposed Zoonosis Center

58 W.B.O. REGIONAL COMMITTEE 53 should operate, as does INCAP, for the benefit of the interested countries. The Representative of Brazil, in this connection, cited figures and data that justify his country's interest in this subject. In the southern part of the country, with its 5,700,000 inhabitants, there are 26,000,000 head of cattle and hogs. Dr. Ferreira gave the indices of infection recorded from 1941 to He added that it is impossible to avoid paying special attention to this problem and to studying the concrete possibilities indicated by the Representative of Argentina for putting AMRO-81 into effect. Dr. Ferreira offered his support for the Argentine suggestion and proposed that a draft resolution be prepared that would authorize the Director to take the necessary steps to obtain the funds required to put the Pan American Zoonosis Center into operation as soon as possible. Dr. HURTADO (Cuba) supported the stand of the Representative of Argentina and the proposal outlined by the Representative of Brazil and stressed the value of setting up a Zoonosis Center. He appreciated the clarity of the explanations given by the Director and the Assistant Director of the PASB, particularly as regards the economic obstacles to the execution of these programs. He recalled that Dr. Soper intended to go into this matter at the Tenth Inter-American Conference in Caracas, but, owing to the predominantly political character of that Conference, the Director had no opportunity to explain his ideas, which were relegated to a document worth remembering. He discussed the economic aspects of the program and mentioned the various allocations to public health programs from funds of the Organization of American States, WHO, UNICEF, and Technical Assistance; still, out of all those allocations, there is only one column that is certain, the one containing the government quotas for financing the PASB. He listed the great variety of contributions and quotas that governments are committed to make to international organizations of a regional or global character and explained the growth of Technical Assistance services since their creation by the United Nations and the Inter-American Economic and Social Council. He pointed out the complexity of this machinery, which results in the economic aspects having priority over the public health aspect in Technical Assistance programs, without consideration being given to the fact that the public health programs actually constitute an economic coefficient. In the complex operation of administering and distributing contributions, even when large sums are involved, the direct allocation of funds to be utilized in public health programs very often lies outside the jurisdiction of the health agency. Dr. Hurtado recalled that the United Nations created the World Health Organization as a specialized agency to deal with questions of health, and likewise the Organization of American States declared the Pan American Sanitary Bureau to be its specialized organization for such matters. It would therefore seem logical for any public health program to be handled through the appropriate channels, that is, the agency dealing with public health. The Inter-American Economic and Social Council entrusted to the PASB all matters relating to the technical aspect of the Zoonosis Center but did not provide the Bureau with the funds to carry out the project. The same thing, on the world level, is true of the WHO with respect to United Nations Technical Assistance funds. To obviate the difficulties encountered by national public health authorities in this complicated international setup, it was declared at the Rio de Janeiro Conference (1942) that the public health departments are health portfolios with cabinet rank, whose chiefs participate in the government, thus bringing to a close the period when health departments were under an official of a department dealing with other matters. Today, every one of the American countries has a minister or secretary of public health, and the officer responsible for public health services participates in the general administrative activities of the government and can maintain direct relations with international health agencies. Dr. Hurtado added that the public health ministers of the respective countries should study the difficulties pointed out by Dr. Soper in connection with the economic aspects of the programs, the multiplicity of contributions and quotas, and the variety of channels through which funds are distributed. He went on to say that these problems should be studied in the respective countries by the ministers of health and of foreign affairs, with the chief executive, so that the foreign activities of the governments in health and in other matters would follow a uniform policy, thereby avoiding the situation wherein a representative of a country might uphold one thesis in one technical agency, and another representative of the same country, a different one in another technical agency. Dr. Hurtado also stressed the fact that it would be desirable for the countries, when making their contributions to Technical Assistance funds, to stipulate what part of their contributions should be

54 P.A.S.O. DIRECTING COUNCIL allocated to public health programs, definitely specifying the technical organization that should administer the program.

59 54 P.A.S.O. DIRECTING COUNCIL allocated to public health programs, definitely specifying the technical organization that should administer the program. If this procedure had been adopted, the creation of the Zoonosis Center would not have encountered the economic difficulties now being discussed. In conclusion, the Representative of Cuba offered to draft the text of a proposed resolution providing for the convocation of a meeting at which the ministers of public health would study this problem and decide how to make available the necessary funds for health programs. The session was adjourned at 12:30 p.m. SIXTH PLENARY SESSION Tuesday, 13 September 1955, at 3:00 p.m. Chairman: Dr. HÉCTOR A. COLL (Argentina) The CHAIRMAN called the meeting to order and announced that the Secretary would report on the decisions taken at the meeting of the General Committee. The SECRETARY reported that the Technical Discussions were scheduled for Friday and Saturday, and it was therefore necessary for the Council to elect a moderator and a rapporteur for each of those meetings. Dr. José Bustos would present the introductory statement on the topic "Methods of Improving the Education of Public Health Personnel," and Dr. Myron E. Wegman, Chief of the PASB Division of Education and Training, would act as technical secretary. The introductory statement on the topic "Medical Care in Rural Areas" would be made by Dr. J. A. Diaz Guzmán, and Dr. Gustavo Molina, Chief of the PASB Division of Public Health, would act as technical secretary. The election of the moderators and the rapporteurs would be held during the present session. Thus, the persons designated would have sufficient time to exchange impressions with the authors of the introductory statements and with the technical secretaries. Topic 9: Proposed Program and Budget of the Pan American Sanitary Bureau for 1956 (continuation) Dr. BRADY (United States) referred to the question of Technical Cooperation of the Organization of American States, because it had been mentioned at the morning session and, in the opinion of the speaker, certain information that might be useful to the Directing Council had not been made available to that body. He requested that more data be provided regarding the Coordinating Committee on Technical Assistance, feeling it advisable that a document be prepared to show which organizations are members of that Committee, what the amount of regular budget funds is for each of those organizations in a specific year, and what the Committee's terms of reference are. He said that he was requesting details on the terms of reference because he was interested in knowing exactly to what degree the Coordinating Committee determines what projects will be acceptable under Technical Assistance. He thought it quite possible that the Inter-American Economic and Social Council makes the decisions on such projects, rather than the Coordinating Committee. He also inquired as to the percentage of the OAS Technical Assistance funds that is made available to the Pan American Sanitary Organization, and asked that this information be provided to the Directing Council in such manner as to show the percentages both with and without the Pan American Foot-and-Mouth Disease Center. He said that, inasmuch as the Center is not primarily a health project, it would be interesting to see the percentage figure that includes the Center and also the percentage figure that does not. These figures, he felt, may influence the discussion of the program and budget for the Americas, particularly in regard to the Zoonosis Center. Dr. GONZXLEZ (Assistant Director, PASB) said that at this time he could reply only to some of the questions raised by the Representative of the United States. He offered to prepare a document to be distributed within a short time. As to the last question, referring to the percentage of Technical Assistance funds assigned to the PASB, he said that the total annual OAS Technical Assistance budget has been approximately from $1,500,000 to

W.H.O. REGIONAL COMMIT'EE 55 $2,000,000 and that the allocation for the Pan American Foot-and-Mouth Disease Center has varied between $250,000 and $300,000.

60 W.H.O. REGIONAL COMMIT'EE 55 $2,000,000 and that the allocation for the Pan American Foot-and-Mouth Disease Center has varied between $250,000 and $300,000. Apart from this amount, the PASB once received an allotment of some $13,000 for several nurses seminars. Mr. SALZMAN (Observer, OAS) said that he could answer most of the questions raised by the Representative of the United States, with the exception, perhaps, of the budget figures of the various organizations comprising the Coordinating Committee on Technical Assistance (CCTA). The OAS Technical Cooperation Program operates under the Inter- American Economic and Social Council, pursuant to a resolution adopted on 10 April The Inter- American Economic and Social Council might be called the legislative body of the Program, and the CCTA, the executive body. The latter is composed of seven agencies, under the chairmanship of the Secretary General of the OAS. These agencies are the Pan American Union, the Pan American Sanitary Bureau, the American International Institute for the Protection of Childhood, the Pan American Institute of Geography and History, the Inter-American Statistical Institute, the Inter-American Indian Institute, and the Inter-American Institute of Agricultural Sciences. The executive heads of these agencies, or their representatives, make up the CCTA. Under an original orientation established in 1950, the projects under the Program are primarily limited to technical education and are proposed annually by the component agencies of the CCTA. A program-planning meeting is held each year for review of the projects, and a proposal is made to the Inter-American Economic and Social Council, indicating which of these projects should be included in the Program. The Inter-American Economic and Social Council, in turn, approves annually the total Program of Technical Cooperation. No project may be initiated until it has received the approval of the Council in the current year. Following approval by this body, the CCTA may assign funds from a special account made up of voluntary contributions from the twenty-one American governments. The total budget of the 1955 Program is $1,550,279, of which $248,000 are assigned this year to the Pan American Foot-and-Mouth Disease Center. As the Assistant Director of the PASB had mentioned, in 1951 the allocation of funds for health activities was very small. It consisted of approximately $13,000 for a training center in communicable-disease nursing, which was organized in Guatemala under the auspices of the PASB. He regretted being unable at the time to provide the percentages requested, but he felt that they could be calculated on the basis of the aforesaid figures. The appropriation for the Foot-and-Mouth Disease Center has not varied much, and the total budget of the Program has remained about the same during the past years. Mr. Salzman offered to furnish any additional information. The CHAIRMAN asked the Observer for the OAS whether it might be possible for a project approved by the Inter-American Economic and Social Council not to be implemented because the Coordinating Committee failed to allocate the necessary funds. Mr. SALZMAN (Observer, OAS) replied in the affirmative, adding that the Inter-American Economic and Social Council may, in some cases, approve programs without being sure whether it can count upon sufficient funds for the following year, since, as was said before, the contributions are voluntary. Moreover, contributions to the international programs are not always deposited in the year for which they are pledged. Therefore, in practically every one of the annual programs, the Council has included some projects that are thought to be of considerable value and to which it attached a high priority, hoping that they could be initiated provided that more necessary funds became available. One such project is the Zoonosis Center. On the other hand, when the CCTA wishes to initiate a new activity, it may request authorization to do so from a Standing Committee of the Council. This Standing Committee maintains continuing supervision of the program. The CHAIRMAN asked the Representative of the United States whether he considered the information furnished sufficient or whether he wished a document to be prepared, as he had requested previously. Dr. BRADY (United States) said that he still wished the document to be distributed,' adding that the answers received had prompted him to ask more questions. During the morning session his impression with respect to the Zoonosis Center had been that certain governments believed that the project had been approved by the OAS Technical Assistance, and that one government, acting in good faith on the basis of such information, provided a building and grounds for the project. Afterward, it was decided that no OAS Technical Assistance funds would be available for the project, and this brought about the present dilemma. He asked whether his 'Document CD8/51.

61 56 P.A.S.O. DIRECTING COUNCIL impression was correct and if there was a commitment on the part of the CCTA. Dr. GONZÁLEZ (Assistant Director, PASB) thought that he could reply to the question raised by the Representative of the United States. The project was studied for the first time after a resolution was adopted in 1953 by the Inter-American Economic and Social Council. That resolution requested the establishment of a Zoonosis Center under the OAS Program of Technical Cooperation. The Bureau studied the matter and submitted the project to the Directing Council that year for consideration. The Council approved it along with other programs to be administered by the Bureau as part of its activities. The proposed project was presented also, through the Coordinating Committee on Technical Assistance, to the Inter-American Economic and Social Council, and it was approved officially by the latter under the program of Technical Cooperation of the OAS, provided funds were available. During 1954 it was not possible to finance the project, but in January 1955, with the hope of having funds available, the CCTA authorized the Bureau to proceed with the preliminary arrangements to ascertain the interest of the Member Governments in participating in the project and to obtain from possible host governments offers of buildings and grounds. One government offered headquarters for the Center, with suitable buildings, installations, and personnel. This fact was communicated officially to the CCTA and to the Inter-American Economic and Social Council, together with a request for allotment of funds. Unfortunately, according to available information, there will be no funds for the project either in 1955 or in Mr. SALZMAN (Observer, OAS) confirmed the information furnished by the Assistant Director of the PASB. All that might be added was a comment on the procedure followed in initiating projects under the Program of Technical Cooperation. The first of the many preliminary steps is an authorization by CCTA, which is not granted unless it has been ascertained that the majority of the countries are really interested in participating in the program designed for them. At the same time, the governments are asked whether they are willing to provide the site and other facilities for the project. However, it must be kept in mind that, in this phase of the negotiations, no firm commitment is made by anyone; rather, there is merely an exchange of information. That is what was done in connection with the Zoonosis Center. Preliminary arrangements were made in the hope that sufficient funds would be available, and one government offered excellent facilities for the project. For its part, the PASB officially informed the Coordinating Committee that, from a technical viewpoint, those facilities are acceptable. The next step will be for the Coordinating Committee to decide whether there are sufficient funds to go ahead, and that would mean acceptance of the offer of the host government, the organization of the Center, the announcement of grants for fellowships, and all the other details that would have to be taken care of in initiating the Center. Dr. ORELLANA (Venezuela), referring to his country's experience in recent years, said that a National Committee was set up to coordinate all projects established under Technical Assistance and to assign priorities. The Committee requested the various governmental departments to present applications for the projects they intended to undertake, establishing priorities for them and presenting a program. At the same time the United Nations Technical Assistance Board assigned a total of $300,000 to Venezuela for 1955, of which amount $36,000 were reserved for project Venezuela-1 (Local Health Services). The creation of a National Coordinating Committee obviates the difficulties that could arise from placing in the hands of a single department the interests of all the others. If all are represented in the same agency, it is possible to formulate a well-balanced general program. The speaker then commented on a proposal presented at the previous session by the Representative of Cuba and acknowledged the importance that a meeting of ministers of public health might have in studying the problems related to the distribution of Technical Assistance funds. He felt, however, that such a meeting is unnecessary for that purpose and that, because of its political importance, it should be held only for more important reasons. If the ministers of public health were to meet, why not also the ministers of economy and development who, in turn, would stress the importance of economic development programs at the expense of programs for education and social welfare? Quite possibly the meeting of ministers that had been mentioned would be unable to solve the problem and, therefore, the speaker thought it inadvisable for the Directing Council to adopt the proposal that had been suggested. The CHAIRMAN consulted the Observer for the OAS as to the procedure to be followed in a case like that of the Pan American Zoonosis Center,

62 W.H.O. REGIONAL COMMITTEE 57 which, because of its characteristics, is an intercountry project. Mr. SALZMAN (Observer, OAS) said that the Program of Technical Cooperation of the OAS is a regional program, with no direct assistance being given to individual countries. The reason for this policy is the relatively small size of the program and the need for distributing its services over as many countries as possible. Practically all the OAS Technical Cooperation projects include regional training centers. The establishment of priorities for the various projects was originally the function of the Inter-American Economic and Social Council, and the Program became relatively fixed at its present size and with -its present number of projects. It is evident that these are not projects that can be completed within a few months or even two years. According to the PASB, the Pan American Footand-Mouth Disease Center should operate for at least ten years. Because the Technical Cooperation Program has a fixed number of projects and a relatively fixed budget, expansion must be limited. The only way to expand is to eliminate gradually some of the existing projects or to reduce their allotments, so as to be able to initiate new activities. Dr. ALLWOOD PAREDES (El Salvador) said that, in view of all the questions, replies, and comments, it might be well to re-examine the program and budget of the Pan American Sanitary Organization and of the World Health Organization for An objective and realistic policy would have to be adopted, since it is useless to attempt to achieve inaccessible goals. At present, the Technical Assistance programs, like those of UNICEF, must be carried out on the basis of direct understanding between the various organizations and the governments. What is important here is concentrating on the program and budget of the PASB and of the WHO Regional Office, over whose funds the Directing Council has control. It was noted, he said, that a change had taken place in the programming policy, as could be seen by the number of programs that, during the last three or four years, have been developed as country and intercountry programs. On several occasions the conviction has been expressed that it is in national programs that the PASB can attain its real objectives. The Representative of El Salvador recalled that his country has a long history of international cooperation, as evidenced by its forty-year collaboration with the Rockefeller Foundation. Because of this experience, he felt that country programs carried out with "experts" in the countries themselves, that is, with technicians who have had long experience working in those countries, are the ones that yield the greatest benefits. However, the PASB seems to be departing from this view. More and more funds are being devoted to intercountry and interzone programs, to the detriment of those interests whose defense should be the main purpose of the Organization. The PASB has undertaken twelve programs in eight countries; the WHO, sixteen in eleven countries. But, in reality, one half of those programs are being carried out in only three or four countries, the remaining countries not receiving direct benefit. There is, then, no equitable distribution of material resources, and the same might be said of the personnel. The speaker admitted that some intercountry programs, because of their nature, are in keeping with the policy of the PASB. He gave, as examples, INCAP, the Inter-American Center of Biostatistics, the Carlos Finlay Institute, and the Oswaldo Cruz Institute. But he felt that disease-control services whose programs appear under the title AMRO could be subdivided and converted into country programs, instead of being concentrated in the Zone Offices and served by experts who make only brief visits to the countries. The session was recessed at 4:00 p.m. and resumed at 4 :20 p.m. Election of the Moderators and the Rapporteurs for the Technical Discussions The CHAIRMAN announced that the next item on the order of business would be the election of the moderators and the rapporteurs for the Technical Discussions. He asked, first, for nominations for the posts of moderator and rapporteur for the Technical Discussion on "Methods of Improving the Education of Public Health Personnel." Dr. WILLIAMS (United States) nominated as moderator Dr. Manoel Ferreira, Representative of Brazil, who has had extensive experience in training public health personnel and is one of the outstanding public health educators in the Western Hemisphere. Dr. BISSOT (Panama) nominated as rapporteur Dr. Juan Montalván Cornejo, Representative of Ecuador. Dr. HURTADO (Cuba) and Dr. HENAO MEJÍA (Colombia) seconded the two motions.

58 P.A.S.O. DIRECTING COUNCXL Decision: By unanimous vote, Dr. Manoel Ferreira, Representative of Brazil, was elected moderator of the first technical discussion topic, and Dr.

63 58 P.A.S.O. DIRECTING COUNCXL Decision: By unanimous vote, Dr. Manoel Ferreira, Representative of Brazil, was elected moderator of the first technical discussion topic, and Dr. Juan Montalván Cornejo, Representative of Ecuador, was elected rapporteur. Dr. HURTADO (Cuba) nominated Dr. Daniel Orellana, Representative of Venezuela, as moderator of the discussion on "Medical Care in Rural Areas," because of his experience in rural matters. Dr. ALLWOOD PAREDES (El Salvador) inquired whether the experts invited by the Bureau to present introductory statements could be nominated as rapporteurs. If so, he would nominate Dr. J. A. Diaz Guzmán. The CHAIRMAN declared that the expert appointed to prepare the introductory statement is the speaker and that the rapporteur has the task of preparing the final report of the pertinent Technical Discussions. Therefore it would be inappropriate to nominate the former as rapporteur. Dr. MONTALVÁN (Ecuador) nominated Dr. Alberto Bissot, Jr., Representative of Panama, as rapporteur for the second topic. Dr. HURTADO (Cuba) and Dr. HENAO MEJfA (Colombia) seconded the motion. Decision: By unanimous vote, Dr. Daniel Orellana, Representative of Venezuela, was elected moderator for the second topic, and Dr. Alberto Bissot, Jr., Representative of Panama, was elected rapporteur. Authorization for the Distribution of Document CSP14/34 The CHAIRMAN requested the Council's authorization for distribution of Document CSP14/34, "Unification of Action in Public Health Programs in the Region of the Americas," to be included in the documents prepared and distributed at the present meeting. It was so agreed. Topic 9: Proposed Program and Budget of the Pan American Sanitary Bureau for 1956 (continuation) Motion of the Representative of Brazil (Pan American Zoonosis Center) Dr. RODRIGUES (Brazil) reiterated the proposal made by the delegation of his country to the effect that the Director of the PASB be authorized to take appropriate measures in order that the Pan American Zoonosis Center might as soon as possible receive the funds necessary for its operation. Dr. ACOSTA FLEYTAS (Paraguay), seconding the motion of Brazil, stated that, at the Third Border Health Meeting of the Rio de la Plata Countries (August 1955), it was agreed to recommend to the Member Countries that the Zoonosis Center be established as soon as possible. The CHAIRMAN put the motion presented by the Representative of Brazil to a vote. Decision: By a vote of 12 to 0, with 6 abstentions, it was agreed to authorize the Director of the Pan American Sanitary Bureau to take appropriate measures so that the Pan American Zoonosis Center might receive, as soon as possible, the funds necessary for its operation.' Motion of the Representative of El Salvador (Local Programs within Countries) The CHAIRMAN announced the resumption of the debate on the proposal made by the Representative of El Salvador on the general policy of the Bureau. Dr. HURTADO (Cuba) asked the Representative of El Salvador whether he had some specific motion that would set forth the principles he had explained, whether it was a matter of opposition to the proposed program of the Bureau and a suggestion for revision thereof, or whether he wanted his statements to be kept in mind for the future. Dr. ALLWOOD PAREDES (El Salvador) reiterated his previous statements concerning the reduction of the country programs paid for out of regular funds of the PASO and WHO. He pointed out that the PASB had twenty-eight country programs in 1954, seventeen in 1955, and eleven planned for As the WHO Regional Office, it carried out twenty country programs in 1954, conducted seventeen in 1955, and had sixteen planned for He mentioned again the importance his country attributes to the country program as contrasted with the intercountry and interzone programs. He felt that, save in exceptional cases, the Bureau should change the present tendency, expending available funds preferably on the country programs and, if possible, redistributing the funds of some intercountry and interzone programs to country programs. It will be said that introducing changes at this late date is difficult, as has been said on previous occasions. He ' Resolution VII, p. 11[.

64 W.H.O. REGIONAL COMMITTEE 59 believed that the representatives should be consulted as to whether his country's proposal should be given consideration or whether they preferred to continue the policy of centralization of programs. Dr. BRADY (United States) said that in matters of this nature the United States practically always finds itself in agreement with the Republic of El Salvador, but that in this case he could not go along with the thesis presented by Dr. Allwood Paredes. There are two types of activities in the field of international health. The first refers to traditional international health services that have grown up over a period of decades, such as quarantine, the establishment of common names for drugs moving in international commerce, and other items of world-wide or regional interest. The other type of activity is that of regional programs. All the nations have certain common problems, and it is necessary for some agency of an international nature to promote joint action by these adjacent countries so that they may work with greater effectiveness against the diseases that harass all of them. It is in this aspect that the importance of the WHO and of the PASO should be stressed. Therefore, the delegation of the United States has viewed with pleasure the fact that greater attention has been given to intercountry programs than to those carried out within a single country. Consequently, as he pointed out, he could not agree with the statements of the Representative of El Salvador. Dr. RODRIGUES (Brazil) also thought that, from the viewpoint of international health, the WHO and the PASB should give preferential attention to the intercountry programs. The purpose of international agencies is to promote joint action by the countries, as indicated by the Representative of the United States. Whenever possible, assistance should, of course, be given to the countries through demonstration of work methods, operation of services, etc.; the same can be said with respect to national eradication programs, such as the one carried out in Haiti against yaws. But, if the trend of PASB activities toward intercountry programs were to be modified, there would be the danger of disputes between countries eager to obtain the largest possible amount of funds and personnel for their national activities. Therefore, he considered the intercountry programs to be best suited for carrying out the Bureau's international activities. Dr. ALCERRO-CASTRO (Honduras) felt that the Representative of El Salvador was concerned because, in view of the present trend of the Bureau's work, the country program may disappear in a short while, and there are still countries in need of this direct aid. He therefore supported the proposal of El Salvador, to the effect that the trend toward increasing the intercountry programs be held in check, and he requested that a resolution be adopted to express the concern of certain countries in this matter. Dr. MONTALVXN (Ecuador) felt that the subject brought up was of the utmost importance and required thoughtful consideration, since it concerned the future policy of the PASB. The Representatives of the United States and Brazil had declared themselves clearly in favor of intercountry programs. Even though it has been stated on various occasions that the Americas represent a unit, owing to the many common interests shared by their countries, it is also true that there are obvious differences among them. Today two divergent views have been expressed on this subject, a fact that confirms these differences. The underdeveloped countries do not see the problem of international cooperation from the same point of view as the United States and Brazil, which, being highly advanced and possessing great resources, have a different concept of collective programs. El Salvador hopes to improve the whole by improving the parts. The question being raised here cannot be answered once and for all. The most we can do, he said, is to record the concern expressed here with regard to the fact that the country programs are being overshadowed. Dr. HURTADO (Cuba) agreed that two different stands had been taken. On the one hand, the United States had favored the global policy of present-day international cooperation, which leads to extensive intercountry, interzone, and continental programs. But opposed to this position was the realistic attitude based on the need for certain countries to solve their urgent national problems. Much could be said in favor of this stand. Although Cuba was of the opinion that the international organizations should not replace local or national agencies, it agreed with the view expressed by the Representative of Ecuador. However, the only action open to the Directing Council at this moment is to take note of the concern expressed and to recommend to the PASB that it attempt to render specific assistance to certain countries. Thus, the existing problems can be solved, and the day will come when all countries may go forward together in developing international public health cooperation.

60 P.A.S.O. DIRECTING COUNCIL Dr. ALLWOOD PAREDES (El Salvador) thanked the Representative of Ecuador for his statement, which coincided with his own feelings.

65 60 P.A.S.O. DIRECTING COUNCIL Dr. ALLWOOD PAREDES (El Salvador) thanked the Representative of Ecuador for his statement, which coincided with his own feelings. He observed that the country programs are not necessarily being carried out in the countries that are underdeveloped. At the present time, half of the activities undertaken by the WHO and the PASB are being absorbed by six countries. But this is not the most important point; more important is the fact that there are countries not yet capable of coordinating their activities with those of other countries. It is therefore necessary to stimulate in them the desire for improvement and progress in their public health activities. He proposed the closure of the debate and a vote on the motion as to whether the Bureau should follow the present trend of favoring intercountry programs. Dr. GONZÁLEZ (Assistant Director, PASB) said that he had listened with great interest to all the comments made, as they will help to decide the future policies of the PASB. At previous meetings the tendency to favor intercountry programs had been praised and there are even Directing Council resolutions on the advisability of attacking problems from the intercountry, zone, or even continental viewpoint. He recalled that, with respect to the WHO programs in the Region of the Americas, the tendency toward intercountry programs drew favorable comments at the Fifteenth Session of the WHO Executive Board, which took place at Geneva in January and February The Bureau felt that by presenting a series of intercountry programs it had interpreted the wishes of its governing bodies correctly, in the conviction that this was the most economical and efficient way to cooperate with the countries. An analysis of these programs will show that most of them are concerned with educational activities, such as the organization of seminars, training centers, courses for advanced training, and fellowship grants. From an administrative point of view it would be difficult to allocate in the budget a small sum to each country for one fellowship, but there are plenty of examples showing that most of the countries have been able to participate in this type of technical meeting. To cite one case, he pointed out that at one seminar on sanitary engineering ten countries were represented but that this information was not included under the individual countries in the budget documents, for administrative reasons. He felt that the objectives of the Organization, prominent among which is the strengthening of the national public health services, are furthered by that type of program. It should be remembered that a fellowship granted under an intercountry program has the same value as one granted for a program within a specific country. Figures have been cited in connection with country programs financed with regular PASB and WHO funds, but when this question is studied the number of projects financed with funds from other sources should be taken into consideration, because in a discussion of this kind it is impossible to distinguish between them. The program submitted to the Council for consideration contains 99 projects, of which 35 are intercountry projects and 64, country projects. Mention has also been made of certain activities of the Bureau in eradication programs. It should be pointed out that in the eradication activities the Bureau has acted on the specific instructions of its governing bodies. The Aedes aegypti eradication campaign is based on a resolution of the I Meeting of the Directing Council, held in 1947, and the smallpox eradication campaign, on a resolution of the XIII Pan American Sanitary Conference; the malaria eradication program is based on a resolution of the XIII Conference and on specific instructions of the XIV Conference; the yaws eradication program was initiated in a Member Country at the request of its government. So far, it has been the understanding of Bureau officials that the intercountry programs had the backing of the governing bodies of the Organization. In any case, he would be pleased to hear the comments of the representatives and would like to know whether it was the wish of the Directing Council to change the trend of Bureau activities. Dr. HURTADO (Cuba) asked for the floor to raise a point of order. The Representative of El Salvador had requested that the debate be closed and that the question as to whether the Bureau should continue in its tendency toward intercountry programs, to the detriment of the country programs, be put to a vote. This matter could not be put to a vote, because the discussion had not yet brought the matter sufficiently into focus. He noted certain contradictions in the statements of the Representative of El Salvador. The Assistant Director of the Bureau had made a very clear statement showing that, out of 99 programs in which the Bureau is expected to participate, 35 are intercountry and 64 are country projects, a fact that invalidates the statement of El Salvador that there is a distinct preference for intercountry programs. Moreover, he recalled that at the session the previous day the Council ap-

66 W.H.O. REGIONAL COMMITIEE 61 proved the Annual Report of the Director, which reflects the policy of the Bureau. It was impossible now to retract that approval by a motion such as the Representative of El Salvador proposed. What should be done is to take into consideration the concern expressed by the Representatives of El Salvador, Ecuador, and Honduras as to the necessity of continuing direct aid to those countries whose internal public health programs must still be developed. Dr. González had shown clearly that the intercountry programs give assistance to a large number of countries. If statistics were drawn up, it would be seen that practically all the countries have benefited from this type of program. He concluded by suggesting that the Representative of El Salvador change his stand and withdraw his motion, although the Bureau might take note of his observations for future reference. Dr. PESQUEIRA (Mexico) believed that it would be going against progress to vote against the trend of the Bureau to increase intercountry and interzone programs. This does not mean that direct aid to the countries should be discontinued, but there should still be the trend, slow or rapid, toward intercountry programs. The Organization cannot be requested to change this policy, since it is a policy dictated by circumstances rather than by the Organization. He was of the opinion that the Representative of El Salvador, in his proposal, might request the Bureau to continue giving direct aid to the countries that need it, without changing the trend toward intercountry programs. Dr. ALLWOOD PAREDES (El Salvador) declared that he could not agree with certain points brought up by the Representative of Cuba, nor could he pass over them in silence, since that might be interpreted as a confession of error in his argument. The fact that he had vigorously expressed his country's point of view as to the advisability of a change of policy did not mean any failure to appreciate and be grateful to the Director and the members of his staff. Approval of the Annual Report of the Director did not preclude the adoption of decisions on the policy of the Bureau, since policy comes within the Council's jurisdiction. It was also said that the speaker had misrepresented facts when quoting wrong figures, but that was not so. In 1954, 1955, and 1956, there has been a decrease in the number of programs financed from regular funds of the PASB and the WHO. Even though this obvious tendency has not been reflected in the programs financed from TA funds, that fact still does not compensate for such decreases; there were 15 country programs financed from TA funds in 1954 and 18 in 1955, and 16 have been provided for in But in these three years, the over-all figures of 59 in 1954, 52 in 1955, and 42 in 1956 do show a decrease. He thought that the Council should think over the statements made by the Representatives of Ecuador and Honduras and by the speaker himself, with regard to the special circumstances existing in certain countries where the strengthening of public health services would suffer. He further declared that the fellowship program was one of the intercountry programs that should be kept up. The Council should decide whether the number of country programs should be further decreased or whether the trend toward increasing the number of intercountry programs should be checked. Dr. MONTALVÁN (Ecuador) asked for the floor on a point of order. The Representative of El Salvador had asked that the debate be closed. However, the questions he had raised were most important and had given rise to interesting comments. The speaker was opposed to having the debate closed; that would be in order only if the Representative of El Salvador presented a definite motion, not one containing alternatives. The CHAIRMAN put to a vote the motion for closure of the debate. The SECRETARY read Article 39 of the Rules of Procedure of the Council, which establishes the procedure in such cases. Decision: By a vote of 14 to 1, with 3 abstentions, it was agreed not to close the debate on the motion presented by the Representative of El Salvador. Motion of the Representative of Ecuador (Local Programs within Countries) Dr. MONTALVÁN (Ecuador) proposed the following motion to replace that of the Representative of El Salvador: Taking into account the general conditions affecting the development of public health organizations in the various countries of the Americas, the Directing Council recommends that, in the preparation of the programs and budgets of the Pan American Sanitary Organization, an effort be made to maintain the proper balance and harmony between the intercountry and interzone programs and those carried out within a single country. Dr. ALCERRO-CASTRO (Honduras) seconded the motion presented by Ecuador.

67 62 P.A.S.O. DIRECTING COUNCIL The CHAIRMAN asked the Representative of El Salvador if the motion interpreted the feeling of his delegation and satisfied his desire to place on the record the concern he had expressed with respect to the programs of the Bureau. Dr. ALLWOOD PAREDES (El Salvador) answered that the proposal of Ecuador fulfilled in general the purpose of his original proposal. The CHAIRMAN requested that the Secretariat reproduce and distribute the motion presented by the Representative of Ecuador, so that it could be considered by the Council. It was so agreed. The session was adjourned at 6:00 p.m. SEVENTH PLENARY SESSION Wednesday, 14 September 1955, at 9:45 a.m. Chairman: Dr. HÉCTOR A. -COLL (Argentina) The CHAIRMAN called the meeting to order. The SECRETARY reported on the documents distributed that day. Expression of Gratitude from the United States-Mexico Border Public Health Association The SECRETARY, at the request of the Director, informed the representatives that the U. S.-Mexico Border Public Health Association, at its Thirteenth Annual Meeting, held in Mexico City from 6 to 9 May of this year, had approved a resolution, which he read, expressing its sincere appreciation to the Directing Council of the PASO and the staff of the PASB for the valuable support given both in helping to set up the Association and in collaborating in its work. Topic 21: Election of Three Member Countries to Fill the Vacancies oxn the Executive Committee Created by the Termination of the Periods of Office of Brazil, Haiti, and Panama (Document CD8/9) The CHAIRMAN announced that the order of business called for the election of three Member Countries to the Executive Committee as a result of the expiration of the terms of office of Brazil, Haiti, and Panama. The SECRETARY read Document CD8/9 and Articles 32 and 34 of the Rules of Procedure of the Directing Council, pertaining to elections. The CHAIRMAN stated that the ballot would be secret. At the suggestion of the Chair, the Representatives of Ecuador and Venezuela were named tellers. The SECRETARY reported that there were delegations from twenty-one Member Countries present, namely: Argentina, Bolivia, Brazil, Chile, Colombia, Cuba, the Dominican Republic, Ecuador, El Salvador, France, Guatemala, Haiti, Honduras, Mexico, the Netherlands, Nicaragua, Panama, Paraguay, the United Kingdom, the United States, and Venezuela. The votes were cast and the tellers announced the results, as follows: Cuba, 19 votes; Nicaragua, 19; Bolivia, 15; Honduras, 6; Chile, 1; Costa Rica, 1; and Venezuela, 1. Decision: By majority vote, Bolivia, Cuba, and Nicaragua were elected to fill the vacancies on the Executive Committee.' The CHAIRMAN, in the name of the Directing Council and on his own behalf, warmly congratulated the Representatives of Bolivia, Cuba, and Nicaragua, the new members of the Executive Committee. He was sure that these Representatives would continue the tradition of efficiency and good will that characterized that body. Motion of the Representative of Colombia (Vote of Thanks to the Representatives of Brazil, Haiti and Panama) The SECRETARY then read a proposed resolution submitted by the Representative of Colombia, in which the Directing Council thanked and congratulated the Representatives of Brazil, Haiti, and 'Resolution VIII, p. 9, also General Committee, pp. 119 and 120.

W.H.O. REGIONAL COMMITTEE 63 Panama for their collaboration in the Executive Committee and for their valuable contribution to the programming and success of the work of the PASO. Mr.

68 W.H.O. REGIONAL COMMITTEE 63 Panama for their collaboration in the Executive Committee and for their valuable contribution to the programming and success of the work of the PASO. Mr. OLIVERO (Guatemala) said that his delegation had heard with great pleasure the Chairman's congratulations to the new Executive Committee members. He seconded the motion of the Representative of Colombia for a vote of thanks to the departing members. Dr. HURTADO (Cuba), Dr. SOMARRIBA (Nicaragua), and Mr. DE LA ROCHA (Bolivia), in the name of their respective Governments, expressed their thanks for the honor conferred upon them and promised to perform their high mission to the best of their abilities. Dr. ALCERRO-CASTRO (Honduras) voiced his thanks for the votes that had been cast for his Government. Dr. BISsoT (Panama) congratulated the new members of the Executive Committee and went on to say that, at the close of the term of office of his country, he was relinquishing his post with a feeling of satisfaction at having done his best in carrying out his duties on that Committee. He said that, as a member of the Executive Committee, he had become intimately acquainted with the operation of the PASB and had been able to help work toward a common goal: the health of all the inhabitants of our Hemisphere. The CHAIRMAN submitted the proposed resolution of the Representative of Colombia, seconded by Guatemala, for approval. Decision: The resolution was unanimously approved.' Topic 9: Proposed Program and Budget of the Pan American Sanitary Bureau for 1956 (conclusion) Motion of the Representative of Ecuador (Local Programs within Countries) (continuation) The CHAIRMAN recalled that at the close of the last session a proposed resolution of the Representative of Ecuador, summarizing the views of the Directing Council as expressed during the discussion at that session, had been approved in principle. 'Resolution IX, p. 10, also General Committee, p Dr. HURTADO (Cuba) suggested that, to expedite the work, the proposed resolution, the text of which had already been distributed, be put to a vote. Dr. ALLWOOD PAREDES (El Salvador) said that the proposed resolution under discussion contained the essence of his thought, but in his opinion the text was somewhat incomplete and so, without departing from the content of the original motion, he would like to change it by adding the general points that belong in a resolution of this type. The CHAIRMAN suggested that consideration of this proposed resolution be postponed until the text drafted by the Representative of El Salvador had been distributed. Dr. ALLWOOD PAREDES (El Salvador) made some comments with regard to the points that might be examined in connection with the malaria eradication program, and the CHAIRMAN ruled that, following the order of business, such comments should be part of the discussion of the budget, the topic under consideration. Malaria Eradication Dr. ALLWOOD PAREDES (El Salvador) pointed out that in the green document, under item AMRO-90, there was the sum of $100,000 approved by the Conference for the malaria eradication campaign. In the gray document, it was explained why these funds were used to set up the Coordination Office of the Malaria Eradication Program (COMEP). He went on to say that there were other items on malaria eradication in intercountry programs, but that he was unable to find, in the entire budget, a single national malaria eradication program. He pointed out that some countries run into technical difficulties in carrying out responsibilities with respect to the execution of this continental malaria eradication program. Such difficulties are due to the lack of sufficient staff to do this work effectively in their national territory. The Representative of El Salvador wanted to know whether the Bureau had considered the fact that many countries could not, for lack of funds, cooperate in implementing a program the success of which depends on the fact that it can be carried out simultaneously throughout the Hemisphere. He also wanted to know what provisions the Bureau had made for giving such countries the technical aid they need, aside from the establishment of the COMEP, which is a coordinating body.

64 P.A.S.O. DIRECTING COUNCIL Dr. MONTALVÁN (Ecuador) felt that the Representative of El Salvador had called attention to a point of capital importance for the decisions the Council had to make.

69 64 P.A.S.O. DIRECTING COUNCIL Dr. MONTALVÁN (Ecuador) felt that the Representative of El Salvador had called attention to a point of capital importance for the decisions the Council had to make. He said that the XIII Conference had voted in favor of the development of antimalaria activities in the Americas, a measure that was given concrete encouragement by the XIV Conference at Santiago. In 1950, the success of the residual-action insecticides became evident; in 1954, the resistance of insects to these substances was observed with alarm. The PASB, acting on those resolutions, the repercussions of which were felt later at the World Health Assembly in Mexico, started the eradication work. With the establishment of COMEP in 1955, the help the American countries were asking began to materialize, although not to the extent desired. It was impossible to extend to Ecuador the activities of COMEP because they were circumscribed by limits set by the Bureau. National programs have not been promoted. Dr. Montalván added that the American countries want activities that will stimulate national malaria eradication programs to be shown in the PASB budget. He agreed with Dr. Allwood Paredes. Dr. FERREIRA (Brazil) said that the delegation of Brazil, represented at this meeting by the Chief of the Malaria Service of that country, was pleased with the step taken to make the Bureau's cooperation in the malaria eradication campaign a reality and considered it an achievement. He added that, notwithstanding the provisions of the XIV Conference and the funds granted by UNICEF, it was impossible to transform the malaria control services into eradication services immediately. He thought that there was no more effective step than project AMRO-90. He read the paragraph in which the malaria eradication campaign was described in the gray document, a paragraph giving the aims of the Bureau in establishing COMEP. He went on to say that the Bureau cannot use its funds effectively unless it first examines the facilities and the needs in each country. The establishment of COMEP was no small step, and in taking it the Bureau did what was expected of it. The governments by themselves cannot consider national eradication of malaria until after the international policy that is to be followed to banish this disease from our Americas has been formulated. He thought that the Directing Council should approve the measures taken by the Executive Committee, which had acted in accordance with the decision of the XIV Conference to give highest priority to malaria eradication. Dr. ORELLANA (Venezuela) said that the views expressed by Brazil were identical to those that his delegation wished to present, and he therefore supported Dr. Ferreira's remarks. Nevertheless, he pointed out that the sum allocated to the Bureau for interzone programs is small, and with this amount the Bureau has been unable to draw up a better program than the one it has launched. If this sum had been divided in order to implement country programs, it would have been inadequate for carrying them out effectively. He believed that each country might appropriate the greatest possible amount of its own funds to help wipe out this disease. He referred to the procedure followed in the interzone programs when setting up the Latin American Center for Classification of Diseases, the object of which is to help improve comparative mortality and morbidity statistics in the Americas. If the sum allocated to this Center were to be distributed among the various countries, it would be practically wasted. He stressed the fact that the amount of money allocated enabled the PASB to undertake only a project of the type of COMEP. The session was recessed at 11:00 a.m. and resumed at 11 :25 a.m. The CHAIRMAN invited the Director of the Bureau to reply to the questions raised by the representatives in the course of the debate. Dr. ALLWOOD PAREDES (El Salvador) said that, before hearing the Director, he wished to make it clear that his country was not against the establishment of COMEP but wanted the PASB to pay more attention to the needs of a technical nature in the various countries, in order to ensure the success of the malaria eradication campaign. Dr. SOPER (Director, PASB) said that he would not go into detail with respect to the budget but considered it necessary to make a few statements on the orientation and the thinking in connection with malaria eradication, on the possibilities of carrying it out successfully, and on the funds required for the task. He referred, as a basis for this view, to what happened in the matter of Aedes aegypti eradication, recalling that in 1947 the Directing Council had requested that the Bureau collaborate with the countries to eradicate the A. aegypti and attempt to resolve the problem of yellow fever. At first the

W.H.O. REGIONAL COMMIIIEE6E 65 Bureau had done all it could to work directly with several governments, and after years of experience there was set up for A.

70 W.H.O. REGIONAL COMMIIIEE6E 65 Bureau had done all it could to work directly with several governments, and after years of experience there was set up for A. aegypti something similar to what COMEP now represents in antimalaria work. What happened in the A. aegypti eradication campaign constitutes an example of what can be done to eradicate malaria, he said, but in the case of the aegypti campaign manuals and instructions have already been established as a means of orienting and standardizing all the work. Dr. Soper said that, on the basis of that experience, he was convinced that the establishment of an agency such as the Coordination Office in Mexico is of great importance. The Director went on to say that the figure of $100,000 appearing in the budget was based on preliminary estimates, but at no time was it ever believed that it would be possible to eradicate malaria with this sum. He remarked that a strange psychological effect is produced when one speaks of eradicating a disease. It is difficult to convince a person that a disease can be eradicated without giving the impression that it is an easy task. Any such idea must be abandoned. The eradication of malaria is not easy and is not going to be accomplished in five years. It requires intensive and extensive work and an approach different from that followed in control campaigns. The latter are usually organized in rich regions where the disease assumes a more serious character. In the eradication campaign, on the other hand, it is necessary to take into account the country as a whole and the application of all the measures in all the countries simultaneously. The sum of $100,000 will make it possible only to determine the scope of the problem; the amount is not sufficient to permit initiation of the eradication work in the various countries of America. An undertaking of this kind may come up against not only financial but also administrative difficulties. In certain countries it will be difficult to adapt the existing health services to the new requirements of eradication. Dr. Soper explained that there is a great difference between a control campaign and an eradication campaign. When it is a question of converting the former into the latter, there must be a transformation of the campaign, with the consequent psychological adaptation that this entails, and not a mere extension. In the case of A. aegypti, when the possibility of reorienting the campaign was ascertained, a change took place also in the minds of the officials, who in control campaigns considered the results satisfactory when the stegomic index was low. But when there is no reference to this index a psychological change occurs, reflecting the change in the services. Talking of what has already been done is quite a different thing from talking of what remains to be done, starting, so to speak, from zero in measuring the desired results. Dr. Soper said that he had wanted to point out this general orientation of the work before mentioning some of the positive results achieved since the Conference. He recalled that it had not been possible to organize COMEP until February and stressed the difficulties of setting up such a service and the need for adapting programs, training personnel, etc. He referred to the interest of the Government of Mexico in finding a radical solution to the malaria problem. From the very beginning, Mexico has considered the funds expended in this campaign as a capital investment, just like money invested in permanent public works. Dr. Soper added that the possibility of collaboration from UNICEF has been considered in studying the feasibility of the Mexico program; the Executive Board of UNICEF has agreed in principle to help in the eradication of malaria. Considering the implications of its participation in campaigns on such a great financial scale, UNICEF requested a report from the UNICEF/WHO Joint Committee on Health Policy, which made a favorable report and in May approved the inclusion of malaria eradication programs among those deserving UNICEF's support. Dr. Soper added that this UNICEF decision is as important as Mexico's decision to make a frontal attack on the problem. UNICEF's aid consisted previously in providing insecticides, transportation, and supplies for specific programs, and its approval of a $2,400,000 annual appropriation for the Mexico program now means that it has accepted the responsibility of continuing its help as long as this vast campaign lasts. UNICEF has thus taken a stand on the malaria eradication problem, and Dr. Soper recalled in this connection that the Regional Director of UNICEF had told him that, in the future, he would not recommend any aid for malaria programs unless the activities had already been approved and the governments had guaranteed their continuation. The Director went on to say that, when he saw

66 P.A.S.O. DIRECTING COUNCIL the widespread interest in this matter of the possible eradication of malaria, he was able to view the future more clearly and with more confidence.

71 66 P.A.S.O. DIRECTING COUNCIL the widespread interest in this matter of the possible eradication of malaria, he was able to view the future more clearly and with more confidence. He recalled that when he had spoken with a well-known journalist some months ago about this possibility of eradicating malaria throughout the world, the latter had shown great interest and asked how much a program of such vast scope might cost. No one can come up with an exact figure, and it must be remembered that most of the expenses incurred will have to be borne by the governments, as there is no international agency capable of defraying them. But, as the journalist insisted on a figure, he had answered that it would run into hundreds of millions of dollars. Dr. Soper then discussed the various features of the problem in different countries. He said that since the Santiago Conference he had seen the President of the Rockefeller Foundation to tell him of the decision taken concerning the need for eradicating malaria in the Americas. The President had asked him how much he thought the Rockefeller Foundation ought to contribute toward aiding this campaign and was so insistent on that point that Dr. Soper's hopes for immediate results began to rise; this, however, was not the proper moment, as he had only wanted to inform the Foundation, which for forty years had done so much against malaria, that there was the possibility of contributing toward an international campaign with guaranteed results. He had added that it was still impossible for him to mention a specific amount and that what he would really wish for was that they give him a blank check, leaving it up to him to spend what could usefully be invested. But the problem is so important that there will have to be a special fund and it will depend on the collaboration of all countries desiring to eradicate malaria from within their borders. He reiterated that the undertaking will not be an easy one and that adapting the national health services of certain countries to the eradication campaign will present difficulties. Yet, he said, an important step has been taken and much has been gained in listening to the statements of representatives both of the countries that recognize the need for direct collaboration by the Bureau and of those that recognize the need for an increase in the funds for carrying out malaria eradication campaigns. The CHAIRMAN thanked the Director of the PASB for his interesting comments. He said that the Directing Council had been examining Topic 9 for two days and, if there was no objection, he would put the proposed program and budget for 1956 to a vote, as a whole. Dr. MONTALVXN (Ecuador) recalled that, during the discussions of the past two days, the Representative of El Salvador had made several statements concerning the two principal aspects of the budget that the Council should study before proceeding to vote on the budget as a whole. One of those aspects was the general principles that should be followed in the preparation of future programs and budgets, and the other specifically referred to the malaria campaign. He added, however, that with respect to the last item, it appeared that Dr. Allwood Paredes had made no concrete proposal. The CHAIRMAN explained that he had proposed putting the budget to a vote because he understood that there was general agreement among the members of the Council concerning the general principles governing the preparation of future budgets. And as regards the malaria eradication program, the Representative of El Salvador had presented no proposal. Motions of the Representatives of Ecuador and El Salvador (Local Programs within Countries) (continuation) Dr. ALLWOOD PAREDES (El Salvador) asked that the text of his proposal on local programs within countries, distributed as Document CD8/40, be put to a vote, in order to formalize the agreement that had been reached, in principle, the previous day. The text was as follows: The Directing Council, Considering that in the development of the field activities of the Bureau there is an increasing tendency to decrease the number of programs in the countries; and Bearing in mind the fact that many countries still need direct international aid so that they may organize and strengthen their health administrations and assume their own responsibilities in carrying out continental programs, Resolves: To recommend to the Director of the Bureau, Regional Director of WHO, and to the Executive Committee that, in the preparation of the proposed programs and budgets of the Organization, they bear in mind the advisability of carrying out local programs in the countries that need and desire such programs. Dr. RODRIGUES (Brazil) said that, when he expressed opinions the day before that coincided

W.H.O. REGIONAL COMMITTEE 67 with those of the United States, he may have given the impression that conditions in Brazil are different from those in other countries. This, however, is not true.

72 W.H.O. REGIONAL COMMITTEE 67 with those of the United States, he may have given the impression that conditions in Brazil are different from those in other countries. This, however, is not true. In Brazil the problems confronting the various states must be studied whenever the necessary technical facilities are not available and, in this, the problem is similar to the intercountry problems. He felt that Ecuador's proposal had been accepted in principle-a proposal that he considered sound-but he felt that the wording suggested by the Representative of El Salvador was better. Nevertheless, he proposed two amendments: one to eliminate the first clause in the preamble and the other, in the operative part, to substitute the words "they continue to bear in mind" for "they bear in mind." Dr. HURTADO (Cuba) said that an extensive examination of the budget had been made during the last two days and that the principal items had been discussed. At no time, however, had any specific change been proposed in the budget presented by the Bureau. It was therefore proper, in his opinion, to put the proposed program and budget for 1956 to a vote and then, so as not to neglect any of the observations made on the subject, decide on the text of the motions reflecting those observations. With respect to the proposal of the Representative of El Salvador, he supported Dr. Rodrigues' suggestion to eliminate the first clause in the preamble. He declared, however, that he preferred the motion presented by Ecuador, although he would take the liberty of proposing an amendment in it, namely, to state "proper balance and harmony be maintained" where it read "an effort be made to maintain the proper balance and harmony."' He also recalled the recommendation made by the Representative of Argentina to the effect that, within the financial possibilities of the Bureau, a way should be sought to implement the Pan American Zoonosis Center. Dr. ALLWOOD PAREDES (El Salvador) inquired whether Document CD8/4, on the utilization of available funds, should not be examined in connection with the budget. Dr. HURTADO (Cuba) insisted that the Council should proceed to vote on the budget, as he believed that no request to change a single item therein had been made. The comments that had been made could then become the subject of pertinent decisions. 'For full text, see p. 61. Appropriations Resolution The CHAIRMAN put to a vote the proposed resolution appearing in Document CE25/2, Proposed Program and Budget of the Pan American Sanitary Bureau for He asked the Secretary to read the proposed resolution. The SECRETARY read the first paragraph of the proposed appropriations resolution appearing in Document CE25/2 and the figures listed in the same document, as follows: THE DIRECTING COUNCIL RESOLVES: 1. To appropriate for the financial year 1956 an amount of $2,200,000 as follows: Purpose of Appropriation Part I: Pan American Sanitary Organization $168,839 Part II: Pan American Sanitary Bureau- Headquarters ,990 Part III: Pan American Sanitary Bureau- Field and Other Programs... 1,067,171 Total-All Parts... $2,200,000 Less estimated miscellaneous income $77,468 Contributions in respect of the territories of France, the Netherlands, and the United Kingdom... 22,532 Total estimated miscellaneous income ,000 Total for assessment... $2,100,000 Decision: By a vote of 18 to 0, with 3 abstentions, the proposed appropriations resolution was approved.' Text of Resolution on the Pan American Zoonosis Center The CHAIRMAN, for the purpose of information, read the text of the resolution concerning the Pan American Zoonosis Center that was approved at the previous day's session. Motions of the Representatives of Ecuador and El Salvador (Local Programs within Countries) (conclusion) The CHAIRMAN then asked the representatives whether they wished to consider first the proposed 1 Resolution X, p. 10, also General Committee, pp. 120 and 123.

73 68 P.A.S.0. DIRECTING COUNCIL resolution presented by the Representative of Ecuador, with the amendment proposed by Cuba, or the proposed resolution presented by the Representative of El Salvador as amended by Brazil. Dr. HURTADO (Cuba) said that it should be made clear first whether two different resolutions were involved; if so, they should be considered in the order in which they were presented. If Dr. Allwood Paredes' resolution is an amendment of Dr. Montalván's, the amendment should first be considered. In the latter case, there should be a vote on the proposed resolution presented by Dr. Allwood Paredes, with the amendment by Brazil. Dr. MONTALVÁN (Ecuador) said that, in order to facilitate the decision of the Directing Council, he would prefer that the proposal of El Salvador be considered an amendement to the motion he himself had made. He asked that the proposal of Dr. Allwood Paredes, with the amendment introduced by Brazil, be put to a vote first. The CHAIRMAN put to a vote the proposed resolution of El Salvador, with Brazil's amendment. Decision: By 14 votes in favor, 2 against, and 4 abstentions, the proposed resolution was approved with the first clause of the preamble deleted. The operative part recommends to the Director and the Executive Committee that, in the preparation of the proposed programs and budgets of the Organization, they continue to bear in mind the advisability of carrying out local programs in the countries that need and desire such programs.' The CHAIRMAN stated that, in view of the decision just taken by the Council, and pursuant to the Rules, the proposed resolution of Ecuador would not be examined. The session was adjourned at 12:55 p.m. 'Resolution XI, p. 11. EIGHTH PLENARY SESSION Wednesday, 14 September 1955, at 3:00 p.m. Chairman: Dr. HÉCTOR A. COLL (Argentina) Later: Dr. BERNARDO HENAO MEJfA (Colombia) The CHAIRMAN called the session to order. The SECRETARY summarized the decisions of the General Committee, reporting that the dates of the Technical Discussions had been changed to 19 and 20 September. Topic 15: Emergency Revolving Fund (Document CD8/3) The SECRETARY read Document CD8/3, which transmitted the report on the use of the Emergency Revolving Fund, presented by the Director to the 25th Meeting of the Executive Committee, and set forth a proposed resolution taking note of the fact that the Fund had been restored to the authorized level of $50,000 through the reimbursement by a Member Government of the cost of emergency assistance rendered to it in Dr. HURTADO (Cuba) stated that, from a general point of view, he was in agreement with the proposed resolution but felt that mention of a specific country in the operative part was unnecessary. The resolution should merely take note of the fact that the Emergency Revolving Fund had been restored to the authorized level, without specifying which country had made the payment. Dr. QUESADA (Nicaragua) agreed with this proposal. The CHAIRMAN suggested that the Secretariat prepare a new text taking into account the comment made by the Representative of Cuba. It was so agreed. Topic 13: Proportionate Program Distribution of Budget Funds, (Document CD8/5) The SECRETARY read Document CD8/5 transmitting the report on this topic.

74 W.H.O. REGIONAL COMMNITIEE 69 Dr. HURTADO (Cuba) requested an explanation as to the scope of this document and its annexes, since the figures given therein referred to previous years or were approved at that morning's session during the discussion of the budget. Dr. GONZÁLEZ (Assistant Director, PASB) stated that, as those who had attended the XIV Pan American Sanitary Conference would recall, during the discussion on the Director's Annual Report and on the proposed programs and budgets, the delegation of Chile had requested that comparative data should be made available to enable the Directing Council and the Executive Committee to review the manner in which the PASB used its funds in previous years and how it estimates its expenditures for future years. The Delegate of Chile had felt that in this way future budgets could be studied in the light of past years' experience and that the trends in the expenditures could readily be observed. This point was the subject of a resolution at the 24th Meeting of the Executive Committee, which recommended that the Director prepare for the next meeting of that Committee a report on the proportionate distribution of funds administered by the Bureau in its various technical and administrative activities, in such manner as to show a comparison of the expenditures of the last four years with those budgeted for future programs. The report prepared in accordance with this resolution contained four tables showing the actual expenditures of previous years as compared with budgeted funds for future years. When this report, now appended to Document CD8/5, was presented at the 25th Meeting of the Executive Committee held in Mexico City, it elicited interesting comments. Dr. HURTADO (Cuba) thanked Dr. González for explaining fully the reason why the figures for 1955 and 1956 were included. It was therefore not a matter of reviewing budgets that had already been approved. The speaker felt, however, that it might perhaps have been advisable to study this topic before considering the proposed program and budget for In any case, it should be noted that the Bureau had ably complied with the request made by the Executive Committee, and it would now be appropriate for the Directing Council to adopt a resolution similar to that approved by the Executive Committee at its 25th Meeting, taking note of the report. Dr. ORELLANA (Venezuela) observed that Table II in the report, entitled "Summary of All Activities from Funds Administered by PASB/WHO for the Years 1952 through 1956, by Principal Groups," reflects the policy followed by the Bureau during the past years. It shows that for Group I (Executive Offices) the sum spent in 1952 represented 20.6% of the total expenditures, whereas the amount budgeted for 1956 represents 17.5% of the total allocations. Under Group II (Technical Services and Supply), the proportion of the total expenditures in 1952 was 25.8%, whereas for 1956 it is 26.6%. Under Group III (Programs), the proportion of expenditures in 1952 was 45.7 %, and for 1955 it is 54%. The table shows clearly that the greatest portion of the funds is devoted to programs. On the other hand, Table III, "Summary of Field Activities," shows the trend with respect to the different types of programs. Thus, it can be observed that during the last four years there has been a decrease in funds allocated to antituberculosis campaigns, to the extent that there is no allocation shown for As for "Social and Occupational Health," no figures are shown from 1953 on, a fact that confirmed the opinion he had expressed during the consideration of the Director's Report. For "Health Education of the Public" and "Mental Health" no figures are given for Dr. JIMÉNEZ GANDICA (Colombia) stated that, although Table III summarizes the field activities, he felt that a resolution should be adopted to request the PASB to prepare a document showing the exact percentage distribution of expenditures by country. Such data would be very useful in determining the success or failure of the campaigns carried out in each country. This new document could be presented at the next meeting of the Executive Committee. The CHAIRiMAN pointed out that the document under consideration is a working tool and, as stated by the Representative of Venezuela, is very useful in examining the policies followed by the PASB. Colombia had requested that another document be prepared to show a new comparative analysis by country. He called for comments on this proposal. Mr. OLIVERO (Guatemala) felt that the document complied with the request of the delegation of Chile. He therefore seconded the motion of the Representative of Cuba and proposed that to it be added both a vote of thanks, on the part of the Council, for the efficient manner in which the re-

75 70 P.A.S.O. DIRECTING COUNCIL quest had been carried out, and congratulations to the Pan American Sanitary Bureau. The request of the Representative of Colombia could then be studied as a new proposal. Decision: It was unanimously agreed to take note of the report on proportionate program distribution of budget funds and to congratulate the Director of the Pan American Sanitary Bureau on the presentation and contents of the report.' Motion of the Representative of Colombia (Proportionate Distribution of Funds for Field Activities, by Countries) Dr. JIMÉNEZ GANDICA (Colombia) stated that the proposed program and budget for 1957 lists the specific programs of the various countries. However, it would be very useful if a table similar to Table III, annexed to Document CD8/5, were prepared so as to show the percentages of funds allocated to programs for each country. He requested that such a document be prepared. Dr. ORELLANA (Venezuela) agreed, in part, with the request of the Representative of Colombia, since it would be advantageous to be able to compare the funds assigned to the various programs in each country. However, he felt that this information would inevitably be incomplete, as it would be impossible to determine to what extent the general expenditures and the expenditures for intercountry programs correspond to each country. Dr. GONZÁLEZ (Assistant Director, PASB) pointed out that the value of a document like the one presented lies mainly in its showing the work carried out in the Hemisphere as a whole, without geographical discriminations that might lead to difficulties not in harmony with the spirit of the Pan American Sanitary Organization. He thanked the Council for its comments on the manner in which the earlier request had been carried out and explained that obstacles of an administrative nature would indeed make it difficult to furnish the exact information requested by the Representative of Colombia. Furthermore, the representatives have the opportunity of obtaining all kinds of detailed information in the documents presented yearly in connection with the program and budget, since these documents show the totals corresponding to the geographical regions of the Continent. One of the difficulties that would be encountered in ' Resolution XIII, p. 11. preparing a document like the one requested would be to show to what extent each country benefits from the intercountry programs. What is most important, however, is to consider the Hemisphere as a unit in which attention is given to problems that deserve first consideration, according to existing circumstances. Dr. JIMÉNEZ GANDICA (Colombia) did not think that the document that he had requested would create difficulties. The spirit that motivates all the countries is such that none of them would come with complaints that a greater amount of funds had been granted to a neighboring nation. What is really important is to know in greater detail how the Bureau's activities are developed and what is allotted for the public health plans in each country, so that the exchange of technical and administrative information may be facilitated. The speaker did not minimize the difficulties that, from the financial viewpoint, might be entailed in the preparation of such a document, but he felt that such difficulties are not insurmountable. Hence, he reiterated his request. Dr. HURTADO (Cuba) said that it was a very delicate matter to decide whether a request for information made by the representative of a country should be complied with or denied. In principle, it might be said that all information requested should be furnished. However, it is necessary to analyze each case objectively and to take into account the possible implications. The Representative of Colombia had asked that a table be prepared to give a breakdown of the information on field activities presented in the document that had been prepared at the request of Chile, and that the percentages appearing therein be subdivided by country. The Representative of Venezuela had said that such a report could be only partially complete, because it would be impossible to show in detail the portion of the general expenditures and of the expenditures for intercountry programs that correspond to each country. The Assistant Director had mentioned the difficulties that might arise from an analysis based on geographical distribution. Dr. Hurtado felt that it would be better to use another expression, because what was being discussed was not a question of geography but of the political units that comprise the Organization. Once the matter is placed on the political plane, it must be kept in mind that statistics are not a mere pastime, but that their objective is to obtain benefits through

76 W.H.O. REGIONAL COMMITIEE 71 numerical analysis. He thought that making a table to show the expenditures in each country has no practical statistical basis whatever, since there are cases like that of the United States, which contributes 66% of the budget and yet receives practically no assistance. If the assistance that the United States receives were to be reduced to a percentage, it would be insignificant; nevertheless, this fact does not lead that country to cease to contribute to the PASB. The people of the United States know-because all decisions taken by the Government of the United States have the support of the public-that, because their country is prosperous and strong, it must accept such a situation. The opposite case would be that of a country that contributes little and benefits a great deal. A report like the one requested implies treading on dangerous ground, as was pointed out during this session. And it is not necessary to run such risks, because the principal data are already contained in the proposed program and budget document. He did not believe it advisable to prepare such a report, considering it to have no statistical value and feeling that it could disrupt the harmonious unity that has existed up to the present and should be preserved at all costs. Therefore, he announced that he would vote against the motion of the Representative of Colombia. Mr. OLIVERO (Guatemala) recognized that sound reasons lay behind all the statements made. The PASB, oldest of the international health institutions, has always worked in a spirit of cordiality and cooperation. He was certain that, if the motion of the Representative of Colombia were approved, no difficulties of a practical nature would arise. However, he acknowledged that the future must be kept in view and all possible contingencies foreseen. All that Guatemala asks is that collaboration be given it when needed. Dr. FERREIRA (Brazil) recalled that a similar matter had come up in the World Health Organization, where it was considered advantageous to present tables that, at a glance, would show amounts and establish comparisons. Undoubtedly, the Representative of Colombia would be satisfied if a table were prepared in such a way as to facilitate the work of anyone wishing to examine, in a general way, the PASB program and budget. Therefore, the minutes could record the suggestion that the Secretariat, insofar as possible, prepare a supplementary document designed to facilitate such an analysis. Only today the Representative of El Salvador had called attention to the difficulties encountered in making a rapid study of the budget, and such difficulties would probably disappear if a table were prepared so as to show the situation graphically and concisely. The CHAIRMAN asked the Representative of Colombia if he agreed with the proposal of Brazil. Dr. JIMÉNEZ GANDICA (Colombia) said that he appreciated the correct interpretation that the Representative of Brazil had given to the request of the Colombian delegation. He added that his delegation had not acted in a spirit of selfishness or with a desire to control what is assigned to a country for its programs. The example of a powerful -nation and of a weak nation had been given, and there was no doubt that if all countries enjoyed the cultural, health, and economic standards of the United States, such issues as had been discussed at this meeting would not have been brought up. But one of the specific functions of the Organization is, undoubtedly, to provide the assistance that the strong can and should render to the weak. Besides, if a document like the one requested were prepared, the detailed presentation of the percentages corresponding to the programs of each country would show to what extent the programs are meeting with success. He reiterated his appreciation to the Representative of Brazil and accepted his suggestion. The CHAIRMAN announced that the minutes would record the suggestion that the Secretariat, insofar as possible, prepare a supplementary document to facilitate analysis of the budget. The session was recessed at 4:15 p.m. and resumed at 4:45 p.m. The Vice-Chairman, Dr. Henao Mejía, Representative of Colombia, then took the Chair Topic 15: Emergency Revolving Fund (conclusion) The SECRETARY read the new text of the proposed resolution reflecting the change that had been suggested by the Representative of Cuba during the discussion on this topic. The CHAIRMAN put the proposed resolution to a vote. Decision: It was unanimously agreed to take note of the fact that the Emergency Revolving Fund

72 P.A.S.O. DIRECTING COUNCIL had been restored to the authorized level of $50,000 through the reimbursement of the cost of the emergency assistance rendered to the Member Governments.

77 72 P.A.S.O. DIRECTING COUNCIL had been restored to the authorized level of $50,000 through the reimbursement of the cost of the emergency assistance rendered to the Member Governments.' Topic 14: Utilization of Available Funds (Document CD8/4) (Building Reserve Fund; Installations at Headquarters; Antimalaria Campaign) The SECRETARY read Document CD8/4 transmitting the report of the Director on this topic and setting forth a proposed resolution concerning the use of surplus funds for the establishment of a Building Reserve Fund, the installation of a new elevator at PASB Headquarters, and an increase in the allocation for the antimalaria campaign. He explained the annexes to the document, which included a report of the Permanent Subcommittee on Buildings and Installations and two documents submitted by the Director as additional information relating to the proposed increase in antimalaria funds. 2 Dr. ALCERRO-CASTRO (Honduras) recalled that at the morning session his delegation had abstained from voting on the proposed program and budget for 1956, feeling that, as the Representative of El Salvador had requested, it was advisable first to examine Topic 13 (Proportionate Program Distribution of Budget Funds) and Topic 14 (Utilization of Available Funds), a study that might have brought about modifications in the budget. For example, the speaker felt that the increase in the allotment for the antimalaria campaign in the amount of $54,593.75, which is suggested in the proposed resolution, could change the total appropriation for that campaign in 1956, although it is not specified that the aforesaid amount is to be spent this coming year. In order to clarify this and similar questions, it would have been advisable for the two aforesaid topics to have been examined before the budget was approved, and that is why the delegation of Honduras abstained from voting on the budget. Dr. BRADY (United States), speaking as Chairman of the Permanent Subcommittee on Buildings and Installations, explained the background that had caused the Subcommittee to approve the recommendation of the Director to the effect that $100,000 1Resolution XII, p. 11, also General Committee, p "Hemisphere-wide Malaria Eradication" (Statement by Dr. Fred L. Soper) and "Notes on Malaria Control in the Americas (1954), with Estimates on Cost of Eradication" (Document CE25/12, Annexes IV and V). of the available funds be utilized for the establishment of a Building Reserve Fund and $19,000 for the installation of a new elevator in one of the Headquarters buildings. He recalled that some years ago, at a meeting of the Council, a resolution was adopted to the effect that the present buildings should serve as Headquarters for ten years; therefore, within four or five years the question will arise of finding a new permanent Headquarters for the Bureau. The two present buildings have been entirely paid for and, in addition, such improvements have been made as the installation of airconditioning equipment, a new heating system, installation of a new elevator, and changes in partitions-these improvements having helped increase the value of the premises, which may now be estimated as being worth perhaps $500,000. Despite all these improvements, the Headquarters is not without its inconveniences, among them the fact that the offices are divided between two buildings, the lack of a large room for holding meetings of the governing bodies, and a lack of office space. Therefore, thought should be given to the construction, within four or five years, of a building that is designed for the PASB's purposes and is centrally located. By then it may be possible that certain properties will be available in an area of Washington where governmental buildings also are to be constructed. For that reason and in view of the exceptional surplus funds in 1954, which cannot be expected in future years, it was recommended that a Building Reserve Fund be established, in an initial amount of $100,000. It is estimated that the cost of the new building will be approximately one million dollars. The second recommendation approved by the Subcommittee refers to the installation of a new elevator in the building at 1515 New Hampshire Avenue, since the present one is antiquated. He recalled that when these recommendations were presented to the Executive Committee, an amendment was introduced to the effect that the Director be authorized to utilize as much of the Building Reserve Fund as may be required in the event that additional funds should be necessary for the intensification of the malaria eradication program. In conclusion, Dr. Brady recommended that the Council approve the allotment of the two items of $100,000 and $19,000, respectively. Dr. CONCHA VENEGAS (Colombia) said that in the report entitled "Notes on Malaria Control in the Americas (1954)," Annex V to the document under discussion, Colombia is listed among the

W.H.O. REGIONAL COMMITTEE 73 countries in which malaria control is incomplete. Obviously control is incomplete because it does not cover the entire country.

78 W.H.O. REGIONAL COMMITTEE 73 countries in which malaria control is incomplete. Obviously control is incomplete because it does not cover the entire country. In referring to the campaign in Colombia, the document states that "although $1,217,000 was spent during 1954 to spray, either once or twice, 390,000 of the 1,400,000 houses in the malaria zone, the program was spotty and inadequate." These data are erroneous, inasmuch as the number of houses is approximately 1,152,000. But, as Director of the Division of Malariology for the last five years, what he could not accept was the statement that the program was spotty and inadequate. Such a statement constitutes an offense to the prestige of the said Division, a prestige based on its efficient work in the control program that was carried out with the advisory services of a member of the PASB staff. The speaker pointed out that in 1954 more than three million Colombian pesos were spent and the program was carried out under the same conditions as in 1952, with the advisory services of Dr. da Silva, Representative of the Zone IV Office of the PASB, and utilizing the same insecticide, to which was added a certain amount of dieldrin. It should not be stated that the program was spotty, because in the Caribbean zone only one spraying was applied and this procedure was a subject of intense discussion when the Colombian program was planned. At that time Dr. da Silva insisted on the use of a single spraying in the Caribbean zone, because malaria had been controlled in Brazil by this system, which had proved to be sufficient. Therefore, if there have been defects, they were caused by the PASB adviser himself, for the Colombian health authorities had insisted that two sprayings be applied. As to the word "inadequate," he pointed out by way of example that Dr. Gabaldón, of Venezuela, had told him that the proper techniques had been used in conducting the antimalaria campaign in Colombia in 1954, although the campaign suffered from several defects that were also apparent in certain areas of Venezuela, owing to the presence of some vectors whose ecology was difficult to study and whose control, therefore, was more complex. The speaker also quoted Dr. Carlos Calero, Chief of the Division of Malariology of Mexico, who had stated that the campaign in Colombia was well organized and that the control results were good, except in the areas bordering the Caribbean, where there was an uncontrolled malaria incidence of long standing. He added also that Dr. David Clyde, head of the malaria investigation services of the British East African colonies, who had spent three weeks in Colombia visiting the services and laboratories in the control areas, had reported finding no fault whatever in the planning and development of the campaign. The speaker went on to say that physicians trained at the School of Malariology at Maracay (Venezuela) participate in the program in Colombia and have put to use the new techniques learned at the school, whose prestige is well known to all. After explaining the methods employed in spraying the houses, Dr. Concha Venegas said that he thought it surprising that, in the report under discussion, Colombia should be described as being the only country in which the antimalaria campaign in 1954 was spotty and inadequate, a fact that he attributed either to impulsiveness or to incomplete information, since no such statement is made in the case of the other countries. He pointed out, finally, that the incidence of malaria in his country had decreased considerably, as witnessed by the following statistical data for approximately 70,000 examinations made: in 1952 the incidence of the disease in the Caribbean area was 3.4 %; in 1953 it was 0.3%; and in 1954 it dropped to 0.28%. Therefore, it cannot be said that the program was spotty and inadequate. Dr. ALLWOOD PAREDES (El Salvador) asked whether the Director had already made plans as to the way in which the funds for the antimalaria campaign, provided for in the proposed resolution, would be utilized. Dr. SOPER (Director, PASB) said that at the morning session he had pointed out that the malaria eradication campaign requires that the PASB collaborate in the programs of the various countries, adding that he had even referred to the possibility of having to expend considerable amounts in dealing with the problems that arise. In such a campaign, it is not possible to know when some countries will be able to cope with the problem of eradicating the disease. Therefore, the Bureau must be in a position to meet any eventuality, whenever and however necessary. When this subject was discussed at the UNICEF Executive Board meeting last March, the PASB agreed not to ask that organization to pay the salaries of the technical personnel of programs for which UNICEF provides equipment and supplies. What is now suggested is the establishment of a fund that may be utilized in the malaria program to deal with any contingencies that might arise. The Representative of Honduras had called atten-

74 P.A.S.O. DIRECTING COUNCIL tion to the fact that the resolution under study does not stipulate that the amount should be spent in 1956.

79 74 P.A.S.O. DIRECTING COUNCIL tion to the fact that the resolution under study does not stipulate that the amount should be spent in It should be borne in mind that the PASB does not use its surplus funds to undertake commitments that may result in an increase in its future obligations. An effort has been made to set aside and to utilize the funds, but in such a way as not to create a future commitment to be charged against the regular budget. Moreover, thought should be given to the need for the Bureau to have a certain freedom of action. A precedent has already been established by other eradication programs. In the case of yellow fever, for example, both the Rockefeller Foundation and the Government of Brazil decided to establish the services without their being subject to the limitation of any budget document, since it was considered necessary to deal with events as they occurred and in the most suitable manner. This flexibility has been maintained for several years. Another similar case was that of the Anopheles gambiae in Egypt, in 1944, when the Government of that country decided to proceed with the eradication work, spending all the money required to obtain its goal. While it is not expected that the Bureau will be granted similar authority with respect to the utilization of funds for the antimalaria program, the Bureau does need to have certain facilities available in order to adapt its action according to circumstances. It is not possible to anticipate at this time the budget requirements that will arise in 1958 or Therefore, the surplus funds have a special value, as they constitute a margin with which programs may be developed without establishing beforehand how and when the money will be spent. As to the statement by Dr. Concha Venegas, it should be kept in mind that the description appearing in the document he referred to is a summary based on information gathered by Dr. Alvarado during a trip he made last year. Dr. Soper regretted that the words used in the document could be interpreted as criticism, since that was not their intention; the purpose, rather, was to present a general picture of the existing situation. In order to reach definitive conclusions a more extensive investigation would be required. Finally, he asked that the discussion on malaria problems be postponed until the Council had examined the reports on the malaria eradication programs. consider the question raised by the Representative of Colombia would be when the Council examines Topic 23 (Reports on the Malaria Eradication Programs in the Americas). Dr. COLL (Argentina) pointed out that the first operative paragraph of the proposed resolution recommends the establishment of a Building Reserve Fund in an initial amount of $100,000, and the second paragraph authorizes the Director to utilize as much of the Fund as may be required for the intensification of the malaria eradication program. He asked what administrative procedure would be followed to restore the fund to its initial amount in the event that sums should be utilized for the malaria campaign, since the proposed resolution makes no provision on this point. Dr. SOPER (Director, PASB) explained that the idea that the Building Reserve Fund should be used, if necessary, for antimalaria activities, did not originate with the Bureau. Rather, it came from a Member of the Executive Committee, Haiti, which has a serious malaria problem and is making great efforts to eradicate this disease, a problem of primary importance for the entire Hemisphere. The proposed resolution does not specify how the sums utilized in the antimalaria campaign are to be restored, because in order to do so it would probably be necessary to establish new budget commitments. Dr. COLL (Argentina) said that his delegation agreed that importance and priority should be given to the malaria program, among the activities of the PASB. His previous statement did not indicate a change in attitude; rather, he questioned the wording of the resolution, which he felt was not correct from an administrative point of view, since first a fund was established for buildings and later the possibility of limiting it, in case of emergency, was provided for, with no stipulation as to how the fund would be restored to its original level. As the Director had stated, restoring such funds could result in new budget commitments-for example, an increase in country quota contributions. Therefore, Dr. Coll felt that, unless the administrative procedure for making such restoration were specifically stated, perhaps it would be advisable to eliminate the second operative clause. The CHAIRMAN put to a vote the proposed resolution appearing in Document CD8/4. The CHAIRMAN said that the appropriate time to Decisi'on: lt was unanimously agreed: (1) to

80 W.H.0. REGIONAL COMMITTEE 75 approve the recommendations made by the Director and adopted by the Executive Committee at its 25th Meeting, concerning the establishment of a Building Reserve Fund in an initial amount of $100,000; the installation of a new elevator in one of the Headquarters buildings at a cost of $19,000; and an increase in the allocation for the antimalaria campaign in the amount of $54,593.75, plus any saving that may be realized from the installation of the elevator; and (2) to authorize the Director to utilize as much of the Building Reserve Fund referred to in the foregoing paragraph as may be required in the event that additional funds should be necessary for the intensification of the malaria eradication program.' The session was adjourned at 5:50 p.m. ' Resolution XIV, p. 12. NINTH PLENARY SESSION Thursday, 15 September 1955, at 9:45 a.m. Chairman: DR. HÉCTOR A. COLL (Argentina) Later: Dr. JUAN ALLWOOD PAREDES (El Salvador) The CHAIRMAN called the meeting to order. The SECRETARY reported on the documents distributed. Second Report of the Committee on Credentials The CHAIRMAN announced that the Committee on Credentials had submitted its second report, as follows: The Committee on Credentials met on 14 September and has the honor to inform the Directing Council that it has examined the credentials of the Representatives of Chile, Haiti, and Peru, which were found to be in good and due form and hence were accepted. Decision: The second report of the Committee on Credentials was unanimously approved. At the invitation of the Chairman, Dr. Allwood Paredes (El Salvador), Vice-Chairman, took the Chair Topic 10: Proposed Program and Budget of the PASO and Proposed Program and Budget of the WHO for the Region of the Americas for 1957 (Document CD8/19 and Official Document No. 12) The SECRETARY explained that this budget document had been published separately as No. 12 in the Official Documents series. In addition, Document CD8/19 set forth the proposed resolution of the 26th Meeting of the Executive Committee to the effect that the Council approve the transmittal of the 1957 WHO Regional budget to the Director- General of the WHO and take note of the preliminary draft of the 1957 PASO budget. The CHAIRMAN opened the discussion on Official Document No. 12, saying that the General Committee deemed it advisable for the Directing Council to study at the same session both the proposed program and budget for the Region of the Americas and the general program of work in the Region of the Americas during the period (Document CD8/12). The latter document, prepared for Topic 16 of the agenda, contained information that would be useful in putting the proposed budget for 1957 into proper perspective. He therefore suggested that Topic 16 be discussed first and that Topic 10, which pertains to the budget for 1957, be taken up later. Topic 16: General Program of Work in the Region of the Americas during the Period (Document CD8/12)' The CHAIRMAN, noting that the document for Topic 16 makes reference to the general program of work during the four years 1957 through 1960, thought that the discussion could best be guided by having an administrative officer of the Bureau give a detailed explanation of the long-range programs and their relation to the proposed budget for Dr. GONZÁLEZ (Assistant Director, PASB) said that Document CD8/12 had been prepared so that 'See Annex 1, p. 125.

81 76 P.A.S.O. DIRECTING COUNCIL it might be used as a basis for the discussions of the Directing Council of the PASO, Regional Committee of the WHO for the Americas, on the general program of work in the Region of the Americas, in accordance with a resolution approved by the Eighth World Health Assembly. In short, it is a document prepared by the Secretariat for the sole purpose of facilitating the discussion of this topic by the Directing Council. He stressed the fact that it is incumbent upon the governing bodies to lay down the general policy for long-range programs of work. Regarding the proposed budget for 1957, he said that the programs are based on the standards established for the Pan American Sanitary Organization, Regional Office of WHO, in Resolution III approved by the VII Meeting of the Directing Council in This resolution, in turn, is in line with the general principles enunciated by the World Health Assembly in its First General Program of Work. The proposed program and budget for 1957 also conforms to the principles contained in the Second General Program of Work of the World Health Assembly. Dr. ORELLANA (Venezuela) agreed in principle with the suggestion that both documents be studied together. Document CD8/12 explains how the directives now governing the Bureau's programs had come to be established. In his opinion, the points set forth therein are well taken and will be useful in directing the activities of the Bureau in the next four years. He then examined the points one by one, emphasizing the obvious value of the first of these, relating to the analysis of the needs and resources of the various countries on the basis of information furnished by the governments. The point relative to the strengthening of fundamental health services is probably the most important of all, he said, since no backward national public health service can effectively cooperate in the continental public health programs, and, considered as a whole, no international public health system can be stronger than the weakest of the national health services. The PASB has in this respect a vast field of action and should pay more attention to the manner in which national plans of great scope are made. As for the two other points, which refer to education and training and the eradication of communicable diseases, the speaker felt that they had already been studied in detail. The Representative of Venezuela found the manner of presentation and the content of the document to be excellent but noted that the order in which the topics are dealt with, although highly acceptable, establishes no order of priority among them. He reiterated his appreciation of the document, which he considered useful as a guide and a statement of principles. If the programs are based thereon, valuable work can be accomplished. Dr. HURTADO (Cuba) agreed with Dr. Orellana. He said that the document contains an over-all review of the problem, together with reference material of great value for the preparation of future programs. As regards the three concepts on which the Bureau's future activities will be basederadication, integration, and education-he felt that no priority should be set on one over the other. The document will assuredly be a source of inspiration in the preparation of national programs. But if the trend toward changing control services into eradication services is approved, the countries will need the Bureau's technical collaboration. That is exactly where the trouble begins: the worry and uncertainty of national agencies as regards budgets and appropriations, since assurance that programs will be carried out depends on whether they are to be paid for out of PASB or WHO funds, or come under the budget headings of U. N. Technical Assistance or other extrabudgetary funds. In this connection, Dr. Hurtado cited his country's programs, the funds for which come from the last-named sources. He went on to say that, as long as there continues to be uncertainty regarding funds that are beyond the control of our Organization and the PASB and WHO funds cannot be increased, the American countries will remain in a weak position as regards the execution of programs. This critical situation is noticeable mainly in the eradication programs that come under the heading of Technical Assistance. Dr. COLL (Argentina) thought that Document CD8/12 reflected the wide experience acquired by the Bureau in its years of international public health work. He felt that the Directing Council should adopt one or more resolutions that would contain the conclusions set forth in that document. He therefore requested that those conclusions be read. The CHAIRMAN explained his reasons for wishing to have the two documents discussed at the same time. He pointed out the various circumstances that make the preparation of long-range programs difficult. The Bureau could have confined itself to submitting a document containing only the WHO budget, but instead it had included, for information purposes, the budget items met from Technical Assistance and other extrabudgetary funds. He

82 W.H.O. REGIONAL COMMITTEE 77 mentioned how difficult it was for the Bureau to prepare a preliminary draft of the proposed budget for 1957 for submittal to the Executive Committee in April, prior to the Directing Council meeting. The decision of the Technical Assistance Board that henceforth Technical Assistance funds will be allocated to the countries through direct negotiations with the governments concerned made the preparation of the preliminary draft even more difficult. Therefore, the figures in the column headed U. N. Technical Assistance represent only an estimate, or a hope that may not materialize. Supporting the request of the Representative of Argentina, he asked that the conclusions contained in Document CD8/12 be read by the Secretary. The SECRETARY read the conclusions appearing in Section D of the document.' Dr. COLL (Argentina) said that, in the opinion of his delegation, these conclusions constitute an entire program of work that the Directing Council should implement by approving an appropriate resolution. He emphasized the main idea underlying these conclusions, namely, that it is the countries themselves, basically, that determine and make possible the work of the international health organizations. With respect to conclusion (a), he felt that the Directing Council should suggest to the Bureau that it draft questionnaires that will enable the Member Governments to make an inventory of public health conditions and resources in their own countries for presentation at the XV Pan American Sanitary Conference. This inventory might be prepared in stages with a view reaching useful conclusions. Conclusion (b) in itself merits a Directing Council resolution, he thought, and the preparation of national health plans should be the topic of one of the technical discussions. Referring to conclusion (c), he said that everyone in the public health field knows the importance of establishing a public health staff of full-time, well-paid employees, and he thought that the Directing Council might ask the Director to request the presentation of annual reports on full-time, national health service personnel, their academic training, and their salaries. With regard to conclusion (d), the Representative of Argentina said that, at a meeting of the General Committee, the Director of the Bureau had made a comment on the malaria eradication problem that was generally applicable to all eradication programs. Dr. Coll suggested that this point be placed permanently on the agenda for Directing Council meetings. 'See p With reference to conclusion (e), he pointed out that border meetings are very useful to the participating governments; the Directing Council should urge the Bureau to encourage the holding of such meetings. Conclusion (f) calls for no special measures, as it is a statement of the present policy of the Organization. The proposals he had just listed might be made into one or several Directing Council resolutions. Dr. Coll closed by saying that the document was, in his opinion, a very good synthesis of international public health work and he urged the Council to convert the principles it described into reality. Dr. JIMÉNEZ GANDICA (Colombia) felt that Document CD8/12 could be considered a sort of public health "bible." The ideas expressed in it are extremely interesting. He took the opportunity to return to a point that had already been discussed, the one mentioned in Section D, third paragraph and conclusion (b). He said that a country in which the health level is below that of its neighbors represents an obstacle to the progress of international health work. He recalled that his delegation had urged the holding of national public health conferences for the better guidance and information of national officers with respect to the health problems of their countries, even in the most outlying districts. Bureau experts should be called on to help with such conferences, which should be attended by public health officials of other countries, neighboring or not, having the same health problems. He was happy to see that these ideas had been set forth in the conclusions of this document and he shared the opinion of the preceding speakers who had praised it. The session was recessed at 11:00 a.m. and resumed at 11:S0 a.m. Mr. OLIVERO (Guatemala) expressed his appreciation to the Secretariat for having prepared Document CD8/12, to the Chairman for having aroused the interest of the representatives in it, and to the representatives for having commented so aptly on it. Agreeing with the Representative of Colombia, he thought that the point relative to stability of employment for professional health personnel in the various countries should be underscored in the conclusions. Dr. ORELLANA (Venezuela) noted that conclusion (a), unlike the other conclusions, contains a time limit, since it calls for the completion of the inventory of national health conditions and rescurces for presentation at the XV Pan American Sanitary Conference. Such an inventory, however, could

83 78 P.A.B.O. DIRECTING COUNCIL never be complete, since requirements and resources are continually changing and such information should be furnished not only to the XV Conference but to later Conferences as well. He suggested that the first sentence of conclusion (a) read: "That an inventory of national health conditions and resources be maintained for presentation at each Conference." Dr. FERREIRA (Brazil) said that if there were any matter on which the unanimity of opinion was obvious it was the one under discussion. He added that the delegation of Brazil was pleased with the very intelligent presentation of this document and with the Chairman's success in stimulating interest in the matter. He thought that in public health work it is occasionally necessary to stop along the road and look both backward and forward in order to see the situation clearly. The document in question is indeed a sort of public health "bible," a body of doctrine, the fruit of great maturity of thought and ripe activity, which could not have been produced fifteen years ago. The study of this interesting document was one of the main tasks of the meeting. The Representative of Brazil stressed the importance of the conclusions. With reference to (a), he said that, just as in changing from control campaigns to eradication programs, it is more important to know what remains to be done than what has already been done; when the inventory of national health conditions and resources is taken, the representatives should be requested to give information based on actual facts about the current situation in their countries, and, instead of presenting a summary of achievements, they should indicate in blank on their graphs and maps those areas not covered by public health work. The Representative of Brazil said that in due course he would submit a draft resolution on this point, but he emphasized the importance for the health of the American nations, where such work is sometimes hampered by political, financial, or administrative factors, of presenting a review of tasks ahead instead of past achievements. He compared the budget total for the Regional Office of the Americas with the total of all national health budgets and recalled that his country is spending for the malaria control campaign alone an amount equivalent to $4,000,000, a figure equal to the total budget of the PASB. He added that if the inventories showed what should be done in the field of public health but could not be accomplished, these statistics on our deficits would be highly significant. He spoke of the importance of giving public health officials general orientation in their work. He referred to the various opinions voiced as to whether priority should be given to national or to regional programs, saying that what is essential, once this issue has been debated, is to find the way to continue working together. In closing, he said that the document presented by the Secretariat not only is valuable as a background document but could have, as a study, practical value if it were approved in a resolution of the Directing Council. Topic 10: Proposed Program and Budget of the PASO and Proposed Program and Budget of the WHO for the Region of the Americas for 1957 (conclusion) The CHAIRMAN thought that the discussion of the general program of work for the Region of the Americas during the period had been extremely useful. The Council should now proceed to adopt the proposed resolution on the Regional Office budget for He said that if there were no objection he would put the proposed resolution appearing in Document CD8/19 to a vote; he added that the budget for 1957 is a preliminary draft that had to be examined by the WHO Director-General, the Executive Board of the WHO, and, finally, the World Health Assembly. The Directing Council will merely take note of the document and approve its transmittal to the Director-General. Dr. COLL (Argentina) moved that the proposed resolution be approved. Decision: The resolution on the Proposed Program and Budget of the Pan American Sanitary Organization and Proposed Program and Budget of the World Health Organization for the Region of the Americas for 1957, was unanimously approved.' Topic 25: Regional Programs to be Financed with Funds of the United Nations Expanded Program of Technical Assistance (Document CD8/18) The CHAIRMAN announced that Topic 16, General Program of Work in the Region of the Americas during the Period , would next be discussed. Dr. HURTADO (Cuba) pointed out that this topic was closely related to Topic 25, since it concerned the financing of the regional programs with Technical Resolution XV, p. 15, also General Committee, p. 121.

84 W.H.O. REGIONAL COMMITTEE 79 Assistance funds. He asked whether the two could not be considered together. The CHAIRMAN agreed that the topics were related and recalled the decision of the Technical Assistance Board that aid to the programs would in the future be granted through direct negotiations with the respective governments. The resolution proposed in Document CD8/18, to the effect that the Directing Council endorse the regional projects shown in the 1957 proposed budget and authorize the Director o submit these projects for financing under the U.N. Technical Assistance Program in 1956 and/or 1957, would enable the Director to submit requests for programs that are of interest to several countries. Dr. GONZÁLEZ (Assistant Director, PASB) said that the Chairman had explained the problem very clearly. The proposed resolution under consideration would give the Director of the PASB the support of the Directing Council in requesting the allocation of Technical Assistance funds for regional programs, which are known as interzone or intercountry programs in the terminology of WHO and PASB. This type of program is of great interest to the Organization. He recalled the decision of the Technical Assistance Board providing that 15% of the total funds allocated to the agencies participating in the Expanded Program may be counted upon for intercountry programs. Dr. HURTADO (Cuba) explained the complexity of administering Technical Assistance and suggested that it would be desirable for the Director to transmit to the World Health Organization the comments made in the Council with respect to the regional programs financed with Technical Assistance funds. The Representative of Cuba felt that the procedure established by the Technical Assistance Board, of negotiating programs directly with the countries and by-passing the international organizations, was not a very good one. Motion with respect to Article 25 of the Rules of Procedure Dr. ALCERRO-CASTRO (Honduras) asked to what extent the order of business should be adhered to. He recalled that on the previous day consideration of a subject in which the Representative of El Salvador was interested had been postponed because it did not appear on the order of business as approved by the General Committee. Nor was that subject on the order of business today. Although he had no objection to the proposed resolution, Dr. Alcerro- Castro wanted to know whether Article 25 of the Rules of Procedure of the Directing Council, which he proceeded to read, was going to apply or whether the debate that had already started should proceed. The CHAIRMAN thanked the Representative of Honduras for his observation and felt that it should be considered as a point of order. He said that Topic 25 could be examined separately if the representatives should decide to study it at another session. He asked their opinion on the matter. Dr. HURTADO (Cuba) remarked that the point of order should have been raised when consideration of Topic 25 was proposed, not when the debate on the subject was already fairly well advanced. He believed that the Council is sovereign in such matters and that the time spent on the present subject should not be wasted. The CHAIRMAN expressed his regret for having overlooked the matter pertaining to the order of business and put to a vote the question of whether consideration of Topic 25 should be postponed or continued. Decision: By 16 votes in favor, with no dissenting votes or abstentions, it was decided to continue consideration of Topic 25. The CHAIRMAN, after explaining that a point of order might be raised at any time during the discussion, requested the officers of the Bureau to enumerate the intercountry programs that will be financed with Technical Assistance funds. He pointed out that in the 1957 budget there are Technical Assistance allocations totaling $7,865 in Part I, Pan American Sanitary Organization; $67,694 in Part II, Pan American Sanitary Bureau, Headquarters; and $1,050,184 in Part III, Pan American Sanitary Bureau, Field Programs and Others, all in the 1956 column. He also stated that detailed figures for the programs that are to be carried out with Technical Assistance funds are given under the heading "Summary of Programs by Major Expense," but the figures are either theoretical or represent only probable receipts. Dr. COLL (Argentina) wanted to know whether the 15 % limit set by the Technical Assistance Board had been borne in mind when the budget was prepared. Dr. GONZÁLEZ (Assistant Director, PASB) stated that three programs have not yet been submitted to the Technical Assistance Board, namely: AMRO-50 (Fluoridation of Water); AMRO-64 (Seminar on

85 80 P.A.S.O. DIRECTING COUNCIL Sanitary Engineering); and AMRO-97 (Seminar on Training of Sanitary Inspectors). Other intercountry programs that have been started and for whose continuation funds are expected to be available include the malaria eradication programs in Central America and Panama and in the Caribbean area; the yaws eradication programs in certain areas of the Caribbean; and the Inter-American Center of Biostatistics. He said that the "planning" figure on which these programs are based is about $247,000. The figure is more than the 15 % mentioned, but, as he understood it, this 15% applies to the total amount of the funds allocated to the World Health Organization and all its Regional Offices, and it might happen that one Region would have fewer intercountry programs, thus compensating for the difference. The CHAIRMAN explained that the maximum figure of $247,000 mentioned by the Assistant Director does not include the Technical Assistance allocations in Parts I, II, and III of the budget, and the total figure would therefore be $320,000. Dr. HURTADO (Cuba) suggested that the proposed resolution be approved as it stands in Document CD8/18. The CHAIRMAN submitted the proposed resolution to the Council for approval. Decision: The draft resolution in Document CD8/18, on the regional programs to be financed with funds of the United Nations Expanded Program of Technical Assistance, was unanimously approved.' The CHAIRMAN announced that Topic 16, on the general program of work, would be taken up again at a session to be determined by the General Committee. The session was adjourned at 12:35 p.m. 'Resolution XVI, p. 13, also General Committee, p TENTH PLENARY SESSION Thursday, 16 September 1955, at 3:30 p.m. Chairman: DR. HÉCTOR A. COLL (Argentina) The CHAIRMAN called the meeting to order and announced that the Secretary would report on the order of business. The SECRETARY reported on the order of business approved by the General Committee. He added that some of the reports presented by the Member Countries on malaria eradication in the Americas had already been distributed. These reports were from Brazil, Ecuador, El Salvador, Honduras, Mexico, Panama, and the United States. The others would be distributed as they were delivered to the Secretariat by the representatives. Topic 23: Presentation of Reports on the Malaria Eradication Programs in the Americas Statement of the Representative of the Netherlands Dr. SWELLENGREBEL (Netherlands) said that the eradication of malaria means, primarily, the extinction of the disease in rural areas. Such an objective is at times extremely difficult to achieve and the work was always very expensive as long as it required the adoption of antilarval measures. But it became generally practicable when antimalaria activities were directed against adult mosquitoes. As early as 1910, the famous Brazilian scientist, Dr. Carlos Chagas, established the principle that the place where man acquires malaria infection is in his own home. At present, it is known that this rule is not without exception. Suffice it to recall the case of Trinidad and many others. Nevertheless, Dr. Chagas' rule holds good in numerous instances. It was a long time, however, before his rule was taken as a basis for the antimalaria activities and for directing the work against adult mosquitoes rather than the larvae, so as to take the campaign into all the dwellings. Something to that effect could also be said of the Gorgas fumigation campaign against the Aédes aegypti carried out in Havana. Positive results have been achieved in the control of malaria merely by applying the principles set forth by Dr. Chagas. This has been done, first, by exterminating only adult Anopheles; secondly, by

86 W.H.O. REGIONAL COMMITTEE 81 exterminating them only in dwellings; and, finally, by destroying them only in those dwellings that were found infected or were suspected of being infected, that is, in houses inhabited by persons who had been suffering from malaria or had experienced it in the two preceding years. In the Netherlands this principle has been applied since Later on, the introduction of residual-action insecticides was an important advance and has yielded valuable results in recent years. He added that those who advocate eradication of malaria are correct, since eradication has been proved to be possible. Seventeen years ago, before the discovery of DDT, the disease was successfully controlled in a village in the north of Holland. Since that time, in the period 1943 to 1949, a wave of malaria struck the province but that village was not touched. Now that residualaction insecticides are available, it is evident that highly successful results can be obtained in the campaign against this disease. Report of the Representative of Venezuela Dr. ORELLANA (Venezuela), presenting his country's report (Document CD8/26), said that an antimalaria campaign on a national scale, using residualaction insecticides, was begun in Venezuela in the latter part of 1945 and that from the beginning the insecticides were used to cover the most extensive area possible in order to eradicate the disease. An area of 20,000 square kilometers ended its first year with a zero index in 1950 and another area of 180,000 square kilometers completed its third year with a zero index in From the viewpoint of the progress of the malaria eradication program, Venezuela may be divided into five areas. In the first of them, an area of 180,000 square kilometers, the work of eradication has been completed; in Area II, representing less than 0.1 % of the country's malaria zone, the vector is the Anopheles aquasalis and transmission occurs for the greater part outside dwellings, which is the reason why malaria was not appreciably reduced with the application of DDT. Area III represents 56.6 % of the country's malaria zone, but there are extensive sectors in which the disease has been eradicated. Areas IV and V represent, respectively, 3.3% and 5.6% of the malaria zone, eradication having already been achieved in many municipalities. The radical reduction in the disease has changed the economic program of the country entirely, and a great increase in agricultural production is taking place. Since 1943, Venezuela has contributed to the antimalaria campaign on an international scale, through the training of a large number of professional personnel from many countries in its School of Malariology. At present, only 20% of the Venezuelan population live in infected municipalities, but the disease is already much reduced and only a final effort is needed to eliminate it from the entire national territory. Report of the Representative of the United States Dr. BRADY (United States) presented his country's report (Document CD8/31) and said that he was summarizing the experience of the United States during recent years. He recalled that, some years ago, throughout the whole south of the United States, malaria was an endemic disease. In fact, it was endemic even in some of the northern states. Over one hundred years ago an historian said that the settlers in the State of Illinois wondered whether or not they should settle in that state because of the viciousness of the malaria problem. Indeed, it was only in the 1930's that real progress came about in the eradication of malaria. In that decade the campaigns were definitely directed at malaria control, using methods of that day. The work later progressed into another era, that of malaria eradication, which brings the situation up to the present report. As shown in the report, in 1947 there were 16,000 malaria cases in the country, with 200 deaths. The principal eradication activities began in 1948, and in 1950 there were only about 2,000 cases. During the period June 1950 to December 1952 thousands of servicemen returned to the United States from the combat zone in Korea, and more than 23,000 of them subsequently experienced malaria attacks, because of relapses in vivaz malaria and the lack of an effective, safe curative drug for this type of malaria. In 1951 there were 5,600 civilian cases reported to the National Office of Vital Statistics. With the advent of primaquine as a curative agent against vivax, effective action was initiated and, of the 3,000 cases appraised in 1952, only 34 were thought to be primary indigenous cases. And it is interesting to note that of these 34 cases, 28 probably were transmitted from Korean veterans and 6 from nationals of another country. Furthermore, of the 28 cases that had been transmitted from Korean veterans, 24 occurred from a single veteran, who had a summer cottage adjacent to a Girl Scout Camp. In 1954 there were only 8 autochthonous cases and 82 imported cases. The disease was therefore reduced to such insignificant proportions that to all intents and purposes it can be considered eradicated in the United States.

87 82 P.A.B.O. DIRECTING COUNCIL Report on the British Caribbean Territories Dr. HARKNESS (United Kingdom), in presenting his report (Document CD8/56), first referred to the British territories in the Caribbean area in which malaria no longer exists or is on the point of disappearing as a result of the measures carried out. Barbados, which suffered an invasion of Anopheles albimanus in 1927, is the first region in the world to claim malaria eradication as a result of positive antilarval measures. On the island, which has 240,000 inhabitants, there is no indigenous malaria. In the islands of St. Kitts and Nevis, autochthonous cases of malaria have not occurred since 1951 and 1950, respectively. For the past three years the island of Antigua has had no locally contracted malaria, although there was light breeding of A. albimanus in five small areas. With the cooperation of the PASB/WHO, sprayings with residual-action insecticides are being carried out, primarily for the eradication of the Aedes aegypti. The islands of the Caymans and the Turks and Caicos group, which are dependencies of Jamaica, are free from malaria. The island of St. Vincent is likewise free from malaria, although there remains a small focus of Anopheles in a very restricted locality in the northwest of the island. In Dominica, malaria control measures were intensified in 1951 by the introduction of residual spraying of houses in addition to the antilarval and drainage measures previously pursued. As a result, there has been considerable improvement in the situation. Grenada and St. Lucia have reached the stage where eradication can now be seriously contemplated. In British Guiana, the Anopheles darlingi has been eliminated from all inhabited areas as a result of the residual-spraying campaign that has been in operation for several years. Nevertheless, the A. aquasalis is a potential transmitter of malaria in the northwest of the country, and until this focus has been dealt with it cannot be said that total eradication of malaria has been accomplished. In Trinidad and Tobago, there has been a great reduction in malaria during the past ten years, but in the cocoa-growing areas in Trinidad the A. bellator continues to present a problem. This mosquito does not enter houses and therefore is not affected by residual-spraying methods. However, satisfactory results are being achieved in the control of this vector by spraying in the cocoa-growing areas with copper sulfate solutions. In Jamaica, considerable progress has been made in extending the malaria control activities to all parts of the island, in spite of certain organizational difficulties which it is hoped will be overcome soon. Residual-DDT house spraying is being extended to include every house in the colony. Important assistance has been received from the PASB/WHO in these activities. In British Honduras, residual spraying has reduced the incidence of malaria by more than 80% since initiation of the work in Dr. Harkness stressed the contribution of the Pan American Sanitary Bureau to the recent progress made, adding that material assistance has also been received from the United Nations Technical Assistance Program and from UNICEF. Report of the Representative of Paraguay Dr. ACosTA FLEYTAS (Paraguay) said that the report of his country (Document CD8/91) would be distributed shortly. He explained that, as the result of an agreement concluded by Paraguay in October 1950 with the Pan American Sanitary Organization and UNICEF, a malaria control campaign had been initiated. The activities actually began in February 1951 and an area of 24,000 square kilometers, with a population of some 100,000 inhabitants, has been covered since that time. Work was started to install an entomological laboratory, but, unfortunately, sufficient equipment was not available. The collaboration of the PASB was requested in order to carry out studies on the eradication campaign, and through the AMRO-78 project an evaluation and analysis of the situation will be undertaken during the coming month of October. The first step will be to collect all necessary information; when the survey is completed, it will be possible to prepare a plan for eradication of the disease, to be carried out as intensively as the financial resources of the country will permit. Report of the Representative of Panama Dr. BISSOT (Panama) presented his country's report (Document CD8/34). He said that in 1950 his Government, convinced of the importance of the malaria problem, made an effort to intensify the antimalaria work as far as its resources permitted. It has been confirmed that autochthonous malaria exists not only in populated areas situated at sea level but also at altitudes of a little over 2,500 feet. The latest studies show that the endemic zone and peripheral areas cover a total of approximately 45,- 000 square kilometers, in which there are some 650,- 000 inhabitants and 130,000 houses. During the

88 W.H.O. REGIONAL COMMITTEE 83 past six years, the morbidity index for malaria has been about 500 per 100,000 inhabitants, a decrease being noted in comparison with the period 1943 to 1947, when the indices were always over 1,000 per 100,000 inhabitants. The decrease in indices beginning in 1948 coincides with the utilization of residual-action insecticides. Briefly, it may be said that the efforts made by the Government in recent years have brought about a decrease in malaria morbidity and mortality, but this disease continues to constitute a serious public health problem. In order to solve that problem, the country hopes to have the international cooperation of UNICEF, WHO, and PASB. Report of the Representative of Nicaragua Dr. QUESADA (Nicaragua) said that, as stated in his country's report (Document CD8/72), which would be distributed shortly, Nicaragua has an area of 148,000 square kilometers, of which approximately 120,000 are malaria zones. In these zones there are many localities that are scarcely accessible. The only regions free from malaria are those over 1,300 meters above sea level. In one survey carried out in 1943 (before the use of DDT), in 1,800 slides examined at the laboratories of the Ministry of Public Health, different species of Plasmodium were found in the following proportion: P. vivax, 25%; P. falciparum, 10%; and P. malariae, 0.5%. The vector species in the country are the Anopheles albimanus and the A. pseudopunctipennis, the first of which is the most important, the latter taking a very secondary place in transmission. The few regions that are exempt from malaria are situated, for the most part, in the central zone of the country. In 1950 a malaria control program was formally initiated, the main weapon used being intradomicile spraying with residual-action insecticides (almost exclusively DDT). In this program eight spraying cycles have been carried out, but they were not completed in an over-all and entirely satisfactory manner; nevertheless, the reduction in malariometric indices was considerable. Now, in September 1955, the ninth cycle is in progress. In addition to the imagocide campaign, another antilarval campaign was conducted, but on a smaller scale. The preliminary phase of the conversion of control programs into eradication programs has been under way since July of this year. The parasitic index, which was 21.36% in 1943 and 42.07% in 1949, began to decrease sharply in 1950 and by 1954 had dropped to 0.23 %. Dr. Quesada concluded by saying that, in conformity with the decision taken by the XIV Pan American Sanitary Conference and endorsed by the eighth World Health Assembly, the Government of Nicaragua, which participated in both those meetings, is prepared to carry out the conversion of the control program into an eradication campaign. A bill has been drafted and 1,000,000 cordobas have been appropriated to bring the campaign into operation. Report on Surinam Dr. FAVEREY (Netherlands) said that, with regard to malaria, his country, Surinam, can be divided into two zones, the coastal and the inland. In the coastal zone, which is cultivated and inhabited, it can be said that malaria is under control and that in the near future the disease will be entirely eradicated. But the same cannot be said of the inland zone, where there are several tribes in which the adults are parasite carriers. These inhabitants have only lately come into contact with Western civilization, but now, attracted by modern industry, they come down to the cultivated areas and form a constant source of infection for the people residing there. The same occurs when the inhabitants of the coastal zone visit the interior of the country. For this reason, it is necessary to extend malaria control to the interior zones and to plan for the future eradication of the disease throughout the country. This will, of course, require very much more money than is needed for the antimalaria campaign along the coast, since the villages in the interior are widely dispersed and difficult to reach. Report of the Representative of Mexico Dr. PESQUEIRA (Mexico), presenting his country's report (Document CD8/55), said that malaria is not only Mexico's most pressing health problem but also an economic factor of the greatest importance. Malaria eradication is for Mexico the equivalent of conquering the tropics, for it means incorporating into the national economy that region of the country in which water is plentiful and the land is fertile. Nearly two thirds of the population, that is, some 17,000,000 people, inhabit the malaria zone, and only one of the nation's thirty-two states is free from the scourge. Little progress has been made up to now in combating the disease, because the procedures followed in the past required enormous sums that the Government was simply unable to provide. The new methods used in antimalaria campaigns,

84 P.A.S.O. DIRECTING COUNCIL which at present require far less funds, have led the Mexican Government to undertake wholeheartedly an over-all eradication campaign.

89 84 P.A.S.O. DIRECTING COUNCIL which at present require far less funds, have led the Mexican Government to undertake wholeheartedly an over-all eradication campaign. In so doing, it is complying with the recommendations of the XIV Pan American Sanitary Conference and receives the full support of the PASB. Of the $20,- 000,000, at which the cost is estimated, approximately 50 % will be provided by UNICEF, as assistance in the form of insecticides and some equipment, and the rest will be provided by the Government of Mexico. In order to direct the activities, a committee was established, headed by the Minister of Public Health, Dr. Ignacio Morones Prieto, with Dr. José Zozaya serving as executive member. The training of national personnel has been initiated, and it is hoped that the field work will begin shortly. Dr. Pesqueira concluded by expressing the conviction that, with the cooperation of UNICEF and the Pan American Sanitary Bureau, the eradication campaign will be entirely successful. Report of the Representative of Honduras Dr. ALCERRO-CASTRO (Honduras) said that his country's report (Document CD8/35) was merely a preliminary document; a more complete one was being prepared and would be presented in the near future, in the hope that it would help Honduras obtain technical and economic collaboration and moral support. The country is making a supreme effort to strengthen its national health services, and for this task it requires a large amount of funds. The School of Nursing, together with the School of Medicine, are being reorganized. It is hoped that a mass BCG-vaccination campaign will soon be initiated, and health centers are being opened throughout the nation. Also, a preliminary study is being made with a view toward improving the rural public health services; and, in an important series, some projects have already been approved, while others are in the preparatory stage. The country is therefore in need of international collaboration, as it by no means wishes to remain the weak link in the public health chain of the Americas. When the Inter-American Cooperative Public Health Service began its activities in 1942, one of its first funetions was to determine the seriousness of the malaria problem in the various areas of the country, since at that time malaria was considered to be the principal public health problem. Surveys were conducted throughout the country; the regions where malaria was found to be endemic and hyperendemic were indicated, and entomological studies were made, showing the presence of twelve species of anophelines and proving that the Anopheles albimanus was the principal vector. With the financial assistance of UNICEF and the technical assistance of the PASB/WHO, the application of DDT was initiated in 1949, with residual spraying of dwellings. In February 1955, the leaders of the antimalaria campaigns in Guatemala, Honduras, and El Salvador met to discuss the possibility of a coordinated plan for the eradication of malaria. At a second meeting, held in Tegucigalpa late in March of the same year, to which the director of the antimalaria campaign of Nicaragua was invited, the conclusion reached was that converting the control programs into eradication programs was a matter of the utmost urgency. It has been estimated that the endemic area in Honduras covers an area of 40,000 square kilometers, with a population of approximately 600,000 inhabitants, of whom 450,000 reside in rural areas and 150,000 in urban areas. The United Fruit Company and the Standard Fruit Company, which operate along the Atlantic coast of Honduras, have been working in collaboration with the Division of Malariology, assuming the responsibility for the work in the areas within their jurisdiction. Inasmuch as these areas encompass 25,000 dwellings and the total number in the endemic area is 120,000, the Division of Malariology is responsible for 95,000 dwellings, 70,000 of them in rural areas and 25,000 in urban areas. As the eradication program progresses, DDT will continue to be used and, in addition, dieldrin will be used in the more inaccessible areas. In the interest of greater efficiency, the country will be divided into four zones. At present, one expert trained at the School of Malariology of Maracay, Venezuela, is at work on the program, and a physician is pursuing further studies at that School. The National Department of Public Health will do everything in its power to ensure the participation of all the public health services in the campaign. The session was recessed at 4:05 p.m. and resumed at 4:SO p.m. Report of the Representative of Haiti Dr. DURAND (Haiti) said that, although it is rather difficult to give exact information on the malaria situation in his country, the fact is well known that malaria is one of the diseases that cause the greatest concern to the Government and people of Haiti. The source of much distress, it affects from around five hundred to six hundred

90 W.H.O. REGIONAL COMMITTEE 85 thousand homes in the lowlands, where water accumulates every year following the rainy season. One of the reasons why the figures on the status of the disease are somewhat inexact is the fact that the inhabitants of the highlands move to the valleys, and vice versa, causing the disease to spread, since Anopheles albimanus reproduces easily. This mosquito feeds on both man and domestic animals, and therefore the speaker wondered if complete eradication of the disease can be achieved merely by spraying houses. In his country, evidence points to the fact that the serious epidemics, like the one that broke out after the last hurricane, originate with people living far from the urban centers. In Haiti attempts are being made at present to control malaria through the treatment of urban dwellings, and there are almost no cases of the disease in urban centers. The A. albimanus has peculiar habits, requiring clean, not rapidly flowing waters to live; therefore, whenever a case of malaria occurs in Port-au-Prince, it comes from some village where the disease was contracted. As for total eradication of the disease in Haiti, the problem cannot be dealt with only in the lowlands, it being necessary also to take into account the villages located on the mountain slopes and in the deep valleys. In these areas, three months ago, it was necessary to control four or five extremely serious epidemics that broke out among a population that had never experienced epidemics like these and, as a result, the Public Health Service was much concerned. The speaker added that weekly reports on the incidence of malaria in Haiti are sent to the Pan American Sanitary Bureau, so that the Bureau can work out the proper plans for eradicating this disease, once Haiti has completed the eradication of yaws. Report of the Representative of Guatemala Dr. AGUILAR (Guatemala) presented the report on the malaria situation in his country (Document CD8/57). The endemic areas (known and assumed) cover about 90,000 square kilometers, an area slightly more than 80 % of the total territory of the country. Approximately 1,200,000 inhabitants, occupying 240,000 houses, live in this area. The principal vector is Anopheles albimanus and, of secondary importance, are the A. vestitipennis and the A. pseudopunctipennis. So far, the Government has supplied all the funds required by the Division of Malariology for carrying out the campaign: 165, quetzales in the first half of the current year and 400,000 quetzales for the second half. Furthermore, the Government, encouraged by the assistance offered by UNICEF, has promised to continue financing the eradication campaign for as many years as may be necessary for its completion. The speaker described the composition and operation of the spraying teams and the means at their disposal. During five months of operations, 49,413 houses have been sprayed, the output of the spraying teams being 6.7 houses per man-day. It is expected that the figure will reach 7.5 at the end of the first year following the conversion into an eradication campaign. During the first year after the conversion it is expected that 60 % of the houses will be sprayed, and in another three years the coverage should be 100 %. After the first five months, the campaign has shown that Guatemala must reorganize the spraying activities so as to assure steadier supplies, better supervision, and an increased output by the sprayers. In November, Guatemala will present a revised eradication plan. The speaker concluded by expressing his appreciation for the valuable assistance given by the Bureau in the eradication campaign in Guatemala and for UNICEF's contribution of supplies and equipment. Report on the French Departments Dr. HYRONIMUS (France) reported that the malaria problem had improved considerably in the French territories in America during recent years. Today it can be said that malaria has been eradicated in French Guiana. In Martinique there have been no autochthonous cases of malaria for ten years. The serious epidemic that followed the First World War disappeared slowly but progressively. In Guadeloupe the disease still exists in certain areas. In Martinique the vector is the Anopheles aquasalis, whereas in Guadeloupe not only the A. aquasalis is found but also A. albimanus in large numbers, as well as A. albitarsis; however, A. albimanus is believed to be the principal vector. The speaker felt that the eradication of malaria in these islands is feasible, because the territories lend themselves to treatment. The best procedure, undoubtedly, is house spraying, but the antilarval campaign should not be neglected either, especially in densely populated areas. As for insecticides, he considered that BHC is more economical and produces more rapid effects than DDT. In these French territories the method followed is the spraying of the interior and exterior of the houses, and not only up

86 P.A.S.O. DIRECTING COUNCIL to three meters, as it has been found that this latter method of spraying is sufficient for the extermination of certain mosquitoes, but probably not the A. albimanus.

91 86 P.A.S.O. DIRECTING COUNCIL to three meters, as it has been found that this latter method of spraying is sufficient for the extermination of certain mosquitoes, but probably not the A. albimanus. He also pointed out that immigration has an effect on the persistence of malaria. For example, in French Guiana several cases of malaria were reported upon the arrival of a great number of workers, and it would therefore be advisable to give preventive treatment to immigrants suspected of being infected. In conclusion, the speaker stated that, through a combination of antilarval measures, environmental sanitation, and the control of the immigrant population, malaria eradication may perhaps be achieved more quickly than through the use of only one of these methods, particularly the spraying method. Report of the Representative of El Salvador Dr. ALLWOOD PAREDES (El Salvador) presented his country's report on the progress made in the malaria eradication program (Document CD8/27). He reported that the endemic malaria areas are inhabited by approximately 1,400,000 people. Until 1950 the antimalaria program consisted almost exclusively of isolated control measures; use was made of the recognized sanitary engineering methods and, in some isolated communities, the interior of houses was sprayed with DDT. From 1950 on, the eradication program was broadened to cover all the areas of the country classified as hyperendemic. Up to the end of 1954 approximately 800,000 inhabitants had been protected, that is, 60 % of threatened population. Through this effort the morbidity per 100,000 inhabitants was reduced from 2,422 in 1950 to 575 in 1954, and the corresponding mortality rates were 91 and 44, respectively, per 100,000 inhabitants. As a result of the new directives approved by the XIV Pan American Sanitary Conference, the public health service of El Salvador, in consultation with the Pan American Sanitary Organization, has expanded its eradication programs. To this end, the Government has proceeded to increase the campaign budget; legislation is being drawn up to make the eradication work more effective, and provisions of a financial nature are being made to facilitate the utilization of funds. Bordering countries have been invited to coordinate their efforts in the fight against malaria, and three meetings have already been held for that purpose. The speaker then outlined the following technical problems that El Salvador is faced with in this campaign; he submitted them to the Bureau for consideration so that the necessary assistance might be given in solving them. They are as follows: (1) Although it was previously determined that the only malaria vector in El Salvador was A. Albimanus, there is still suspicion that A. pseudopunctipennis also intervenes in the transmission. (2) There is strong suspicion, as yet unconfirmed, that the unknown vector is showing proof of resistance, especially evident through the changes in its habits observed in areas treated with insecticides over a long period of time. (3) Problems arise in protecting large groups of migrant laborers, who live in sheds without walls during their periods of work in the coastal areas. (4) As yet there is no positive information as to the variations that may result from the residual action of DDT in the different types of dwellings, or as to the effect that the location of dwellings may have with respect to the degree of protection against winds. Despite the spectacular results achieved in the control program, the Government and the people of El Salvador have given their support to an eradication program. Dr. Allwood Paredes said that he had mentioned these technical problems in order to stress how important it is for the Bureau to give individual assistance to the countries faced with such problems. The public health service of El Salvador stands before its people as having shouldered the financial and moral obligation of eradicating malaria within a short period of time, and it hopes to receive the necessary assistance from the Bureau to achieve this goal. Report of the Representative of Ecuador Dr. MONTALVÁN (Ecuador) presented his country's report (Document CD8/28) on the national antimalaria campaign, summarizing its various aspects. The Division of Malariology of the National Institute of Hygiene spent several years in making a survey of malaria in the country, its findings being published in the Revista de Medicina e Higiene Tropical. There an explanation was given of the studies made and these showed clearly the extent of the problem, a serious one for a country situated on the equator, with large hot areas where temperatures and conditions favor the development of malaria. Up until 1947 the fight against the disease had not assumed the proportions fitting a problem of this magnitude. After the advent of DDT, and with the help of epidemiological studies and the experience acquired by other countries,

W.H.O. REGIONAL COMMITTEE 87 the National Congress in 1948 approved a plan designed to eradicate the disease. The country's legislation contains the specific term "eradication.

92 W.H.O. REGIONAL COMMITTEE 87 the National Congress in 1948 approved a plan designed to eradicate the disease. The country's legislation contains the specific term "eradication." The speaker recalled that at the XIII Pan American Sanitary Conference, held in Ciudad Trujillo in 1950, his country was one of those that backed the resolution entrusting to PASB the task of sponsoring antimalaria programs with the aim of eradicating the disease throughout the Continent. From the beginning, all activities in Ecuador were aimed at eradication, an effort being made to cover the greatest possible portion of the country. The speaker stated that the map appended to his country's report shows the affected areas, together with those protected and those insufficiently protected. The campaign was extended with the purpose of achieving eradication in the whole country, but, as happens in other nations, even those with greater resources, it became apparent in Ecuador that all the inhabitants exposed could not be protected. Nevertheless, there was an immediate reduction of malaria, resulting in an immediate stimulus to the economic development of the country. But as the seriousness of the situation diminished the funds assigned for the campaign diminished accordingly, and the work that in the beginning had augured so well lapsed into control activities. People had become used to the idea that the annual DDT spraying removed all serious threat of malaria. However, later evidence of a certain degree of anopheline resistance to the residual action of insecticides showed the impracticability of continuing control programs indefinitely. For purposes of the campaign, the country has been divided into four zones, each headed by a specialized physician trained at the School of Malariology of Venezuela. Through coordinated action it has been possible to cover between 80% and 95 % of the population. Dr. Montalván pointed out that the report presented by the Bureau at the 25th Meeting of the Executive Committee contained an erroneous statement regarding the situation of the malaria campaign in Ecuador, inasmuch as it declares that malaria continues to constitute a serious problem in that country. The speaker made it clear that of the 1,495,000 inhabitants exposed, 1,377,000 have been protected. There remain only 53,000 houses to be sprayed, whereas the report of the Bureau sets this figure at 124,000. He found it surprising that this incorrect statement had been published and felt that it awas probably because of this error that the Bureau has viewed the campaign in Ecuador so unfavorably. The malaria problem in the country is not grave, but from a technical point of view, serious. It is essential to return to eradication, in accordance with the resolutions of the XIII and XIV Pan American Sanitary Conferences, and Ecuador therefore requests the assistance of the PASB, not only in providing technicians to review plans and requirements, but also in collaborating to secure the necessary funds to re-intensify the eradication program. This assistance should be forthcoming before the danger that lies in the growing resistance of the Anopheles increases. The speaker said that he hoped to be able, at some future meeting, as other countries have done, to express appreciation for the assistance of the Bureau-assistance that is urgently requested and to which he felt his country is entitled. Report of the Representative of the Dominican Republic Dr. BERGÉS SANTANA (Dominican Republic) submitted his country's report on the malaria situation (Document CD8/62), stating that the Government has undertaken an extensive campaign against the disease. Since 1941, when the Division of Malariology was set up, an effective and ever-expanding campaign has been under way. Until 1949, control was based on the use of the standard methods of the day: drainage construction, application of larvicides, etc. Since that year the entire campaign has been based on house-to-house spraying with DDT. In 1954, 174,067 houses were sprayed and a population of 1,040,000 was protected. The Government has had the cooperation of the PASB, the WHO, and UNICEF in carrying out the insect-control campaign, which has been waged in the country since 1953 and includes, in addition to the antimalaria campaign, a plan for eradicating the urban vector of yellow fever. The Government's total appropriations for staff salaries, maintenance of vehicles, equipment, and per diem was $183,780 in 1954, excluding DDT supplies. The present status of the campaign does not allow a repetition of DDT sprayings at six-month intervals, because of the size of the malaria-infested area. As a result there is still some transmission, although on a reduced scale, which must be halted if the disease is to be completely eradicated. In compliance with the resolution adopted at the XIV Pan American Sanitary Conference, the Government of the Dominican Republic will, in 1956, launch an intensive four-year antimalaria cam-

93 88 P.A.S.O. DIRECTING COUNCIL paign to eradicate this disease from the country. To this end, an additional $165,560 has been allocated for the campaign; this, added to the $275,300 already appropriated, makes a total of $440,860 a year available for this undertaking. The campaign will be conducted in two stages: one, eradication proper, and the other, surveillance and prevention of reinfection. The first will take four years and three months, during which time, after a geographic survey of the country has been made, as many houses will be sprayed as is necessary for the direct or indirect protection of the inhabitants of the malaria-infested area. The speaker closed by saying that his Government, which has been making remarkable progress for a quarter of a century, knows that malaria afflicts all nations and that throughout human history its index has been the barometer of backwardness, poverty, and economic and social instability of numberless communities. The Dominican Republic is eager to eliminate this terrible disease as quickly as possible and for that reason is making extraordinary efforts-psychological, technical, and financial-as its contribution to the ideal of a better world. Report of the Representative of Cuba Dr. HURTADO (Cuba) said that he had listened with pleasure to the reports submitted by the various countries and had been impressed by the thorough knowledge of the problem shown by the speakers. In Cuba's experience, there are some facts indicating that the standard antimalaria methods used by the departments of sanitary engineering are valid and cannot be completely replaced by modern methods. Cuba once had a very high malaria incidence, which, with the collaboration of the Rockefeller Institute, it was able to reduce to such a point that, prior to the discovery of residual insecticides, the disease had been confined to the extreme eastern part of the island and a small locality in the west. Naturally, when residual insecticides appeared, Cuba used them, continuing the campaign until a considerable reduction of malaria in the country had been achieved. Nevertheless, it recognizes the urgent need for eradication, because the residual insecticides are losing some battles. In this connection, he pointed out that Cuba has produced a new insecticide, which it has submitted to the proper committee of the WHO; mosquitoes have not proved resistant to it. Malaria is not a serious epidemiological problem in the country, but Cuba is joining with the other countries of the Americas in the eradication of the disease. The only cases that occur are imported with manual laborers. A National Malaria Commission has been set up in Cuba; there is the Rockefeller Foundation school, and now the country is awaiting the visit of the PASB expert to prepare the ground for the eradication campaign, which, in view of the situation in the country, can be carried out with a comparatively small outlay. The session was adjourned at 5:30 p.m. ELEVENTH PLENARY SESSION Friday, 16 September 1955, at 9:45 a.m. Chairman: DR. HLCTOR A. COLL (Argentina) Later: DR. JUAN ALLWOOD PAREDES (El Salvador) The CHAIRMAN called the session to order. The SECRETARY reported on the arrangements made for the transportation of the representatives to Philadelphia, where the Jefferson Medical College would hold ceremonies commemorating the centennial of the graduation of Carlos J. Finlay. Topic 23: Presentation of Reports on the Malaria Eradication Programs in the Americas (conclusion) The CHAIRMAN granted the floor to the Representative of Colombia.

94 W.H.O. REGIONAL COMMITTEE 89 Report of the Representative of Colombia Dr. CONCHA VENEGAS (Colombia), in presenting his country's report (Document CD8/61), said that he would briefly describe the antimalaria campaign conducted from 1943 to the present time. That year marked the founding of the National Institute of Malariology and the initiation of malariometric investigations. In 1946 the application of DDT was started on a small scale in a demonstration area. The spraying campaign reached its full development in the years 1950 and 1951, by which time the Institute had the necessary personnel. The Representative of Colombia went on to give a detailed explanation of the progress made, saying that the number of houses treated with DDT between 1946 and 1955 was approximately 408,000. In 1952 the program of technical and economic cooperation with UNICEF and the PASB began, and the campaign against Aedes aegypti and that against malaria were combined. He corrected the figure given in the report prepared by Dr. Alvarado as the total number of houses sprayed and he protested the fact that the report describes the 1954 campaign in his country as inadequate and insufficient; that statement may, perhaps, be due to the fact that Dr. Alvarado's trip to Colombia was very short and did not enable him accurately to evaluate the situation. The speaker read a document describing his country's plans for carrying out the campaign during the next few years. Colombia is divided into five natural geographic regions: those of the Caribbean, the Pacific, the Andes, the Orinoco, and the Amazon. But from the point of view of malaria, the country can be divided into tropical, equatorial, and para-equatorial malaria zones. Eight known vectors of malaria are present in Colombia, and there is need for thorough investigation of malaria indices and of the anopheline vectors, their ecology, and their susceptibility to the various insecticides. He gave data on the work remaining to be done and on the complete plans for the spraying program, the cost of which has been estimated at $2.40 per house sprayed. He added that the Malariology Division must assume complete and exclusive responsibility for malaria eradication and allocate the funds required to execute the program, funds which it is estimated will come to $24,518,000 for the next four years. These funds will be contributed by the Government of Colombia and by the interested international agencies, whose contribution is estimated at $1,000,000 a year for the duration of the campaign. Dr. Concha Venegas went on to say that the sanitary legislation will have to be broadened so as to give the Department of Public Health and Social Welfare the authority to make certain measures compulsory. The 1956 national budget will contain the appropriations necessary to launch the program. Malariometric studies over a ten-month period will cost about $600,000. The conversion of control services into eradication services will require an expenditure of $2,400,000. Finally, he stated that plans and estimates are being drawn up for the execution of the campaign in Report of the Representative of Brazil Dr. FERREIRA (Brazil), summarizing his country's report (Document CD8/25), said that Brazil was in the front line of the campaign against malaria, as regards both the time at which it was started and the importance ascribed to it. He explained that, before the use of residual-action insecticides was begun, an estimated 8,000,000 persons were affected. After 1947, when DDT was introduced on a nation-wide scale, the incidence decreased to 100,000 cases. That was a critical time for malariologists. The personnel assigned to the antimalaria campaign were withdrawn for work against Chagas' disease, filariasis, and other diseases. It was assumed that malaria was already a thing of the past. In 1951, however, the appearance of vector resistance began to concern the malariologists anew. After the XIV Pan American Sanitary Conference, which changed the direction of the campaign, Brazil reappraised the problem of malaria. Dr. Ferreira described what it meant to convert a control campaign into an eradication campaign and the new point of view that has to be applied in evaluating it. He explained that in his country, with its 52,000,000 inhabitants, it was estimated that 65% of the population live in malaria zones. The malaria services applied DDT in an incomplete manner in some two and a half million houses, in 20% of the malaria region. It was then decided to establish eradication zones in the areas where the control campaign had been most successful. The areas included in the 1955 eradication campaigns include 3.3 % of the total geographic area of Brazil and 30.6 % of its population. Dr. Ferreira then took up in detail Tables 1, 2, 3, and 4 in the report presented by his delegation. He pointed out that the sudden increase in cases recorded might be due to the improved system of detection. It is easy to speak of eradication, he

95 90 P.A.S.O. DIRECTING COUNCIL said, but various obstacles arise when a control campaign is converted into an eradication campaign. He mentioned the three points that, in his opinion, present difficulties in antimalaria campaigns: (1) supply of insecticides and transportation; (2) increase in the personnel assigned to the malaria services; and (3) the problem of resistance, which is not solely that of the insects to the insecticides but also that of the finance ministers to allocating the necessary funds. He indicated that a nationwide budget of $3,571,000 could not provide more than two thirds of the needed insecticides and transportation. Finally, he stated that until the point is reached where malaria can be considered to be residual, that is, the malaria that persists after application of residual insecticides, it will not be possible to say that Brazil has overcome the problem. Report of the Representative of Bolivia Mr. DE LA ROCHA (Bolivia) reported on the status of the malaria control program in his country (Document CD8/79), a program that began to make headway after the introduction of residual insecticides, mainly DDT, and has been expanding gradually to cover an area of 61,000 square kilometers, in which 31,847 houses have been treated. This campaign employs seven spraying teams and eight men working individually. In most places, all houses have been sprayed. Residual DDT has proved its effectiveness. The route followed by the teams almost always depends on accessibility by road. Spraying is done every six months, the interval considered effective for halting transmission through the residual action of the insecticide. The National Malaria Control Department of Bolivia recognizes the imperative need to eliminate endemic malaria and, in order to cooperate with the malaria eradication programs in all countries of the Americas, it has a vast plan for eradicating malaria in Bolivia once and for all. For this purpose it conducted a study to compile all the necessary data: number and location of houses in the malaria-infested area, type and quantity of insecticide needed, proper spraying cycle, together with other features of the campaign and other technical factors, as well as recommendations and instructions to be given to the inhabitants in the various regions. The National Malaria Control Department of Bolivia has estimated the cost of this plan, in terms of equipment, personnel, insecticides, and other expenses, at about $180,000, and in order to conduct the work satisfactorily Bolivia would, of course, like to be able to count on financial assistance from the competent international agencies. Report of the Representative of Argentina The CHAIRMAN, Dr. Coll, announced that he would speak as representative of his country in presenting the report on malaria problems in Argentina (Document CD8/73). In Argentina, the malaria problem involves a total of about 270,000 square kilometers, including an endemic zone of 120,000 square kilometers and an epidemic zone of 150,000 square kilometers, which have an estimated population of 1,250,000 and 600,000, respectively. Up to 1947 there were from 250,000 to 300,000 cases per year, most of which occurred in the endemic zone. The antimalaria campaign was aimed at eradication, and for several years now there have been only 400 to 500 annual cases of residual malaria, while in some provinces of Argentina no cases at all have been recorded for some time. Malaria may be considered eradicated in the La Rioja, Cordoba, San Luis, and San Juan areas, where for over three years no autochthonous or other cases have been recorded. The Office of the Director of the Malaria Campaign, however, has been carrying out an intensive campaign in these areas, especially in La Rioja and Catamarca, to confirm the eradication of malaria. Dr. Coll said that this meeting of the Directing Council would serve as a stimulus for the continuation of the campaign, in accordance with the new policy of eradication, that is, ceasing to emphasize what has been done and stressing more and more what has not been done. This policy must be inculcated in the national services. The Representative of Argentina listed the problems raised by the campaign and announced that in his country the antimalaria service has been re-organized in such a way as to make it possible to resolve some of the unknown factors that still exist. He believed that the doctrine of eradication, reiterated so often at this meeting, would provide a sound and solid basis for attacking the problem and would be of enormous help to the countries in attaining the desired objectives. The session was recessed at 10:55 a.m. and resumed at 11 :15 a.m. The Chairman called on the Representative of El Salvador Dr. Allwood Paredes, Vice-Chairman of the meeting, to take the Chair. The CHAIRMAN invited Dr. Alvarado, Chief of the Coordination Office of the Malaria Eradication

W.H.O. REGIONAL COMMIITEE 91 Program (COMEP), to give his views on this subject. Statement by the Chief of the Coordination Office of the Malaria Eradication Program (COMEP) Dr.

96 W.H.O. REGIONAL COMMIITEE 91 Program (COMEP), to give his views on this subject. Statement by the Chief of the Coordination Office of the Malaria Eradication Program (COMEP) Dr. ALVARADO (COMEP), after expressing the deep satisfaction with which he had listened to the representatives' reports on the malaria eradication campaigns, said that the present meeting undoubtedly would go down in the history of the eradication of this disease as the meeting at which the word "eradication" was made a part of the international public health vocabulary. He apologized to the Representative of Colombia for the difference in the data that the latter had pointed out, especially as regards the impression that the campaign was inadequate. He said he was almost happy to have made this explanation necessary, since nothing is as gratifying to a sanitarian as finding out that more progress than was thought has actually been made. In this connection, he stressed the importance of Colombia's malaria problem, which at present represents 13 % of the continental problem, being second in magnitude to that of Mexico in the Americas. If Mexico yields that position as a result of its largescale eradication program, Colombia then will occupy first place, with 28% of the problem, and consequently the situation of that country is of exceptional importance to the eradication of malaria in the Western Hemisphere. Dr. Alvarado then briefly recounted the history of the continental eradication program. As the result of Resolution XLII of the XIV Pan American Sanitary Conference (Santiago, Chile), the Director of the Bureau and he had been invited by UNICEF to present a general outline of the philosophy and strategy of the program. Shortly thereafter, on 1 April, the Bureau decided to organize and set up an office charged with coordinating eradication activities throughout the Americas. This Office, named Coordination Office of the Malaria Eradication Program, or COMEP, was established with headquarters in Mexico City. In May the UNICEF/ WHO Joint Committee on Health Policy (eighth session), meeting in New York to lay down the conditions under which UNICEF was to collaborate in the eradication programs, made the following recommendations, among others:... The achievement of malaria eradication requires total control in all areas where transmission of malaria occurs... (No. 8). The Committee believes that new antimalaria projects should aim at eradication and that the requesting countries should be expected to have, or to establish, for such period as may be necessary, an adequate central antimalaria organization for the implementation, coordination, and guidance of the national program; should promote the necessary supporting legislation and should pledge their financial support for the duration of the program. UNICEF, on the other hand, should endeavor to continue its assistance till the termination of the program... (No. 10). The Committee recommends that UNICEF give highest priority to the support of malaria eradication programs (No. 11). The speaker explained that, after the Joint Committee meeting, the Bureau undertook to study the technical standards for the eradication programs, particularly those that require UNICEF's financial assistance. COMEP therefore prepared a certain number of documents' that were submitted to an Advisory Committee for the Eradication of Malaria, established by the Director of the Bureau and composed of the most eminent specialists in malariology in our Continent: Dr. Justin Andrews, of the United States; Dr. Arnoldo Gabaldón, of Venezuela; and Dr. Manoel Ferreira, of Brazil. Dr. Paul Russell, the WHO Malaria Adviser, was also a member of the Committee. The first meeting took place on 2 June, and the recommendations made were of such importance that he wished to refer to them later in greater detail. The first of the documents to which he had referred, entitled "Differences between a Malaria Eradication Program and a Malaria Control Program," contained three or four points of special importance. The first refers to the area of operations, which, for eradication purposes, is defined as "wherever there is transmission." As to the minimum acceptable quality of work for the eradication program, the document gives "perfect," i.e., transmission should be interrupted everywvhere in the area. The parasitological confirmation of all suspected cases is stated to be "of supreme importance"; and the administrative evaluation of the program should measure, in the case of control programs, "the work accomplished" and, for eradication programs, "the extent of what is still to be done." The Representatives of Brazil and Argentina, he said, had already referred to the latter point, which will unquestionably have a great effect on future reports on the status of the programs. In an eradication program it is important to measure not what has been done, but rather what remains to be done, a fact that will no doubt present a seri- 'COMEP/ACME Nos 1, 2 and 3.

97 92 P.A.B.O. DIRECTING COUNCIL ous problem to malariologists. In an eradication program, it is not at all important to determine the initial magnitude of malaria in order to initiate operations; it is enough to determine its presence. The document contains categorical definitions as to what should be understood by an eradication program, and he considered it essential for all these points to be made very specific, so that there would be no misunderstanding of what "eradication" means. With respect to the second document, dealing with the evaluation of the malaria eradication programs, Dr. Alvarado pointed out that in control programs evaluations have always been made on the basis of the number of houses sprayed, inhabitants protected, square meters covered, and the amount of DDT used. These words no longer have any meaning in an eradication program, he said, except for keeping account of the operations, for the internal use of the service, so as to permit an appraisal as to whether, from an operational viewpoint, the work is being carried out properly or not. The basis for the evaluation of eradication programs will be the existence of new malaria cases. The third document, Dr. Alvarado explained, contained charts showing the chronological order of the spraying operations. These operations have two basic characteristics: first, the time within which they should be carried out ought to be well established; they have, so to speak, a strictly defined period. Second, the funds for the operations are also limited, since they have to be estimated on the basis of the total expenditures for the duration of the program. It is, therefore, essential that a system for developing and organizing the operations be established, and, at the same time, that this system be adapted to a schedule. With this philosophy, he said, the Committee decided that an eradication program should be developed in two basic stages. The first, which might be called eradication in the true sense of the word, refers to the time when large-scale spraying operations are carried out in order to interrupt the transmission completely. The second stage is that of vig lance and the prevention of reinfections. During the first stage, that of eradication, spraying and evaluation operations should be conducted with the same intensity, the same exhaustiveness. The Committee advised that the evaluation operations merit, on the part of those responsible for the service, the same attention, the same interest, as do the spraying operations, whereas in the past the fundamental interest of those responsible for the execution of an antimalaria program was exclusively, or almost exclusively, in the application of the insecticide. For the spraying operations, three stages, or periods, were established. The first is that of development, expansion, or conversion, during which a control service should be made into an eradication service. Dr. Soper, he said, had used a very useful expression the previous day, which he would repeat: An eradication program is not merely the extension of a control program; it is the transformation of it. Other representatives had also referred to this fundamental point. This transformation, of course, requires a period that may last for months or for a year, according to the pre-existing conditions of the malaria service and the control program. When this period has elapsed, the second period begins, the one of total coverage, which means that each and every house in the transmission area should be sprayed in such a way that transmission is interrupted from the very beginning. Contact should remain broken until the sources of infection are exhausted, so that the sprayings can be discontinued without any danger of the re-establishment of endemicity. This period of total coverage will last from three to four years, according to existing conditions. The third period is that of suspension of the spraying operations. Chart No. 2 in the document deals with evaluation operations: reporting and registration of cases, parasitological verification of all cases, parasitological indices in individuals with fever, questioning, and epidemiological surveys in each and every instance. What each of these means is explained in the document. The Representative of Brazil had made an interesting reference to the practical value of parasitic indices in individuals with fever. The first point in the evaluation operations, the reporting and registration of cases, is a factor that until recently had no value whatever in the control programs. Charts 3 and 4 refer to supplementary operations and other responsibilities that are self-explanatory. Dr. Alvarado stated that these documents should be considered as practical guides for the organization and development of eradication programs. However, the Advisory Committee took other points into consideration. The Joint Committee on Health Policy had decided that UNICEF assistance should be given only when an efficiently organized antimalaria service was already existing; hence the need to define what should be considered as an efficiently organized antimalaria service. After giving

98 W.H.O. REGIONAL COMMITTEE 93 the matter considerable thought, the Committee declared that it was impossible to define for all countries how an adequately organized central service for the eradication program should be set up. The Committee did, however, stipulate a few requirements considered absolutely indispensable for carrying out such programs. First, such a service should occupy a primary place in the public health services, equivalent to that of a high-level administrative division. Second, the service should be headed by a full-time specialist having complete authority to carry out all technical and administrative activities required. Third, the necessary facilities for diagnosis should be provided or existing ones improved, so that during the eradication campaign all suspect cases can be confirmed by parasitological test. Fourth, there should be a qualified staff, sufficient in number and adequately remunerated, to devote their full time and energies to the program. The speaker referred to the question of the number of professional personnel considered adequate to enable the antimalaria service to cope with the problem. Studies had been made on the number and quality of personnel in the existing services of countries like the United States, Venezuela, Brazil, and Argentina, where satisfactory operations had been carried out; the minimum figures given for the services in Brazil and Venezuela, respectively, were 2.8 and 3.9 professionals on the malaria service staff for every 100,000 sprayings. Seeing that it was impossible to give a concrete suggestion on this point, the Committee agreed to take the above ratios as minimum figures, especially in view of the fact that the Representative of Brazil, then Chairman of the Advisory Committee, stated that the ratio of 2.8 professionals per 100,000 sprayings was considered insufficient in his country for carrying out the eradication program, and that he would attempt to have this number increased so as to develop a staff of the proper size and quality to face the new responsibilities. Another of the requisites established for an efficient antimalaria service was an adequate budget. The Advisory Committee also considered the problem of legislation. The Joint Committee on Health Policy had ruled that supporting legislation would be necessary. The Advisory Committee decided that such legislation should include: compulsory notification of all malaria cases; authorization to take blood samples for parasitological tests; authorization to enter homes to carry out entomological surveys and, above all, sprayings with insecticides; authorization to impose control over immigrants; authorization to obtain and to administer the required funds. Dr. Alvarado explained another point brought to the Advisory Committee's attention: the need to establish recommendations as regards delineation of malaria-infested areas. The old school of malariology had a set of orthodox rules by which it could be determined accurately where malaria transmission occurred. But these proved too complicated and too expensive for the purposes of an eradication program, in which it is not a question of measuring the extent of malaria in a certain region, but simply of determining whether it is present. In this connection, the Committee recommended that it would be sufficient to make an exploratory survey limited to detecting persons with fever, through house-tohouse visits, taking blood samples to verify the existence of transmission, and substantiating these findings by making entomological tests to confirm the presence of the vector in the house. With respect to insecticides, he said, the Committee made two recommendations of fundamental importance: first, that DDT continue to be used until proved inadequate to control transmission in a given location; and second, that the use of DDT as a larvicide be banned, a recommendation that should be extended to cover the entire group of chiorinated hydrocarbons, because their use is the surest and quickest way to build up resistance against insecticides in the anopheline vectors. Another very important recommendation, the value of which had been commented upon by several representatives, was that, when the existence of residual malaria-more properly called persistent malaria-has been proved, this fact should not be attributed to failure of the insecticide until it has been shown that such insecticide was properly applied. He stressed this point because, as a usual thing, which one sees happening everywhere, as soon as new confirmed cases of malaria appear in areas that have been sprayed, the service personnel claim that the insecticide is at fault or that people are sleeping outside their houses; that the house walls are too flimsy for the insecticide to be applied; or, which is still more serious, that there is presumption that a certain degree of resistance is appearing in the anopheline vectors. In most of the cases in which this state of affairs has been studied, it has been possible to show that the situation was due exclusively to poor application of the insecticide, because of an incomplete application within the house, because there was too long a period between

94 P.A.S.O. DIRECTING COUNCIL applications, or, what is more frequent still, because of the failure to apply the insecticide to many houses in the area where such cases of malaria occurred.

99 94 P.A.S.O. DIRECTING COUNCIL applications, or, what is more frequent still, because of the failure to apply the insecticide to many houses in the area where such cases of malaria occurred. The last recommendation of the Committee, the speaker explained, was to establish as a routine procedure a service responsible for measuring the susceptibility of the Anopheles to the insecticides. There are very simple procedures, the Busvine and Fay tests, which can easily be applied. PASO has already prepared practical recommendations to all the services on how to apply this observation as a routine measure. Dr. Alvarado went on to explain the status and activities of the small organization called COMEP. The first problem naturally was to set it up. It was not easy to find at this particular time employees qualified to take a direct interest in studying and working in malaria problems. As the Representative of Brazil had pointed out, the signal success achieved in the early control campaigns made the malariologists believe that their era was over and attention was turned to other fields. Fortunately for malariologists, conditions have changed and they are now facing a golden quarter of a century. But this is happening only just now, and the group of qualified malariologists has not yet been trained. So far, the COMEP staff-which should comprise, in addition to the chief, an epidemiologist, an entomologist, a malariological engineer, and a parasitologist-includes only the entomologist and the sanitary engineer. Therefore, many of the difficulties in reaching the countries with the advice and counsel for the solution of technical problems cannot be overcome because of lack of personnel. Another matter to which COMEP devoted a great deal of time was the preparation of the program for the eradication of malaria in Mexico. The importance and the magnitude of this problem are well known, and, according to directives from the Bureau, it was given priority. A result of this effort, in which the national personnel of Mexico performed so great a task, was the preparation of the plan of operations for malaria eradication in Mexico. The compilation of background material, the study and classification of it, and then the detailed preparation of the plan of operations, constituted a major task. The other point to which COMEP is now devoting attention is the preparation of a handbook of technical standards, with general instructions on preparing and carrying out an eradication program in the respective countries. The Office wants to prepare a handbook similar to that now in use for the yellow fever work, especially for the eradication of Aedes aegypti. But malaria eradication presents a more complicated problem, one that covers very different fields from those dealt with in the eradication of Aedes aegypti, for which there is a technique and long-standing experience. Dr. Alvarado then mentioned some of the technical problems encountered, such as the study of the equipment needed for the antimalaria campaign, which was not a simple matter, for in nation-wide eradication programs, and especially programs that are to be conducted throughout the Americas, equipment planning is fundamental. The WHO Committee on Insecticides issued complete specifications as to the requirements, those for insecticide sprayers, for example. A study of this matter by the COMEP engineer revealed, to cite a single example, that one of the spray guns considered as meeting all the requirements did not meet two major ones, and that later a number of other circumstances arose that made it necessary to review those specifications. As a result, it was decided that the technician should study the matter thoroughly, visiting factories and going to Geneva to discuss the point with the Expert Committee on Insecticides, which is to meet early next October. Dr. Alvarado said that the matter was of such great importance that he would like to explain what could happen. In the program in Mexico an average of 16,000 pounds of DDT will be used a day. A sprayer that does not work well, a nozzle that is faulty, will mean the loss of at least 10 % of the insecticide. The losses that occur because of faulty equipment are considerable, and his figures were minimum ones. Ten per cent of 16,000 pounds is 1,600 pounds of DDT, the value of which will amount to $400,000 during the entire course of the program. He considered it very worth while, then, for this problem of equipment, especially the problem of sprayers, to be thoroughly studied, not only in the interest of the service and the quality of the work, but also because of the importance of this problem to the agencies collaborating in this campaign, especially UNICEF, which so far has been providing the insecticide in the cooperative programs. Dr. Alvarado concluded by saying that an eradication program can be compared to a watch movement. The movement of the parts should be most precisely adjusted, so that the operations can follow the initial program regularly, one after the other, and the results can be measured in such a way as to be discernible and comparable. This requires not

100 W.H.O. REGIONAL COMMITTEE 95 only a devotion to detail on the part of the services and the authorities in every country but a great interest and a great effort on the part of the international agencies entrusted with the responsibility of orienting and coordinating these programs. Dr. Alvarado assured those present that his group, that the Organization, is ready to carry out faithfully that task. The CHAIRMAN thanked Dr. Alvarado on behalf of the Directing Council, and on his own behalf, for the valuable statement on the malaria problem. Interpreting the feelings of the representatives, he asked the Secretariat to have a complete transcription of Dr. Alvarado's statement made and distributed to the members of the Directing Council. He then invited Mr. Robert L. Davée, Regional Director of UNICEF for the Americas, to address the Council. Statement by the Representative of UNICEF Mr. DAVÉE (Observer, UNICEF), after expressing his appreciation of the honor of speaking before the meeting, explained that the purpose of his remarks was to report on and review UNICEF's experiences of the past months, devoted to the preparation of malaria eradication campaigns with the technical aid of experts from the WHO and the PASB. He said that the Executive Board of UNICEF, meeting in New York the previous afternoon, had approved a total of $3,400,000 for malaria eradication programs. The total for these programs in 1955, he said, would be $4,000,000. The largest outlay was for Mexico, for which an allocation of $2,400,000 for the first eighteen months of the campaign was approved. This amount, and particularly the latter allocation, was certainly the largest sum ever approved by an international organization for a public health program. It was the result of the work begun last October at the meeting of the Pan American Sanitary Organization in Santiago, Chile, and of the efforts of Dr. Soper and Dr. Alvarado. It was also a proof of the confidence these experts inspire. There was no doubt that the decision required a certain amount of courage, the speaker said, for, as practical men, all those present were well aware of the risks involved in campaigns of this type. The decision is, therefore, of the utmost significance, since much of the future of international cooperation hinges upon it. As for UNICEF's stand with regard to the future, Mr. Davée said that the Executive Board gave its approval, in principle, to the preparation of malaria eradication programs throughout the world, up to a maximum outlay of $5,000,000 per year. Of this five million, UNICEF has already been authorized to assign three million to Latin America. Should anyone ask the reason for this relatively privileged situation, he would say that the main reason is that, of all the world, Latin America is the continent that has experts who can be considered among the foremost, both as to personal qualifications and as to number. Another reason is that the conditions of insect-vector transmission and the general conditions throughout the malaria areas are also the best known in the world. However, the figures quoted show already that there will be certain limitations to these activities. UNICEF already has certain commitments with Mexico that it wishes to honor. The speaker could not deny that certain figures he heard quoted that morning had made a deep impression on him. It was unfortunate, he said, that UNICEF did not yet possess any criterion or have any intellectual or administrative methods for selecting problems or establishing priorities. For example, at the beginning Brazil had not been included in the preliminary draft budget. The delegate of Brazil on the UNICEF Executive Board called attention to the problem, and the Board decided that there was no real reason why a program of activities in Brazil, subject to certain conditions and limitations, should not be considered. This meant that UNICEF's task would be more complicated. Mr. Davée could see but two possible criteria. The first is the limitation of available funds, which sets up a certain barrier beyond which the budget estimates cannot go; the second, and slightly easier of achievement, is the technical improvement of the entire project. He said that Dr. Alvarado had mentioned in this connection the work of the WHO/UNICEF Joint Committee on Health Policy, and there was no need to go further into the matter. He wished merely to recall the three fundamental criteria established by the Committee for judging the effectiveness of a project: (a) that the country have an administration especially or exclusively to deal with malaria; (b) that it possess legislation specifically on malaria; and (c) that the national budget include the funds required for conducting a true eradication campaign. Mr. Davée wished to supplement the information and data furnished by Dr. Alvarado on two or three points, which, while relatively minor, were quite important in practice.

101 96 P.A.S.O. DIRECTING COUNCIL The experience with the Mexico plan, in particular, shows that it is also important-and he believed Dr. Alvarado had not mentioned this-for the administration to have a certain flexibility in its budget. Mexico is going to establish an independent administration, with a National Council on Malaria Eradication. The country has also created a fund with a special legal basis that will permit flexibility in the handling of budgetary funds and allocations; it probably will be possible to transfer funds received within one year to the next year, without the limitation that such funds be expended during the fiscal year, as is the case in certain countries, Brazil for example, a limitation that is such a handicap to the smooth execution of a campaign. The precedent established in Mexico is therefore, from that point of view, extremely valuable for the whole malaria eradication project. With respect to matters more directly related to UNICEF, there were two important factors that Mr. Davée wished to mention: vehicles and insecticides. The problem of vehicles has always been a critical one in UNICEF campaigns in Latin America, and it will be particularly so in the malaria eradication campaign. In the case of Mexico, UNICEF's capital investment for vehicles will be one million dollars. This is an enormous, almost colossal amount, he said, when speaking of public health campaigns. It is UNICEF's hope that this fleet of vehicles will last for the duration of the campaign, and the Government has made the commitment that it will. Such a fleet will require special regulations on driving, maintenance, repair shopsin a word, a whole series of regulations will be necessary and UNICEF is counting on them heavily. Should the Mexican campaign show any sign of failure on this score, he said, there is no question but that it would discourage UNICEF from undertaking additional campaigns in other countries. The speaker then pointed to the fact that it is not advisable to request excessive amounts of insecticides from UNICEF at any one time. Experience in the various countries has shown that the storage of large quantities for long periods may weaken the potency of the insecticides, even though at the time of purchase they complied perfectly with WHO specifications. Another point Mr. Davée wished to make, as the result of previous experience, was the matter of "surprises"-surprises for the non-specialists, like himself, and sometimes even for the specialists. In the first place, we have learned to appreciate the importance of the epidemiological service in the malaria eradication campaign, and of the evaluation service as well, and there is no doubt that these services entail certain supplementary expenditures in the national budget estimates. A surprise that perhaps will never disappear, perhaps a rather bitter one, is the concept of the extent of the malariainfested area. Mr. Davée feared, for his part, that when a more exact idea was gained of the extent of the malaria-infested area, some programs would far outgrow the preliminary budget estimates of the national governments and of the international agencies. With respect to this point, Dr. Alvarado and Professor Ferreira had already stressed the necessity of complete 100% coverage. There are, for instance, the areas of low endemicity that were disregarded in the control campaigns and will have to be included in the eradication campaign, a factor Mr. Davée believed, that will increase considerably the budget of any eradication campaign. Finally, another difficult point arises when making the distinction between a control program and an eradication campaign. He had been pleased to hear Dr. Soper's phrase, quoted by Dr. Alvarado, that "an eradication campaign is not merely the extension of a control campaign; it is the transformation of it." He was afraid that this fact, too, is a bitter surprise to some countries. He did not wish to sound pessimistic, as UNICEF had just made decisions of an optimistic and confident nature-but on the one hand there was the prospect of future budgetary limitations, and on the other hand an increase could be foreseen in the expenditures that were estimated a few months ago. In view of these limitations, it was difficult to decide what the best strategy would be. There is a geographic criterion, he said, with which the work had started in Mexico. The geographic strategy consists in starting eradication at the border of a country already free from malaria, the United States, and continuing it down to the narrow strip that ends on the Isthmus of Panama. To this part of the Hemisphere would be added the islands of the Caribbean, where, everyone agrees, eradication is feasible. This would provide, if he might suggest a time schedule, a sort of work plan, covering let us say Central America in 1956 and South America in This was, of course, only a planner's suggestion, he said, which might not fit in at all with conditions in a given country. He mentioned it only to state what the point of view might be of one who has to take part in continental planning.

W.H.O. REGIONAL COMMI=TEE 97 On the other hand, he thought that imagination might be used in trying to find certain criteria and certain rules of strategy in planning.

102 W.H.O. REGIONAL COMMI=TEE 97 On the other hand, he thought that imagination might be used in trying to find certain criteria and certain rules of strategy in planning. For example, one point that had impressed him was the fact that two malaria eradication programs submitted to the present meeting of the Directing Council showed quite different cost estimates. One program estimated the per capita cost at $0.25, whereas the other set the figure at $0.40. That morning he had heard of a cost estimate for Colombia amounting to $4.40 per house for two annual sprayings, if he was not mistaken, and if he was he would appreciate being set right on this important point. Yet according to estimates for eradication campaigns carried out in the United States in 1948, the cost per house was $3.50, which apparently means that the Colombian estimate is high. According to his estimates, the cost for Mexico will be $1.25 per house. There are thus cost differences that are evidently due to specific conditions in each country, such as cost of living, wages, and other factors that must be taken into account. There is a whole scale of different costs, and it would be to the common interest to find an average one that would be economically sound; in this respect, on the basis of the Mexico experience, he could think of three phases of the work in which economies might be achieved. The first is the output of the men who do the spraying, and this is a matter in which UNICEF can be of assistance, inasmuch as the supply of vehicles raises the workers' output considerably. For example, in reviewing recent programs it was found that in Mexico one man can spray ten houses per day, and in other programs in El Salvador the output was 6Y2 houses per man-day. Of course, here too there is a certain margin, a certain difference, which finds expression in higher or lower costs for the interested government. Another aspect is the use of dieldrin instead of DDT, by which the speaker did not mean to recommend one insecticide in preference to another. There was the experience of Venezuela, Guatemala, and Mexico, and whenever it is possible to spray twice a year dieldrin is undoubtedly more economical to use than DDT. Finally, there was the barrier technique introduced by Dr. Alvarado in the Mexican program; taking into account the final total of houses protected, this technique constitutes a real saving of 20%. This is a very delicate point, which in itself might justify setting up a sort of "working party." It is unfortunate, Mr. Davée said, that the burden of other work is so heavy on all, but he thought that the governments might give considerable help to international efforts if they took upon themselves what Dr. Alvarado called the preparatory year. The preparatory year, in the case of Mexico, represents a large expenditure, particularly for UNICEF. If expenditures for this phase of the work did not have to be made in other largescale programs in countries where, in his opinion, such action is possible-especially because those countries are ones where malaria is not a new problem-that would be one way of making the limited funds stretch as far as possible. But the most delicate point is to ascertain to what extent it is possible to utilize what has already been done under the philosophy and techniques of control when that program is transformed into an eradication campaign. On this point the experts are decided. As a matter of fact-and this is the meaning of the "transformation" of a control campaign to an eradication campaign-control work, to put it bluntly, counts for very little when an eradication campaign is undertaken. And when the experts conceive of an eradication campaign, in most cases they conceive of it as meaning the obligation to repeat for three or four years exactly what has already been done, but to an even greater extent, since eradication must include the areas of low endemicity that were often disregarded in the control campaigns. This is the point that causes UNI- CEF the greatest concern. He mentioned this because of UNICEF's confidence in the experts who have accepted the conclusions just cited; but he would like to suggest the following point for the representatives to consider: Determine whether the areas that were properly treated during a wellconducted control campaign may have reached the point in the time schedule where spraying can be interrupted. As he was not a specialist, he only stated the problem; he was not attempting to solve it. Mr. Davée, in concluding his remarks, asked to be pardoned if he spoke too frankly. UNICEF funds were going to be short; if it was wished to go beyond the limit authorized for the present for Latin American countries, he was convinced that greater aid would have to be received from Latin America. UNICEF is a world organization; it has to keep a certain equilibrium and must follow a certain philosophy of justice. Nor can it destroy the balance of its programs. In many cases it would be a great shame if, in order to make a special effort to combat malaria, other highly useful campaigns were to be neglected, such as those being carried out against yaws and against leprosy or certain programs

103 98 P.A.S.O. DIRECTING COUNCIL of environmental sanitation. And with respect to this point he wished to make two other observations. The first was his belief that the work in this field deserves the total cooperation of international organizations. The second was that, as a European, he had been very slow in understanding the deep feeling, the historic force of Pan Americanism, and conferences like the present one had taught him a great deal. But at the same time, as a European and as an American, since he was bound to this Continent now by family ties, he wished to state how discouraged he had been when he failed in the attempt to introduce the idea that Latin America could really make an effort, in its Pan American solidarity, through UNICEF. This is the psychological moment, he said, because a continental eradication campaign is being launched, and therefore his plea was twofold: one, that we not let ourselves be discouraged when occasionally faced with the situation that a country weighs its aid to us in terms of our efforts in its behalf. He was not disputing that philosophy, but he did dispute the fact that these terms are often very narrow. Moreover, and this was the second part of his plea, he wished to call upon the more fortunate countries of Latin America, which are precisely those that neither need nor request aid of UNICEF, to give thought to how, using what UNICEF does as the instrument, they can really help their brothers in Latin America. The CHAIRMAN, on behalf of the Directing Council, thanked Mr. Davée for his very pertinent remarks on UNICEF aid in the continental antimalaria campaign. He asked the Secretary also to have a full transcription of Mr. Davée's remarks made and distributed. The session was adjourned at 12:35 p.m. TWELFTH PLENARY SESSION Friday, 16 September 1955, at 2:50 p.m. Chairman: DR. HÉCTOR A. COLL (Argentina) The CHAIRMAN called the meeting to order. The SECRETARY reported on the order of business established by the General Committee, saying that, if examination of the topics were completed on schedule, the technical discussions would start on Saturday morning. Topic 26: Conditions of Employment of Regular and Project Personnel in the PASO/WHO (Document CD8/36) The SECRETARY read Document CD8/36 containing a report by the Director on the problem of differences in the conditions of employment of the regular and the project staff of the PASB. Dr. BRADY (United States) said that this document showed that the problem was very complex and difficult, since it raised questions on fairness to the employees of the PASB and to the Organization itself and on relations with other agencies. He therefore considered it advisable that a working party be appointed to make a more detailed analysis of the problem and to present pertinent recommendations. In view of the complexity of the issue, time would be saved in this way. Dr. HURTADO (Cuba) said that the document was informative, touching on different aspects of the problem. He thought it quite possible that this matter would give rise to difficulties, some of a psychological nature and others based on real facts. Although he agreed in principle with the statement of the Representative of the United States, he said that, in view of the present status of the Directing Council's deliberations and of the numerous matters that remained to be taken up, among them the technical discussions, it was improbable that the working party would have sufficient time for a thorough study of such a complex question as had been raised in the document just read. Therefore, he suggested that the Directing Council submit the matter to the Executive Committee for consideration, so that this body could study the problem and propose the recommendations it deems advisable. Dr. SOPER (Director, PASB) said that he had listened with great interest to the statements of the Representatives of the United States and Cuba. Indeed, the problem is very complex, as are the conditions under which the work of the Bureau must be carried out at present. The system now being followed, with respect to the personnel, leads

104 W.H.O. REGIONAL COMMITTEE 99 to complicated procedures, excess work, and administrative pressure. Nevertheless, desirable though it may be to seek simpler working procedures, it cannot be said that this aspect of the question requires a hasty solution. What is really urgent is consideration of certain aspects of the Staff Rules concerning salaries paid to regular employees and to project personnel, and those cases in which members of the regular staff are, because of circumstances, assigned to field work. At present there is evidently a situation of unfairness that makes for difficulties. The WHO has been approached with a request that it provide a solution, but the only result was a promise that the matter would be discussed in 1956 by the Consultative Committee on Administrative Questions of the-united Nations. The most difficult aspect of the problem concerns those members of the regular staff who, because of the growth of the Organization and the development of its programs, have been assigned to projects and have been authorized the allowances of both regular and project staff. Twenty members of the regular staff are in this category. Six of them receive salaries from the Pan American Sanitary Bureau funds, seven from the United Nations Technical Assistance funds, and seven from the Technical Assistance funds of the Organization of American States; but not a single employee in that category receives his salary from the WHO. The present state of affairs requires inmediate action. Something must be done before the end of The PASB personnel have too long been subjected to the above-mentioned inequities. Under these conditions it is impossible for the Organization to have personnel who, because they are satisfied with the treatment they receive, are willing to remain in their posts indefinitely. Naturally, when better salaries are offered to persons working on a project, it is difficult to find competent persons who are willing to work on a permanent basis in the Organization under less favorable conditions. Dr. Soper said that two weeks ago, during his visit to Paraguay on the occasion of the border meeting of the Rio de la Plata countries, he interviewed the Bureau personnel. After the preliminary comments had been made, those present were invited to bring up any point they considered to be of interest, and the questions raised referred precisely to problems like those indicated in the document read at this session. It is evident that, as had been stated by several representatives, the matter requires detailed study. Therefore, what could be done was to appoint a committee similar to the one named when the Headquarters' buildings were purchased; at that time, the Pan American Sanitary Conference held in 1950 appointed a subcommittee composed of three countries to study the problem, in collaboration with the Director. Obviously, as the Representative of Cuba said, it would be most difficult for a working party to study the problem and to propose a solution within the few days left before the end of this meeting of the Council. However, it is essential that definitive action be taken before the end of the year. Dr. BRADY (United States) said that, after hearing the statements made by the Representative of Cuba and by the Director of the Pan American Sanitary Bureau, he was convinced that a working party was not necessary. Either the proposal of the Representative of Cuba or that of the Director of the Bureau would meet with the approval of the delegation of the United States. Therefore, he withdrew his proposal. Dr. HURTADO (Cuba) thanked the Representative of the United States for withdrawing his proposal because, in that way, he felt that the discussion would be expedited. He considered that the problem should be submitted to the Executive Committee for consideration, because, among other reasons, the Committee would meet immediately after the Council concluded its deliberations and, consequently, the matter would not be unduly delayed. He was not in favor of the appointment of special committees; in fact, he was opposed to them even when the Permanent Subcommittee on Buildings and Installations was constituted, because, in his opinion, such committees impinge upon the functions of the Executive Committee. It must be borne in mind that the Pan American Sanitary Organization has a triple system of government, consisting of the Conference, which is its parliament; the Directing Council, which represents the Conference; and the Executive Committee, whose functions are exactly what its name implies. The Directing Council should not circumvent the Executive Committee, but rather entrust it with matters like the present one, and not constitute other special bodies for that purpose. However, in view of the complexity of the issue now under study, Dr. Hurtado considered it proper to recommend to the Executive Committee that it appoint a subcommittee to study the matter. He asked that a resolution be adopted to take note of Document CD8/36 and submit the question to the Executive Committee for study,

105 100 P.A.S.O. DIRECTING COUNCIL with the recommendation that it be given preferential attention. Dr. ALLWOOD PAREDES (El Salvador) pointed out that nothing had been said that could serve as a guide in solving the matter under discussion, whether the question be referred to the Executive Committee or to any other body. The document that was read emphasized the distinction between project and regular personnel and mentioned the dissatisfaction of the latter staff members because they feel that they are working under less favorable conditions than the former. However, it also stated that the project personnel with one or two-year contracts have raised the question of the duration of such posts, expressing the desire to be placed in more secure positions. That is to say, the same discontent that exists among the regular personnel is also present among the project personnel, and there are some project employees who would like to occupy permanent posts at Headquarters or in the Zone Offices. Certainly it would be a mistake not to create certain incentives for the project personnel, though, of course, in such a way that they will not work a hardship on the rest of the employees. Without such incentives, experts could not be recruited to go to countries where their services are of vital importance. It is necessary to establish conditions that are satisfactory both to the Headquarters and the Zone Office personnel, yet without creating differences that would make the project work unattractive. The matter should be studied on the basis of specific data for each case and situation. What is needed is to examine the problem, keeping in mind the broad outlook of the Bureau's policy of work. The CHAIRMAN felt that, if the problem is to be solved intelligently, it would be advisable for the Bureau to ascertain two specific points: the first refers to the possible budgetary implications of changes proposed in connection with personnel recruitment conditions, and the second matter is determining who has the responsibility and the authority to change the established salary scales. Mr. HINDERER (Chief, Division of Administration, PASB) replied that it was impossible to give a precise answer to the first question raised by the Chairman until it was known exactly what changes would be made in the present situation. The Director has not recommended a general increase in salaries, but a thorough study is being made of the problem. Some months ago the Government of the United States increased the salaries of its employees by 7.5 %, and because of this fact the question of the salaries of employees in international organizations located in Washington has been raised. Most of such organizations have agreed to increase salaries, in some cases for the entire staff and in others, for the local personnel only. Unfortunately, the study of the matter could not be completed before this meeting of the Directing Council, and it is therefore impossible to give exact figures. But, in principle, a salary increase for local personnel could be estimated to be approximately 6% of the present figure, amounting to some $20,000. As to the second question, the Staff Rules now in force were approved by the Executive Committee, and it is this body that has the authority to approve such changes therein as it deems advisable. Many of the factors affecting the problem have their origin in the United Nations Technical Assistance, whose staff rules were adopted, in part, for the purpose of uniformity, by the World Health Organization and, in turn, by the Pan American Sanitary Bureau. Dr. HURTADO (Cuba) said that the discussion had shown the need for a detailed study of the document presented, in order to find solutions of an executive nature, because the Director, for the present, has limited himself to reporting on the existing concern over the situation, without presenting the data in concrete form. When such solutions are found, they no doubt will be financial. The Director sees a danger in the present system, in which the personnel in field services receive higher salaries than the regular employees. Apparently, this danger arises from the fact that the experts prefer to work- in the field. But it is also evident, as the Representative of El Salvador pointed out, that there are employees who prefer the privileges enjoyed by those working at Headquarters. Nothing should be done that might weaken the field programs as a consequence of strengthening the bureaucratic services, because this would be contrary to the Organization's general policy. If the solution of the problem requires a decision of a financial nature, such a decision will have to be taken by the competent bodies, since the Director cannot raise or lower salaries except within the budget limits. The approval of any measures that might go beyond such limits is incumbent upon the Directing Council. Dr. Hurtado agreed, to a great extent, with the statement of the Representative of El Salvador, to the effect that the Directing Council should define its views on the substance of the matter, but he

106 W.H.O. REGIONAL COMMITTEE 101 felt that the most expeditious manner of arriving at a solution was the procedure he had proposed previously and which he restated in the following terms: that the Directing Council take note of the document presented and transmit it to the Executive Committee, with any additional data that might serve as background information. Mr. BARROS (Chile) considered that the document under discussion contained interesting background data on the personnel situation and the differences in salary rates and allowances. He was certain that the government will give due consideration to measures to put an end to any injustices that may exist. However, the fact must be recognized that the document is not so complete as to enable the Directing Council to make specific recommendations. Further information is required in order to settle the matter and, to that end, he supported the motion of Cuba to transmit the document to the Executive Committee, together with a report of the Director and all other pertinent data. Dr. SOPER (Director, PASB) said that this matter arose as the result of a letter received from the World Health Organization, but in reality Article 030 of the Staff Rules sets forth the administrative procedures to be followed in this case. Mr. ANGUIANO (Guatemala) said that, as a member of the Permanent Subcommittee on Buildings and Installations, he was aware of the benefits derived from the work of that committee. He therefore favored the establishment of a similar body, also on a permanent basis, to deal with personnel matters. The creation of such a committee, which would in no way lessen the regular powers of the Executive Committee, would be a practical move, demonstrating the interest of all the countries in ensuring the adequate remuneration of personnel serving with the Organization. Dr. HURTADO (Cuba) recognized the advantages of establishing a subcommittee specifically entrusted with the study of personnel problems. He admitted that the Subcommittee on Buildings and Installations had successfully performed the task entrusted to it. Nevertheless, he considered that the Directing Council should not, at this time, create a special subcommittee for the subject under consideration. Matters concerning buildings require continuous attention, but the question of salaries is a problem of the moment and, once it has been solved, the subcommittee will no longer be needed. To simplify the discussion, however, he agreed that the motion before the session should contain a recommendation to the effect that the Executive Committee bear in mind the desirability of establishing a special subcommittee. Mr. ANGUIANO (Guatemala) agreed with the spirit of the statements of the Representative of Cuba but disagreed with the idea that the special subcommittee would outlive its usefulness after the present problem was resolved. On the contrary, the work of that body would be just as useful in the future as that of the Subcommittee on Buildings and Installations has been, since the problems concerning personnel do not arise only once, but are constantly changing and require continuous attention. Therefore, he thought it advisable to specify that the committee be made permanent. With this clarification, he accepted the proposal of the Representative of Cuba. Dr. JIMÉNEZ GANDICA (Colombia) pointed out that several motions had been made during the discussion, a fact that indicated the importance of the question. He agreed with the Representative of Cuba and seconded his motion, believing that the matter should be transmitted to the Executive Committee so that the latter could adopt the procedure it deems desirable, including the possible establishment of a subcommittee. The study of the problem is a function of the Executive Committee and anything that might detract from that Committee's functions or powers should be avoided. Decision: It was unanimously agreed to take note of Document CD8/36 and to transmit it to the 27th Meeting of the Executive Committee for study, with the express recommendation that the Committee give it special attention and consider the advisability of establishing a subcommittee charged with examining the conditions of employment of regular and project personnel of the Pan American Sanitary Organization/World Health Organization.' The session was recessed at 4:25 p.m. and resumed at 4:55 p.m. Invitations from the Governments of Guatemala and Ecuador Regarding the IX Meeting of the Directing Council The SECRETARY reported that he had received a note from Mr. Humberto Olivero, Representative of Guatemala to the VIII Meeting of the Council, Resolution XVII, p. 13, also General Committee, p. 122.

102 P.A.S.0. DIRECTING COUNCIL transmitting a cable received from the Ministry of Foreign Affairs of that country, in which the Government extended an invitation to have the IX Meeting of the

107 102 P.A.S.0. DIRECTING COUNCIL transmitting a cable received from the Ministry of Foreign Affairs of that country, in which the Government extended an invitation to have the IX Meeting of the Directing Council held in Guatemala City. He said that another communication had been received from Dr. Emilio Romero Menéndez, Representative of Ecuador to the present meeting, extending an invitation on behalf of his Government to have the IX Meeting held in Quito. Topic 16: General Program of Work in the Region of the Americas during the Period (conclusion) Motion of the Representative of El Salvador The CHAIRMAN stated that Document CD8/121 on this topic had already been fully studied. He submitted to the Council for consideration a proposed resolution (Document CD8/71) on this subject, presented by the Representative of El Salvador. Dr. ALLWOOD PAREDES (El Salvador) requested that a few minor changes be made in the text of the proposed resolution, to read as follows: THE DIRECTING COUNCIL, Considering that paragraph 1 of Resolution III approved by the Council at its VII Meeting sets forth guiding principles and methods suitable for the development of a plan of long-range public health programs; Taking into account Resolution I of the XIII Pan American Sanitary Conference, which requires that the Pan American Sanitary Bureau consider itself responsible only for those programs or recommendations that are supported by budgetary funds; Having in mind the recommendation adopted by the Eighth World Health Assembly in Resolution 10, paragraph 2; and Having seen Document CD8/12 presented by the Pan American Sanitary Bureau, RESOLVES: 1. To reaffirm the principles and methods approved in Resolution III, paragraph 1, of the VII Meeting of the Directing Council, with respect to the plan of long-range public health programs. 2. To recommend to the Member Countries that have not yet done so that they prepare, during the year 1956 if possible, national plans for public health work for the period To recommend to the Director of the Pan American Sanitary Bureau that he prepare, in consultation with the governments and in accordance with the plans they have ' See Annex 1, p drawn up, the proposed annual programs and budgets for the period He pointed out that when long-range programs are prepared it is necessary to take into account the principles set forth in Resolution III of the VII Meeting of the Directing Council, together with the terms of Resolution I of the XIII Pan American Sanitary Conference, which stipulates that the Bureau should consider itself responsible only for those programs and recommendations that are supported by budgetary funds. Resolution WHA8.10 of the Eighth World Health Assembly is mentioned because it states that it would be desirable for each regional committee to formulate a general program of work for the region concerned for the period Therefore, because of the authority conferred upon the Regional Committee by the Assembly, the decision adopted would carry the necessary authorization of the governing bodies. Dr. BRADY (United States) made some general comments on Technical Assistance funds. In the first place, he said that for this year and next there would be greater financial stability in the Technical Assistance Program than in previous years. There had also been talk of a possible fluctuation in the program of the specialized agencies, and it had been said that there might be a decrease of 15 % in health programs. In his opinion, this was a pessimistic attitude, as by the same token there might be a 15 % increase. Whether there is an increase or a decrease depends on the ability of the health officers in the countries to convince the other ministries of the important role of health in economic development. With respect to the resolution presented by the representative of El Salvador, Dr. Brady felt that all were agreed that long-range planning of public health programs is very necessary, but the third operative paragraph of the proposed resolution seemed rather ambiguous to him. Supposedly, it refers to the proposed annual programs of the budgets of international assistance, but the reference might be to technical assistance funds; and whether such funds are for country or for intercountry programs is not clear. He asked the Representative of El Salvador to elaborate on this question. Dr. ALLWOOD PAREDES (El Salvador) explained that his proposed resolution was based on the fact that, when the Directing Council and the Conference have had to set up plans for long-range programs, they have done so on the basis of priorities that in the long run were not easy to follow, as they had to be modified because of economic cir-

108 W.H.O. REGIONAL COMMITTEE 103 cumstances or decisions made by other agencies. In Document CD8/12, and in the others referred to in the proposed resolution, the importance is stressed of having the Bureau carry out its work in the future according to and in harmony with the programs prepared bythe governments. The fact that the proposed resolution recommends that the countries prepare national programs of work for the period would be an incentive to the countries to fill an urgent need. Some of the governments have already prepared programs, but others have not. It would be most helpful if all of them prepared programs for that period, to be included in the general program of work of the PASO and the WHO for these four years. In reply to the Representative of the United States, he said that no reference was made in the proposed resolution to Technical Assistance funds, because both Technical Assistance and the aid from other international agencies, such as that provided under the bilateral agreements with the International Cooperation Administration of the United States and the assistance that UNICEF might give to national programs, would already have been taken into consideration in the plans of the governments. Thus the Bureau would be able to prepare programs in accordance with the needs of the countries and could take into account, in any long-range planning, the contributions of international agencies for country as well as intercountry programs. Dr. ORELLANA (Venezuela) recalled that in connection with Document CD8/12, which had been examined and highly praised at the ninth plenary session, two points had been raised: first, acceptance of the document as a general plan or statement of principles of the Bureau for the guidance of its work programs during the next four years, a statement making it an important instrument that would set very valuable policies. In the second place, there was the proposal of the Representative of El Salvador, which took the matter up in greater detail. The speaker thought that the Council should take a decision on the document presented by the Director, which is the fundamental issue. The CHAIRMAN asked the Representative of Venezuela if he wished to make any amendment to the proposed resolution of El Salvador. Dr. ORELLANA (Venezuela) felt that the correct procedure was first to adopt a resolution on Document CD8/12 and then to study separately the proposed resolution of El Salvador. Dr. FERREIRA (Brazil) agreed that the fundamental document on this topic was the one presented by the Director of the Bureau, which stems from Resolution WHA8.10 of the Eighth World Health Assembly. However, he did not feel that approval of this document was incompatible with the resolution proposed by El Salvador. It might therefore be possible to include in the latter resolution the first operative paragraph of the resolution of the Eighth World Health Assembly, which, adapted to the Region of the Americas, would read as follows: "Considers that this program of work provides a broad general policy for the development of detailed annual programs in the period for the Region of the Americas." There was a certain contradiction, he felt, between paragraphs 2 and 3 of the proposed resolution of El Salvador, as paragraph 2 did not state that the programs prepared by the governments should be reported to the Pan American Sanitary Bureau; yet if this were not done, the Bureau could not prepare its proposed annual programs and budgets in accordance with the national programs. He suggested that, by remedying this contradiction, it would be possible to combine the proposal of Venezuela with the proposed resolution of El Salvador. The CHAIRMAN suggested that this contradiction could be corrected by stating in the proposed resolution that the governments will report their national programs of work for the period to the Director of the Pan American Sanitary Bureau. Dr. ORELLANA (Venezuela) agreed with the suggestion of the Representative of Brazil, but believed that the first paragraph, instead of stating that "this program provides a broad general policy... " should make a more concrete statement, as for example that the Council decides "to adopt the program of work indicated in Document CD8/12, which sets forth the general standards..." Dr. HURTADO (Cuba) asked the Representative of El Salvador if he agreed to the changes suggested. Dr. ALLWOOD PAREDES (El Salvador) replied that he had no objections. The CHAIRMAN, summarizing the discussion, stated that it was proposed to adopt a resolution whose operative part would be worded as follows: (1) To adopt the Program of Work indicated in Document CD8/12, which sets forth the general standards for the preparation of the detailed annual programs for the Region of the Americas for the period (2) To reaffirm the principles and methods approved

104 P.A.S.O. DIRECTING COUNCIL in Resolution III, paragraph 1, of the VII Meeting of the Directing Council, with respect to the plan of long-range public health programs.

109 104 P.A.S.O. DIRECTING COUNCIL in Resolution III, paragraph 1, of the VII Meeting of the Directing Council, with respect to the plan of long-range public health programs. (3) To recommend to the Member Countries that have not yet done so that they prepare, during the year 1956 if possible, national plans for public health work for the period , informing the Director of the Pan American Sanitary Bureau of such plans so that he may prepare suitable proposed annual programs and budgets for the period Decision: The proposed resolution on this topic was unanimously approved as read by the Chairman.' Motion of the Representative of Brazil (Economic Impact of Health Programs) The SECRETARY announced that the delegation of Brazil had presented the following proposed resolution for consideration: THE DIRECTING COUNCIL, Considering that the methods now being used to combat many diseases, whether in eradication or in control campaigns, bring to light social implications and economic repercussions that can be adequately measured; Considering that there is no better way of obtaining funds than by having them appear as a capital investment; and Considering that the proper presentation of requests for such investment will make it possible to observe its discernible effects on the entire national economy, RESOLVES: To recommend that the Director make a study on methods of assessing the economic impact of health programs on the national economy of Member Governments. The CHAIRMAN asked the Representative of Brazil whether he felt that the resolution just adopted covered the same subject as the proposal he was now presenting or whether he would like his proposal to be submitted to the Council for consideration. Dr. FERREIRA (Brazil) requested that, in view of the importance of the economic aspect of public health work, the proposed resolution be submitted to the Council for consideration. Dr. ALLWOOD PAREDES (El Salvador) said that the resolution proposed by Brazil did not fit into any of the topics in the agenda of the meeting; he felt, consequently, that it should be considered as a new topic and that the normal procedure should be followed in placing it on the agenda. t Resolution XVIII, p. 13. Dr. WILLIAMS (United States) stated that his delegation considered the resolution proposed by the Representative of Brazil to be a matter of great importance and he seconded it. But he felt, as the Representative of El Salvador had pointed out, that this was a new subject and should go through the normal procedure before being taken up. Dr. FERREIRA (Brazil) stated that there were two points to be considered in connection with the subject brought up by his delegation. First, when the proposed program and budget was discussed, there were various statements to the effect that the financial contributions of the countries should be increased to allow for progressive development of the Pan American Sanitary Bureau. At that time his delegation had felt that one of the factors that might contribute to a clearer understanding of the investment of funds in public health work would be the adoption of a resolution along the lines he now proposed. On the other hand, a budget is made up of two parts: receipts and expenditures. Receipts are subject to certain limitations that are well known to all, and by means of this proposed resolution the delegation of Brazil wished to give the Director of the Bureau, through presentation of his study to the Member Governments, a basis for obtaining greater contributions from them. He felt, for that reason, that his proposal was related to the proposed program and budget and, without going into technicalities, he believed that it was proper to consider it. Dr. MONTALVÁN (Ecuador) understood the importance of the proposal of Brazil but, like the Representative of El Salvador, he believed that it did not fall within the scope of any of the topics on the agenda and that the normal procedure should therefore be followed. The CHAIRMAN read Article 15 of the Council's Rules of Procedure, which provides that supplementary items may be added to the agenda during any session of the Council if two thirds of the representatives present and voting approve. He therefore put to a vote the question of including on the agenda the resolution proposed by the Representative of Brazil. Decision: By a vote of 8 to 2, with 9 abstentions, the inclusion of the proposed resolution presented by the Representative of Brazil as a new topic on the agenda was approved. Dr. FERREIRA (Brazil) said that his delegation felt that the importance of its proposed resolution

110 W.H.O. REGIONAL COMMI'I1EE 105 was such that the proposal should not be subject to procedural difficulties. Furthermore, the proposal was related to the proposed program and budget, since it tended to procure for the Bureau greater financial support from the countries. However, in view of the discussion on the question of whether or not the proposed resolution should be considered at this meeting, and being convinced of its importance, he would withdraw it and present it at a time when it would not give rise to procedural difficulties. The session was adjourned at 6:00 p.m. THIRTEENTH PLENARY SESSION Saturday, 17 September 1955, at 10:10 a.m. Chairman: Dr. HÉCTOR A. COLL (Argentina) Later: Dr. JUAN ALLWOOD PAREDES (El Salvador) The CHAIRMAN called the session to order. The SECRETARY reported on the documents distributed and on the order of business. Topic 18: Rules for Technical Discussions at Directing Council Meetings (conclusion) The CHAIRMAN said that Document CD8/42, containing the report of the Working Party on Rules for Technical Discussions at Directing Council Meetings, had been distributed. This Working Party, composed of the Representatives of the Dominican Republic, Ecuador, Guatemala, and Panama, had suggested a series of changes in the proposed Rules in accordance with the observations and suggestions expressed by the Council at an earlier session, when this topic was under consideration. The Working Party considered as approved Articles 1 to 14 in the form adopted by the Directing Council. It recommended that Articles 17, 18, 20, and 22 be retained unchanged; proposed new texts for Articles 16, 19, 21, 23, and 24; and recommended deletion of Articles 25 and 26 from the original text, which read: Art. 25-The report of the rapporteur shall contain no recommendation or proposed resolution for consideration by the Directing Council. Art. 26-At the closing session of the Directing Council, the moderator shall present a summary of the activities conducted during the Technical Discussions. The Directing Council shall take note of this report without opening a discussion thereon. Mr. CALDERWOOD (United States) felt that the changes proposed by the Working Party accomplished the objective of bringing the Rules into accord with the revised Article 15 and were in general entirely satisfactory. He proposed, however, that the word "sufficiently" be deleted from Article 23, which reads: "The rapporteur shall present his report at a special session of the Directing Council, which shall be held sufficiently in advance of the closing session of the Directing Council." He said, furthermore, that he did not agree with the deletion of Articles 25 and 26 as proposed by the Working Party. Mention should be made of the fact that the Council is not normally expected to take up business after the report of the rapporteur of the Technical Discussions has been prepared. The deletion of these articles would lead to the supposition that the Directing Council will study the proposals contained in the report of the rapporteur. The Technical Discussions are held near the close of the sessions of the Council, when many representatives will have already left, so that it would be difficult to adopt resolutions on proposals arising out of the Technical Discussions. He therefore suggested that a new article be added providing that the Directing Council would take no action as a result of the Technical Discussions, unless the Directing Council, by a two-thirds vote, should decide otherwise. Dr. MONTALVÁN (Ecuador), as member of the Working Party, explained the reasons for the changes made in the draft Rules. With regard to the proposed new article, the Working Party had studied the question raised by the Representative of the United States but had felt it unnecessary to

111 106 P.A.S.O. DIRECIING COUNCIL include such a provision, in view of the new wording given Article 15 and the fact that the inclusion of a new topic requires a two-thirds vote and also the approval of the General Committee. Dr. HURTADO (Cuba) was not in favor of including the article proposed by the United States, since the Cuban delegation has always been opposed to negative provisions. Nor did he agree with the interpretation given to the requirement of a two-thirds vote, for the Technical Discussions are now part of the activities of the Council and are therefore included on the agenda. He supported the deletion of Articles 25 and 26. Mr. CALDERWOOD (United States) said that it was just because he, like Dr. Hurtado, understood that the rule requiring a two-thirds vote did not apply in this case that he had proposed the new article. Article 2 states that the study of the technical topic should produce "immediate and practical results." It had seemed to him difficult to reconcile this recommendation with the provision in the original draft that the conclusions of the report should not lead to any resolutions or recommendations. When he had pointed out this apparent inconsistency at the meeting of the Executive Committee in April, he was informed that the immediate and practical results would be obtained by the members of the Directing Council and by national health administrations adopting any measures that might appear to them useful on the basis of the recommendations. It was also pointed out that if any member were of the opinion that the Directing Council should take any action, it would be more appropriate to consider that question at the next meeting. Under the new text of Article 15 it would be possible for the Council to act on the conclusions of the Technical Discussion immediately. For this reason, he believed that the new article he had suggested should be included, thereby preventing the presentation of approval of new resolutions at the very end of the meeting of the Council, except as an extraordinary measure. Mr. OLIVERO (Guatemala) explained that one of the reasons that had led the Working Party to propose the deletion of the last two articles was that Article 24 already prescribed what the content of the rapporteur's report should be. Dr. BIssOT (Panama) remarked that the new text of Article 15 changed entirely the tenor of the Rules as they were approved at the 25th Meeting of the Executive Committee held in Mexico City. For this reason, it was believed advisable to specify that the report of the rapporteur should be presented at a special session before the end of the Council meeting. He said that it would be impossible to discuss the report when the meeting was drawing to a close. He supported the statements made by the Representatives of Ecuador and Cuba. Mr. CALDERWOOD (United States) accepted the suggestion made by Dr. Hurtado that the proposed article be stated in positive, not negative, terms. He therefore changed the wording he had proposed as follows: Art. 25-The Directing Council normally will take note of the report of the rapporteur unless, by a twothirds vote, it decides otherwise. The CHAIRMAN announced that, if there was no objection, the motion proposed by the Representative of the United States would be put to a vote. Dr. FERREIRA (Brazil) wished to ask, before the vote was taken, whether the interpretation of Article 10 of the Rules of Procedure of the Council on the count of two thirds of the votes was sufficiently clear so that difficulties would not arise in the future. The CHAIRMAN considered that Dr. Ferreira had raised a point of order. Dr. SOPER (Director, PASB) observed that this was not the first meeting of the Council at which this problem had arisen nor was this the only organization where it had been raised. He thought that the decision of the Chairman at the session of the previous day was the most logical one; if a Member Country abstains from voting, it voluntarily leaves the decision in the hands of the others. He added that, in his opinion, the abstentions do not invalidate the quorum and should not automatically interrupt the work of the Directing Council. Motion of the Representative of Cuba (Rules of Procedure of the Directing Council) Dr. HURTADO (Cuba) thought that the question raised by the Representative of Brazil was not one of order, but an incidental point. He did not wish to go deeper into the substance of the question, but felt that a legal interpretation was involved and that a report thereon should be given by the legal adviser, who should include in the opinion a study of the problem of the two-thirds majority, with the

W.H.O. REGIONAL COMMITTEE 107 count of the abstentions, as well as the problems of a quorum and of the instances in which a twothirds majority is needed. Dr.

112 W.H.O. REGIONAL COMMITTEE 107 count of the abstentions, as well as the problems of a quorum and of the instances in which a twothirds majority is needed. Dr. Hurtado moved that, on the basis of such a report of the legal adviser, the Director submit a report of his own to the Executive Committee, which, in turn, would submit its recommendations to the Directing Council. Dr. MONTALVÁN (Ecuador) agreed that the matter raised by Brazil was not a point of order. He summed up the discussion and supported Dr. Hurtado's proposal. The CHAIRMAN regretted having considered, perhaps mistakenly, that a point of order had been raised, and thanked the representatives for their clarification of the matter. Dr. FERREIRA (Brazil) apologized for having raised the point; he had only wished to have it clarified. He, too, supported the proposal of Cuba. Dr. SOPER (Director, PASB) said that the Bureau has not had a legal adviser for some time, as the legal section was abolished when the Bureau was reorganized. However, if a legal opinion is desired, the Bureau could ask it of Dr. Fenwick, Director of the Department of International Law of the Organization of American States. Dr. HURTADO (Cuba) thought it both surprising and unusual that the Pan American Sanitary Bureau, having such complex relations with other agencies and with the various countries, should be without a legal adviser. He objected to this situation and asked that the Council request the Executive Committee to study the re-establishment of the legal department, which is so necessary to an agency like the PASB. Resolution on he Rules for Technical Discussions The CHAIRMAN, considering that the discussion had strayed from the topic under study, called for a vote on the motion of the United States to include in the Rules for Technical Discussions at Directing Council Meetings the article whose text had been read by Mr. Calderwood. Decision: By a vote of 6 in favor, 5 against, and 6 abstentions, it was decided to include the article proposed by the United States delegation. The Rules for Technical Discussions, incorporating this article, were approved as a whole.' ' Resolution XIX, p. 14. Vote on the Motion of the Representative of Cuba (Rules of Procedure of the Directing Council) The CHAIRMAN said that a vote would be taken on the proposal of the Representative of Cuba according to which the Executive Committee would be asked to submit to the next meeting of the Directing Council a report based on the requested legal opinion. Dr. BIssOT (Panama) said that, although the matter raised by the Representative of Cuba was very important, it was not included in the order of business. Dr. HURTADO (Cuba) replied that the normal outcome of a discussion and the incidental resolutions arising from such a discussion should not be confused with the introduction of a new topic. He thought that the question he had raised was legitimate and that failure to take a decision on it would mean paralyzing the action of the Directing Council. The CHAIRMAN felt that, in submitting for consideration the motion presented by Dr. Hurtado and seconded by the Representative of Brazil, he had interpreted the wishes of the Council. Dr. SWELLENGREBEL (Netherlands) asked whether, since the question under discussion was a juridical matter, his delegation, which represents a territory, should vote. The SECRETARY read the pertinent articles of the Rules of Procedure. The CHAIRMAN stated that a legal opinion was under discussion, but not a juridical question on which the representatives of territories should not vote. He then put the proposal of Cuba to a vote. Decision: The proposal of the Representative of Cuba was approved, with 17 votes in favor, 0 against, and 1 abstention.l The session was recessed at 11:25 a.m. and resumed at 11:50 a.m. The SECRETARY made an announcement with regard to the trip of the representatives to Philadelphia, where the Centenary of the graduation of Carlos J. Finlay would be observed at the Jefferson Medical College. 1Resolution XX, p. 14, also General Committee, p. 123.

113 108 P.A.S.O. DIRECTING COUNCIL The Chairman invited the Representalive of El Salvador, Dr. Allwood Paredes, Vice-Chairman of the meeting, to take the Chair The CHAIRMAN submitted for discussion the next topic on the order of business. Topic 19: Selection of Topic for Technical Discussions during the IX Meeting of the Directing Council, VIII Meeting of the Regional Committee of the WHO (1956) (Document CD8/13) Dr. FERREIRA (Brazil) proposed as the topic for the Technical Discussions during the next meeting the subject, methods for the development of national public health plans. Dr. COLL (Argentina), Dr. WILLIAMS (United States), and Dr. JIMÉNEZ GANDICA (Colombia) supported the proposal. The SECRETARY read the proposed resolution appearing in Document CD8/13 and the title of the topic, as proposed in writing by Dr. Ferreira, as follows: "Methods for the Preparation of National Public Health Plans." Dr. COLL (Argentina) requested a rereading of paragraph 2 of the proposed resolution, in which the Director of the PASB was requested to designate an expert to present the introductory statement on the topic selected and to carry out the other measures prescribed in the Rules for Technical Discussions. Dr. MONTALVÁN (Ecuador) agreed to the proposed topic but considered paragraph 2 of the proposed resolution unnecessary, inasmuch as it repeats a provision already included in the Rules for Technical Discussions. The CHAIRMAN asked the Director of the Bureau whether a specific agreement on this point is necessary, since measures involving expenditures are concerned. Dr. SOPER (Director, PASB) thought that the approved regulations duly authorize him to adopt such measures, and he believed that the auditor would agree to the expenditures involved, either through a specific agreement or by virtue of the regulations. The CHAIRMAN called for a vote on the proposal of Ecuador to delete the second operative paragraph from the proposed resolution. Decision: By a vote of 10 in favor, 2 against, and 6 abstentions, Ecuador's motion was carried. It was unanimously agreed that the topic for the Technical Discussions during the IX Meeting of the Directing Council be the one proposed in writing by the Brazilian delegation and read by the Secretary.2 Topic 24: Resolutions of the WHO Assembly and Executive Board of Interest to the Regional Committee for the Americas (Document CD8/11) The CHAIRMAN said that this topic had been included on the agenda at the request of the Director- General of the WHO. The SECRETARY read Document CD8/11 informing the Council of the following WHO resolutions: WHA8.12 (Relations with UNICEF); WHA8.13 (Status of Annual Contributions); WHA8.20 (Public Information Activities); WHA8.30 and EB16.R16 (Malaria Eradication); WHA8.32 (Planning for 1956 Technical Assistance Program); and WHA8.38 (Smallpox Campaigns). Dr. SOPER (Director, PASB) wished to state, with respect to Resolution WHA8.13, that at the last moment he had received a communication from the Director-General of the WHO on the present status of the annual quota contributions of each American country. He announced that a note was being drafted to transmit the pertinent information to each delegation. The CHAIRMAN said that what was in order, then, was to take note of these Assembly and Executive Board resolutions and to state that the wishes of the Director-General of the WHO had been complied with. He pointed out, however, that in Resolution WHA8.30, on malaria eradication, the term "intensify," in connection with plans of nationwide malaria control, should be taken by the Pan American Sanitary Organization to mean the "conversion" of these programs along the lines described by Dr. Alvarado in his statement on the eradication programs, and that this fact should be brought to the attention of the Director-General of the WHO. Decision: Note was taken of the WHO Assembly and Executive Board resolutions of interest to the ' Resolution XXI, p. 14.

114 W.H.O. REGIONAL COMMITTEE 109 Regional Committee for the Americas, in the terms set forth by the Chairman.' Topic 22: Place of the IX Meeting of the Directing Council (Document CD8/10) The CHAIRMAN, in opening the discussion on this topic, announced that a proposed resolution had been prepared, omitting only the name of the country that is to be designated as seat of the next meeting, and that invitations had been received from two governments. Motion of the Representative of Argentina (Selection of the Seat of Meetings) Dr. COLL (Argentina) thought that the Council should resolve to hold the meetings successively in each of the Member Countries, in turn. The CHAIRMAN considered this to be an important proposal, but felt that, under some circumstances, it would be impossible for such a rotation system to operate. Dr. HURTADO (Cuba) saw the reason behind the idea of establishing a system of rotation, but he could not accept it as a set procedure since, as he recalled, it is necessary for the interested country to extend an invitation. He opposed establishing a system of rotation by a decision, but considered that such an order might be kept in mind each time the place of the next meeting is decided upon. The CHAIRMAN, while pointing out the difficulties that would arise if an order of rotation were formally established, found the proposal of Argentina very interesting. He put the proposal to a vote. Decision: The motion of Argentina was defeated by a vote of 10 to 2, with 8 abstentions. The CHAIRMAN mentioned that the two governments that had offered to be host to the meeting are Ecuador and Guatemala. Dr. SÁNCHEZ VIGIL (Nicaragua) felt that the country that is host to the next meeting should hold, at the close of the deliberations, a seminar on an appropriate and timely scientific topic. Mr. OLIVERO (Guatemala) explained the reasons that had led his Government to extend an invitation for the next meeting. The CHAIRMAN announced that, since only one country could be selected, a vote would be taken 'Resolution XXII, p. 15. by secret ballot. He asked Dr. Harkness, Representative of the United Kingdom, and Dr. Bissot, Representative of Panama, to act as tellers. The votes were counted, the representatives of twenty countries having cast their ballots. Four representatives were absent. The tellers announced the following result: Guatemala, 14 votes; Ecuador 5 votes; and one blank ballot. Decision: Having obtained the necessary majority, Guatemala was selected as seat of the IX Meeting of the Directing Council. The CHAIRMAN, after thanking the tellers, read the text of the proposed resolution, the preamble of which took note of the invitations received. The operative part set forth the following points: (1) the date of the IX Meeting and the place, Guatemala, in accordance with the vote taken; (2) the request that the Government of Guatemala and the Director of the Bureau conclude the pertinent agreement, following the approved model; and (3) provisions covering the eventuality that, owing to unforeseen circumstances, it might be impossible to hold the meeting at the appointed place. Dr. HURTADO (Cuba) thought that the resolution should state only that the place will be Guatemala, without setting a date, referring to the invitations of the governments, or including any other details. The CHAIRMAN said that the third operative paragraph of the proposed resolution was in keeping with previous resolutions of the Pan American Sanitary Conference. The SECRETARY read the background information and stated that the adopted resolution that pertains to cases in which the Conference cannot be held at the designated place could, by analogy, apply to the meetings of the Directing Council, if this body so desired. Dr. HURTADO (Cuba) reiterated his point of view, believing that only the country selected as the seat should be mentioned and that all other points are procedural details that need not be included in a proposed resolution. If, for some reason, the meeting could not be held at the place designated, the pertinent provisions of the regulations would, by analogy, be applicable. Dr. COLL (Argentina) agreed with the representative of Cuba. He thought that, in the event it should prove impossible to hold the meeting at the

115 110 P.A.S.O. DIRECTING COUNCIL designated place, there were enough precedents to permit appropriate action to be taken. Dr. ROMERO MENÉNDEZ (Ecuador) expressed pleasure at the selection of a sister republic like Guatemala as the seat of the next meeting, and he shared the views of the Representatives of Cuba and Argentina with regard to the brevity of the resolution to be adopted. The CHAIRMAN summarized the situation, recalling the terms of the proposed resolution and of the proposal presented by Cuba and supported by other delegations, to the effect that the text indicate only the selection made. Mr. BARROS (Chile) agreed that only the name of the country selected should appear in the resolution, and felt that the other views on the matter should be recorded in the minutes. The CHAIRMAN, after further comments by the Representative of Cuba, called for a vote on the proposal presented by Cuba and supported by other delegations. Decision: The motion was carried by a vote of 14 to O, with 3 abstentions, it being agreed that the resolution would consist of only one operative paragraph stating that Guatemala had been selected as the place of the IX Meeting of the Directing Council.' Mr. OLIVERO (Guatemala), on behalf of his Government, thanked the Council for the honor it had conferred on his country and expressed his deep appreciation of the graciousness displayed by the Representative of the sister republic of Ecuador. The session was adjourned at 1:10 p.m. 'Resolution XXIII, p. 15. FOURTEENTH PLENARY SESSION Wednesday, 21 September 1955, at 9:45 a.m. Chairman: Dr. HÉCTOR A. COLL (Argentina) The CHAIRMAN called the meeting to order and the SECRETARY reported on the documents distributed that morning. Presentation of the Reports of the Rapporteurs of the Technical Discussions METHODS OF IMPROVING THE EDUCATION OF PUBLIC HEALTH PERSONNEL Dr. MONTALVÁN (Ecuador), Rapporteur of the Technical Discussion on "Methods of Improving the Education of Public Health Personnel," presented the following report: On Monday, 19 September 1955, the Directing Council devoted its meetings to the Technical Discussion on the subject "Methods of Improving the Education of Public Health Personnel." The group congratulated Dr. José Bustos on his important paper, which it used as a basis for the discussion. Most of the discussion was focused on the phase of in-service education, but several speakers referred to the need for considering also some closely related points, including problems of recruitment, stability of appointments, and creation of a true public health career system. There was particular emphasis on the importance of obtaining the collaboration or participation of the universities in the training of public health personnel and in maintaining a properly balanced relation between such training and university-academic education. There were noted, however, certain inherent but correctible difficulties in university courses, including (a) the need for faculty members to know the characteristics of the various environments in which their students must work; (b) the desirability that students should have had a period of practical experience in health services and thus know the "language of public health" before being admitted to university courses; and (c) the need for making university courses more realistic, emphasizing the teaching of method rather than just facts. 1. Principles and Objectives The first specific subject discussed in relation to inservice training concerned the principles and objectives of such training. It was agreed that personnel who work in any public health program must be aware of the fundamental philosophy governing its activities, as well as familiar with the necessary techniques, so as to become integral members of the team to which they belong. Objectives related to this principle should, among

116 W.H.O. REGIONAL COMM TIIEE 111 other things, include the following: (a) giving specific and practical instruction to personnel on the functions they are to perform and the method of operation of the health department or agency in which they work; (b) developing an understanding and appreciation of the value of the team approach in health programs, making each person feel he is part of a group working toward a common goal; (c) providing opportunity for more general participation of the personnel in program planning and in the study of problems; (d) helping establish clearly defined functions for all health workers within the agency; (e) providing opportunity for cooperative evaluation and adjustment of programs. Repeated emphasis was placed on the fact that, while instruction in specific techniques and in up-to-date methods is important, true esprit de corps and mutual understanding of goals by everyone in the organization are also very important factors. 2. Categories of Personnel Reached With regard to the categories of personnel reached and the courses given, there was general agreement that training programs of some type should reach all members of the organization, not only professionals but the subprofessional staff, including auxiliaries and nontechnical personnel of all types. A point was made of the need to include administrative staff. Distinction should be made between the training offered to existing staff and that offered to newcomers, in both cases instruction being adjusted according to the level of background training possessed by the employee and the task for which he is to be trained. All personnel, however, need to receive continually up-to-date information on technical advances. Furthermore, not only is there need for regular refresher courses for all personnel, but under certain circumstances there may exist a need for the reorientation of the entire staff in accordance with the evolution of the fundamental philosophy and technical methods of the public health department. S. Methodology In regard to methodology, there was some disagreement as to how extensive the program of in-service training should be. There was agreement that every individual member of the health department staff should be aware of the necessity for constant study and self-education. Some thought it essential that each unit of the health service, even the smaller ones, should have some sort of continuing program, even though it consist only in a schedule of occasional visiting instructors and staff meetings. Others thought this measure too difficult to carry out. All were agreed that in every country certain centers should be set up as primary teaching centers while other centers, according to social conditions and existing needs, should be designated as places that might be visited for further educational experience. One of the latter centers should have the function of coordinating the teaching and setting standards for the country or district. In any case, it is desirable to have a director and coordinator of in-service education programs on a national level. It was further agreed that any center participating in such an in-service education program should designate one member of the staff as responsible for the promotion and development of the training program, and this worker should have the collaboration of various other persons on the staff. In the larger centers where the basic teaching program is carried on, those responsible for teaching need to have this task as a major assignment and be allotted adequate time to perform it. Teaching must not be thought of as a minor or incidental function to be carried out merely in the form of lectures, without proper preparation or follow-up. In the more important centers it is highly desirable that there be a nucleus of teaching staff devoting their time exclusively to teaching and related technical activities, and utilizing, when necessary, the aid of the various specialists engaged in the regular services of the center. Great importance was attached to the role of supervisors. Teaching is an inherent part of supervision, and it follows that all supervisors contribute to in-service education. In addition, such workers are in an excellent position to evaluate the effectiveness of the in-service education received by the personnel under their supervision. Supervisors in all centers should become familiar with the content of the education given and follow through with specific advice in practical field work. Several types of instruction are effective, including: (a) classroom teaching and demonstrations (audio-visual aids); (b) supervised field experience; (c) case studies; (d) round-table discussions; (e) lectures by special consultants; (f) socio-dramas; (g) provision to individual staff members of literature giving current information on recent developments in the health field. To assure the success of these programs, the personnel should be encouraged to participate freely. 4. Evaluation Evaluation of the educational program itself should involve: critical, methodological, and objective analyses of the activities of the center; reports by the participants; and review by outside consultants or by supervisors from a central unit. Effective use can be made of changes in specific indices of health department activities to measure the adequacy of the in-service training. For example, the training of nurses and auxiliaries in maternalhealth supervision should mean that a higher percentage of mothers will go to the clinic early in pregnancy and continue to attend regularly. It is desirable, therefore, to seek constantly new and more effective methods of evaluating all levels of in-service training. Improvement of health services will be the best demonstration of the effectiveness of in-service education programs.

117 112 P.A.S.O. DIRECTING COUNCIL Mr. OLIVERO (Guatemala) congratulated Dr. Montalván on the excellent report he had just presented to the Council. Dr. HURTADO (Cuba), adding his own congratulations, requested that the report be transmitted to the Executive Committee as a Directing Council document, so that the Committee might utilize any material that would enable it to prepare recommendations or take decisions as to future activities. The CHAIRMAN announced that the document would be transmitted to the Executive Committee for such purposes as the latter deemed pertinent. Dr. ALLWOOD PAREDES (El Salvador) considered that action should not be limited to transmittal of the report to the Executive Committee. Because of the value of the document, it should be given the widest possible distribution by publishing it in the Bulletin of the Bureau, so that the efforts summarized in the report would not be lost, but rather serve as a stimulus to all the Member Countries in their public health work, enabling them to profit from the excellent content of this study. Dr. HURTADO (Cuba) agreed with what the Representative of El Salvador had said. Cuba's purpose in requesting that the document be transmitted to the Executive Committee, he said, was precisely to encourage this type of paper, since he felt that the only way to make such papers effective is to refer them to that body for appropriate action. He accepted the addition made to Cuba's proposal by El Salvador, as he thought it very much to the point. Dr. FERREIRA (Brazil) agreed with the statements of the Representatives of Guatemala, El Salvador, and Cuba and said that congratulations should be extended also to Dr. Myron E. Wegman, Technical Secretary of the discussion on this topic, for his work and for the assistance he had given at all times. The CHAIRMAN announced that a resolution would be prepared taking note of the report; expressing the satisfaction of the Council at the manner in which the Technical Discussions had been conducted and at the accuracy with which the report had interpreted them; and transmitting the report to the Executive Committee with the recommendation that the Director of the Bureau give it the widest possible distribution. MEDICAL CARE IN RURAL AREAS Dr. BIssoT (Panama), Rapporteur of the Technical Discussion on "Medical Care in Rural Areas," presented his report as follows: An analysis of the statement of Dr. J. A. Díaz Guzmán and the ensuing discussion, which led to the conclusions and recommendations listed below, are summarized as follows: 1. General Remarks on the Introductory Statement of the Expert Designated by the Bureau Dr. Díaz Guzmán's paper received well-deserved praise, and it was recommended that the Bureau give it wide distribution. The participants agreed that it is impossible to separate the practice of curative and preventive medicine in rural areas; and they recognized that each country has to use its own methods in achieving an integration of these two aspects of medicine and an adequate balance between the various health activities. The discussion pointed up the need for obtaining the cooperation of the medical profession through the efforts of the public health officers themselves, by reorienting the training given in medical schools and encouraging the system of supervised practice in rural areas. 2. Definition of a "Rural Area" and Its Demographic and Administrative Organization It was agreed that no definition of a rural area is applicable in every instance. Each country has to determine the extent of its rural areas, in accordance with a study of local conditions. For intermediate cases, the following characteristics of a rural area should be borne in mind: houses separated by wide spaces; arrangements for water supply and garbage and excreta disposal made on an individual basis; the fact that the inhabitants derive their livelihood mainly from agriculture. The discussion shed light on the importance of rural areas in the majority of the American countries, because of their social, demographic, and epidemiologic influence on national health conditions and because of the lack of health services in such areas. There was unanimous agreement on the point that adequate care of the rural population requires the prior or simultaneous establishment of regulatory and supervisory agencies, headed by competent and full-time personnel, within the national or state public health service. It was also noted that it is the large and average-size urban centers that still are considered to be the major public health problem in many countries, owing to their effect on the demographic indices and to the fact that they possess greater administrative and financial means for solving the problem. S. Structure and Limitations of the Rural Medico-public Health Program The medico-public health services in rural areas should be as adequate as those offered to the nation's urban

W.H.O. REGIONAL COMMITTEE 113 inhabitants, in keeping with the specific objectives pursued and the quantitative and qualitative limitations imposed by the nature of the rural population.

118 W.H.O. REGIONAL COMMITTEE 113 inhabitants, in keeping with the specific objectives pursued and the quantitative and qualitative limitations imposed by the nature of the rural population. (a) In the least developed rural areas, preventive and curative activities are so closely related that, in most countries of America, they should be organized as an integral unit. Rather than constituting an end in itself, the organization of medical care, both curative and preventive, in the rural health centers is one of the many means that should be used within an over-all coordinated public health structure, so as to assure the inhabitants of rural localities of the same level of health that is sought for the urban population. Problems related to housing, agricultural production, home improvement, and general cultural and living standards merit the same degree of attention as medico-public health problems on the part of special agents or, under certain conditions, on the part of public officials duly trained for this- work. (b) Minimum medico-public health services in rural centers: (i) environmental sanitation, with emphasis on water supply and excreta disposal; (ii) control of infectocontagious diseases; (iii) maternal and child health; (iv) medical care: consultations and hospitalization (childbirth, emergency aid) and ambulance facilities; (v) statistics, with emphasis on the medical certification of causes of death; (vi) laboratory facilities; and (vii) health education. 4. Integration with Urban Senrices If the rural services are to fulfill their objectives, they should be integrated with the urban services, thereby forming a single institutional network, on a regional basis, in which each service carries out functions that are supplemented by others within the same socio-demographic zone. This network should include district and regional centers of growing specialization, equipped in such a way as to provide the less differentiated centers with routine supplementary services, consultation, training, and supervision. At the same time, a prerequisite for the steady growth of the rural services is the existence of appropriate agencies, within the national public health service, for backing, supporting, and coordinating the rural services. 5. Organization and Administration (a) Basic information A general, though simple, medico-public health survey should be carried out in each locality where a rural health center is to be established, to serve as a guide in determining the relative importance of each problem and the emphasis to be placed on each aspect of the program. The periodic revision of such surveys and the annual study of the demographic indices will determine any shift of emphasis required in the programs already under way. (b) Personnel (i) Minimum personnel: 1 public health officer-physician; 2 clinic auxiliaries (one of them a midwife); nurse, if possible; 1 auxiliary in sanitation and statistics; 1 service employee; 1 chauffeur, if there are ambulances. (ii) The medical and auxiliary personnel who are to work in the rural health centers should be as well trained to perform their duties as those in urban centers. Therefore, the program to be studied for providing medical care services in rural health centers should give special attention to the adequate training of personnel before and during their period of service. Each country should establish a rational training system, with levels corresponding to the various posts that the rural physicians and other personnel are to fill. (iii) Attention was called to the extreme importance of offering the personnel of rural services attractive working conditions, especially with respect to salaries, security, and opportunities for self-improvement and advancement. The recommendation was made that housing for the personnel be constructed, if it is inadequate in the locality. (iv) Continued supervision and encouragement are particularly necessary in rural public health work, and they should be provided by the various members of the medico-public health team, in the district and regional centers and in the national administration. Systematic visits by general consultants or specialists, periodic district and regional meetings, visits to larger centers, and similar measures should be organized. (c) Community participation Because of the greater difficulties faced by the rural physician and the rural service, active and informed participation on the part of the individuals and groups in their care is even more important than it is in urban areas. The entire staff should give special attention to encouraging all kinds of cooperation by the local authorities, teachers, and civic leaders and to organizing committees and cooperative groups, both for the benefit of the preventive and medical-care program and for the agricultural, social, and cultural improvement of the community. (d) Financing The financing of the rural services depends principally on allotments from the national, state, and regional budgets. Other sources worthy of consideration are municipal governments, social security extended to rural areas, and private concerns or individuals. The community that is served can do its share by paying for curative services and through voluntary assistance to sanitation projects and other preventive work. Dr. FERREIRA (Brazil) thought it unnecessary to give voice to the high appreciation merited by

119 114 P.A.S.O. DIRECTING COUNCIL the paper just presented. He said that the report revealed the quality of the Technical Discussions and that this type of activity should be given increasing importance in the work of the Organization, since it represents a truly constructive effort. The only comment that might be made is that, in the phrase where "agricultural improvement" is mentioned, "and animal husbandry" should be inserted; otherwise areas that are of the utmost importance might not be considered as included. The CHAIRMAN agreed to the suggestion of the Representative of Brazil, announcing that the phrase in question would be replaced by "improvement of agriculture and animal husbandry." Dr. HURTADO recommended that this report be dealt with in the same way as the previous one. The CHAIRMAN congratulated Dr. Bissot on his report and proposed that the decisions on the two technical reports be combined into a single resolution. Decision: By unanimous vote it was agreed to take note of the reports on the Technical Discussions, expressing the satisfaction of the Council at the manner in which the discussions were conducted and at the accuracy with which the reports interpreted them; to transmit these reports to the Executive Committee for whatever action it deemed advisable; and to recommend to the Director of the Bureau that he give the reports the widest possible distribution.l The CHAIRMAN pointed out that, since a new resolution had been approved, it would have to be incorporated in the Final Report. The session would therefore be recessed so that the General Committee might meet, as that Committee, pursuant to Article 43 of the Council's Rules of Procedure, prepares the Final Report, incorporating therein all the decisions taken. Vote of Thanks Dr. HURTADO (Cuba) said that, before the study of the Final Report was begun, he wished to cal] attention to a specific matter. The text of the Final Report distributed that morning contained all the decisions taken so far, but one was missing that traditionally had always been taken. The Directing Council had been meeting for several days, working with great enthusiasm and with results of great value to the future of the Organization. ' Resolution XXIV, p. 15. The Council had been able to work so effectively because of the collaboration it received from the Bureau's staff. He was referring, not to the officers who were responsible for running the meeting well, and who always had run it well, but to the many anonymous collaborators who had been carrying out widely varied tasks and had provided promptly a truly magnificent service. Prominent among them were the members of the interpretation service, thanks to whom it had been possible to carry on a very active discussion in the four official languages of the Pan American Sanitary Bureau. He suggested that it be left to the General Committee to prepare a paragraph expressing to all the Secretariat staff the Council's appreciation. The CHAIRMAN welcomed the suggestion of the Representative of Cuba, for he was certain that all the members of the Council were in accord with it. Decision: By unanimous vote it was agreed to express the appreciation of the Directing Council to the Secretariat of the Pan American Sanitary Bureau.' The session was recessed at 10:30SO a.m. for the meeting of the General Committee and was resumed at 11: 55 a.m. Statement of the Representative of El Salvador DR. ALLWOOD PAREDES (El Salvador) said that, before the Final Report was read, he wished to express his appreciation of the manner in which the Secretariat of the meeting had interpreted the statements of the delegation of El Salvador. In every case the précis minutes had given an exact version of the statements made. He considered that, because of their interesting content, the minutes should be published in their present length. The SECRETARY announced that the definitive minutes would be distributed in their present length, after introduction of any changes requested by the representatives within the time limit set. Statement by the Observer for the United Nations and United Nations Technical Assistance Board The CHAIRMAN granted the floor to Mr. Gustavo Durán, Observer for the United Nations and the United Nations Technical Assistance Board. Mr. DURÁN (Observer, United Nations) thanked the Chairman for having granted him the floor and ' Resolution XXV, p. 15.

W.H.O. REGIONAL COMMITI'EE 115 announced that his statement would be very brief, since he had nothing to add to what had been said during the very successful meeting that was drawing to a close.

120 W.H.O. REGIONAL COMMITI'EE 115 announced that his statement would be very brief, since he had nothing to add to what had been said during the very successful meeting that was drawing to a close. He said that the flexibility of the Pan American Sanitary Organization makes it possible to coordinate and integrate to a great degree its activities with those of the other international organizations having related programs. It is impossible to discover any aspect of PASB activities that has been inadvertently overlooked. The program of the Pan American Sanitary Organization is a harmonious complement to the program carried out by the United Nations in similar or related campaigns. Another noteworthy fact is that problems are approached from every point of view and are not limited to the medical aspect. On behalf of the Secretary General of the United Nations and the Executive Secretary of the United Nations Technical Assistance Board, he extended a cordial greeting to the Pan American Sanitary Organization and expressed the hope that the excellent program that had been approved would be vigorously carried out in the future and that it would be crowned with success. The CHAIRMAN thanked the Observer of the United Nations for his statement. Reading, Approval, and Signing of the Final Report The SECRETARY read the Final Report (Document CD8/95), pointing out that two resolutions, numbers XXIV and XXV, had been added to the text distributed that morning; they contained the decision taken earlier in the session on the technical discussions and the vote of thanks to the Secretariat personnel. Mr. CALDERWOOD (United States) asked that in the English text of the Final Report the words "having seen," which appear in Resolutions XV, XVIII, and XXII, be replaced by "having examined." The CHAIRMAN replied that this would be done. Dr. ALLWOOD PAREDES (El Salvador) inquired whether Document CD8/85 (Rules for Technical Discussions at Directing Council Meetings), cited in Resolution XIX, included all the amendments that had been introduced in the text originally distributed. The SECRETARY replied in the affirmative. He then read the texts of Resolutions XXIV and XXV, as approved by the General Committee. Dr. HURTADO (Cuba) asked that in the English text of Resolution XXV the word "staff" be added after the word "Secretariat," since that was really the fundamental idea of the measure. It was so agreed. The CHAIRMAN submitted the resolutions in the Final Report separately, and then the document as a whole, to the Directing Council for approval. Decision: By unanimous vote the Final Report and each of the resolutions, from I through XXV, were unanimously approved.' The CHAIRMAN declared that, since the Final Report had been approved, the members of the Directing Council should proceed to sign the document, together with the Director of the Pan American Sanitary Bureau and the Secretary General of the Bureau, Secretary of the Directing Council. The SECRETARY called the Representatives of Argentina, Bolivia, Brazil, Chile, Colombia, Cuba, Ecuador, El Salvador, United States of America, France, Guatemala, Haiti, Honduras, Mexico, Nicaragua, Netherlands, Panama, Paraguay, Peru, United Kingdom, Dominican Republic, and Venezuela, who signed the Final Report in Spanish and English. He next invited the Director of the Bureau to sign both copies of the document and then affixed his own signature thereto. Closure of the VIII Meeting of the Directing Council The CHAIRMAN said that, with the signing of the Final Report, another fruitful meeting of the Directing Council had come to an end. He repeated his thanks, on behalf both of his country and himself, for the honor that had been bestowed on him by his election as Chairman. He had been very deeply moved by this honor and wished to say so clearly, so that those now returning to their countries would be convinced of the sincerity of his words. The meeting had been extraordinarily successful, he said, because of the lofty spirit with which the deliberations had been imbued and the effective collaboration of all who had participated in the work of the Council. The documents themselves demonstrate the interest that all had taken in solving the problems at hand. At this meeting a new feature had been added to the work of the Council, one that, on future occasions, would prove ' See p. 3.

121 116 P.A.S.0. DIRECTING COUNCIL even more worth while: the Technical Discussions. New directives would unquestionably arise from these discussions and the reports of the rapporteurs would certainly serve as a source of inspiration for all those public health workers who, scattered throughout the towns of the Americas, do not have an opportunity of participating personally in this distinguished forum. On behalf of the officers of the meeting, he expressed his appreciation of the magnificent collaboration received from the representatives in settling all the questions raised in the course of the discussions. He also expressed his appreciation to the interpretation service, which had so accurately rendered all the oral statements, and to all the Secretariat personnel, thanks to whom it had been possible to conduct the sessions punctually and efficiently. Dr. HURTADO (Cuba) said that although, officially, the meeting was practically over, he thought it necessary to make special reference to the way in which the Chairman had presided over the VIII Meeting of the Council. In his summary of the Council's activities, the Chairman had described the meeting, most accurately, as fruitful and had expressed his thanks for the collaboration given him by all the representatives present. Not out of mere courtesy, but as a statement of the simple truth, the Directing Council should place on the record its appreciation of Dr. Coll, who, with the assistance of the two Vice-Chairman, had presided in so cordial and able a manner. He declared that Dr. Coll, a great colleague and excellent discussion leader, had proved to be one of the most capable chairmen ever to preside over such international meetings. The session was adjourned at 1 :00 p.m.

122 GENERAL COMMITTEE FIRST SESSION Friday, 9 September 1955, at 12:30 p.m. Chairman: Dr. HÉCTOR A. COLL (Argentina) The CHAIRMAN of the Directing Council, Dr. Coll, opened the session and stated that, unless the representatives had some comment to make, the order of business adopted at the first plenary session would be followed. It was so agreed. Request of the Representative of the Netherlands The SECRETARY referred to the General Committee the request of Dr. Nicolaas H. Swellengrebel, Representative of the Netherlands, that the discussion of Topic 8 (Annual Report of the Director) be postponed until Monday. The CHAIRMAN proposed, after a brief discussion, that the report of the Committee on Credentials and Topics 12 (Quota Contributions), 17 (Fellowship Stipends), 18 (Rules for Technical Discussions), and 20 (PASO Meetings away from Headquarters) be dealt with at the afternoon session and Topic 8 and Topic 11 (Financial Report and Auditor's Report), at the morning session on the 12th. It was so agreed. Presence of the External Auditor Dr. ALLWOOD PAREDES (El Salvador) asked if the Auditor would be present during the discussion of Topic 11. Dr. SOPER (Director, PASB) explained that the External Auditor also serves the WHO and that just now he is probably in Europe. Reference Documents on Topic 23 Dr. ALLWOOD PAREDES (El Salvador) remarked that under Topic 23 in the draft agenda (Reports on the Malaria Eradication Programs in the Americas) there was no mention of the reports on malaria by the Director and by Dr. Alvarado, which were submitted to the Executive Committee at its 25th Meeting and appeared as annexes to Document CD8/4 (Utilization of Available Funds). Such mention, he said, would be most desirable, inasmuch as these reports were closely related to Topic 23. Dr. HURTADO (Cuba) pointed out that, since Document CE25/12, the annex to Document CD8/4, was in the collection of documents distributed to the representatives, it would be enough for the Secretary to inform the delegates of this fact at the afternoon session. It was so agreed. The session was adjourned at 1:00 p.m. SECOND SESSION Monday, 12 September 1955, at 12:30 p.m. Chairman: Dr. HÉCTOR A. COLL (Argentina) Order of the Day September, Topics 9 (1956 Program and Budget) and 10 (1957 Program and Budget). The CHAIRMAN proposed, as the order of business for the afternoon session, Topics 8 (Director's It was so agreed. Report), 11 (Financial Report and Auditor's Re- Request of the Delegation of Nicaragua port), 18 (Rules for Technical Discussions), and 20 (PASO Meetings away from Headquarters); and The SECRETARY announced that t] he delegation for the session to be held Tuesday morning, 13 of Nicaragua wished to have Topic 2] 1 (Election of 117

118 P.A.S.O. DIRECTING COUNCIL Three Member Countries to the Executive Committee) included on the order of business for Wednesday, 14 September. It was so agreed. Rules for Technical Discussions Dr.

123 118 P.A.S.O. DIRECTING COUNCIL Three Member Countries to the Executive Committee) included on the order of business for Wednesday, 14 September. It was so agreed. Rules for Technical Discussions Dr. ALLWOOD PAREDES (El Salvador) thought that a working party might be established to study Topic 18 and also to draft a resolution to the effect that the Rules for Technical Discussions should apply not only to the Directing Council but to the Conference as well. Dr. HURTADO (Cuba) took this proposal to mean that the Directing Council would submit to the Conference for study the Rules for Technical Discussions at Directing Council Meetings, with the recommendation that the Conference adopt similar rules. The CHAIRMAN felt that it was up to the Directing Council to decide on the matter brought up by the Representatives of El Salvador and Cuba. Reports on Malaria Eradication Programs The SECRETARY thought, in connection with Topic 23 (Reports on Malaria Eradication Programs in the Americas), that it would be well to decide on the form of the reports that the countries are to submit by virtue of Resolution XLII of the XIV Pan American Sanitary Conference. Dr. ORELLANA (Venezuela) proposed that the discussion of this topic be scheduled for the last day. Dr. ALLWOOD PAREDES (El Salvador) thought it necessary to offer suggestions on the way these reports are to be prepared, adding that his delegation had prepared a 27-page memorandum as its report. Dr. HURTADO (Cuba) considered it advisable to have a brief summary prepared by the Bureau which, in the future, could draw up a specific form for the preparation of such reports, so as to ensure the desired uniformity. Dr. SOPER (Director, PASB) explained that malaria is a permanent problem and permanent topic and that the governments should feel the need for reporting periodically on the measures they have taken, in the intervals between Council meetings, to eradicate the disease. If the delegations have prepared written reports, they may submit them to the Secretariat, without prejudice to their making an oral report at a plenary session. It was so agreed. The session was adjourned at 1:00 p.m. THIRD SESSION Tuesday, 13 September 1955, at 12:30 p.m. Chairman: Dr. HÉCTOR A. COLL (Argentina) Order of the Day The CHAIRMAN proposed as the order of business of the afternoon session the continuation of Topics 9 (1956 Program and Budget) and 10 (1957 Program and Budget) and that at the session to be held in the morning of Wednesday, the 14th, the following topics be included: 21 (Election of Three Members to the Executive Committee), 15 (Emergency Revolving Fund), 13 (Proportionate Program Distribution of Budget Funds), and 14 (Utilization of Available Funds). It was so agreed. Technical Discussion Moderators and Rapporteurs The CHAIRMAN, after hearing the information given by the Secretary, said that the Directing Council should elect the moderators and the rapporteurs for the Technical Discussions on the topics "Methods of Improving the Education of Public Health Personnel" and "Medical Care in Rural Areas," for which the Director of the Bureau had appointed Dr. Gustavo Molina and Dr. Myron E. Wegman as the respective technical secretaries. He proposed, following the suggestion of the Representative of Cuba, that the election of these moderators and rapporteurs be held when the afternoon session was resumed after the recess. It was so agreed. The session was adjourned at 12:45 p.m.

124 W.H.O. REGIONAL COMMITTEE 119 FOURTH SESSION Wednesday, 14 September 1955, at 1:00 p.m. Chairman: Dr. HÉCTOR A. COLL (Argentina) Presence of the United States Representative Text of Resolution VI The CHAIRMAN announced that Dr. Brady (United States) had been invited to attend the General Committee sessions at which the Final Report would be discussed, in order to give approval to the English text of the resolutions under consideration. Text of Resolutions I and II The SECRETARY read Resolutions I (Annual Report of the Chairman of the Executive Committee) and II (Status of the Collection of Quota Contributions). The resolutions were approved. Text of Resolution III The SECRETARY read Resolution III (Fellowship Program). Dr. BRADY (United States) proposed that in the preamble the words "subject of fellowship stipends" be replaced by "fellowship program." Dr. HURTADO (Cuba) proposed that in the Spanish text of the last paragraph of the resolution the word privilegios be replaced by prerrogativas. Resolution III was approved with the modifications in wording proposed by the Representatives of Cuba and the United States. Text of Resolution IV The SECRETARY read Resolution IV (Annual Report of the Director of PASB). Dr. ALLWOOD PAREDES (El Salvador) felt that in the preamble the words "Regional Office of the WHO for the Americas" should be added to "Pan American Sanitary Bureau." Resolution IV was approved with this change. Text of Resolution V The SECRETARY read Resolution V (Financial Report of the Director and Report of the External Auditor for 1954). The resolution was approved. The SECRETARY read Resolution VI (Meetings of PASO Governing Bodies held away from Headquarters). Dr. BRADY (United States) proposed that the words "together with the model agreement appended to that resolution," which correspond to the Spanish text y el modelo de acuerdo anexo a dicha resolución, be deleted. Resolution VI was approved with the proposed modification. Text of Resolution VII The SECRETARY read Resolution VII (Pan American Zoonosis Center). The resolution was approved. Text of Resolution VIII The SECRETARY read Resolution VIII (Election of Three Member Countries to the Executive Committee). The CHAIRMAN proposed that the Secretariat prepare a new proposed resolution taking into account the suggestions made by Dr. Jiménez Gandica, Dr. Orellana, and Dr. Soper. It was so agreed. Discussions in Plenary Sessions Dr. SOPER (Director, PASB) stated that the debates in plenary session had been very fruitful. He considered that the activities of collaboration with the countries were necessary, even though the present budget does not permit developing them to the extent that would be desirable. He requested that the General Committee not limit the time for the discussions of the Directing Council. Proposal of the Representative of El Salvador Dr. ALLWOOD PAREDES (El Salvador) suggested that Topic 16 (General Program of Work in the Region of the Americas during the Period 1957-

125 120 P.A.S.O. DIRECTING COUNCIL 1960) be discussed together with Topic 10 (1957 Program and Budget). Order of the Day The CHAIRMAN proposed as the order of business for that afternoon Topics 15 (Emergency Revolving Fund), 13 (Proportionate Program Distribution of Budget Funds), and 14 (Utilization of Available Funds); for Thursday morning, 15 September, Topics 10 and 16; and for the afternoon session of the same day, Topic 23 (Reports on Malaria Eradication Programs). He suggested also that the Technical Discussions take place on Monday and Tuesday, 19 and 20 September. It iwas so agreed. The session was adjourned at 1:35 p.m. FIFTH SESSION Thursday, 15 September 1955, at 12:40 p.m. Chairman: Dr. HÉCTOR A. COLL (Argentina) The CHAIRMAN called the meeting to order. Tezxt of Resolution VIII The SECRETARY read Resolution VIII (Election of Three Member Countries to the Executive Committee). Dr. HURTADO (Cuba) suggested that the phrase "to elect" be replaced by "to declare elected," which was more exact. The Committee approved, in principle, Resolution VIII, agreeing that it would be redrafted to include the amendment proposed by the Representative of Cuba. Tezt of Resolution IX The SECRETARY then read Resolution IX (Vote of Thanks to the Representatives of Brazil, Haiti, and Panama). Dr. ALLWOOD PAREDES (El Salvador) proposed that, in the Spanish text, the word aporte be replaced by contribución. Resolution IX, with the proposed amendment, was approved. New Tezt of Resolution X The SECRETARY read Resolution X (Program and Budget of the Pan American Sanitary Organization for 1956). Dr. BRADY (United States) considered it advisable, in order to avoid confusion, not to use twice the term "estimated miscellaneous income" in the resolution. The CHAIRMAN, taking into account Dr. Brady's suggestion and other suggestions made in the course of the debate, requested the Secretary to make a new draft of Resolution X. Tezt of Resolution XI The SECRETARY then read Resolution XI (Local Programs within Countries), which was approved without change. Text of Resolution XII The SECRETARY read Resolution XII (Emergency Revolving Fund). It was decided to eliminate the words "to the Member Governments" in the operative part and to add "in 1954" in the preamble, after the words "Emergency Revolving Fund." The text of Resolution XII, as amended, was approved. Tezt of Resolution XIII The SECRETARY read Resolution XIII (Proportionate Program Distribution of Budget Funds). The resolution was approved without change. Tezt of Resolution XIV The SECRETARY read Resolution XIV (Utilization of Available Funds).

126 W.H.O. REGIONAL COMMITTEE 121 Dr. ALLWOOD PAREDES (El Salvador) asked whether the Financial Regulations provided for a method of transferring funds from the regular budget to a reserve fund, and vice versa. The CHAIRMAN recalled that in plenary session he had requested that there be a clarification of the method for re-establishing the Building Reserve Fund in the event that the Director made use of the authorization given him under point 2 of the resolution under consideration. Dr. SOPER (Director, PASB) explained that the funds in question are not regular funds and that they can be used for the eradication of malaria, as has been done in similar cases with other extrabudgetary funds. Therefore, the operation referred to by Dr. Allwood Paredes does not create any problem. As to the question raised by the Chairman, he explained that this authorization is necessary for the utilization of these funds and that the External Auditor would accept it as being sufficient, should it become necessary to have recourse to it. Resolution XIV was approved. Order of the Day Dr. ORELLANA (Venezuela) stated that Topic 16 (General Program of Work) could be added to the order of business of that afternoon, and that the other topics pending could be assigned to the eleventh plenary session, to be held Friday morning, 16 September. Topics that might not be considered in the morning could be left for the afternoon session. The CHAIRMAN proposed that Topic 23 (Reports on Malaria Eradication Programs) be assigned to the afternoon session that day, together with the continuation of Topic 16. The remaining topics, numbers 18 (Rules for Technical Discussions), 19 (Selection of Technical Discussion Topic), 24 (WHO Resolutions of Interest to the Regional Committee), 26 (Conditions of Employment of Personnel), and 22 (Place of the IX Directing Council Meeting), could be examined at the morning session on Friday, 16 September. It was so agreed. Time Schedule of Sessions Dr. SOPER (Director, PASB) requested that the morning sessions be adjourned on time in order to facilitate the work of the Secretariat. The session was adjourned at 1:50 p.m. SIXTH SESSION Friday, 16 September 1955, at 12:30 p.m. Chairman: Dr. HÉCTOR A. COLL (Argentina) The CHAIRMAN called the session to order. Text of Resolutions VIII and IX The SECRETARY read Resolutions VIII (Election of Three Member Countries to the Executive Committee) and X (Program and Budget of PASO for 1956), which were approved without change. Text of Resolution XV The SECRETARY then read Resolution XV (Proposed Program and Budget of the PASO and the WHO for the Region of the Americas for 1957). Dr. ALLWOOD PAREDES (El Salvador) thought it desirable to substitute "document" for the words "budget document" at the end of the resolution. Resolution XV, with the proposed amendment, was approved. Text of Resolution XVI The SECRETARY read Resolution XVI (Regional Programs to be Financed with Funds of the UN Expanded Program of Technical Assistance). Dr. ALLWOOD PAREDES (El Salvador) proposed that the last part of the resolution read as follows: "to be financed under the United Nations Ex-

127 122 P.A.S.O. DIRECTING COUNCIL panded Program of Technical Assistance in the years 1956 and/or 1957." Resolution XVI, with the proposed amendment, was approved. Seat of the IX Meeting of the Directing Council The SECRETARY, in reply to a question by the Representative of Cuba, announced that Ecuador had said that it would submit a communication offering to be the host country for the IX Meeting of the Directing Council. Dr. ALLWOOD PAREDES (El Salvador) remarked that he had been informed that a Central American country was going to make a similar offer. Technical Discussions and Order of the Day Dr. ORELLANA (Venezuela) asked whether it would not be advisable to begin the Technical Discussions the next day, upon completion of the examination of the pending topics. The CHAIRMAN took note of the proposal of the Representative of Venezuela and suggested that the Technical Discussions start on Saturday, provided that consideration of the topics submitted to plenary session were concluded and that discussion of Topics 16, 18, 19, 24, 26, and 22 continued during the Friday afternoon and Saturday morning sessions. It was so agreed. The session was adjourned at 1:00 p.m. SEVENTH SESSION Saturday, 17 September 1955, at 1:00 p.m. Chairman: Dr. HÉCTOR A. COLL (Argentina) The CHAIRMAN called the meeting to order. Approval of Preamble and Last Pages of Final Report The SECRETARY read the introduction and last pages of the Final Report and pointed out that the document contained the first sixteen resolutions, which had already been approved by the General Committee. The draft of the Final Report submitted by the Secretary was approved. Text of Resolution XVII The SECRETARY then read (Conditions of Employment of The text of Resolution XVII the deletion of the words "of Sanitary Organization/World tion," at the end. Text of Resolution XVIII Resolution XVII Personnel). was approved, with the Pan American Health Organiza- The SECRETARY read Resolution XVIII (General Program of Work during the Period ). Dr. ALLWOOD PAREDES (El Salvador) said that the text of this resolution had been discussed with the Representatives of Brazil and Venezuela, who had presented amendments to it. The text of Resolution XVIII was approved. Resolutions Pending The SECRETARY announced that the final five resolutions approved at the morning session still remained to be submitted to the General Committee. Schedule of Work The CHAIRMAN proposed that, in compliance with the wishes of the representatives, no afternoon plenary session be held that day; that the General Committee meet on Monday, the 19th, at 9:00 a.m.; and that immediately thereafter the Technical Discussions begin with the examination of the topic "Methods of Improving the Education of Public Health Personnel." The session was adjourned at 1 : 30O p.m.

W.H.O. REGIONAL COMMITTEE 123 EIGHTH SESSION Monday, 19 September 1955, at 9:10 a.m. Chairman: Dr. HÉCTOR A. COLL (Argentina) The CHAIRMAN called the meeting to order.

128 W.H.O. REGIONAL COMMITTEE 123 EIGHTH SESSION Monday, 19 September 1955, at 9:10 a.m. Chairman: Dr. HÉCTOR A. COLL (Argentina) The CHAIRMAN called the meeting to order. Text of Resolution XIX The SECRETARY read Resolution XIX (Rules for Technical Discussions at Directing Council Meetings), the text of which was approved without change. Text of Resolution XX The SECRETARY then read Resolution XX (Rules of Procedure of the Directing Council). The wording of Resolution XX was approved, with the replacement of el dictamen by la opinión in the operative part of the Spanish text. Text of Resolutions XXI, XXII, and XXIII The SECRETARY read Resolutions XXI (Topic for Technical Discussions during the IX Meeting of the Directing Council), XXII (Resolutions of the WHO Assembly and Executive Board of Interest to the Regional Committee for the Americas), and XXIII (Place of the 29th and 30th Meetings of the Executive Committee and the IX Meeting of the Directing Council). The resolutions were approved without change. Distributíon of Minutes The SECRETARY announced that the minutes in Spanish, including those of the Saturday session, had been distributed to the representatives. Schedule of Work The CHAIRMAN proposed that a vote of thanks to the Secretariat for its work be included in the minutes. He also suggested that the Directing Council meet on Wednesday, at 9:00 a.m., to hear the reports of the rapporteurs of the Technical Discussions and that the Final Report be read, approved, and signed immediately thereafter. The 27th Meeting of the Executive Committee could be held the same day, at 2:30 p.m. It was so agreed. The session was recessed at 9:30 a.m. and resumed at 11:00 a.m. New Text of Resolution X Dr. ALLWOOD PAREDES (El Salvador) stated that the 1956 program and budget had been approved, but with observations arising out of the discussions of the 1957 program and budget, a fact not reflected in Resolution X (Program and Budget of PASO for 1956). Moreover, in the text the program for 1956 was not expressly approved, a matter he considered essential. He proposed that, as had been done on other occasions, such as the XIV Conference, it be stated specifically in the text that the program had been approved with the changes suggested in the course of the discussion. Dr. HURTADO (Cuba) agreed with the Representative of El Salvador and said that it would be sufficient to introduce a paragraph in the preamble and to state in the first operative paragraph that the program and budget for 1956 had been approved. The CHAIRMAN proposed that the text of the paragraph in the preamble be drafted as follows: "The Directing Council, having examined and discussed Documents CE25/2 and Corrigendum and CE25/27, Rev. 1, together with Official Document No. 12," and that in the operative part the following paragraph appear: "1. To approve the Program and Budget of the Pan American Sanitary Organization for 1956 contained in Documents CE25/2 and Corrigendum and CE25/27, Rev. 1, and in Official Document No. 12." The text of Resolution X was approved in the form proposed by the Chairman. Dr. BRADY (United States) asked whether the new paragraph 1 implied that the Director of the PASB must carry out projects as proposed in the budget documents. The CHAIRMAN replied that this was not the case, but that the new paragraph was added solely to show the basis upon which the budget was discussed. The session was adjourned at 11 :20 a.m.

129 124 P.A.S.O. DIRECTINO COUNCIL NINTH SESSION Wednesday, 21 September 1955, at 11:00 a.m. Chairman: Dr. HÉCTOR A. COLL (Argentina) Resolution on the Technical Discuasions The CHAIRMAN stated that it had been necessary to call this session because the Directing Council, at the morning session, had approved two resolutions which, according to the Rules of Procedure, were to be examined by the General Committee before being incorporated in the Final Report. He said that Dr. Brady's collaboration had once more been requested. He then submitted a resolution on the reports presented by the rapporteurs of the technical discussions, the text of which read as follows: The Directing Council, Having examined the reports presented by the rapporteurs of the technical discussions held at this meeting, Resolves: 1. To take note of the reports on the technical discussions, expressing its satisfaction at the manner in which the discussions were conducted and on the accuracy with wbich the reports have interpreted them, and to transmit these reports to the Executive Committee for whatever action it may deem advisable. 2. To recommend to the Director of the Bureau that he give the above-mentioned reports the widest possible distribution. The text of the resolution proposed by the Chairman, was approved. Vote of Thanks Dr. ORELLANA (Venezuela) proposed the following vote of thanks: The Directing Council wishes to express its appreciation to the Secretariat of the Pan American Sanitary Bureau for the efficiency and conscientiousness it has shown in the -performance of its duties, thereby contributing in large measure to the success of this meeting. The vote of thanks proposed by the Representative of Venezuela was approved without change. The SECRETARY stated that the vote of thanks would appear as Resolution XXV, and the other resolution as Resolution XXIV, the two being inserted in the text of the Final Report. In this way, it would be possible to keep the Final Report in the form in which it had already been distributed to the representatives. He added that another change would have to be made to state that the General Committee held "nine sessions" instead of "eight sessions." The two new resolutions could be added to the table of contents of the Final Report. The session was adjourned at 11 :80 a.m.

ANNEXES Annex 11 TOPIC 16: GENERAL PROGRAM OF WORK IN THE REGION OF THE AMERICAS DURING THE PERIOD 1957-1960 A. Introduction 1. Framework for World Health Programs.

130 ANNEXES Annex 11 TOPIC 16: GENERAL PROGRAM OF WORK IN THE REGION OF THE AMERICAS DURING THE PERIOD A. Introduction 1. Framework for World Health Programs.-At its Fifteenth Session the Executive Board of the World Health Organization approved, for submission to the World Health Assembly in accordance with Article 28 (g) of the Constitution, a "General Program of Work Covering a Specific Period," for the years inclusive. This document, EB15/29 Rev. 1, restates the principles and criteria expressed in the "First General Program of Work" for the period , which were approved by previous World Health Assemblies, and establishes guiding principles for the activities of the Organization for the next period of work, taking advantage of the experience gained. The Eighth World Health Assembly approved the General Program, with some editorial rearrangement, and adopted Resolution WHA8.10, the operative part of which states that the Assembly: 1. considers that this programme of work, as amended, provides a broad general policy for the development of detailed annual programmes in the period ; 2. believes it would be desirable for each regional committee to formulate within the framework provided a general programme of work for the region concerned; and 3. requests the Director-General to recommend to regional committees that their annual programmes be so planned as to secure their adequate integration in the approved general programme of the Organization. Pan American Sanitary Organization. The Directing Council, at its VII Meeting (1953), approved (Resolution DC7/R/III) "the development of a plan of long-range public health programs, based on continuous survey and evaluation of the needs and resources of the Member Countries" to: (a) strengthen the fundamental services for the promotion and preservation of the health of the people in each country; (b) provide means for the training of professional and subprofessional personnel... and develop local and regional resources to this end; and (c) coordinate and assist in the planning and operation of individual or regional programs for the eradication of communicable diseases... which constitute a potential threat to the Hemisphere and for which there are suitable means of eradication. This plan of long-range programs is consistent with the principles adopted by the governing bodies of WHO and therefore provides a sound basis for all health programs in the Americas, regardless of the source of funds. Thus, for the purpose of this document there is need only to consider what further elaboration of the General Program may be practicable and desirable for the specific period , in order to provide a further guide for the preparation of successive annual programs. In view of paragraph 2 of the above resolution B. General Approach this subject is presented to the Directing Council 1. Participation and Cooperation.-The principle of full participation and support of all coun- of the Pan American Sanitary Organization, Regional Committee of the World Health Organization for the Americas. Its consideration is of the tries expressed in the General Program is fulfilled in the Americas. With the tradition of hemispheric utmost importance because the General Program, cooperation built up during half a century, the which establishes for the world the objectives to be countries of the Americas are giving support to, are achieved and the basis for building annual programs, familiar with, and are willing to use the collaboration of the Organization. Through PASO and must be adapted to the special conditions in each Region. WHO, every country participates in the program. 2. Long-Range Program in the Americas.-It is appropriate to recall that there exists a substantial The governing bodies repeatedly have stressed the intercountry, regional, and continental approach body of policies, objectives, and long-range programs established by the governing bodies of the American Sanitary Bureau in stimulating action to health problems and also the role of the Pan 'Document CD8/12. and enlisting support of governments for the solu- 125

131 126 P.A.S.O. DIRECTING COUNCIL tion of health problems affecting various countries or the entire Continent. Border agreements and working arrangements among groups of neighboring countries have been stimulated by the Organization and have proven to be an important element for the coordination of health activities in the Americas. 2. National Planning for Health.-National planning for health is accepted as the keystone of health programs, both national and international. The plan of long-range public health programs (DC7/R/ III) provides for "continuous survey and evaluation of the needs and resources of the Member Countries...." Unfortunately, the goal of national planning is easier to state than to achieve. Most countries still have much to do. More and better information is needed for a proper establishment of priorities to concentrate efforts toward those activities that will produce maximum benefits for the greatest number of people. Obviously, national health plans are fundamental for the strengthening of health services. As the program expands, the need for national health planning becomes greater and increasing emphasis must be given to it. Therefore, the Organization has a responsibility for collaborating with the Member Governments to carry on this fundamental task. National planning and international planning are so thoroughly linked that each strong point or weakness in a national plan is reflected in the international program. S. Annual Program.-The methods employed in preparing the annual program should assure conformity with the long-range program, adjusted to needs and conditions of individual countries. It may be useful to recall that the system of decentralization through Zone Offices provides a means of onthe-spot consultation in each country. In the period from January to mid-april of each year, consultation is carried on with national health authorities to review with them their needs and resources in relation to the national health plans, the nature and extent of the cooperation expected from the Organization, as well as the national participation and support for intercountry and continental programs. In this annual planning procedure, provision also is made for flexibility, so as to adjust previous advance planning to changing situations and practical realities. Thus, while advance plans are being made for the second succeeding year, the previously drawn plans for the succeeding year are adjusted to currently known problems and potentialities. The interest and participation of governments and national health workers are essential for the improvement of this system in order to guarantee that planning for long-term, intermediate, and even immediate objectives is properly related to the health needs, problems, and plans of each country. 4. Evaluation.-It is now fully recognized that evaluation is an essential part of all health programs and that it must start in the planning stage, be carried on during implementation, and be continued to permit constant adjustment to changing conditions. Adequate basic information is, in every case, a prerequisite for this purpose. Since the techniques of evaluation are far from adequate and vary with each subject, one of the most important activities of the Organization must continue to be the preparation and application of these techniques. It is essential to include adequate evaluation techniques as an integral part of eradication campaigns. Proper and continuous application of these techniques is the only way to measure the progress of eradication and to confirm its accomplishment. Evaluation techniques are equally important for programs of general public health and for the education and training of health personnel. C. Program for Analysis of Needs and Resources.-In order to plan as far ahead as 1960, it would be necessary to analyze carefully health needs and technical resources. Although existing problems are known in general terms, there is great need for more precise, complete, and reliable statistics and information in practically every country of the Americas. Indeed, one of the objectives, and an extensive current activity of the Organization, is to promote the collection and critical analysis of adequate data on health conditions and requirements of the Member Countries. In accordance with the Constitution and resolutions of the governing bodies of PASO, reports on health conditions were presented to the XIII and XIV Pan American Sanitary Conferences, the reports to the latter showing considerable improvement. For the XV Conference (1958), Member States are expected to present complete statistical and narrative data that will permit an analysis of the needs and resources for sound international health programs. In view of the difficulties of analyzing existing problems with the information available, it is obviously much more difficult to judge what health problems will arise in the future. Entirely new problems as well as new solutions will arise out of

132 W.H.O. REGIONAL COMMIT'EE 127 scientific developments now on]y in the research stage. In the light of the foregoing comments, the program discussion that follows relates largely to a projection of currently known problems. 2. Strengthening of Fundamental Health Services.- Annual reports for past years, as well as program plans for the future, show the emphasis placed on activities directed toward cooperating with Member Countries in strengthening their fundamental health services. While the final objective of all activities of the Organization is to attain this goal, the activities most directly concerned are those related to planning, organizing, staffing, and expanded permanent health services at all levels, including rural areas. Successful development of these services is dependent upon full participation and support of governments, professional groups, and the community as a whole. One of the approaches by which the Organization cooperates with Member Governments is through the provision of technical consultation and advice of staff members. Permanent staff of the Washington and Zone Offices are available for recurring visits to countries for cooperation on both general and specific matters. Another approach is through activities usually referred to as "projects," a term used for administrative convenience. Most of the projects are centered around the provision of one or a group of technical consultants who are assigned to work with national staff for whatever time is necessary to solve a particular problem. The scope of the project may be large or small, and the period of service of the consultants may be long or short, depending upon the goal to be achieved. The responsibility for execution and continuation of the work rests entirely with the government; so that the speed with which international staff can complete their advisory mission and withdraw is a measure of success. Projects commonly known as "integrated public health services" are a good example of this activity carried out on a large scale and over a long period. Many governments, taking into account the recent developments in public health administration and the rapidly growing social consciousness, have decided upon a program of nation-wide reorganization and expansion of their health services at central and local levels, even to remote rural areas, with emphasis on sanitation, communicable diseases, maternal and child health, health education, and other basic fields. The international cooperation for such a program needs to be extended over a reasonably long period, usually not less than five years, and will therefore continue to occupy an important place in the work of the Organization during the specific period under consideration. There are numerous examples of short-term projects that provide collaboration to governments through the assignment of consultants in specialized fields. International cooperation of this type may include technical advice on the establishment or reorganization of specific services, e.g., food and drug control, public health laboratories, statistical services; on the modernization of health legislation; on the use of techniques, such as iodization of salt and fluoridation of water; on the introduction of newly discovered public health procedures, etc. Each national health service, as it develops and expands, may find an increasing number and variety of special problems for which international cooperation is required. In fact, the eagerness that health services show in seeking to apply new technical knowledge is a measure of their progress. In the long run, the activities described above can only be judged by the extent to which the Organization has successfully collaborated with governments in demonstrating the value of modern health departments and in stimulating the organization of adequate national health services, staffed with well-trained, adequately remunerated, fulltime personnel not subject to political removal. Experience has repeatedly shown that the development of a career service for national health personnel is an essential factor in the full utilization of international consultants and in guaranteeing continuation of work undertaken. 3. Education and Training.-As education and training constitute a major component of the work of the Organization, it is neither possible nor desirable to draw a sharp dividing line between this subject and the remainder of the program. Every public health activity includes a considerable amount of training-by demonstration, field teaching, and specially organized courses-to which most of the international assistance is devoted. To facilitate this discussion, this heading relates broadly to those activities having education and training of health personnel as their major immediate objective. It will be noted that, even with this limiting definition, approximately one third of the funds for field activities is being devoted to education. This relative emphasis is well justified, in view of the obvious importance of training professional and auxiliary health workers in sufficient numbers to carry on expanding health services. The promotion of professional education is one

133 128 P.A.S.O. DIRECTING COUNCIL of the most important avenues of approach to this aim. This involves the improvement and expansion of educational facilities so that national personnel can be trained in or near their own countries. Travel grants for professors, consultants, visiting professors, as well as limited teaching supplies are vehicles of international cooperation for achieving this objective. Cooperation with schools of public health has a high priority, inasmuch as from those schools will come the body of trained leaders and administrators upon whom rests the entire success of the national health programs, ultimate goal of the Organization. Medical education is a rising field and, through coordination with other interested agencies, will be greatly expanded as more individual schools prepare long-range plans. Nursing education has been one of the main fields of activity, and the experience gained should be applied in coming years to expand and improve nursing schools and other training media. Other health professions, such as sanitation personnel, are also the subject of special consideration in the present programs and must continue to receive increased attention. The training of subprofessional personnel constitutes an urgent need in many countries, and sanitation, statistics, and nursing are at present fields of major interest. The increasing demand from various Member Governments makes it necessary to give high priority to the expansion of this type of training in the program for future years. Fellowships for study and observation abroad form a traditional and effective approach through which governments and international agencies have attempted to meet the shortage of trained public health personnel. The names of leading public health officers provide testimony of the results of these efforts. As there is an ever-continuing need for this type of activity, the Organization will pursue its efforts, especially in the direction of providing training in places where social and health conditions are similar to those in the country of origin. It is expected that governments will continue to take all necessary steps for the full utilization of the fellows when they return to their countries. As progress is achieved in this direction, the program for the specific period must provide resources to increase the number of fellowships. Training and exchange of information through seminars and short courses will continue to receive special attention, as they have proved to be a very effective method that can be applied to a wide variety of subjects and provide a unique opportunity for stimulating health workers toward progress in their countries. A further educational activity that should be expanded is the dissemination of technical information by means of the PASB Bulletin, books, technical reports, and pamphlets, as well as through a substantial volume of information conveyed in answer to individual requests on many types of subjects. 4. Eradication of Communicable Diseases.-The principle of eradication as a method of attack on transmissible diseases has since the beginning received special attention by the governing bodies of the Pan American Sanitary Organization. The Directing Council, at its I Meeting (1947), called for the elimination of urban yellow fever through the continental eradication of Aédes aegypti and authorized the Bureau to take pertinent action in cooperation with the respective governments. With few exceptions, the countries of the Americas are faithfully carrying out this campaign and substantial progress has been accomplished. The Organization will continue to take every possible measure in coming years to complete the work under this mandate. Recognizing the feasibility of malaria eradication, as shown by the successful experience of some countries, the XIII and XIV Pan American Sanitary Conferences approved the principle of the eradication of this disease from the Americas and gave a mandate that constitutes the fundamental basis of the work now being developed. The "specific period " will encompass the peak effort of this continental campaign, since several Member Governments have already laid detailed plans for the next four years and most of the others are in the process of doing so. The Organization will give the necessary technical advice and promote coordination in order to complete malaria eradication in the Continent. Given its total scope and magnitude, this task will necessarily extend beyond the specific period under consideration. The successful experience by a Member Country in this Region in a mass campaign aimed at eradication of yaws provides the basis for expanding efforts in this field. In this connection, the XIV Pan American Sanitary Conference recommended that "inasmuch as experiments in mass treatment with penicillin have proved successful in endemic areas of yaws, this procedure be applied to achieve eradication." As the philosophy and techniques of eradication gain increasing recognition in the realm of public

134 W.H.O. REGIONAL COMMITTrEE 129 health, it appears feasible to consider its application to other diseases. Smallpox was the subject of a resolution of the XIII Conference calling for eradication of the disease. Consistent efforts have been applied by the Organization to stimulate systematic vaccination and revaccination in several countries where the disease still exists. The limited success accomplished so far indicates the need for continuing these activities during coming years. Communicable-disease control should continue to be an important component of the Organization's activities regarding those diseases in whose case current knowledge does not yet make eradication a feasible goal. In summary, the eradication activities are bound to increase rapidly and be maintained at a high level during the period through Experience has shown that these activities constitute a valuable contribution to the fundamental task of strengthening the basic national health services. D. Conclusions Formulation of long-range plans for international health work is now a well-defined policy established by the governing bodies of the World Health Organization and of the Pan American Sanitary Organization. The countries and their international health organizations will approach the period with a certain amount of knowledge of what is needed and some accumulated experience with effective working procedures. Recent experience in the execution of annual programs of the Organizations has shown that the basic principles of public health administration laid down by the governing bodies provide a satisfactory basis for international health work. What is needed is improvement in methods and intensification of their application. The countries themselves are basically the ones that determine and make possible the work of their international health organizations, the progress and usefulness of which can be measured only by the rate of development of the national health programs. To fulfill the principles and objectives determined by the governing bodies, certain specific action will be required during the period : (a) Completion of the inventory of national health conditions and resources for presentation at the XV Pan American Sanitary Conference. This analysis can best be made by the health authorities themselves with any necessary cooperation of international staff. (b) Preparation of national health plans. As sound health planning is a fundamental requirement for the success of international cooperation, the Organizations must give highest priority to collaboration with the governments in this task. (c) Establishment of a professional public health career, with full-time employment and adequate salaries; and training of professional and subprofessional personnel for health services. (d) Intensification of continental, regional, and national programs for eradication of communicable diseases. (e) Wider application of the principle of border and area health agreements to meet common problems that can best be solved by cooperation between neighboring countries. (f) Concentration of national and international efforts to eliminate major health hazards, of which those related to environmental conditions are outstanding examples. The solution of those fundamental problems is indispensable for the "attainment by all peoples of the highest possible level of health.'

135 130 P.A.8.O. DIRECTING COUNCIL Annex 2 l TOPIC 5: FINANCIAL REPORT OF THE DIRECTOR AND REPORT OF THE EXTERNAL AUDITOR FOR 1954 Financial Report of the Director for the Year 1 January-31 December 1954 The financial statements of the Pan American Sanitary Bureau are presented herewith, together with the Report of the External Auditor. The principal statements are: 1. Statement of Appropriations, Obligations, and Unobligated Balances of Appropriations for the Year 1954 (Exhibit I). 2. Statement of Income, Expenditures, and Surplus for the Year 1954 (Exhibit II). 3. Statement of Assets and Liabilities as at 31 December 1954 (Exhibit III). Statement of Appropriations, Obligations, and Unobligated Balances (Exhibit I) Against the appropriation of $2,100,000, an amount of $2,099,423 has been obligated, leaving an unexpended balance of $577, viz., almost 100% utilization of the 1954 budget as compared to 93.4 % in Details of obligations incurred are given in the attachment to this report. In accordance with Resolution IX of the VII Meeting of the Directing Council, the Director is authorized to transfer credits between parts of the budget, provided that such transfers of credits between parts as are made do not exceed 10 % of the part from which the credit is transferred. It will be noted that a transfer of $62,923 has been made from Part II of the budget. Of this amount, $9,078 has been transferred to Part I and $53,845 to Part III. The transfers were accomplished by savings in Part II, "Pan American Sanitary Bureau-Headquarters," mainly by reductions in posts and delays in recruitment. Statement of Income, Ezpenditures, and Surplus for the Year 1954 (Exhibit II) Total cash income amounted to $2,367,691, representing the following: 1. Collection of quotas on behalf of Member States for $1,728, Collection of quotas on behalf of Member States for previous years , Collection of quotas on behalf of the Territories of France, the Netherlands, and the United Kingdom... 39,865 'Document CE25/4. 4. Miscellaneous income Unused balances of obligations, refunds, etc., relating to previous years... 45,168 53,780 The greater part of Miscellaneous Income represents the 3% procurement charge, amounting to $24,587. Interest earned during 1954 amounted to $14,742. Other Miscellaneous Income, as detailed in Exhibit II, amounted to $5,839. Expenditures Expenditures against the 1954 budget of $2,100,000 amounted to $2,099,423. In addition, funds expended on behalf of Aftosa, INCAP programs, and other purposes, including purchases for governments, amounted to $1,323,317. Altogether, funds spent by the Pan American Sanitary Bureau, taking into consideration the combined PASB/WHO programs, procurement, and special projects, were as follows: PASB... $2,099,423 Procurement and special projects... 1,323,317 WHO/Regular ,181 WHO/UNICEF... 24,697 WHO/TA ,445 $5,075,063 Surplus The excess of income over expenditures amounted to $268, Of this amount, $100,000 has been transferred to a Special Fund to be utilized for the intensification of antimalaria activities in accordance with Resolution XLIII of the XIV Pan American Sanitary Conference, while the balance of $168, has been placed at the disposal of the Directing Council. This amount, together with a transfer of $5,326.05, totalling $173,593.75, is subject to a separate report with recommendations as to utilization. Statement of Assets and Liabilities (Exhibit III) The statement is divided into six parts, viz.: 1. General Fund 2. Working Capital Fund 3. Emergency Procurement Revolving Fund 4. Special Funds 5. Trust Funds 6. Technical Assistance-Organization of American States The first four funds represent the Pan American Sanitary Bureau's own funds, while the other two

136 W.H.O. REGIONAL COMMITEE 131 are held in trust for purposes indicated in the 3. Emergency Procurement Revolving financial statements. Fund-Cash in banks... 49,322 From Exhibit III it will be noted that the Bureau's 4. Special Funds-cash in banks ,630 liquid funds were as follows: 5. Trust Funds-cash in banks Technical Assistance-OAS--cashinbanks 584, , General Fund-cash in banks and on Total:... $2,655,163 hand... $239, Working Capital Fund... Respectfully submitted, Cash in banks... $95,382 FRED L. SOPER Investments... 1,104,618 1,200,000 Director Summary of Obligations Incurred in Respect of the Budget for the Year 1 January-31 December 1954 Part I. Pan American Sanitary Organization Liquidated Unliquidated Total Conference Section Personnel... $85, $ $85, Organizational Meetings XIV Pan American Sanitary Conference... 71, , , Meetings of the Executive Committee... 19, , , , , Separation Costs, Reimbursement of Income Tax, etc... 10, , Total-Part I , , , Part II. Pan American Sanitary Bureau-Headquarters Executive Office, Division of Education and Training, Division of Public Health, and Division of Administration , , , Common Services-Headquarters Space and Equipment Services... 23, , , Other Services... 23, , , Supplies and Materials... 12, , , Fixed Charges and Claims... 2, , Acquisition of Capital Assets... 3, , Sampling, Testing, Periodicals and Catalogs External Audit... 6, , Hospitality Separation Costs, Reimbursement of Income Tax, etc. 76, , , , , Total-Part II , , , Part III. Pan American Sanitary Bureau-Field and Other Programs Zone Offices Jamaica Field Office... 22, , El Paso Field Office... 21, , Mexico (Zone II)... 77, , , Guatemala (Zone III) , , , Lima (Zone IV)... 85, , , Rio de Janeiro (Zone V)... 54, , Buenos Aires (Zone VI)... 91, , , Hospitality-Above offices , , ,402.47

137 132 P.A.S.O. DIRECTING COUNCIL Summary of Obligations-Continued Liquidated Unliquidated Total Part. III-Continued Country Programs Malaria and Insect Control... 87, , , Venereal Diseases and Treponematoses... 58, , , Endemo-Epidemic Diseases... 78, , , Public Health Administration... 54, , , Nursing... 24, , , Maternal and Child Health... 2, , Nutrition... 8, , , Environmental Sanitation... 6, , Other Education and Training Projects... 35, , , , , , Separation Costs, Reimbursement of Income Tax, etc... 11, , Publications of the PASB Special Publications... 3, , , PASB Bulletin... 20, , , Epidemiology Report AIDIS Journal... 4, , , , , Total-Part III , , ,000, Total-All Parts... 1,908, , ,099, Summary of 1954 Expenditures by Object Groups Pan American Sanitary Bureau Pan American Sanitary Organization Headquarters Field and other Total programs Part I Part II Part III $ $ $ $ Personal Services... 98, , , ,070, Personal Allowances... 12, , , , Travel... 65, , , , Space and Equipment Services , , , Other Services... 5, , , , Supplies and Materials , , , , Fixed Charges and Claims... 9, , , , Grants and Contracted Technical Services , , Acquisition of Capital Assets , , , Total , , ,000, ,099,423.30

138 Financial Statements for the Year 1954 Exhibit I-Statement of Appropriations, Obligations Incurred, and Unobligated Balance of Appropriations for the Year 1954 Obligations Incured Unobli- Aproriated by gated Bj Purpose ofi Ap áel~r.tin Transferred Effective o' Purpose of Appropriation the Betwein Appgpraton Balance t ApproD Council Liquidated by Unliquidated Total of Appro- Partas disbursements prlatlons 8 8 $ 8 $ $ I Pan American Sanitary 198, , , , , , Organization II Pan American Sanitary 954, (62,923.44) 891, , , , Bureau-Headquarters III Pan American Sanitary 946, , ,000, , , ,000, Bureau-Field and Other Programs Total 2,100, ,100, ,908, , ,099, * Figures in brackets denote reductions For the Director Pan American Sanitary Bureau HARRY A. HINDERER, Chief Division of Administration The above statement has been examined in accordance with my directions. I have obtained all the information and explanations that I have required, and I certify, as a result of the audit, that, in my opinion, the above statement is correct, subject to the observations in my report. UNO BRUNSKOG External Auditor Exhibit II-Statement of Income, Expenditures, and Surplus for the Year 1954 Income Contributions from Member States: Amounts collected in respect of 1954 assessments... $1,728, Amounts collected in respect of arrears for previous years , Contributions on Behalf of Territories of France, Netherlands, and United Kingdom: Amounts collected in respect of 1954 assessments... Amounts collected in respect of arrears for previous years... Miscellaneous Income: 3% procurement charge... Interest earned... Sale of old capital assets... Sale of publications... Sundries... Unused Balances of Obligations, etc.: Unused budgetary provisions for Excess of obligations, reserved for Credits against previous years' expenditures... Expenditures Obligations Incurred... Surplus Excess of Income over Expenditures... 22, , , , , , , , $2,228, , , , ,367, ,099, , ($100,000 carried to Special Funds to be utilized for the intensification of antimalaria activities. $168, carried to Special Funds at disposal of the Directing Council) For the Director Pan American Sanitary Bureau HARRY A. HINDERER, Chief Division of Administration The above statement has been examined in accordance with my directions. I have obtained all the information and explanations that I have required, and I certify, as a result of the audit, that, in my opinion, the above statement is correct, subject to the observations in my report. UNO BRUNSKOG External Auditor 133

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141 136 P.A.S.O. DIRECTING COUNCIL Schedule A Statess Contributions in Respect of the Year 1954 Balance Due on 31 Total Balance Due _St tes - on_31 December 1954 n Prir on 31 December Assessaent Collections Balance due to 1954 (See Annex) 1954 Statement of Contributions of Member States Argentina... $148, $148, $148, Bolivia... 7, , $32, , Brazil , $176, Chile... 40, , , , Colombia... 42, , , , Costa Rica... 4, , , Cuba... 41, , Dominican Republic... 6, , , Ecuador... 4, , El Salvador... 6, , , , Haiti... 4, , Guatemala... 7, , , , Honduras... 4, , Mexico... 85, , Nicaragua... 4, , Panama... 6, , , , , Peru... 21, , , , United States... 1,320, ,320, Paraguay... 4, Uruguay... 20, , Venezuela... 42, , , , ,000, ,728, , , , Statement of Contributions on Behalf of Territories of France, Netherlands, and Great Britain France... 4, , Netherlands... 2, , Great Britain... 15, , , ,342.00

142 W.H.O. REGIONAL COMMITI1EE 137 Schedule A, Annex I ea~ y Due on ectin15. Balance Due 31 T States Year 1 January1954 Collected in 1954 December 1954 Totals Arrears of Contributions Due by Member States in Respect to Years Prior to 1954 Argentina $114, , , $114, , , Bolivia , , , , , , , $5, , , , $32, Colombia , , Cuba , , , , , , , , , , Ecuador , , , , , , , Nicaragua , , Paraguay , , , , , , Peru , , , , , , , , , , Uruguay , , , , I 500, I 4, , , , , I I I~~~~~~~~~~~~~~~~~~~~~~~~~~~ I 165, Arrears of Contributions on Behalf of Territories of Netherlands and Great Britain in Respect to Years Prior to 1954 Netherlands , , Great Britain , , , ,523.00

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145 142 P.A.S.O. DIRECTING COUNCIL Schedule H-Technical Assistance (Organization of American States) Balance at 31 December January 194 Amounts (Brought Received or Total Payments MadeUnliguidat Forward Transferred during 1954 Unobga from 1953) during 1954 obtotal Aftosa Center Administration , , , (11,029.19) (5,284.64) 50, ,106.14* 216, (83.08) 199, , , , , , , , , , , , ,226.37t * Includes Revenues 33, t U. S. Dollar Currency... Cruzeiro Currency... Accounts Receivable... Accounts Payable... $103, , $105, , $101,226.37

146 Report of the External Auditor for 1954 Washington, D. C. 21 February 1955 Sir, I have the honor to transmit the financial statements of the Pan American Sanitary Bureau which were submitted by the Director with respect to the financial year 1 January to 31 December These statements have been examined by me, together with the records of the Bureau, pursuant to the Financial Regulations, Article XII, containing the scope of the audit, and are hereby certified. In accordance with the Financial Regulations, I have the honor to present my report with regard to the above-mentioned financial period. I have the honor to be, Sir Your obedient servant, UNO BRUNSKOG Ezternal Auditor The Chairman of the Directing Council of the Pan American Sanitary Organization Report of the External Auditor on the Audit of the Accounts of the Pan American Sanitary Bureau for Pursuant to my letter of appointment as the External Auditor, in accordance with Article XII, paragraph 12.1 of the Financial Regulations for the Pan American Sanitary Bureau, I have examined the accounts of the Bureau for the financial year 1954, with due regard to the provisions concerning the scope of the audit as contained in Article XII of the Financial Regulations, and I have the honor to submit the following report, together with the accounts submitted to me by the Director. 2. Audit certificates have been issued, subject to the observations in this report, to the following statements of the Pan American Sanitary Bureau. These certificates also apply to the Institute of Nutrition of Central America and Panama (INCAP), which funds are controlled by the Bureau. a. Statement of Appropriations, Obligations 143 Incurred, and Unobligated Balance of Appriations for the Year 1954; b. Statement of Income, Expenditures, and Surplus for the Year 1954; and c. Statement of Assets and Liabilities as at 31 December Expenditures 3. Against the total appropriated budget of $2,100,000 for 1954, an amount of $2,099,423 has been expended, leaving an unobligated balance of $577. In other words, close to 100% of the total budget was utilized. As regards the unobligated balances for the years 1953 and 1952, the corresponding figures were $135,889 and $232,942, or 6.6% and 11.3 %, respectively. The strict controls and methods used by the Bureau in operating the budget have made this extremely fine result possible. Since it is very

144 P.A.S.O. DIRECTING COUNCIL rare to achieve a 100% utilization, I have, besides the disbursements, scrutinized the unliquidated obligations very carefully.

147 144 P.A.S.O. DIRECTING COUNCIL rare to achieve a 100% utilization, I have, besides the disbursements, scrutinized the unliquidated obligations very carefully. I am satisfied that no obligations in excess of requirements have been recorded nor that any obligations pertaining to 1954 have been transferred against 1955 funds. I must pay tribute to such a successful management of the budget. 4. In order to cover the amount in excess of the appropriation of Part I, "Pan American Sanitary Organization," an amount of $9,078 has been transferred from Part II, "Pan American Sanitary Bureau-Headquarters." Likewise, a transfer of $53,845 has been made from Part II to Part III, "Pan American Sanitary Bureau- Field and Other Programs," for implementation of new projects. Both transfers have been accomplished by savings mainly due to reduction of staff and delays in recruitment at Headquarters. In reality, the savings under Part II of the budget are greater than shown since, in accordance with new laws, income tax had to be reimbursed in 1954 also to aliens residing in the United States on permanent visa for which no provisions originally had been made in the budget. 5. A comparison between the budget and the obligations incurred relating to Part II and Part III of the budget for the last three years gives an interesting picture, as shown below. The percentages shown reflect the percentage of the total amount budgeted and obligated ' Sl,ooo % $1,ooo % $1,oo0 % Part II-Pan American Sanitary Bureau-Headquarters Budget , Obligations Incurred Part III-Pan American Sanitary Bureau - Field and Other Programs Budget Obligations Incurred. 1, * The 1952 figures have been rearranged in order to conform with the pattern of the budget presented for 1953 and The table shown above indicates firstly a continuing reduction percentagewise in the obligations incurred by Headquarters, and secondly an increase of activities in the field programs. The percentage of the obligations in respect of Part III, "Field and Other Programs" amounts in 1954 to 48%, viz., 6% more than Part II, "Headquarters," which reflects an important deviation from the estimated budget. 6. During my recent visits to some of the Zone Offices, I learned that the bank- rates have not always been used when exchanging U. S. dollars for local currencies. The exchange is normally being performed on a free market when such a market exists. This I find quite in order when such transactions are handled through banks or authorized exchange agencies and are supported by proper exchange notes. Such notes have not always been obtained. 7. When a legal official rate only is recognized by a government and higher exchange rates are given by unauthorized brokers, certain problems will arise. By exchanging U. S. dollars at the official rate of exchange, the cost of operating an office or a project may become increasingly higher since prices are not linked with the official rate of exchange. The practice of the Bureau in all cases is to pay local staff in local currency according to a salary scale established in local currency. Salaries to international staff members are paid by the Bureau in U. S. dollars to staff members' bank accounts in the United States. The Pan American Sanitary Bureau has never adopted a rule similar to one in effect in some other international organizations whereby international staff members are required to draw at least 50 % of their salary in the currency of the country in which the office is established. The reason given by officials of the Bureau for not adopting this rule is that the Bureau normally has no local currencies on hand and, therefore, has to exchange U. S. dollars. An unjustifiable salary reduction would occur if part of the salary is to be paid in local currency at an unrealistic rate which is not in line with the cost-of-living of the country. 8. Summarizing the above, the following problems are present: a. by exchanging U. S. dollar currency at an official rate of exchange for payment of local expenditures, the Bureau will suffer a loss. This loss will be further increased should the Bureau compute salaries to international staff members at a realistic rate established by the Bureau;

W.H.O. REGIONAL COMMITTEE 145 b. by paying the international staff at the official rate of exchange in local currency, the staff would suffer losses in salary; and c.

148 W.H.O. REGIONAL COMMITTEE 145 b. by paying the international staff at the official rate of exchange in local currency, the staff would suffer losses in salary; and c. by paying the international staff in U. S. dollars, the staff may, themselves, exchange U. S. dollars at an unofficial rate of exchange and may violate the laws of the country. I recommend that the Director study this problem. Budgetary Income 9. The revenues during 1954, as compared with those for the two preceding years, are as follows: Contributions Collected from Member States... Contributions Collected on Behalf of Non-Self Governing Territories... 3% Procurement Charges... Interest Earned... Unused Budgetary Provisions for Previous Years... Other Income... Income Credited Directly to the Working Capital Fund... Total ,228,878 S $ $ 39,865 24,587 14,742 48,896 10,723 2,004,085 4,647 34,199 19,132 5,322 16,525 2,367,691 2,083,910 1,901,451 8,559 80,055 25,346 13,580 2,028,991 26,432 2,055, The sums of ordinary contributions received during the year 1954 are shown in the statement below. For purposes of comparison, the corresponding figures for the years 1951, 1952, and 1953 are also given Contributions Assessed, $ 2,000,000 2,000,000 1,943,681 1,943,681 Contributions for the Current Year Collected $ % 1,728, ,743, ,628, ,748, Arrears of Total of Current Contributions Contributions and Arrears Collected Collected, 8 500, , , , ,228, ,004, ,901, ,914, At first sight, the above statement shows an excellent result, since the collection of contri- butions and arrears for the year 1954 amounts to 111% of the assessed contributions, indicating an increase of 11 % as compared to However, when going into detail, note should be taken of the following observations: a. With exception of the year 1952, the collected current contributions for 1954 are lower than both 1951 and 1953 collections. A substantial increase of the percentage of current collections will be required in the future to enable the Bureau to carry out its operations in accordance with the budget and the plan of operations. It is true that in 1954 several Member States have made great efforts to get their future years' contributions on a current annual basis by paying outstanding arrears. If this trend continues, the quota contributions might soon reach a current annual level which will be to the benefit of the Bureau in its operational planning. However, I will point out that there are still three Member States which are in arrears since 1950 or 1951; and b. The income of half a million dollars in collected arrears is mainly due to the Government of Argentina, which paid in full its outstanding arrears up to 1953 amounting to some $400,000. At the end of the year 1954 there were still $436,880 in uncollected contributions. Taking into account the big sums of arrears which have been collected during the last years and that probably half of the present outstanding arrears will be paid in 1955, I draw attention to the fact that these funds, in reality, were reserved for health activities years ago when the various budgets were adopted. In other words, failure to make timely payments of quotas has caused delays in the implementation of various health programs. 11. An amount of $41,411, being a reserve for obligations established in 1953 in excess of requirements, has been reverted and now appears as part of the income (see Exhibit II). The main reason for this excessive reserve is that amounts of awards granted for fellowships, especially in relation to travel costs, have been calculated at maximum amounts. For 1954 the Bureau has endeavored to establish accurate estimates, and I understand that the Bureau will adopt methods and procedures in this respect which will enable fellowship awards to be controlled more efficiently.

146 P.A.B.O. DIRMCTING COUNCIL Cash Surplus for 1954 12. As shown in Exhibit II, the cash surplus for 1954 amounted to $268,268, representing 12.

149 146 P.A.B.O. DIRMCTING COUNCIL Cash Surplus for As shown in Exhibit II, the cash surplus for 1954 amounted to $268,268, representing 12.8 % of the total budget as compared with the cash surplus of $144,089 or 6.9% of the budget in the previous year. The cash surplus for 1954 has been made possible by the collection of arrears of contributions from Member States. 13. An examination of the total voted budget for comparison of income forecast and actual income received gives this picture: Budgetary expenditure... Estimated Budgetary Income: Contributions from Member States... $1,728,574 Contributions on behalf of Non-Self-Governing Territories ,342 Miscellaneous income... 45,168 $2,099,423 1,796,084 Difference... $303,339 This amount has been covered by the following income: Unused Balances of Obligations, etc... $53,780 Collected Arrears from Member States and Non-Self-Governing Territories ,559 $303,339 The remaining balance of Collected Arrears from Member States and Non-Self-Governing Territories represents the Cash Surplus for 1954 and amounts to:... $268,268 The above table reveals that an amount of $303,339 was not covered by estimated income but had to be met from other sources such as receipts of arrears of contributions. Assets and Liabilities 14. From Exhibit III, it will be noted that the Bureau has received a payment of Argentine pesos 1,500,000 as a voluntary contribution. Since it was stipulated in the transmittal letter from the Government that this contribution is to be utilized for activities of the Bureau during 1955 and future years, the amount appears in the mentioned exhibit as a prepayment in 1954 and will be recorded as income in The contribution will greatly assist the Bureau in conserving U. S. dollars for implementation of additional activities and projects. 15. Under Accounts Receivable in Exhibit III, the following amounts relating to procurement of supplies and equipment on behalf of governments are still outstanding: $ Since Bolivia... Ministry of Hygiene 8, Brazil... Yellow Fever Service Cuba... Ministry of Health 2, Guatemala.. Ministry of Health Mexico... Ministry of Health Paraguay... Hospital de Clínicas The Director has repeatedly approached the parties concerned for payment, but so far with no result in the above cases. 16. During 1954, credit in the amount of $34,489 has been extended by the Bureau to the Government of Venezuela. Of this amount, $6,826 has been reimbursed, leaving an unpaid balance of $27,663. From the records, it appears that no real emergency existed justifying payment from the Emergency Procurement Revolving Fund, since the transactions have not been recorded as such. The regulations of the Bureau stipulate that advance payments should be made for purchases of supplies and equipment and I, therefore, have to raise objection to the credit extended in this case. 17. The following payments have been made from the Emergency Procurement Revolving Fund: Government of Mexico... $4, Government of Haiti... 1, By Resolution VIII of the XIV Pan American Sanitary Conference, the expenditure in connection with the flood disaster in Mexico has been charged in 1954 against the budget of the Bureau. The Government of Haiti has reimbursed an amount of $360.33, the amount still outstanding being $ The status of the surplus at the disposal of the Directing Council as at 31 December 1954 was as follows: Cash Surplus for Transfers from Previous "Unbudgeted Appropriations" of Amounts in Excess of Requirements... Total 1954 Surplus... Appropriated for the Purpose of the Intensification of Antimalaria Activities by Resolution XLIII of the XIV Pan American Sanitary Conference... Balance at the Disposal of the Directing Council... $268, , $273, , $173,593.75

150 W.H.O. REGIONAL COMMIlTEE 147 It will be noted that excess amounts of requirements in respect to unbudgeted appropriations have reverted directly to the Surplus Funds at the disposal of the Directing Council, rather than recording the amounts as "Income," as has been the practice previously. 19. The financial position of the Bureau is sound. Inventory 20. A statement of the inventory on hand at Headquarters as at 31 December 1954 has been submitted to me. For comparison, the figures related to the 1953 inventory are included in the following table: $ Typewriters... 22,837 23,880 Adding Machines... 3,063 2,813 Calculators ,248 Other Office Machines... 7,450 6,377 Dictaphone Equipment... 8,393 7,582 Cars... 4,025 4,025 Furniture... 41,979 41,011 Cabinets and Shelving... 19,942 18,715 Medical Equipment... 3,126 3,126 Reproduction Equipment... 15,507 14,995 Cartographic and Drafting Equipment. 5,718 5,517 Various Other... 5,631 6,308 Total , ,597 Administrative Supplies... 5,557 5,225 Grand Total , ,822 Checks made indicate that the statement is correct. 21. I noticed in one of the projects that properties, as listed below and as shown in the inventory records of a Zone Office, were on loan to staff members: refrigerators; electric room heaters; and electric fan. Where ordinary accommodations in houses or apartments can be found, I cannot see any reason why funds should be used for the purchase of equipment of this kind for private use. I have just learned that the items on loan now have been returned to the project by the staff. 22. The new system of inventory which was introduced at the Zone Offices in 1953 has made the control of the inventories much more effective, especially since the administrative officers, to a great extent, are checking the inventories physically in the field. Procurement 23. The total procurement activities are not reflected in the presented accounts. The volume of these activities during the last two years have been the following: Purchases... 1,500,461 1,404,476 Proforma Invoices... 2,672,166 2,517,521 Total... 4,172,627 3,921,997 The purchases represent orders for supplies, etc., for Member States, the Bureau, and the World Health Organization. Quotations, when requested, are given to Ministries of Health of Member Governments for a wide variety of equipment and supplies in the form of proforma invoices showing not only the price of each item but the cost of inland freight, forwarding, marine freight, airfreight, and insurance to port of entry of Member Government. The make-up of these proforma invoices involves about the same work as actual purchases. As no charge is made for supplying these proformas, the Bureau is giving to the Member Governments a great service which is not reflected in the financial records. Reference is made to paragraph 15 concerning some outstanding claims for procurement for different Member States. General Observations 24. I wish to state that the accounting records have been examined to the extent considered necessary to satisfy myself. I have reviewed the accounting system of the Bureau and the arrangements of internal control, and I am pleased to state that the Bureau is continuing its policy of steady improvement. 25. The compliments paid to the Bureau last year under the same heading are once more repeated. Furthermore, I have now had the opportunity to visit most of the Zone Offices and I am glad to state that I have found the present set-up of the Zone Offices to be a very desirable and

WORLD HEALTH ORGANIZATION PAN AMERICAN SANITARY ORGANIZATION

WORLD HEALTH ORGANIZATION PAN AMERICAN SANITARY ORGANIZATION directing council PAN AMERICAN SANITARY ORGANIZATION VIII Meeting Washington, D. C. September 1955 I regional committee WORLD HEALTH ORGANIZATION VII Meeting CD8/95, Rev. 1 (Eng.) 21 September 1955 ORIGINAL: