HANDBOOK OF RESOLUTIONS OF THE GOVERNING BODIES OF THE PAN AMERICAN HEALTH ORGANIZATION

Transcription

1 Official Document No. 241 HANDBOOK OF RESOLUTIONS OF THE GOVERNING BODIES OF THE PAN AMERICAN HEALTH ORGANIZATION Volume IV XXIII Pan American Sanitary Conference XXXII to XXXIV Meeting of the Directing Council 99th to 106th Meeting of the Executive Committee PAN AMERICAN HEALTH ORGANIZATION Pan American Sanitary Bureau, Regional Office of the WORLD HEALTH ORGANIZATION 1991

2 Official Document No. 241 HANDBOOK OF RESOLUTIONS OF THE GOVERNING BODIES OF THE PAN AMERICAN HEALTH ORGANIZATION Volume IV XXIII Pan American Sanitary Conference XXXII to XXXIV Meeting of the Directing Council 99th to 106th Meeting of the Executive Committee o~~pi PAN AMERICAN HEALTH ORGANIZATION Pan American Sanitary Bureau, Regional Office of the WORLD HEALTH ORGANIZATION 525 Twenty-third Street, N.W. Washington, D.C , U.S.A. 1991

3 PAHO Library Cataloguing in Publication Data Pan American Health Organization Handbook of resolutions of the Governing Bodies of the Pan American Health Organization. - Washington, D.C.: PAHO, c1991. vol. 4, 104p. (Official Document; 241) ISBN Title II. (Series) 1. PAHO 2. Health policy 3. Health plans and programs 4. Health priorities-america NLM WA540 Published also in Spanish (1991) as: Manual de resoluciones de los Cuerpos Directivos de la Organización Panamericana de la Salud, Volumen IV ISBN Volume I, (1971) Volume II, (1983) Volume III, (1987) ISBN Pan American Health Organization, 1991 Publications of the Pan American Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention.' For rights of reproduction or translation of PAHO publications, in part or in toto, application should be made to the Editorial Service, Pan American Health Organization, Washington, D.C. The Pan American Health Organization welcomes such applications. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the Pan American Health Organization concerning the legal status of any country, territory, city, or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.

4 CONTENTS' Page Preface... xi Reference List of PAHO Governing Body Meetings... xii 1 PROGRAM General Directives Reorganization of the Pan American Sanitary Bureau Study on Fundamental Principles of Pan American Health Agreements with Member Governments Plan of Long-Range Health Programs and Other Program Criteria Miscellaneous Major Policy Decisions Charter of Punta del Este (August 1961) Task Force on Health at the Ministerial Level (April 1963) Declaration of the Presidents of America (April 1967) Special Meeting of Ministers of Health of the Americas (October 1968) III Special Meeting of Ministers of Health of the Americas-Ten-Year Health Plan (October 1972) IV Special Meeting of Ministers of Health of the Americas-Extension of Coverage (September 1977) International Conference on Primary Health Care- Declaration of Alma-Ata (September 1978)... 2 Strategies for Health for All... 2 Plan of Action Special Initiatives. 2 Priority Health Needs in Central America and Panama... 2 Caribbean Cooperation in Health... 3 Andean Subregion, Joint Plan of Action Other General Programs of Work Covering a Specific Period... 4 Orientation and Program Priorities for Communicable Disease Prevention and Control Epidemiological Surveillance Special Surveillance Measures and Quarantine Border Health Agreements Parasitic Diseases Malaria Chagas' Disease Other Parasitic Diseases. 7 This table of contents pertains only to Volume IV. References to earlier material in Volumes 1, II, and III are given under the various headings in texts. The alphabetical index, which begins on page 87, covers the subjects dealt with in this volume and in Volumes 1, II, and III. iii /11

5 1.2.3 Bacterial, Viral, and Mycotic Diseases Yellow Fever, Dengue, and Eradication of Aedes aegypti and Aedes albopictus Influenza Diarrheal Diseases Tuberculosis Meningitis Sexually Transmitted Diseases and Treponematoses Plague Cholera Leprosy Poliomyelitis Mycotic Diseases Typhus and Other Viral and Rickettsial Diseases Smallpox Hepatitis Acquired Immunodeficiency Syndrome Foot-and-Mouth Disease and Other Zoonoses Expanded Program on Immunization Noncommunicable Disease Prevention and Control Chronic and Degenerative Diseases Cardiovascular Diseases Control of Cigarette Smoking Blindness Diagnostic, Therapeutic, and Rehabilitative Technology Laboratory Technology Blood and Blood Derivatives Essential Drugs, Vaccines, and Biologicals Promotion of Environmental Health Water Supply and Sanitation Sanitary Control of Housing Pollution Control, Including Chemical Safety Food Safety Development of River Basins Health Systems Development Health and Socioeconomic Development Health Planning and Administration National Health Plans Long-Term Planning and Evaluation Coordination Development of Local Health Systems Medical Care Primary Health Care and Community Participation Technical Cooperation among Developing Countries/Economic Cooperation among Developing Countries (TCDC/ECDC) iv

6 1.6.7 Emergency Assistance General Health Protection and Promotion Food and Nutrition Nursing Dental Health Mental Health, Including Drug Abuse Prevention of Accidents Health Education Protection and Promotion of the Health of Specific Population Groups Maternal and Child Health, Including Family Planning Health of Adults Workers' Health Health of the Disabled Women, Health, and Development Training of Health Personnel Fellowships Textbook Program Research Promotion and Development Regional Centers Pan American Foot-and-Mouth Disease Center Pan American Zoonoses Center Institute of Nutrition of Central America and Panama Pan American Center for Health Planning Pan American Center for Sanitary Engineering and Environmental Sciences Caribbean Food and Nutrition Institute Pan American Center for Human Ecology and Health Latin American Center for Perinatology and Human Development Pan American Center for Research and Training in Leprosy and Tropical Diseases Caribbean Epidemiology Center Latin American and Caribbean Center for Health Sciences Information Other Centers Health Information Health Statistics PAHO Publications and Documentation Services v

7 Health Legislation Reports Reports of the Directing Council Annual and C)uadrennial Reports of the Director Annual Reports of the Chairman of the Executive Committee Reports of the Governments WHO Expert Committee Reports Supplies and Equipment PROGRAM BUDGET Budget Policy Consideration and Approval of the Program Budget For PAHO ( ) WHO Regional ( ) For PAHO ( ) WHO Regional ( ) For PAHO ( ) WHO Regional ( ) GOVERNING BODIES OF PAHO Pan American Sanitary Conference Time and Place Rules of Procedure Agenda Technical Discussions Directing Council Presidents of the Directing Council Time and Place Rules of Procedure Agenda Technical Discussions Executive Committee Chairmen of the Executive Committee Membership Time and Place Rules of Procedure Agenda Representation at the Conference and the Council vi

8 4 THE PAN AMERICAN HEALTH ORGANIZATION AND THE WORLD HEALTH ORGANIZATION Agreement between PAHO and WHO WHO Regional Committee for the Americas Study of WHO's Structures in Light of Its Functions WHO Resolutions of Interest to the Regional Committee PAHO Representatives on the Joint Coordinating Board of the WHO Special Program for Research and Training in Tropical Diseases PAHO Representatives on the Policy and Coordination Advisory Committee of the Special Program of Research, Development and Research Training in Human Reproduction W HO Meetings CONSTITUTIONAL AND LEGAL MATYERS Amendments to the Constitution Basic Documents Member Governments Admission of New Member Governments Associate Members Privileges and Immunities Observers Name and Official Insignia Name of the Organization Official Insignia Health Regulations Pan American Sanitary Code International Health Regulations International Transportation of Human Remains COOPERATION WITH OTHER ORGANIZATIONS Organization of American States Inter-American Development Bank Coordination with the United Nations and Other Organizations United Nations Children's Fund International Labor Organization vii

9 6.4 Nongovernmental Organizations Principles Governing Relationship Organizations in Official Relations with PAHO Other Entities Coordination of International Cooperation in the Health Field in the Americas FINANCIAL AND ADMINISTRATIVE MATTERS Financial Matters Financial Regulations and Rules Assessments and Contributions Scale of Assessment Collection of Contributions Working Capital Fund Holding Account Revolving and Special Funds Emergency Voluntary Fund Revolving Fund for the Expanded Program on Immunization Additional Income Sources and Programs Pan American Health and Education Foundation Other Accounts and External Audit Approval of Annual Financial Report of the Director and Report of the External Auditor Appointment of External Auditor Travel Administrative and Staff Matters Staff Rules and Regulations Amendments to the Staff Rules and Regulations Recruitment and Service Recruitment of International Staff Study of Conditions of Employment Hiring Under Local Conditions of Employment Salaries and Allowances Field Service Allowances Language Allowance Cost-of Living Adjustment Study of Salaries and Other Compensations Salaries of Nonclassified Staff Members (Director, Deputy Director, Assistant Director) Tax Equalization Pension Fund Director of PASB Other Officials PAHO Headquarters viii

10 7.3.1 Buildings and Installations for Headquarters Buildings and Installations for Area and Field Offices Administrative Studies Administrative Rationalization PAHO/WHO COUNTRY OFFICES MISCELLANEOUS Awards Public Information and Special Events Congratulations, Expressions of Sympathy, Etc Numerical Index Alphabetical Index ix

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12 PREFACE This edition, Volume IV of the Handbook of Resolutions of the Governing Bodies of the Pan American Health Organization, includes the meetings of the Pan American Sanitary Conference, the Directing Council, and the Executive Committee held during the quadrennium. Volume I of the Handbook, published in 1971, covers the period from 1942 to 1970; Volume II, published in 1983, deals with the meetings held from 1971 to 1983; and Volume III, published in 1987, refers to meetings held during the quadrennium. This edition follows the general plan of Volume III. For each section, reference is made, when appropriate, to the corresponding pages in previous volumes. Since many of the resolutions refer to more than one subject or to different aspects of a subject, some difficulties in classification arose. These difficulties have been overcome to some extent by means of cross-references and footnotes; in some cases a resolution is included in more than one section. Further, the reader can readily find the main subject headings in the Contents at the beginning of the volume, and can also consult the alphabetical index at the end. Like the previous volumes, the current one also contains an index of resolution numbers, which indicates the page or pages where the complete or abbreviated text of each resolution can be found. Purely procedural resolutions have been omitted, and in these cases, their numbers and dates are provided along with the paraphrased contents. The serial number preceding each resolution shows the meeting at which it was adopted. For example, CSP23.R2 indicates the second resolution approved by the XXIII Pan American Sanitary Conference, CD33.R9 the ninth resolution approved by the XXXIII Meeting of the Directing Council, and CE99.R4 the fourth resolution approved by the 99th Meeting of the Executive Committee. Immediately below each resolution the date of adoption is given, along with the number and page reference to the Official Document in which the text was first published. For example, OD 225, 53 refers to page 53 of PAHO Official Document 225. The minutes of the meetings of Governing Bodies and the resolutions approved by them are published each year in a separate volume of the PAHO Official Document series. xi

13 REFERENCE LIST OF PAHO GOVERNING BODY MEETINGS (with the resolution symbol applicable to each meeting and the Official Document number in which they were originally published) Governing Body Executive Committee, 99 Directing Council, XXXII WHO Regional Committee, XXXIX Executive Committee, 100' Executive Committee, 101 Directing Council, XXXIII WHO Regional Committee, XL Executive Committee, 102 Executive Committee, 103 Directing Council, XXXIV WHO Regional Committee, XLI Executive Committee, 104' Executive Committee, 105 Pan American Sanitary Conference, XXIII WHO Regional Committee, XLII Executive Committee, 106 Held June September September June September October June September September June September September 1990 Resolution Symbol CE99.R- CD32.R- CE101.R- CD33.R- CE102.R- CE103.R- CD34.R- CE105.R- CSP23.R- CE106.R- Official Document No 'No resolutions were adopted at this meeting. xii

14 1. PROGRAM 1.1 GENERAL DIRECTIVES 1. Reorganization of the Pan American Sanitary Bureau see Volume I, page MAJOR POLICY DECISIONS 1. Charter of Punta del Este (August 1961)' see Volume 1, page Study on Fundamental Principles of Pan American Health see Volume 1, page Task Force on Health at the Ministerial Level (April 1963)2 see Volume I, page Agreements with Member Governments see Volume 1, page Plan of Long-Range Health Programs and Other Program Criteria 5. Miscellaneous see Volume I, page 3. see Volume I, page Declaration of the Presidents of America (April 1967) 3 see Volume I, page Special Meeting of Ministers of Health of the Americas (October 1968) 4 see Volume I, page 8. OAS Official Records OEA/Ser.S/XIII.1(Eng.), PAHO Official Document 51 (1964). 30OAS Official Records OEA/Ser.C/IX.1(Eng.), PAHO Official Document 89 (1969).

15 2 1. PROGRAM 5. III Special Meeting of Ministers of Health of the Americas-Ten-Year Health Plan (October 1972)' see Volume II, page IV Special Meeting of Ministers of Health of the Americas-Extension of Coverage (September 1977)2 see Volume II, page International Conference on Primary Health Care-Declaration of Alma-Ata (September 1978) 3 see Volume II, page 4. STRATEGIES FOR HEALTH FOR ALL 4 For previous resolutions, see Volume II, page 5, and Volume III, page To thank the Director for the report which has been prepared and presented by the Secretariat in cooperation with the countries of the Region of the Americas. 2. To recommend to the Member Governments that they: a) Adopt appropriate measures to strengthen both the process of health for all and implementation of the primary health care strategy; b) Strengthen their health sector information, analysis, and evaluation systems in order to improve program planning and program execution. 3. To request that the Director: a) Forward the report to WHO Headquarters, together with the comments of the Regional Committee for the Americas; b) Request WHO to prepare guidelines that are more specific and operational than those used in the past, which have posed serious difficulties in their utilization; c) Inform the members of the WHO Executive Board designated by Member Countries in the Region of the Americas about the report, the comments of the Regional Committee, and the need to improve the guidelines to be used in the future for monitoring of the health for all strategies; d) Continue cooperating with the Member Governments to assist them as necessary in preparing any reports and evaluations that may be needed in the future. 'Document WHA39/1986/REC/1, 4. September 1988 OD 225, 136 'PAHO Official Document 118 (1973). 2PAHO Official Document 155 (1978). 'Alma-Ata 1978: Primary Health Care. Geneva, WHO, "Health for All" Series, No. 1, PAHO Official Document 174 (1980). PLAN OF ACTION' For previous resolutions, see Volurne II, page 8, and Volume III, page 3. CD33.R17 Having seen Document CD33/22, which constitutes the chapter for the Region of the Americas in the document titled "Monitoring of the Strategies of Health for All by the Year 2000"; Recognizing that the presentation corresponding to the Region of the Americas has been prepared in compliance with the provisions contained in Resolution WHA39.7' of the Thirty-ninth World Health Assembly; Aware of the difficulties faced by the countries in the implementation and utilization of this instrument-guideline; and Bearing in mind that the report for this Region will be presented to the WHO Executive Board for consideration by the World Health Assembly along with the reports from the other WHO Regions, 'PAHO Official Document 179 (1982). 8. Special Initiatives PRIORITY HEALTH NEEDS IN CENTRAL AMERICA AND PANAMA For previous resolutions, see Voluine lit, page 4.

16 1.1 GENERAL DIRECTIVES GENERAL DIRECTIVES CSP23.R9 The Pan American Sanitary Conference, Considering the positive results of the Central American Health Initiative known as "Health, a Bridge for Peace" to promote the improvement of health, encourage cooperative action, and contribute to solidarity; Taking account of the adoption of Resolution XVII by the XXX Meeting of the Directing Council of the Pan American Health Organization (1984) supporting the plan known as "Priority Health Needs in Central America and Panama" (PPS/CAP); Considering that the VI Special Meeting of the Health Sector in Central America (RESSCA), held in Belize in September 1990, commended the first stage of the Initiative and approved a new proposal for the second stage called "Health and Peace for Development and Democracy in Central America"; Recognizing that this decision follows the mandate given by the Presidents of Central America in their summit meeting at Montelimar in April 1990, reaffirming that health is a political priority and requesting their health ministers to "evaluate the gains of the PPS/CAP over the last five years and frame a new health initiative for Central America," for which purpose they requested the collaboration of PAHO/WHO; Sharing the appreciation expressed by VI RESSCA to PAHO/WHO and the Governments, agencies, and organizations of the international community for their support to the first stage of the PPS/CAP and giving special recognition to the Governments and peoples of the Central American countries for their extraordinary determination in using health as a bridge for peace; and Having seen the Declaration of Belize and the resolutions approved by VI RESSCA that define a second stage of the Central American Health Initiative as an effort to promote common goals in health and thereby to support a process of development with justice, further the consolidation of peace, and strengthen democracy, 5. To urge the international community, including all Governments, development cooperation agencies, international financial institutions, and other international organizations to continue and intensify their technical and financial support for the second stage of the Central American Health Initiative. 6. To request the Director to present a report on the status of the efforts to implement the second stage of the "Health and Peace for Development and Democracy" initiative to the XXIV Pan American Sanitary Conference in 'See Vol. III, p. 4. September 1990 OD 238, 129 CARIBBEAN COOPERATION IN HEALTH see Volume III, page 4. ANDEAN SUBREGION, JOINT PLAN OF ACTION 1. To support the launching of a second stage of the Central American Health Initiative decided upon by the VI Special Meeting of the Health Sector in Central America (RESSCA) under the title of "Health and Peace for Development and Democracy in Central America." 2. To take cognizance of the effort of the Secretariat of the Pan American Health Organization/World Health Organization (PAHO/WHO) to support the Governments in developing the Central American Health Initiative, and to thank the international community for its financial, material, and political support to that initiative over the last five years. 3. To request all sectors in the countries of Central America to join with the health ministers in the promotion of strategies and development efforts for the improvement of health for all, especially in the most vulnerable groups and areas of risk, as proposed in the basic strategy of the second stage of the Central American Health Initiative. 4. To reaffirm the Organization's support for the second stage and to recommend to the Director that he continue collaborating with the countries of Central America in their analysis of the health sector, the review of the programs in the sector, the formulation of projects, and the mobilization of resources for the "Health and Peace for Development and Democracy" initiative. CE101.R8 For previous resolutions, see Volume III, page 5. Having seen the report on Andean cooperation in health (Document CE101/6), which summarizes the guidelines and strategies regarding priority areas for joint action by the countries of the Andean Subregion, To recommend to the XXXIII Meeting of the Directing Council adoption of a resolution along the following lines:' June 1988 OD 225, 96 'For text recommended by the Executive Committee and adopted by the Directing Council, see Resolution CD33.R10 below.

17 4 1. PROGRAM 4 1. PROGRAM_~ CD33.R10 Having seen the report on Andean cooperation in health (Document CD33/17), which summarizes the guidelines and strategies in the priority areas for joint action by the countries of the Andean Subregion; Taking note of Resolution XXII' of the XXII Pan American Sanitary Conference, which supports the formulation of a joint plan of action for the Andean area; and Recognizing the efforts made by the countries of the Subregion, the Secretariat of the Hipólito Unanue Agreement, and PAHO to jointly frame and implement health measures, 1. To congratulate the Governments of the Andean countries on the preparation of the Joint Plan of Action and the commitment that this represents, especially in terms of the effort that the Andean countries will have to make to mobilize local resources and obtain support from external sources. 2. To forward this Plan to WHO and to the Andean Parliament in order to promote active consideration and support for it. 3. To request the Director: a) To orient PASB technical cooperation to the Andean area according to the objectives and strategies of the Plan of Action; b) To seek, jointly with the Governments of the Andean countries, the support of other agencies and governments in and outside the Region for the execution of this Plan; c) To endeavor, jointly with the Governments of the Andean countries, to accelerate implementation of the Plan of Action. 'See Vol. III, p. 5. CSP23.R2 September 1988 OD 225, Other For previous resolutions, see Volume 1, page 9. The Pan American Sanitary Conference, Considering the Regional Initiative signed in Quito on 6 September 1990 by the heads of maternal and child health programs of Latin America and the Caribbean; and Taking into account that this Initiative will be seen and studied by the next World Summit for Children, to be held in New York City on the occasion of the United Nations General Assembly, 1. To support the Regional Initiative on Maternal and Child Health signed in Quito. 2. To urge the Heads of State and Heads of Government of the Region of Latin America and the Caribbean who will participate in the World Summit for Children to make public their commitment to attain in the countries of the Region the goals of maternal and child health proposed for the 1990s, taking into account the interrelationships of population dynamics and the needs for sustained comprehensive development. September 1990 OD 238, GENERAL PROGRAMS OF WORK COVERING A SPECIFIC PERIOD CE105.R4 For previous resolutions, see Volunie I, page 9, Volume II, page 10, and Volume 11I, page 6). ORIENTATION AND PROGRAM PRIORITIES FOR Having examined Document CE105/24 related to the strategic orientations and program priorities for PAHO during the quadrennium; Recognizing that the Pan American Sanitary Conference is the supreme governing authority of the Organization, and that its functions include determining the general policies of the Organization; and Recognizing the need for Member Governments and for the Secretariat to concentrate their efforts and resources on areas that strengthen national health systems and thereby improve the health of the peoples of the Region, 1. To thank the Subcommittee on Planning and Programming and the Director for having proposed a series of strategic orientations and program priorities for PAHO during the quadrennium. 2. To request the Director to revise Document CE105/ 24, entitled "Strategic Orientations and Program Priorities for the Pan American Health Organization during the Quadrennium ," taking into account the comments expressed during the 105th Meeting of the Executive Committee, in particular those related to the organization of the document and to the need for direct linkages between the strategic orientations and program priorities, and to transmit the revised document to the XXIII Pan American Sanitary Conference.

18 1.2 COMMUNICABLE DISEASE PREVENTION AND CONTROL 5 3. To suggest to the XXIII Pan American Sanitary Conference the adoption of a resolution along the following lines:' June 1990 OD 238, 94 'For text recommended by the Executive Committee and adopted by the Pan American Sanitary Conference after amending preambular paragraph 2 and operative paragraph 1, adding operative paragraph 2(a), and amending operative paragraphs 2(b) and 2(c), see Resolution CSP23.R13 below. CSP23.R13 The Pan American Sanitary Conference, Having examined Document CSP23/14, "Strategic Orientations and Program Priorities for the Pan American Health Organization during the Quadrennium ," which includes the revisions suggested by the 105th Meeting of the Executive Committee; ' Taking into account the constitutional function of the Pan American Sanitary Conference in terms of establishing the general policies of the Organization and therefore the points made during general debate on the impact that the dynamic nature of strategic planning has on instruments such as the document under consideration; and Recognizing the need for Member Governments and for the Secretariat to concentrate their efforts and resources on areas that will strengthen national health systems and thereby improve the health of the people of the Region, 1. To approve, as the Organization's basic frame of reference for strategic planning, the document "Strategic Orientations and Program Priorities for the Pan American Health Organization during the Quadrennium ," presented by the Director to the XXIII Pan American Sanitary Conference. 2. To request the Director: a) To continue his efforts to improve and clarify the content and scope of the document, in consultation with Member Governments, the Subcommittee on Planning and Programming, and the Executive Committee; b) To implement the strategic orientations and program priorities contained therein through the biennial programs and annual operating program budgets throughout the quadrennium; c) To ensure that the structure and operations of the Secretariat reflect the evolving nature of the strategic orientations and program priorities for the Pan American Health Organization during the quadrennium; d) To disseminate among Member Governments the document "Strategic Orientations and Program Priorities for the Pan American Health Organization during the Quadrennium "; e) To transmit the document to the Director-General of WHO for his consideration; f) To transmit the document to multilateral organizations and to donor-country cooperation agencies that are involved in health sector activities in Member Governments. 3. To request Member Governments to take into account the strategic orientations and program priorities for the Organization during the quadrennium in the development of their national health policies. 'See Resolution CE105.R4, p. 4. September 1990 OD 238, COMMUNICABLE DISEASE PREVENTION AND CONTROL EPIDEMIOLOGICAL SURVEILLANCE CE105.R12 For previous resolutions, see Volume I1, page 12 and Volume III, page 7. Having examined the report presented by the Director on disease eradication in the Americas between now and the year 2000 (CE105/18, Rev. 1); Considering the progress that has been made in the Region of the Americas in the eradication/elimination of certain diseases; Taking account of the plans that exist at the national, regional, and global levels with regard to disease eradication/elimination; and Recognizing the importance that regional efforts at disease eradication/elimination have in terms of focusing interest and efforts not only on the specific disease in question but on public health and the public health services in general, 1. To transmit the document to the XXIII Pan American Sanitary Conference for its consideration.

19 6 1. PROGRAM 6 1. PROGRAM 2. To recommend to the XXIII Pan Arnerican Sanitary Conference that it adopt a resolution along the following lines:' June 1990 OD 238, 104 c) To provide technical cooperation to the individual Member Countries wishing to proceed toward eradication/ elimination of diseases which may not be suitable targets for a regional effort. September 1990 OD 238, 140 TFor text recommended by the Executive Committee and adopted by the Pan American Sanitary Conference after adding operative paragraph 3, see Resolution CSP23.R16 below. 1. Special Surveillance Measures and Quarantine For resolutions on this subject. see Volume 1, page 40 and Volume II, page 13. CSP23.R16 The Pan American Sanitary Conference, Having examined Document CSP23/6 on disease eradication in the Americas between now and the year 2000, presented by the Director of the Pan American Sanitary Bureau; Considering the progress that has been made in the Region of the Americas in the eradication/elimination of certain diseases; Taking account of the plans that exist at the national, regional, and global levels with regard to disease eradication/elimination; and Recognizing the importance that regional efforts at disease eradication/elimination have in terms of focusing interest and efforts not only on the specific disease in question but on public health and the public health services in general, 1. To thank the Director for the report presented. 2. To accept the basic orientations and proposals contained in Document CSP23/6. 3. To urge the Member Governments to: a) Promote immunization operations on a priority basis with a view to the eradication/elimination of the aforementioned diseases preventable by immunization; b) To set goals for the eradication/elimination of eradicable diseases, such as those resulting from iodine deficiency, taking account of the regional programs for the purpose. 4. To request the Director to: a) Consult with Member Governments and present to the next meeting of the Governing Bodies a detailed report on the status of the eradication/elimination effort in relation to those diseases for which decisions have already been taken to proceed on a regional basis toward eradication/elimination, that is, poliomyelitis, neonatal tetanus, urban rabies, foot-and-mouth disease, and measles; b) Consult with Member Governments and establish mechanisms to determine the feasibility of eradication/ elimination on a regional basis of those diseases which have not yet been targeted, but for which a possibility of eradication/elimination exists, e.g., onchocercosis, leprosy, Chagas' disease, the non-venereal treponematoses, iodine deficiency diseases, and xerophthalmia due to vitamin A deficiency, and in the event that such eradication/elimination is determined to be feasible, prepare the appropriate plans of action to be presented to the Governing Bodies; See also Section (Expanded Program on Immunization). 2. Border Health Agreements PARASITIC DISEASES CE103.R15 1. Malaria see Volume 1, page 81 and Volume 11, page 13. For previous resolutions, see Volume 1, page 11 and Volume 11, page 14. Having examined Document CE103/11, "Malaria Control," which points out the progressive deterioration of the epidemiological situation regarding malaria in the Region of the Americas; and Taking into account Resolution WHA42.30' on malaria control, approved by the World Health Assembly in May of this year, To propose to the XXXIV Meeting of the Directing Council the adoption of a resolution along the following lines: 2 June 1989 OD 232, 93 'Document WHA42/1989/REC/1, For text recommended by the Executive Committee and adopted by the Directing Council, see Resolution CD34.R13 below.

20 1.2 COMMUNICABLE DISEASE PREVENTION AND CONTROL COMMUNICABLE DISEASE PREVENTION AND CONTROL 7 CD34.R13 Having examined Document CD34/7, "Malaria Control," and taking into account Resolution WHA42.30' adopted by the Forty-second World Health Assembly in relation to this topic; and Recognizing that several PAHO Member Countries have eradicated malaria, some more than 20 years ago, and have continued to carry out surveillance activities, thus preventing the reestablishment of malaria transmission in spite of the global increase of the disease, 1. To urge that Member Governments: a) Assign political priority to the effective fight against malaria; b) Promote collaboration and coordination regarding this topic among the different levels of public administration, between it and the private sector, and among those development sectors affected by this issue, such as housing, health, education, agriculture, and mining; c) Ensure that planning and the application of preventive and control methodologies be based on sufficient epidemiological information to allow the stratification of the areas affected by malaria and the analysis of risk factors and groups, in order to make the necessary interventions to prevent, control, and monitor malaria infections and their implications for society at large; d) Commit the necessary resources for the strengthening of the surveillance systems in order to prevent reestablishment of malaria transmission; e) Incorporate malaria prevention and control activities into the local health systems, stimulating social participation and local programming so that related interventions are carried out in a comprehensive, synergic, and sustained manner, using all available human and financial resources (local and national) to address the local situation. 2. To request that the Director: a) Promote the mobilization of institutional, human, and financial resources, internal and external, local, national and regional, in order to develop or use the necessary infrastructure for the execution of effective and consistent malaria control programs; b) Encourage the establishment and adequate functioning of epidemiological services capable of: (i) organizing surveillance and information subsystems; (ii) analyzing causes and trends for transmission as well as risk factors; and (iii) maintaining the process of malaria stratification for planning interventions which decrease, inhibit, or nullify the risk factors; c) Promote the technical cooperation for malaria surveillance systems development through joint efforts among the Member Countries in order to maintain malaria-free status in areas without transmission; d) Formulate a human resources development plan to assist Governments in the organizational strengthening of basic health services, and ensure the development and retention of specialists in terms of various levels of training, professional education, supervision, management, administration, operations, and research; e) Promote the interest of the scientific and financial community in the developed and developing countries to encourage and support research on alternative diagnostic, prevention, and control methodologies which are not only more efficient and effective, but also whose application is feasible in rural areas, as well as cheaper; f) Encourage the process of decentralization/deconcentration, thus strengthening local health systems to develop permanent local programs to control vector-transmitted diseases such as malaria, and supporting the primary health care strategy; g) Support the development of managerial and administrative capabilities at peripheral decision-making levels, in order to encourage local programming and the evaluation of prevention and control methods according to the local situations; h) Carry out the necessary efforts to document and disseminate information on the experiences of countries in relation to their activities in training, research, management, evaluation, and finance. 'Document WHA42/1989/REC/I, 35. September 1989 OD 232, Chagas' Disease 3. Other Parasitic Diseases see Volume I, page 38 and Volume II, page 24. see Volume 11, page BACTERIAL, VIRAL, AND MYCOTIC DISEASES CE99.R6 1. Yellow Fever, Dengue, and Eradication of Aedes aegypti and Aedes albopictus see Volume I, page 20, Volume II, page 19, and Volume III, page 8. Having examined the Director's Report on "Aedes albopictus in the Americas" and its appendix, "Ecology, Biology, and Control of Aedes albopictus" (Document CE99/15);

21 8 1. PROGRAM 8 1. PROGRAM Considering the serious public health implications resulting from the introduction of this exotic vector in two countries of the Americas and its possible dissemination to other countries and territories; Recognizing that this vector could aggravate the problem of dengue and yellow fever in endemic areas of the Americas, and of California encephalitis in North America; and Recognizing that the joint support of all the countries of the Region is necessary for the Plan of Action, and noting that several Member Countries, in cooperation with PAHO, are undertaking surveys to detect possible infestations and reinforcing surveillance activities to prevent the importation of the vector, 1. To express appreciation to the Director for the Plan of Action presented in his report on Aedes albopictus in the Americas (Document CE99/15). 2. To urge Member Countries to prepare and implement national plans of action for the control of Aedes albopictus which would include, as appropriate, the following strategies and activities, integrating them as much as possible with similar strategies and activities from existing Aedes aegypti control programs: a) Initial surveys and the establishment of surveillance systems to determine the presence, distribution, breeding habitats, and insecticide susceptibility of this species; b) Prevention of the establishment of new infestations, and the control or eradication of new and established infestations; c) Emergency control of the vector during disease outbreaks; d) Establishment and continuation of training programs, including those for survey personnel; and e) Research in the distribution, modes of dispersal, breeding habitats, insecticide susceptibility, control methods, and vectorial capacity of Aedes albopictus. 3. To request Member Countries to report periodically to the Director on any infestations of Aedes albopictus, adding this information to that already submitted concerning Aedes aegypti. 4. To request the Director, within available resources, to implement regional activities in support of national efforts, including: a) Assistance in the development of national plans of action; b) Collection and dissemination of technical and surveillance information; c) Assistance to Member Countries in undertaking initial surveys, maintaining their own surveillance and reporting systems, and carrying out appropriate research; d) Provision of training in the biology and control of Aedes albopictus; and e) Preparation of manuals for the identification, surveillance, and control of Aedes species. CE101.R19 June 1987 OD 219, 77 Having reviewed Document CE101/28 which proposes a role for PAHO in dealing with the importation and exportation of Aedes albopictus, and bearing in mind that extensive areas in the Region of the Americas are still infested by Aedes aegypti; and Recognizing the imminent risk an urgent necessity to prevent further spread and to control or eliminate already existing infestations of Aedes albopictus, To recommend to the XXXIII Meeting of the Directing Council that it adopt a resolution along the following lines:' June 1988 OD 225, 109 'For text recommended by the Executive Committee and adopted by the Directing Council, see Resolution CD33.R19 below. CD33.R19 Having seen the report on Aedes albopictus (Document CD33/6), which proposes a role for action by PAHO in this matter; Taking note of Resolution XXV I' of the XXXI Meeting of the Directing Council (1985) that urges the Governments of the countries to take appropriate actions to overcome barriers that may be hindering progress in their programs to control or eradicate Aedes aegypti, giving the necessary attention to the allocation of funds, personnel, and materials for these programs, and to implement measures to prevent exportation of the vector to other countries; and Reaffirming Resolution XXV' of the XXII Pan American Sanitary Conference (1986) which, inter alia, recommended to the Member Countries that they initiate or continue the necessary actions for effective surveillance of Aedes albopictus and measures to prevent its further dissemination or to eradicate it, if possible, 1. To urge the Governments of countries and territories infested with Aedes aegypti and Aedes albopictus to implement the resolutions mentioned above. 2. To reaffirm statements contained in the approved Plan of Action for Aedes albopictus control (Document CE99/15). 3. To urge all Member Countries: a) To take note of the need for adequate legislation and to take the necessary steps to implement regulations regarding importation and exportation of used tire casings; b) To prepare and implement national plans of action for the control of Aedes albopictus with strategies and activities similar to those existing in Aedes aegypti control programs. 4. To request Member Countries to report immediately to the Director on any infestations of Aedes albopictus. 5. To request the Director to continue to support Member Countries in their surveillance and control activities, with particular reference to dissemination of scientific and

22 1.2 COMMUNICABLE DISEASE PREVENTION AND CONTROL COMMUNICABLE DISEASE PREVENTION AND CONTROL technical information which they may use in establishing the necessary legislative and operational steps to prevent the spread of Aedes albopictus. September 1988 OD 225, Plague see Volume I, page 38. 'See Vol. III, p See Vol. III, p Cholera see Volume 1, page 38 and Volume I1, page Influenza see Volume I, page Leprosy see Volume 1, page 35 and Volume II, page Diarrheal Diseases see Volume 1, page 38 and Volume II, page Poliomyelitis see Volume I, page 39 and Volume II, page 28. See also Section (Expanded Program on Immunization). 4. Tuberculosis see Volume I, page Mycotic Diseases see Volume I, page Meningitis see Volume II, page Typhus and Other Viral and Rickettsial Diseases see Volume I, page Smallpox see Volume 1, page Sexually Transmitted Diseases and Volume II, page 29. and Treponematoses see Volume 1, page 35. See also Section (Acquired Immunodeficiency Syndrome). 14. Hepatitis see Volume IIIl, page 9.

23 10 1. PROGRAM 1. PROGRA lo CE99.R Acquired Immunodeficiency Syndrome Having reviewed Document CE99/7 and Add. I on acquired immunodeficiency syndrome (AIDS) in the Americas; and Considering the threat that the AIDS epidemic poses to public health in the Region of the Americas, To recommend to the XXXII Meeting of the Directing Council the adoption of a resolution along the following lines:' June 1987 OD 219, 84 'For text recommended by the Executive Committee and adopted by the Directing Council, see Resolution CD32.12 below. CD32.R12 Having reviewed Document CD32/10 on acquired immunodeficiency syndrome (AIDS) in the Americas and Resolution WHA40.26' of the Fortieth World Health Assembly; Recognizing that the AIDS epidemic presents an unprecedented immediate and long-term threat to public health in the Region of the Americas, requiring urgent, coordinated action; Aware that, under these conditions, special efforts must be made to prevent and control the spread of the disease, yet concerned that these efforts reaffirm human dignity; protect human rights while stressing the social responsibilities of individuals; foster political commitment to health; strengthen health systems based on the primary care approach; and protect freedom of travel, interpersonal communication, and international commerce; Fully supporting the global response to this problem which is being implemented through the WHO Special Program on AIDS, and recognizing its responsibilities as WHO Regional Committee for the Americas to review annually the situation in the Americas, to monitor the use of regional resources, and to report annually to the Director-General of WHO; and Aware of the impact AIDS has on health services, 1. To urge Member Countries: a) To develop, implement and sustain strong national AIDS prevention and control programs along the model recommended by the WHO Special Program on AIDS, adapted to individual national contexts; b) To strengthen national epidemiologic surveillance activities in order to improve national programs; c) To mobilize and coordinate the use of national and international resources for the prevention and control of AIDS while assuring that national health systems are maintained and strengthened in order to combat this epidemic; d) To provide accurate information to their citizens about AIDS, strengthening health information through all mass media and health promotion activities, and promoting responsible, appropriate public action to reduce the transmission of the virus and to provide compassionate responses to those with the disease; e) To continue permitting freedom of international travel, without restrictions based on human immunodeficiency virus (HIV) infection status; f) To provide periodic situation and progress reports to PAHO/WHO, as requested; g) To make every effort to develop the Special Program on Aids within the framework of the policy for health system development and strengthening, making use of the AIDS crisis to promote the needed changes in health services. 2. To request the Director, within available resources: a) To coordinate regional AIDS prevention and control activities with the global program in the establishment of a PAHO/WHO Special Program on AIDS; b) To provide urgently needed technical support to national AIDS prevention and control programs, including support for implementing, strengthening, and maintaining surveillance systems with appropriate laboratory support services; transmission prevention and control programs; health professional training programs; and research activities needed to define the epidemiology of AIDS; c) To develop AIDS control activities, especially those related to health care, together with the development and strengthening of health systems; d) To promote, coordinate, and conduct epidemiologic studies and related research in order to support regional control efforts; e) To disseminate information to the Member Countries concerning technological advances in combating AIDS, epidemiological information about the regional situation, and other information vital for the conduct of national AIDS prevention and control programs; f) To develop mechanisms to facilitate the interinstitutional exchange of technical and resource information at the operational level; g) To provide annual reports on the regional situation and the use of regional resources to the WHO Regional Committee for the Americas; h) To take further steps as may be needed, within his authority, to combat this epidemic. 'Document WHA40/1987/REC/1, September 1987 OD 219, 111

24 1.2 COMMUNICABLE DISEASE PRFVENT`ION AND CONT`ROL COMMUNICABLE DISEASE PREVENI ION ANO CON rrol II CE101.R6 Having reviewed the report on acquired immunodeficiency syndrome (AIDS) in the Americas (Document CE101/17 and Add. I), To recommend to the XXXIII Meeting of the Directing Council the approval of a resolution along the following lines:' June 1988 OD 225, To request the Director: a) To continue to search for funds, in addition to those already approved in the PAHO/WHO regular program budget for the biennium , to support the efforts of the Member Countries to carry out their short- and medium-term programs for AIDS prevention and control; b) To study the feasibility of establishing a revolving fund for the procurement of reagents, equipment, and other critical materials in support of the Member Countries for the implementation of their plans of action against AIDS. September 1988 OD 225, 125 'For text recommended by the Executive Committee and adopted by the Directing Council after amending the fifth paragraph of the preamble and operative paragraph 2, and adding paragraph 3(b), see Resolution CD33.R9 below. 'See p Document WHA40/1987/REC/I, 20. 'Document WHA41/1988/REC/1, 20. CE103.R9 CD33.R9 Having reviewed the report on acquired immunodeficiency syndrome (AIDS) in the Americas (Document CD33/21); Recalling Resolution XII,' adopted by the XXXII Meeting of the Directing Council (1987), dealing with AIDS in the Americas, and Resolutions WHA adopted by the Fortieth World Health Assembly and WHA adopted by the Forty-first World Health Assembly, dealing, respectively, with the global strategy for the prevention and control of AIDS and the avoidance of discrimination in relation to people infected with the human immunodeficiency virus (HIV) and those with AIDS; Considering that the AIDS pandemic continues to grow throughout the Region of the Americas, requiring a sustained commitment by every country to control the spread of HIV and to mitigate the magnitude of the future impact of this disease on health services and national economies; Recognizing the continued need for joint, coordinated international efforts to prevent and control this disease; Cognizant of the need for WHO's global coordination and promotion through the Global Program on AIDS and the joint work carried out in the Region of the Americas by the Pan American Health Organization; and Considering the profound impact that the care of AIDS patients has on the already overtaxed national health services and health resources and the need for national AIDS programs and activities articulated within national plans for strengthening health systems and services, 1. To endorse the objectives, strategies, and goals for the Global Program on AIDS in the Americas, as presented in Document CD33/ To urge Member Countries: a) To make special voluntary contributions for the conduct of catalytic research and cooperative activities regarding AIDS in this Hemisphere; b) To make available to PAHO human and institutional resources to enable the Organization to better fulfill its mandates in this regard. Having reviewed the report on acquired immunodeficiency syndrome (AIDS) in the Americas (Document CE103/24, and Add. I and II), To recommend to the XXXIV Meeting of the Directing Council the adoption of a resolution along the following lines:' June 1989 OD 232, 85 'For text recommended by the Executive Committee and adopted by the Directing Council after amending paragraphs 5 and 6 of the preamble, and operative paragraphs 2(b) and 3, see Resolution CD34.R10 below. CD34.R10 Having reviewed the report on acquired immunodeficiency syndrome (AIDS) in the Americas (Document CD34/13 and Add. I); Recalling Resolution CD33.R9' adopted by the XXXIII Meeting of the Directing Council (1988) dealing with AIDS in the Americas, and Resolutions WHA40.26, 2 WHA41.24,3 and WHA of the World Health Assembly dealing, respectively, with the global strategy for the prevention and control of AIDS, the avoidance of discrimination in relation to persons infected with the human immunodeficiency virus (HIV) and those with AIDS, and the important role played by nongovernmental organizations in the prevention and control of AIDS; Considering that HIV continues to be transmitted throughout the Region of the Americas, requiring an intensified commitment by every country to strengthen its capacity to control the spread of HIV to mitigate the magnitude of the future impact of this disease on health services and national economies; Recognizing the importance of joint, coordinated inter-

25 12 1. PROGRAM national efforts to prevent and control this disease; Cognizant of the increased efforts against HIV/AIDS by the WHO Global Program on AIDS in the Americas, carried out by the Pan American Health Organization; and Considering the ever-increasing impact on national health services and health resources resulting from the need to care for an ever-increasing number of HIV/AIDS patients and the need for national HIV/AIDS programs and activities to be articulated with national plans to strengthen health systems and services, 1. To endorse the objectives, strategies, and future targets for the Global Program on AIDS in the Americas, as presented in Document CD34/ To urge that Member Countries: a) Refrain from imposing discriminatory measures directed at AIDS patients or HIV-infected persons; b) Strengthen and intensify the activities of their national HIV/AIDS prevention and control programs, taking special care to achieve improved articulation with national health systems and services. 3. To request the Director to establish, with extrabudgetary funds, a special program for HIV/AIDS research in the Americas which will be sufficiently flexible and responsive to the many research needs related to HIV and other retroviruses of public health importance, with priority being given to epidemiological, operational, and behavioral research. 'See p Document WHA40/1987/REC/1, 20. 'Document WHA41/1988/REC/1, Document WHA42/1989/REC/1, 36. September 1989 OD 232, 114 CSP23.R19 The Pan American Sanitary Conference, Having reviewed the report on acquired immunodeficiency syndrome (AIDS) in the Americas (Document CSP23/12 and Add. I); Noting the changing situation of the epidemiology of AIDS and the human immunodeficiency virus (HIV) infection in the Region and the status of national and regional AIDS prevention efforts in the Region; Considering the important health, social, and economic consequences of the AIDS pandemic and its long-term repercussions on health programs arid social services in the Americas; and Cognizant of the financial and technical needs to ensure long-term, sustained efforts in the prevention of the sexual, blood-borne, and perinatal transmission of HIV in the socioeconomic context of each individual Member Country, 1. To endorse the targets for the AIDS program in the Americas, as presented in Document CSP23/ To urge that Member Governments: a) Identify and mobilize adequate internal and external resources to ensure continued and efficient multisectoral, governmental, and nongovernmental participation in AIDS diagnosis, prevention, and control at the national level; b) Develop, where necessary, appropriate legal conditions and corresponding laws. 3. To request the Director of the PASB, in coordination with the WHO Global Program on AIDS, to strengthen the regional managerial and resource mobilization and technical cooperation capacities in support of national AIDS prevention programs. September 1990 OD 238, FOOT-AND-MOUTH DISEASE AND OTHER ZOONOSES CE105.R5 Having reviewed the report on acquired immunodeficiency syndrome (AIDS) in the Americas (Document CE105/7 and Add. I), To recommend to the XXIII Pan American Sanitary Conference the adoption of a resolution along the following lines:' June 1990 OD 238, 95 'For text recommended by the Executive Committee and adopted by the Pan American Sanitary Conference after amending operative paragraph 2, see Resolution CSP23.R19 below. see Volume 1, page 36, Volume 11, page 30, and Volume III, page 10. See also Section (Pan American Zoonoses Center) EXPANDED PROGRAM ON IMMUNIZATION For previous resolutions, see Volume II, page 36 and Volume III, page 11.

26 1.2 COMMUNICABLE DISEASE PREVENTION AND CONTROL COMMUNICABLE DISEASE PREVENTION AND CONTROL 13 CE101.R7 Having reviewed the progress report on the implementation of the Plan of Action for the Eradication of the Indigenous Transmission of Wild Poliovirus from the Americas by 1990, To recommend to the XXXIII Meeting of the Directing Council the approval of a resolution along the following lines:' June 1988 OD 225, 94 'For text recommended by the Executive Committee and adopted by the Directing Council after adding preambular paragraph 5 and amending operative paragraphs 3, 4, 4.1(a), 4.1(c), and 4.2, see Resolution CD33.R14 below. CD33.R14 Having examined and reviewed the progress report presented by the Director on the implementation of the Plan of Action for the Eradication of the Indigenous Transmission of Wild Poliovirus from the Americas by 1990; Noting with satisfaction that most countries have prepared five-year plans outlining the activities to be carried out and the costing of the program, with identification of the national and international funding sources; Concerned that many countries have not made enough progress toward implementation of the strategies outlined in the Plan of Action and others have not maintained the strategies over time, and that immunization coverage remains critically low in several of them; Cognizant that less than three years are left before the target date for eradication of wild poliovirus transmission from the Americas and that much remains to be done; and Considering Resolution WHA41.28' (Global Eradication of Poliomyelitis by the Year 2000) of the Forty-first World Health Assembly, 1. To thank the United States Agency for International Development, the Inter-American Development Bank, UNICEF, Rotary International, and the Canadian International Development Agency/Canadian Public Health Association for the level of cooperation and coordination achieved among themselves and with the PAHO Member Countries in carrying out the campaign to eradicate poliomyelitis from the Americas by To urge all Member Countries to make every effort to carry out their adopted national plans of action in accordance with the general guidelines of the Regional Plan of Action and the recommendations of the Technical Advisory Group (TAG). 3. To urge the acceleration and reinforcement of the work of the network of laboratories capable of performing virological tests, in support of diagnostic, surveillance, and control activities in programs of the Member Countries. 4. To place emphasis on the following critical actions requiring the immediate and continuing attention of the Member Countries for attainment of the goal of polio eradication: 4.1 Countries still endemic for polio should: a) Hold at least two regular national mass vaccination days per year as part of their national vaccination programs; b) Utilize these national vaccination days to deliver TOPV as well as other EPI antigens, so that the overall EPI coverage will be increased; c) Continue these measures until eradication of the indigenous transmission of wild poliovirus is achieved and certified. 4.2 Countries not endemic for polio should ensure that high levels of immunization are maintained throughout the country and offer their technical knowledge, resources, and support to countries that may require them. 4.3 All Member Countries should: a) Monitor immunization coverage at the level of the smallest political administrative units; b) Take special measures to improve immunization rates in children under one year of age in areas where TOPV coverage is below 90% in that age group, and use this indicator as a measure of the functioning of the health infrastructure and as a basis for the reallocation of resources. 4.4 Surveillance systems should be strengthened to detect all cases of acute flaccid paralysis: a) All cases of acute flaccid paralysis occurring in persons less than 15 years old should be considered a national emergency and investigated immediately to determine if they represent poliomyelitis; b) Special control measures should be instituted immediately for all cases classified as probable polio cases; c) All cases classified as probable polio cases should be reported as soon as possible to the international level, and specimens immediately sent to designated reference laboratories for prompt and accurate testing. 5. To request that the Director present a progress report to the XXXIV Meeting of the Directing Council in 1989, just one year before the target date for achievement of the goal of polio eradication. 'Document WHA41/1988/REC/1, September 1988 OD 225, 131

27 14 1. PROGRAM 4P CE103.R10 Having examined and reviewed the progress report presented by the Director on the Expanded Program on Immunization and the Plan of Action for the Eradication of Indigenous Transmission of Wild Poliovirus from the Americas by 1990 (Document CE103/3), To recommend to the XXXIV Meeting of the Directing Council the adoption of a resolution along the following lines:' June 1989 OD 232, 86 'For text recommended by the Executive Cominittee and adopted by the Directing Council after adding operative paragraphs 7 and 8(b), see Resolution CD34.Rll below. CD34.R11 Having considered the progress report presented by the Director on the implementation of the Expanded Program on Immunization (EPI) and the Plan of Action for the Eradication of Indigenous Transmission of Wild Poliovirus from the Americas by 1990; Noting that all countries have adhered to the policies and strategies of the Program as outlined in previous Directing Council meetings on this subject, which translates the high priority accorded by Member Countries to this activity; Taking note with satisfaction that immunization coverage with all EPI antigens has steadily increased, reaching historical high levels in 1988 in most countries and in the Region as a whole; Considering that the English-speaking Caribbean countries, Canada, Cuba, and the United States of America have decided to eliminate measles; Recognizing with enthusiasm the tremendous progress made during the last year toward polio eradication, which indicates that this goal will be virtually achieved by the end of 1990; Acknowledging the contribution that these activities have made toward the strengthening of the health infrastructure; and Considering that in spite of all these successes there are still nearly 4 million children born every year in the Hemisphere that do not receive the full benefit of immunization, 1. To reiterate its thanks to the United States Agency for International Development, the Inter-American Development Bank, UNICEF, Canadian International Development Agency/Canadian Public Health Association, and Rotary International for the increased support to this program, and especially to Rotary International for its latest contribution, which helped intensify the "mop-up" operation. 2. To call to the attention of all Member Countries that the program has entered a critical phase and that increased political commitment and resources will be needed if the program is to succeed, that there is no room for complacency, and that, therefore, the policies and strategies set forth in Resolution CD33.R14' of the XXXIII Meeting of the Directing Council (1988)-that all polio-endemic countries should hold national immunization days at least twice a year as a complement to their national immunization program and institute aggressive disease surveillanceshould be continued, and non-endemic countries should ensure that their high levels of immunization are maintained. 3. To request that Member Countries, polio-endemic and non-endemic, take steps to establish a weekly reporting network of flaccid paralysis, including negative reporting, to permit the prompt detection of any suspected case of the disease, so that aggressive investigation and control measures can be instituted. 4. To urge all Member Countries, particularly those still endemic for polio, to institute immediate "mop-up" operations as soon as a probable case is identified, and in all those districts which are at risk of polio transmission. 5. To urge Member Countries to consider the progress already attained toward the goal of polio eradication and to build on this success by: a) Intensifying those actions geared to the control of neonatal tetanus, particularly through vaccination of all women of child-bearing age in those areas already identified as at high risk; b) Intensifying vaccination with measles and DP'T vaccines; c) Increasing further immunization coverage by routine health services, instituting measures to eliminate the missed opportunities for vaccination in all health facilities by offering to vaccinate any eligible children or women of child-bearing age that visit these services. 6. To request that Member Countries and participating agencies decentralize their financial resources to the district level, in order that health workers in the local health system have the required resources to implement promptly the measures necessary to improve coverage and interrupt the transmission of polio. 7. To congratulate and support the English-speaking Caribbean countries on their initiative aimed at the elimination of measles in their countries by 1995, and the similar initiatives of Canada, Cuba, and the United States of America. 8. To request that the Director: a) Institute a reward of US$100 to the first person that reports in writing the first case of an outbreak (as defined in the Plan of Action) in a district for which subsequent laboratory tests confirm that the case was due to wild poliovirus; b) Monitor the initiative of elimination of measles in the English-speaking Caribbean countries, Canada, Cuba, and the United States of America, since its success will be critical for the development of strategies for the elimination of measles from the whole of the Americas;

28 1.2 COMMUNICABLE DISEASE PREVENTION AND CONTROL 15 c) Maintain the same priority accorded so far to this program and to report to the XXIII Pan American Sanitary Conference in 1990 on the achievements of the targets that were established for this program. 'See p. 13. CE105.R6 September 1989 OD 232, 115 Having examined the progress report presented by the Director on the developments of the Expanded Program on Immunization (EPI) and the Plan of Action for the Eradication of the Indigenous Transmission of Wild Poliovirus (Document CE105/13 and Add. I), To recommend that the XXIII Pan American Sanitary Conference adopt a resolution along the following lines:' June 1990 OD 238, 96 'For text recommended by the Executive Committee and adopted by the Pan American Sanitary Conference, see Resolution CSP23.R10 below. CSP23.R10 The Pan American Sanitary Conference, Having reviewed the progress report presented by the Director on the implementation of the Expanded Program on Immunization (EPI) and the Plan of Action for the Eradication of the Indigenous Transmission of Wild Poliovirus (Document CSP23/19 and Add. 1); Noting with satisfaction that immunization coverage levels continued the increased trend observed in previous years, reaching again a historical high in 1989; Taking note of the continued declining trend of the diseases included in this program; Observing from the data presented that indigenous transmission of wild poliovirus may be on the verge of being interrupted in the Western Hemisphere and that an International Commission has been established to start procedures for the certification that transmission has been interrupted; Cognizant that both the increase in immunization coverage level and the effort to eradicate polio have been major factors in the strengthening of the health infrastructure in general and of epidemiological surveillance in particular; and Fully aware that what remains to be done to further increase immunization coverage and achieve the final interruption of transmission will require extraordinary measures by Member Governments, 1. To recognize and express deep appreciation for the critical role that the United States Agency for International Development, the Inter-American Development Bank, UNICEF, the Canadian International Development Agency/Canadian Public Health Association, and Rotary International have played in the last five years, particularly after the Inter-Agency Coordinating Committee was created. 2. To request that these and other development agencies strongly support, financially and technically, the activities outlined in the Concept Paper annexed to Document CSP23/19, entitled "Child Health: Accelerated Immunization Program in the Americas. Phase II: " 3. To urge all Member Governments to assign the necessary funds for vaccine procurement in their national health budgets. 4. To reiterate that all Member Governments need to take strong measures to: a) Eliminate the missed opportunities to vaccinate; b) Achieve and maintain universal coverage with all vaccines included in the Expanded Program on Immunization; c) Increase the measures aimed at the control of neonatal tetanus, particularly in those areas that are identified at high risk for this disease; and d) Further strengthen the control of measles, building on the experience now being gained in the English-speaking Caribbean. 5. To emphasize to Member Governments that adoption of the new polio case classification and acceleration of the national weekly reporting system for flaccid paralysis will be critical for the consolidation of interruption of indigenous transmission of wild poliovirus. 6. To request that Member Governments make every effort to inform the general population that PAHO has instituted a reward of US$100 to be given to the person reporting the first case of flaccid paralysis in a community that is proven to be due to the wild poliovirus, as a measure that will help increase the possibilities of early detection of probable cases of polio. 7. To request the Director: a) To make every effort to sustain the activities needed to stop transmission of wild poliovirus by the end of 1990; b) To take all steps needed to ensure agency coordination and necessary funding for the implementation of Phase II of the project outlined in the Concept Paper, which will sustain and increase immunization coverage and further control the diseases preventable by vaccination; c) To present a progress report on the findings of the International Certification Commission on polio eradication and the funding of Phase II to the XXXV Meeting of the Directing Council of PAHO in September 1990 OD 238, 130

29 16 1. PROGRAM PROGRAM 1.3 NONCOMMUNICABLE DISEASE PREVENTION AND CONTROL CHRONIC AND DEGENERATIVE DISEASES see Volume 1, page 79 and Volume II, page 39. b) Explore the possibility of obtaining extrabudgetary funds from nongovernmental, bilateral, and multilateral organizations, from foundations and professional associations, and from all those sources which may be able to facilitate necessary assistance for the execution of a regional plan of action for the prevention and control of the use of tobacco. September 1988 OD 225, CARDIOVASCULAR DISEASES see Volume II, page 40. CD33.R22 1. Control of Cigarette Smoking For previous resolutions, see Volume 1, page 79. Having seen Document CD33/24, entitled "Fight Against the Use of Tobacco"; Deeply concerned by the avoidable disease, disability, diminished quality of life, suffering, and premature deaths that occur each year in the Region as the unquestionable consequence of the use of tobacco; Recognizing that passive smoking may endanger the health and lives of nonsmokers; and Bearing in mind that there is sufficient evidence to indicate the addictive nature of the use of tobacco, 1. To promote the adoption of public health measures at the regional and national levels to prevent and control the use of tobacco as well as to protect the health of nonsmokers. 2. To urge Member Governments to: a) Adopt legal measures aimed at protecting the health of nonsmokers; b) Adopt measures to control the direct or indirect advertising of all types of tobacco; c) Restrict the consumption of tobacco in any form whatsoever in public places; d) Establish education programs on the dangers of smoking for students in all schools and at all educational levels; e) Make systematic and effective efforts to inform the public through all means, including the mass media, as to the dangers of smoking. 3. To request that the Director: a) Present to the XXXIV Meeting of the Directing Council a regional plan of action for prevention and control of the use of tobacco; CE103.R11 Having examined the "Regional Plan of Action for Prevention and Control of the Use of Tobacco" (Document CE103/20); Noting with satisfaction Resolution XXII' of the XXXIII Meeting of the Directing Council on the fight against the use of tobacco in the Region of the Americas; and Taking note of the Regional Plan of Action presented by the Director in response to the above resolution, 1. To request the Director to amend the proposed plan in accordance with the indications of the members of the Executive Committee. 2. To recommend to the XXXIV Meeting of the Directing Council the adoption of a resolution along the following lines: 2 June 1989 OD 2:32, 88 'See this page. 2 For text recommended by the Executive Committee and adopted by the Directing Council, see Resolution CD34.R12 belowv. CD34.R12 Having examined the "Regional Plan of Action for the Prevention and Control of the Use of Tobacco" (Document CD34/10); Seriously concerned about the growing trends in tobacco consumption in most of the countries of the Region, and about the scale of the promotion of cigarette sales, particularly among youth and women; Bearing in mind the existence of irrefutable scientific evidence that morbidity and mortality associated with the

30 1.3 NONCOMMUNICABLE DISEASE PREVENTION AND CONTROL 17 use of tobacco are preventable and avoidable; and Considering that up to the present few countries have adopted effective measures of prevention and control of the use of tobacco in spite of the fact that it has been shown that those measures are feasible and practicable, 1. To approve the Plan of Action proposed by the Director, with the amendments indicated by the Executive Committee. 2. To urge the Governments to take appropriate decisions and to adopt the necessary measures required by the laws of each Member Country in order to put effectively into practice the Plan of Action in their respective countries. 3. To request that the Director: a) Mobilize extrabudgetary resources to carry out and finance the proposed Plan of Action; b) Continue joint efforts and collaboration with national authorities, nongovernmental organizations, United Nations agencies, and all those institutions interested in collaborating, in order to carry out the Plan of Action in the broader context of prevention and control of the most prevalent noncommunicable diseases BLINDNESS CE103.R12 September 1989 OD 232, 117 For previous resolutions, see Volume II1, page 41. Having examined Document CE103/18, entitled "Blindness Prevention in the Americas," To recommend to the XXXIV Meeting of the Directing Council the adoption of a resolution along the following lines:' June 1989 OD 232, 90 CD34.R16 Having examined Document CD34/9, "Blindness Prevention in the Americas," and Resolution CD26.R13 1 of the XXVI Meeting of the Directing Council (1979); Recognizing that a great part of the eye damage which causes so much human suffering and economic loss can be prevented, cured, or minimized through rehabilitation; Considering that many countries of Latin America and the Caribbean need technical cooperation and coordination in the introduction of local, national, or subregional programs on blindness prevention, primarily to identify populations at risk and in training personnel for the various levels of care; and Taking into account the growing interest and support on the part of the governmental and nongovernmental organizations to develop activities in this area, 1. To urge that Member Governments: a) Maintain and strengthen their policies and programs for eye health and prevention of blindness integrated into general health services on the basis of the primary health care strategy and according to local needs; b) Give special emphasis to the development of uncomplicated prevention, early diagnosis, treatment, and rehabilitative technologies related to the principal causes of blindness, enlisting ample participation from the community and from other sectors, especially the education sector. 2. To request that the Director: a) Continue collaborating with the Governments of Member Countries and with nongovernmental organizations in the promotion of research, personnel training programs, and in the formulation, implementation, and evaluation of national programs of blindness prevention, including the promotion of eye health, and aimed at the major causes of preventable blindness, particularly cataracts, glaucoma, onchocerciasis, and vitamin A deficiency; b) Take steps to obtain extrabudgetary funds and other resources from nongovernmental, bilateral, and multilateral organizations, and from any other source capable of assisting national and regional programs for blindness prevention. 3. To congratulate the nongovernmental organizations on their efforts in the prevention and control of blindness in the Americas. September 1989 OD 232, 121 'For text recommended by the Executive Committee and adopted by the Directing Council, see Resolution CD34.R16 below. 'See Vol. II, p. 41.

31 18 1. PROGRAM PROGRA 1.4 DIAGNOSTIC, THERAPEUTIC, AND REHABILITATIVE TECHNOLOGY LABORATORY TECHNOLOGY see Volume 11, page Blood and Blood Derivatives ESSENTIAL DRUGS, VACCINES, AND BIOLOGICALS see Volume 1, page 74, Volume II, page 43, and Volume III, page 14. see Volume 11, page 42 and Volume III, page PROMOTION OF ENVIRONMENTAL HEALTH For previous resolutions, see Volume 1, page 41, and Volume II, page 43. CE105.R8 Having considered the report of the Director on environmental protection (Document CE105/15), 1. To endorse the general principles and framework for action in the 1990s contained in this report. 2. To transmit the report, together with the comments of the 105th Meeting of the Executive Committee, to the XXIII Pan American Sanitary Conference. 3. To recommend that the XXIII Pan American Sanitary Conference adopt a resolution along the following lines:' June 1988 OD 238, 100 'For text recommended by the Executive Committee and adopted by the Pan American Sanitary Conference after amending operative paragraph 2(c), see Resolution CSP23.Rll below. CSP23.Rll The Pan American Sanitary Conference, Having considered the report of the Director on the significance of the deteriorating environmental health conditions (Document CSP23/16); Recalling Resolution XIII' of the XXII Pan American Sanitary Conference (1986) concerned with the establishment of the Regional Program on Chemical Safety, and Resolution WHA of the World Health Assembly in which support from national health agencies is encouraged in the establishment of policies for sustainable and environmentally sound development; Noting the growing concern of governments and the public that changes in environmental conditions are causing adverse health effects, particularly in the vulnerable segments of the population, especially among the poor, which are likely to grow worse if not brought under better control; Recognizing that these health issues must be given increased attention and that, for the effective execution of the health sector's role with respect to environmental health protection, improvement in information and information management capacities is a key need; Acknowledging that effective environmental health protection activities should involve communities and all relevant sectors at local, intermediate, and national levels; Considering that governments are actively engaged, with the support of the United Nations Environment Program/ Regional Office for Latin America and Caribbean countries, in preparing a Regional Plan of Action for the Environment, which should give consideration to the health needs and well-being of the population; and Noting the Rome Declaration of the Ministers of Health or their representatives (May 1989), which expresses, among others, the need to prevent environmental degradation today to protect the health of future generations, 1. To take note of the report on environmental protection (Document CSP23/16), and to endorse the principles and framework for action in the 1990s contained therein. 2. To urge Member Governments: a) To strengthen the administrative and technical capabilities of national and local institutions as required for the execution of environmental health protection activities, including environmental monitoring and surveillance, covering all segments of the population;

32 1.6 HEALTH SYSTEMS DEVELOPMENT 19 b) To formulate national environmental health strategies, including needed policies, programs, and methods, to facilitate working with communities on environmental health interventions; c) To improve intersectoral cooperation among ongoing national programs and activities, giving increased priority to health protection associated with environmental aspects of water and sanitation, housing, transportation, industrial development, energy generation, urbanization, and resource exploitation. 3. To request the Director: a) To provide technical cooperation for strengthening country capacities in environmental epidemiology, information management, human and scientific resource management, intersectoral coordination, and community mobilization to protect the health of all peoples against environmental hazards, so that appropriate national policies and programs can be formulated and implemented; b) To promote activities of, and cooperate closely with, appropriate national and international health and development agencies to raise awareness and understanding in the population and the industrial sector and to provide information and guidance on the health risks associated with a deteriorating environment; c) To stimulate and support cooperation between countries in the field of protection of the environment; d) To take the necessary steps to mobilize extrabudgetary funding in order to execute programs and projects in the Member Countries which are in line with the subparagraphs above and the principles contained in Document CSP23/ WATER SUPPLY AND SANITATION see Volume 1, page 43, Volume II, page 43, and Volume III, page SANITARY CONTROL OF HOUSING see Volume 1, page 51 and Volume II, page POLLUTION CONTROL, INCLUDING CHEMICAL SAFETY FOOD SAFETY see Volume 1, page 50 and Volume III, page 17. see Volume I, page 74, Volume II, page 150, and Volume III, page 18. September 1990 DO 238, DEVELOPMENT OF RIVER BASINS 'See Vol. III, p Document WHA42/1989/REC/1, 26. see Volume 1, page HEALTH SYSTEMS DEVELOPMENT HEALTH AND SOCIOECONOMIC DEVELOPMENT For previous resolutions, see Volume 1, page 51, Volume II, page 46, and Volume III, page 19. To recommend to the XXXIV Meeting of the Directing Council the adoption of a resolution along the following lines:' June 1989 OD 232, 83 CE103.R8 Having examined the study entitled "Health and Development: Repercussions of the Economic Crisis" (Document CE103/7), 'For text recommended by the Executive Committee and adopted by the Directing Council, after amending the third paragraph of the preamble and operative paragraphs 2-4, see Resolution CD34.R15 below.

33 20 1. PROGRAM PROGRAM CD34.R15 2. Long-Term Planning and Evaluation Having examined the study entitled "Health and Development: Repercussions of the Economic Crisis" (Document CD34/21); Recalling Resolutions CD26.R34' and CD30.R2 2 on analysis of the relation between economic development and health, as well as Resolutions WHA40.30, 3 WHA42.3,4 and WHA concerning monitoring the impact of economic trends and policies on health, support for countries facing economic constraints, and the rationalization of health care financing; Recognizing the relationship of this study to previous studies by the Secretariat concerning the negative impact of the current economic crisis on the health sector; and Expressing satisfaction with the advance of understanding of these repercussions embodied in this study, and observing the challenges for the Member Countries and the Organization which the study brings to light, 1. To take note of the study. 2. To urge Member Countries to address the challenges described in the study, strengthen their information systems, and gather and analyze the pertinent data together with the Organization. 3. To request through the Director that the Organization continue to study with the Member Countries the relationship between health and development; the impact of the economic crisis on health and health services; financing and organization of health care and the administration of health services; and that he provide regular progress reports to the Directing Council. 4. To request the Director to continue to strengthen technical cooperation with Member Countries in order to better characterize and resolve the problems of the economic crisis and health, including more research projects, preferably multidisciplinary ones. 5. To thank the Director for his efforts to focus attention on the relationship between health and economic development through his support and encouragement of research in this area. 'See Vol. II, p See Vol. III, p Document WHA40/1987/REC/1, Document WHA42/1989/REC/1, Document WHA42/1989/REC/1, 6. September 1989 OD 232, 120 CE99.R15 see Volume 1, page 55, Volume II, page 49, and Volume III, page 20. See also Section (General Programs of Work Covering a Specific Period). 3. Coordination For previous resolutions, see Volume III, page 21. Having examined the document "Coordination of Social Security and Public Health Institutions" (Document CE99/ 19); Considering that the process of coordination of health sector institutions has particular interest and importance for the structuring of national health systems in Member Countries; and Noting the need to continue encouraging and supporting national activities in this field to achieve full access to health services for the entire population, 1. To request the Director to present to the XXXII Meeting of the Directing Council the report on "Coordination of Social Security and Public Health Institutions." 2. To suggest to the XXXII Meeting of the Directing Council that it adopt a resolution along the following lines:' June 1987 OD 219, HEALTH PLANNING AND ADMINISTRATION 1. National Health Plans see Volume I, page 53 and Volume II, page 46. 'For text recommended by the Executive Committee and adopted by the Directing Council, see Resolution CD32.R11 below.

34 1.6 HEALTH SYSTEMS DEVELOPMENT HEALTH SYSTEMS DEVELOPMENT 21 CD32.R11 Having seen the report "Coordination of Social Security and Public Health Institutions" for the period (Document CD32/17); Noting that in various countries of the Region lack of functional and operational coordination still persists among the institutions of the health sector, and particularly between the ministries of health and social security institutions, and that this has unfavorable repercussions on the health care of the population and on the efficient and equitable use of the health resources of those countries; and Recognizing the growing significance and importance of the health care programs being carried out by social security institutions in Member Countries, as well as their potential to help in the attainment of universal health care coverage in this Region, 1. To accept the report on "Coordination of Social Security and Public Health Institutions" (Document CD32/ 17). 2. To reiterate to Member Governments the recommendations included in Resolution XXXIV' of the XXVIII Meeting of the Directing Council (1981) and Resolution XV 2 of the XXX Meeting of the Directing Council (1984), especially that governments "include representatives of social security agencies and other health sector institutions in delegations to the meetings of the Organization's Governing Bodies." 3. To recommend to the governments of Member Countries where problems of coordination persist between ministries of health and social security institutions that they adopt a strategy with a clearly defined program of activities to: a) Extend social security coverage to the entire population as a way to avoid "separate clienteles" for ministry of health and social security-programs, aiming at universal health care coverage and the establishment of truly integrated national health policies, based on the strategy of primary health care and the principles of the goal of health for all by the year 2000; b) Improve the efficiency of resource use by formulating and adopting joint investment plans; information, programming, and budgeting processes; the selection, incorporation, and use of medical technology; and the organization of supply, maintenance, and other support components; to this end they should also promote functional integration between ministries of health and social security institutions by developing common systems for the organization and administration of services at the local level; c) Make rational use of health sector financing by coordinating the resources provided by contributions from social security and those allocated from public budgets, and also by tightening production costs and adjusting outlays to priorities; d) Study alternative ways of increasing the amounts received in the aforementioned forms of financing, in view of the rising costs of the sector; e) Work jointly toward the strengthening of health infrastructures and develop firm decentralization policies that permit use of financing at the local level and participation by the public, private, and teaching sectors in order to achieve functional integration of the services network and conciliation of their respective outlooks in the particular circumstances of each country. 4. To urge Member Governments to use and to share experiences regarding coordination of health sector institutions in the Region, which may serve as a reference in the selection of alternative methods for organizing and financing health services. 5. To request the Director, subject to the policies and resources of the Organization, to: a) Promote the inclusion of social security entities in the technical cooperation programs of PAHO at the national level; b) Encourage the exchange of experiences among countries and groups of countries through the preparation of case studies to analyze the legal, organizational, financial, and operational aspects of the health services, while emphasizing institutional coordination aspects within the sector; c) Establish an appropriate mechanism, such as an advisory group, to assist the Organization in the promotion of improved coordination between ministries of health and social security institutions; d) Strengthen PAHO's working relationship with international organizations involved in activities related to social security, and with other intergovernmental agencies, to improve technical cooperation activities in this area; e) Circulate among the Governments information that would be of interest, either presently available or generated in the future, in the area of country studies, analyses of experience, and any other data relating to the aforementioned coordination problems; f) Promote the follow-up of measures taken for the evaluation of progress achieved, and include this subject in his Annual Report. 'See Vol. II, p See Vol. III, p. 21. CE105.R13 September 1987 OD 219, 109 Having seen the document titled "Coordination between the Social Security and the Public Health Institutions" (Document CE105/12); Considering that it is necessary to continue promoting and supporting processes for the functional integration of the institutional resources of the health sector in the Member Countries; and Mindful that development of the potential of social security stands out among the proposals for strategic guidelines and program priorities for the Pan American Health Organization in the quadrennium as a primary means for the transformation and/or improvement of national health systems with a view to the goals of HFA/ 2000,

35 22 1. PROGRAM To propose to the XXIII Pan American Sanitary Conference the adoption of a resolution along the following lines:' June 1990 OD 238, 105 'For text recommended by the Executive Committee and adopted by the Pan American Sanitary Conference, see Resolution CSP23.R12 below. 4. To request the Director: a) To encourage and support the aforementioned processes, and to promote the incorporation of social security institutions into the national programming of the technical cooperation provided by the Organization; b) To continue to emphasize the need for improvement and/or transformation of health systems, including the role of social security, and to allocate specific resources to that purpose, in keeping with the priorities assigned for the period; c) To promote the mobilization of additional local and external resources for greater support to the development of programs and activities for these purposes. September 1990 OD 238, 134 CSP23.R12 The Pan American Sanitary Conference, 'See Vol. III, p See p. 21. Having seen the report "Coordination between the Social Security and the Public Health Institutions" (Document CSP23/25); Recognizing that, up to now, different approaches and modalities have been tried in the Member Countries for coordinating the action of the institutions in the public sector, and of the social security agencies and the health ministries in particular; Considering the persistence, despite these attempts and efforts, of low coverages of the population and duplications of programs and facilities, efforts should be continued and expanded for the political and functional integration of the institutional resources of the health sector; Bearing in mind that the difficult economic situations confronting the countries have a negative effect on the health status of the population and aggravate existing deficits of coverage and the inaccessibility of health services; and Recognizing the significance and importance of Resolutions CD30.R15' (1984) and CD32.R11 2 (1987), approved by the Directing Council of PAHO on this subject, 1. To accept the report on "Coordination between the Social Security and the Public Health Institutions" (Document CSP23/25). 2. To emphasize the validity and relevance of the recommendations made in Resolutions CD30. R15 (1984) and CD32.Rll (1987) of the Directing Council for bringing about the functional integration of the health sector and, in consequence, to urge the Member Governments to renew and broaden their efforts to implement those recommendations. 3. To recommend to the Member Governments that they: a) Review the institutional makeup, macro-organization, and financing of their health care systems; b) Adjust their policies and doctrines on social security based on the current needs of the various population groups, especially those groups constituting the informal sector; c) Take account of the strategic importance of manpower development, the models for continuing education and training, and the adjustment of labor policies in support of the transformation and/or improvement of the health care systems DEVELOPMENT OF LOCAL HEALTH SYSTEMS CE101.R10 Having seen Document CE101/25, "Development and Strengthening of Local Health Systems in the Transformation of National Health Systems," and Resolution WHA41.34' of the Forty-first World Health Assembly, To recommend to the XXXIII Meeting of the Directing Council the adoption of a resolution along the following lines:' June 1988 OD 225, 99 'Document WHA41/1988/REC/1, For text recommended by the Executive Committee and adopted by the Directing Council, after adding operative paragraph 2(c), see Resolution CD33.R15 below. CD33.R15 Having seen Document CD33/14, "Development and Strengthening of Local Health Systems in the Transformation of National Health Systems," Resolution WHA41.34' of the Forty-first World Health Assembly, and the observations of the 101st Meeting of the Executive Committee; Taking into account Resolution XXI 2 of the XXII Pan American Sanitary Conference, which established the ori-

36 1.6 HEALTH SYSTEMS DEVELOPMENT HEALTH SYSTEMS DEVELOPMENT 23 entation and program priorities of PAHO for the quadrennium ; Recognizing the urgent need to accelerate the transformation of the national health systems in order to promote application of the primary health care strategy and to attain the goal of health for all by the year 2000; Concerned about the constraints on the proper development of health care imposed by the present economic crisis and by limitations within the health sector itself; Convinced that the challenge of improving the health of the neediest populations should be met, despite the crisis, with innovative measures for the structuring and administration of available resources; Cognizant of the exercises already under way in most of the countries for the transformation of the national health systems based on the development of local health systems as part of national decentralization and deconcentration processes; and Agreeing that it is at the local level that policies and strategies for social development and health care can be implemented on the basis of social participation, intersectoral action, coordination of financial sources, and integration of programs, cooperation among countries, and to disseminate among governments and local organizations the available information on advances in the development of local health systems and the transformation of national health systems; c) To promote the coordinated participation of all health-related agencies, including those providing services, those training human resources and pursuing research, and those for international cooperation; d) To disseminate to the governments and their ministries and agencies the information available on methodological aspects and advances in the development of local health systems and the transformation of national health systems; e) To support the monitoring of the evaluation of progress in the countries, and to include this topic in his annual reports during the present quadrennium ( ). 'Document WHA41/1988/REC/1, See Vol. III, p. 6. September 1988 OD 225, To thank the Director for Document CD33/14, "Development and Strengthening of Local Health Systems in the Transformation of National Health Systems." 2. To urge Member Governments: a) To continue and to strengthen their work of defining policies, strategies, programs, and activities for the transformation of national health systems through the development of local health systems; b) To ensure coordinated participation in the strengthening of local health systems by all government institutions responsible for the delivery of services, especially the social security administrations, and the international cooperation agencies; c) To promote, in accordance with their institutional realities, the notion of a program-level partnership among the public sector, nongovernmental organizations, and the private sector; d) To place special emphasis on the provision of resources and decentralization to strengthen the operating capacity of local health systems, and on specific programs for dealing with priority health problems; e) To give special attention to the aspects cited in Section IV of Document CD33/14 as a response by the sector for the attainment of greater equity, efficiency, effectiveness, and participation; f) To define and apply suitable indicators and processes for evaluating the development of local health systems and the progress made; g) To promote research on health system services at the local level. 3. To request the Director: a) To strengthen technical cooperation to the Member Countries so that resources will be mobilized for activities to transform national health systems and to support priority programs through the development of local health systems and, particularly, to develop the planning process and information systems, administration, community participation, the leadership of the sector, and personnel training; b) To encourage exchanges of experiences between countries and groups of countries as a form of technical MEDICAL CARE PRIMARY HEALTH CARE AND COMMUNITY PARTICIPATION For resolutions on this subject. see Volume 1, page 63 and Volume II, page 51. see Volume II, page TECHNICAL COOPERATION AMONG DEVELOPING COUNTRIES/ECONOMIC COOPERATION AMONG DEVELOPING COUNTRIES (TCDC/ECDC) see Volume 11, page 54 and Volume Ill. page 22.

37 24 1. PROGRAM PROGRAM EMERGENCY ASSISTANCE CE99.R8 For previous resolutions, see Volume 1, page 80, Volume II, page 56, and Volume III, page 23. Having examined Document CE99/11 on the progress of the Emergency Preparedness and Disaster Relief Coordination Program, To recommend to the XXXII Meeting of the Directing Council that it adopt a resolution along the following lines:' June 1987 OD 219, 80 'For text recommended by the Executive Committee and adopted by the Directing Council, after amending the first preambular paragraph, see Resolution CD32.R10 below. CD32.R10 Having examined the document presented by the Director on the progress of the Emergency Preparedness and Disaster Relief Coordination Program (Document CD32/ 13), together with the conclusions of the meeting on International Health Relief Assistance held in Costa Rica in March 1986; Considering Resolutions X,' XXXVI, 2 XL, 3 and XXIII 4 of the XXIV, XXVI, XXVII, and XXXI Directing Council Meetings, respectively, on the Emergency Preparedness and Disaster Relief Coordination Program; Convinced that, although the health preparedness activities of the countries affected by earthquakes and volcanic eruptions in have contributed to minimize the loss of human lives and to improve the coordination of relief assistance from the international community, additional efforts are required from the governments of disaster-prone countries to increase their level of readiness; and Concerned that the prompt and generous assistance provided to disaster-stricken nations by other Member Countries and by the international community be more attuned to the actual health needs and priorities, 1. To thank the Director of the Pan American Sanitary Bureau for the progress report on the Emergency Preparedness and Disaster Relief Coordination Program and to endorse the recommendations approved at the Meeting on International Health Relief Assistance, held in San José, Costa Rica, March 1986, included in Document CD32/13, particularly those recommendations regarding the need for all potential donors to consult with the health authorities of the affected country before sending health relief assistance and the need to place priority on cooperation between neighboring countries whenever additional medical personnel or resources are needed for disaster management. 2. To urge Member Countries: a) To strengthen their health emergency preparedness programs prior to a disaster by allocating the necessary personnel and budget, to the extent possible, according to the vulnerability of the country to natural disasters, chemical or nuclear accidents, or other emergency situations likely to affect the public health; b) To attach the highest priority to the rapid ancl objective assessment of health needs following a sudden disaster, and to notify PAHO promptly of the results. 3. To request the Director, within available resources: a) To strengthen technical cooperation with Member Countries for the development of their health emergency preparedness programs and for the assessment of their health needs in the case of a disaster; b) In response to the need for disaster relief, to disseminate to potential donors, Member Countries and others, in consultation with the health authorities of a disasteraffected country and in coordination with WHO and with the Office of the United Nations Disaster Relief Coordinator (UNDRO), timely and authoritative information indicating the type of health assistance that may be appropriate, as well as that which is considered unnecessary or counterproductive; c) To disseminate widely the recommendations approved at the San José Meeting on International Health Relief Assistance. 'See Vol. II, p See Vol. II, p See Vol. II, p See Vol. III, p. 24. CD33.R4 September 1987 OD 219, 107 Noting with regret the damage caused by Hurricane Gilbert to Jamaica, Haiti, the Cayman Islands, Dominican Republic, Cuba, Mexico, and the United States of America; Noting, further, the damage suffered by the health sector of Jamaica and the assistance rendered by PAHO to that country; Recalling that one of PAHO's objectives is to cooperate with Member Countries to combat disease and foster the physical and mental health of the peoples of the Hemisphere; Bearing in mind that among PAHO's activities is the provision of emergency aid and assistance to Member Countries in times of natural disasters; and Considering that the United Nations General Assembly has adopted the reduction of disasters as the topic for the forthcoming decade, 1. To request the Director to convey the sympathy of the Member Countries of PAHO to the Government and people of Jamaica and of the other affected countries. 2. To commend the Director for making available assistance from the Organization.

38 1.7 GENERAL HEALTH PROTECTION AND PROMOTION To urge Member Countries to: a) Render assistance to those countries affected by Hurricane Gilbert; b) Consider emergency preparedness of the health sector as a development priority for the allocation of national and international resources in the context of the forthcoming Decade on Disaster Reduction. 4. To request the Director to continue to assist Jamaica in assessing the damage to the health sector and in developing and supporting plans for the rehabilitation and reconstruction of the health system. CD34.R6 September 1988 OD 225, 120 Considering the devastation to several small island countries in the Caribbean and several towns and cities in the United States of America and the immediate adverse effects on human health and welfare, as well as the destruction of crops, facilities, and infrastructure in these countries and the long-term consequences for their productive capacity and balance of payments; and Noting the decision of the Heads of Government of the Caribbean Community countries at their Tenth Meeting in July 1989 to institutionalize arrangements within the framework of their Community to enable quick responses to be made to their Member Countries in the event of natural disasters, according to their respective capacities, 1. To express deep sympathy to the Governments and people of those countries which have suffered damage, loss of life, and injury as a result of the recent Hurricane Hugo. 2. To commend the Director for his usual immediate and sensitive response on behalf of the Organization to the urgent needs in the afflicted countries, especially in the smaller countries, and to acknowledge the expression of appreciation for those efforts by the Representatives of those countries in this Meeting of the Directing Council. 3. To request that the Director: a) Intensify the efforts of this Organization in assisting its members which are frequently affected by natural disasters in their activities geared to better preparedness, in emergency relief, and in long-term rehabilitation and reconstruction of their health and medical facilities and services where necessary; b) Explore further possibilities, within the program and budget for the current and the next biennium, for increasing the support of the Organization in the relief and reconstruction efforts necessitated as a result of Hurricane Hugo. September 1989 OD 232, GENERAL HEALTH PROTECTION AND PROMOTION FOOD AND NUTRITION For previous resolutions, see Volume I, page 70, Volume II, page 61, and Volume III, page 25. To recommend to the XXXIII Meeting of the Directing Council the adoption of a resolution along the following lines:' June 1988 OD 225, 106 CE101.R17 Having seen Document CE101/10 on the Organization's food and nutrition policy, based on an analysis of the current situation and its trends in a biological, economic, and social context; Recognizing that, despite national and international efforts, serious food and nutrition problems persist in the Region and affect, in particular, low-income groups and groups at high biological risk; and Agreeing with the proposals made on this subject of paramount importance to the Member Governments, 'For text recommended by the Executive Committee and adopted by the Directing Council after amending operative paragraph 1(a) and adding operative paragraphs 1(b) and 2(g), see Resolution CD33.R16 below.

39 26 1. PROGRAM CD33.R NURSING Having seen Document CD33/23 on the Organization's food and nutrition policy; Considering the persistence of serious food and nutrition problems in the Region, largely due to the marginal social and economic conditions of important population groups and to the severe economic situation in the countries; Aware that the nature of the problem will require coordinated multisectoral action, in which the ministries of health carry out specific measures in the national health systems and provide leadership in the technical aspects of their interaction with the other sectors involved; Concerned that the stabilization and structural adjustment measures being adopted by the countries may aggravate existing deficits in the availability and consumption of food in low-income groups and increase the prevalence of undernutrition; Recognizing that, in addition to protein-energy malnutrition, there are specific iodine, iron, and vitamin A deficiencies, as well as malnutrition from nutrient excesses and imbalances in the diets of many population groups; and Taking into account the important role that the Organization plays in the food and nutrition area, both directly and in coordination with other technical cooperation agencies, 1. To urge the Member Governments: a) To strengthen their multisectoral policies and strategies for increasing purchasing power and improving the availability and consumption of food, particularly in lowincome populations and groups at high biological risk, in order to improve their nutritional status; b) To carry out measures for improving the food habits of the population that will result in a nutritionally balanced diet; c) To step up food and nutrition activities in national health systems and under the primary health care strategy, with broad social participation, through the effective mobilization of local and external resources, and taking account of the important part played by women in this work. 2. To request the Director, in working with Member Countries, to emphasize technical cooperation in the following aspects: a) The planning, execution, and evaluation of food and nutrition strategies directed at low-income populations and priority groups; b) Food and nutrition surveillance; c) Distribution of food to priority groups, especially mothers and children and other groups at the poverty level; d) Education and social communication in food and nutrition, including warning against the effects of malnutrition caused by insufficiencies and excesses; e) Control of specific nutrition deficiencies: iodine, iron, and vitamin A; f) Preventive nutrition in the management of chronic diseases associated with food and nutrition; g) Research into balanced diets using basic foods which, to the extent possible, are locally produced. September 1988 OD 225, DENTAL HEALTH MENTAL HEALTH, INCLUDING DRUG ABUSE CE101.R18 see Volume 1, page 65, Volume II, page 61. and Volume III. page 26. see Volume 1. page 74 and Volume II, page 63. For previous resolutions, see Volume I, page 73, Volume II, page 64, and Volume III, page 26. Having seen the report "Drug Abuse Prevention" (Document CE101/22), which summarizes the status of PAHO/ WHO prevention activities for controlling the abuse of psychoactive substances, To recommend to the XXXIII Meeting of the Directing Council that it adopt a resolution along the following lines:' June 1988 OD 225, 108 'For text recommended by the Executive Committee and adopted by the Directing Council after amending operative paragraph 1 and adding operative paragraph 3, see Resolution CD33.R18 below.

40 1.7 GENERAL HEALTH PROT'ECTION AND PROMOTION GENERAL HEALTIl PROTECTION AND PROMOTION 27 CD33.R18 CD34.R14 Having seen the report "Drug Abuse Prevention" (Document CD33/19); Considering Resolutions XLI' of the XXVII Meeting of the Directing Council, XXV 2 of the XXI Pan American Sanitary Conference, and XVII 3 of the XXIX Meeting of the Directing Council, in which the Member Governments and the Bureau are requested to collaborate in the strengthening of national and regional activities for the control of drug abuse, in the development of systems to provide information on the size and nature of the problem, and in the study of the causal factors and the impact of drugs on the health of the population in the Region; Recognizing the importance of the work done by PAHO/ WHO in promoting prevention activities and research on drug abuse; and Considering that the high levels of the traffic in and the production and consumption of illegal drugs are affecting primarily and increasingly the Region's young population, to the detriment of their health and well-being, 1. To support coordination between PAHO/WHO and the Inter-American Drug Abuse Control Commission (CICAD) of the Organization of American States (OAS), the United Nations Fund for Drug Abuse Control (UNFDAC), and other international agencies and bodies doing similar work in the Region. 2. To request the Member Governments to support PAHO/WHO activities in this area by making technical and institutional resources available to the Organization and providing voluntary contributions to the PAHO budget for such purposes. 3. To support, and to encourage cooperation among, Member Governments in their strong enforcement measures against drug traffickers. 4. To request health authorities of the Member Governments to intensify their participation and to provide leadership for groups and commissions that formulate intersectoral policies and programs for drug abuse control in the countries. 5. To promote the participation of the health sector in coordination with other sectors to promote and encourage primary prevention programs for the general population, with emphasis on groups at risk and on adolescents. 6. To request the Director, as available resources permit, including those of the Regional Director's Development Program and from extrabudgetary sources, to increase the attention and resources devoted by the Organization to this problem, and to make every possible effort to undertake the activities recommended in the report and additional ones as they are developed. September 1988 OD 225, 138 Having seen the resolution of the Special Meeting of Ministers of Health of the Andean Area; Considering Resolution XVIII' of the XXXIII Meeting of the Directing Council in which the Member Countries are urged to support and cooperate in their strong enforcement measures against drug traffickers and to formulate and develop programs to prevent and control narcotics consumption; Considering, furthermore, recent events in Colombia related to this matter; and Aware of the serious consequences that drug addiction has on the health of communities, 1. To support in solidarity the people and Government of Colombia in their determined, brave struggle against drug trafficking. 2. To request that the Member Countries promote all activities leading to prevention, with emphasis on groups at risk and adolescents. 3. To ask the Member Countries to support activities to combat, control, and confiscate, implementing all necessary measures in the fight against drug trafficking. 'See this page. September 1989 OD 232, PREVENTION OF ACCIDENTS see Volume II, page HEALTH EDUCATION 'See Vol. 11, p See Vol. 11, p See Vol: III, p. 26. see Volume 1, page 66 and Volume 11, page 67.

41 28 1. PROGRAM PROGRAM 1.8 PROTECTION AND PROMOTION OF THE HEALTH OF SPECIFIC POPULATION GROUPS MATERNAL AND CHILD HEALTH, INCLUDING FAMILY PLANNING CE101.R9 For previous resolutions, see Volume I, page 70. Volume II. page 69, and Volume III, page 27. Having seen the report "Maternal and Child Health and Family Planning Programs" (Document CE101/9), To recommend to the XXXIII Meeting of the Directing Council that it adopt a resolution along the following lines:' June 1988 OD 225, 97 'For text recommended by the Executive Comrnittee and adopted by the Directing Council after amending operative paragraphs 1(f) and l(g) and adding operative paragraph 2(b), see Resolution CD33.R13 below. CD33.R13 Reaffirming and reiterating the concepts and mandates contained in Resolution VIII' of the XXX Meeting of the Directing Council (1984) and Resolution XVIII 2 of the XXXI Meeting of the Directing Council (1985); Recognizing the advances achieved by the joint work of the Organization, the Member Countries, and the United Nations Fund for Population Activities in executing the mandates contained in the aforementioned resolutions; Taking note of the constraints that prevent a faster pace of execution; and Reaffirming the statements contained in Document CD33/13, "Maternal and Child Health and Family Planning Programs," which the Director has presented as a second progress report on the status of execution of the Organization's policy for action in population matters, 1. To urge Member Governments: a) To continue efforts to implement the mandates contained and unanimously adopted in Resolutions VIII and XVIII, so that faster progress can be made in the strengthening of maternal and child health and family planning programs, stressing activities among groups at greatest risk, particularly adolescents, to reduce differences between and within the countries; b) To make a special effort to study information on population, health, and existing services so as to update and maintain the situational diagnosis needed to program the measures to be taken in the last decade of the century; c) To design specific proposals for the participat:ion of other development sectors in coorclinated actions to benefit the health of mothers, children, and the population at large; d) To take the necessary action to coordinate technical and financial cooperation in the area of population, health, and development, and especially in maternal and child health and family planning programs; e) To emphasize not only the extension of coverage but also the quality of maternal and child health, family planning services, and the prevention, detection and treatment of cervical cancer as part of the strategy for the development and strengthening of local health systems; f) To set, before the end of 1990, national goals for the reduction of maternal mortality by the year 2000, and to design plans of action to this end so that maternal mortality may be reduced significantly-by at least 50% in countries whose index for this mortality is higher than 5 per 10,000 recorded live births; g) To initiate intersectoral and sectoral actions directed toward the community, teachers, and parents, with a view to helping adolescents develop healthy lifestyles and avoid risk-associated behaviors that lead to drug addiction, accidents, sexually transmitted diseases, and unwanted pregnancies. 2. To request the Director: a) To continue the support of activities required for implementation of the collective mandates in this field, especially the mobilization of national and international technical and financial resources for a more appropriate response to existing needs; b) To propose to the Governing Bodies in 1990 a regional plan of action for the reduction of maternal mortality in the Americas; c) To report on the progress made in this area to the Directing Council at its meeting in 'See Vol. III, p See Vol. III, p. 28. September 1988 OD 225, 129

42 1.8 PROTECTION AND PROMOTION OF THE HEALTH OF SPECIFIC POPULATION GROUPS 29 CE105.R15 Having examined the Regional Plan of Action for the Reduction of Maternal Mortality in the Americas (Document CE105/17, Rev. 1), To recommend to the XXIII Pan American Sanitary Conference the adoption of a resolution along the following lines:' June 1990 OD 238, 109 'For text recommended by the Executive Committee and adopted by the Pan American Sanitary Conference, see Resolution CSP23.R17 below. CSP23.R2 The Pan American Sanitary Conference, Considering the Regional Initiative signed in Quito on 6 September 1990 by the heads of maternal and child health programs of Latin America and the Caribbean; and Taking into account that this Initiative will be seen and studied by the next World Summit for Children, to be held in New York City on the occasion of the United Nations General Assembly, 1. To support the Regional Initiative on Maternal and Child Health signed in Quito. 2. To urge the Heads of State and Heads of Government of the Region of Latin America and the Caribbean who will participate in the World Summit for Children to make public their commitment to attain in the countries of the Region the goals of maternal and child health proposed for the 1990s, taking into account the interrelationships of population dynamics and the needs for sustained comprehensive development. CSP23.R17 September 1990 OD 238, 123 The Pan American Sanitary Conference, Having examined the Regional Plan of Action for the Reduction of Maternal Mortality in the Americas (Document CSP23/10); Reaffirming, reiterating, and expanding the concepts and mandates of Resolutions CD30.R8' (1984), CD31.R18 2 (1985), CD32.R9 3 (1987), and CD33.R13 4 (1988), related to population matters, maternal and child health and family planning, and to women, health, and development; and Endorsing the proposal contained in the Regional Plan of Action for the Reduction of Maternal Mortality in the Americas presented by the Director, 1. To urge Member Governments: a) To develop a comprehensive health care policy addressing women and the prevention of maternal morbidity and mortality; b) To set targets for the reduction of maternal mortality by at least 50%, to be attained within the next 10 years; c) To carry out programs for the communication and dissemination of information to build collective awareness and informed public opinion on the protection of maternity and promotion of reproductive health; d) To design and execute action plans for the reduction of maternal mortality including, whenever appropriate, the goals, intervention strategies, action guidelines, and policies proposed in the Regional Plan; e) To undertake an analysis of the cost of a national plan for the reduction of maternal mortality, define a strategy for financing it, and assign to it the necessary resources; f) To make special efforts for the participation of other sectors in the implementation of actions in promotion of women's health and maternal health; g) To make a special effort toward improving the quality and use of demographic, health, and services information in order to maintain an up-to-date diagnosis of the situation related to the health of women in general, and their reproductive health in particular; h) To establish a maternal mortality surveillance system; i) To evaluate the national plan for the reduction of maternal mortality every two years and inform PAHO on its progress; j) To continue efforts to execute the unanimously adopted mandates contained in Resolutions CD30.R8 (1984), CD31.R18 (1985), CD32.R9 (1987), and CD33.R13 (1988) as a means of achieving rapid progress in executing maternal and child health and family planning programs, thus increasing activities aimed toward groups at greater risk, and particularly those activities aimed at promoting the health of women and protecting their reproductive health, with the goal of reducing the differences within and among countries. 2. To request the Director: a) To support activities to prevent maternal morbidity and mortality as demanded by the Organization's collective mandates, giving particular attention to mobilizing national and international technical and financial resources to execute regional, subregional, and national activities proposed in the plan of action; b) To report on the progress attained in this field to the Meeting of the Directing Council in 'See Vol. III, p See Vol. III, p See p See p HEALTH OF ADULTS September 1990 OD 238, 141 see Volume II, page 71 and Volume III, page 28.

43 30 1. PROGRAM PROGRAM WORKERS' HEALTH CE105.R19 For previous resolutions, see Volume II, page 71. Having examined Document CE105/8 on workers' health, To recommend to the XXIII Pan American Sanitary Conference that it adopt a resolution along the following lines:' June 1990 OD 238, 113 'For text recommended by the Executive Committee and adopted by the Pan American Sanitary Conference after amending subparagraph 2(b) and adding subparagraphs 2(h), 2(i), 3(c), 3(d), and 3(e), and paragraph 4 in the operative part, see Resolution CSP23.R14 below. CSP23.R14 The Pan American Sanitary Conference, Having examined Document CSP23/4, entitled "Workers' Health"; Taking into account the existence of vulnerable workers' groups exposed to high-risk situations; and Noting that risk factors in the workplace are related to high ratios of morbidity, absenteeism, and mortality caused by occupational accidents and diseases and other work-related illnesses, 1. To adopt the programmatic and cooperation guidelines for PAHO contained in the document "Workers' Health" (CSP23/4). 2. To request that Member Governments: a) Give priority to the formulation and evaluation of specific policies related to occupational health in both the formal and the informal sectors, with particular emphasis on achieving coordination among national institutions with responsibility for this area; b) Give priority to the development and implementation of occupational safety and health laws, to the development and enforcement of standards related to exposure to hazards in the workplace, to research into occupational safety and health and into measures to reduce occupational health risks, and to the development and implementation of disease and injury prevention technologies; c) Increase the development of different institutional workers' health care arrangements in order to promote the attainment of universal coverage, with special emphasis on education for health, the promotion of health, primary health care, and the inclusion of occupational health at all levels of health services, including local health care systems; d) Promote and facilitate greater community participation, including workers and employers, in programming, execution, and evaluation of occupational health programs; e) Train and increase the human resources needed for the gradual expansion of workers' health programs and services, drawing on the experience acquired by the countries of the Region in this area through cooperative exchange programs; f) Include occupational health activities in all relevant health programs in order to address the needs of all workers, particularly those who are most vulnerable, such as child and adolescent workers and women of reproductive age; g) Establish information and epidemiological surveillance systems on occupational health; h) Promote and facilitate employee participation in healthy lifestyles to include: smoking cessation, healthy nutrition, exercise, and programs to decrease injury and disease risks for specific occupations; i) Encourage the development of legal instruments on working conditions and environments in countries where they do not yet exist, and the issuance of regulations to implement them in the countries whose legislatures have framed and enacted them. 3. To request that the Director: a) Give workers' health a greater priority when formulating the program budgets during the quadrennium; b) Promote and encourage mechanisms leading to a greater mobilization of resources and an increase of PAHO's technical cooperation capacity in occupational health; c) Promote cooperation to the extent possible and encourage the development of specific occupational health projects for people employed in the agricultural sector, in small businesses, and in the informal sector; d) Give greater support to efforts toward the establishment of the Andean Center for Occupational Health; e) Take, to the extent possible, measures to strengthen the national institutes of occupational health and build a regional network based on such measures and on those to be established. 4. To designate 1992 as the year of workers' health in the Region of the Americas and, with the agreement of all the Governments present, to propose to the World Health Organization that it be made an international year of workers' health. September 1990 OD 238, 137

44 1.8 PROTECTION AND PROMOTION OF THE HEALTH OF SPECIFIC POPULATION GROUPS HEALTH OF THE DISABLED CE105.R14 For previous resolutions, see Volume III, page 29. Having seen the report on disability (Document CE105/ 10) presented by the Director, To propose to the XXIII Pan American Sanitary Conference the adoption of a resolution along the following lines:' June 1990 OD 238, 107 'For text recommended by the Executive Committee and adopted by the Pan American Sanitary Conference after adding operative paragraph l(b), see Resolution CSP23.R15 below. and to facilitate appropriate coordination between the various governmental and nongovernmental organizations and the organizations of the disabled themselves; b) To sponsor research into the causes and develop priority programs for the prevention of disabilities, particularly in children, and for the early detection of persons with disabilities; c) To ensure that the treatment requirements of the disabled are met by general health services and to make those services more accessible to these individuals; d) To examine their national legislation and ensure that all discriminatory provisions are removed; e) To insist on the improvement and broadening of the approach of community-based rehabilitation in their health programs. 2. To request the Director, on the basis of the "specific objectives" and "goals" stated in Document CSP23/7: a) To continue his efforts to increase collaboration by the Secretariat with the Member Governments and with local and international nongovernmental organizations as a contribution to the development of programs and activities for the prevention of disability and the full integration of the disabled into society; b) To obtain extrabudgetary funds from multilateral and bilateral agencies and from all sources able to collaborate with national or regional programs on disability. 'See Vol. II, p See Vol. III, p. 29. September 1990 OD 238, 139 CSP23.R15 The Pan American Sanitary Conference, Having seen the report on disability (Document CSP23/ 7), Resolution XLIII' of the XXVIII Meeting of the Directing Council (1981), and Resolution VII' of the XXX Meeting of the Directing Council (1984), on the International Year of Disabled Persons and the United Nations Decade of Disabled Persons; Reaffirming the importance of the United Nations Decade of Disabled Persons for the recognition accorded in it by the Member Countries of the United Nations organizations, nongovernmental organizations, and other regional organizations to the rights of the disabled and to their role in society; Considering that concrete actions must be taken to promote improvement of the health of disabled persons, to assimilate them into society with full exercise of their rights and duties, to identify risks that lead to disability, and to prevent disabilities; and Recognizing that these actions must continue beyond the end of the Decade as part and parcel of the strategies for attainment of the goal of Health for All by the Year 2000, 1. To urge the Member Governments: a) To designate a focal point, or to strengthen it if it already exists, in their Ministries of Health, to ensure that they participate in planning and programming activities, WOMEN, HEALTH, AND DEVELOPMENT CE99.R7 For previous resolutions, see Volume II, page 74 and Volume III, page 29. Having seen the report of the Special Subcommittee on Women, Health, and Development (Document CE99/18, Add. I); and Advised that, in compliance with Resolution XIV' of the XXXI Meeting of the Directing Council, the Special Subcommittee on Women, Health, and Development has met to consider and evaluate the progress made in this field in the Region, to propose solutions and continue

45 32 1. PROGRAM PROGRAM promoting concerted action in the field of women, health, and development, To recommend the following proposed resolution to the XXXII Meeting of the Directing Council for approval: 2 June 1987 OD 219, 78 'See Vol. III, p For text recommended by the Executive Committee and adopted by the Directing Council after amending operative paragraph 1(e) and adding operative paragraph 2(e), see Resolution CD32.R9 below. 2. To request that the Director: a) Continue his efforts to increase the represeritation of women in PAHO so as to attain the goal of 30% in professional and higher posts, as approved by Resolution XII of the XXII Pan American Sanitary Conference, and also to increase the representation of women as temporary consultants, coordinating with the national focal points for the identification of candidates; b) Promote in all areas of the Organization and the countries increased participation by women in regional meetings, fellowships, training activities, and technical and scientific meetings of all kinds; c) Increase the mobilization of the resources needed to apply the approved regional strategies and to promote, execute, and disseminate specific activities under the Program on Women, Health, and Development in the countries and throughout the Region; d) Support the conduct of research, particularly in the areas recommended in the Subcommittee's report; e) Inform the Directing Council every two years on the activities and progress made in the prevention of maternal mortality and in guaranteeing all women maternity without risk. CD32.R9 September 1987 OD 219, 106 Having seen the report of the Special Subcommittee on Women, Health, and Development (Document CD32/14 and Annex I); Bearing in mind the previous resolutions approved by the Governing Bodies of PAHO on women, health, and development, particularly Resolution XII,' adopted by the XXII Pan American Sanitary Conference; and Mindful of Resolution WHA40.92 approved by the Fortieth World Health Assembly, 1. To urge the Member Countries: a) To complete their plans for carrying out during the biennium programs and activities that will implement the Regional Strategies on women, health, and development approved in Resolution XII of the XXII Pan American Sanitary Conference; b) To continue strengthening the national focal points in accordance with the guidelines laid down in the document "Structure and Functions of the National Focal Point of the Program on Women, Health, and Development," approved by the Subcommittee; c) To review and revise their health policies for both the public sector and the social security system with a view to providing real access for all women to comprehensive health services; d) To study the national legislation and adjust it for attainment of the goal of equality for women in the quality and coverage of the health services available to them; e) To develop and integrate within comprehensive health services specific programs for women which especially address the aspects of financing, quality, coverage, and proper use of technology, and provide solutions to distinctively women's problems; f) To conduct the operations research needed to better identify the health problems of women, their specific needs as seekers of services, and their situation as providers thereof, chiefly in the areas cited in the recommendations of the Subcommittee's report. 'See Vol. III, p Document WHA40/1987/REC/1, 8-9. CE101.R2 Having seen the report of the Special Subcommittee on Women, Health, and Development (Document C'E101/ 24), To recommend the following resolution to the XXXIII Meeting of the Directing Council for its approval:' June 1988 OD 225, 88 TFor text recommended by the Executive Committee and adopted by the Directing Council, see Resolution CD33.R6 below. CD33.R6 Having seen the report of the Special Subcommittee on Women, Health, and Development (Document CD33/28); Bearing in mind previous resolutions adopted by the PAHO Governing Bodies on women, health, and devel-

46 1.8 PROTECTION AND PROMOTION OF THE HEALTH OF SPECIFIC POPULATION GROUPS 33 opment, in particular Resolution XII' of the XXII Pan American Sanitary Conference; and Taking into account Resolution WHA adopted by the Fortieth World Health Assembly, 1. To urge the Member Countries: a) To fulfill the provisions of paragraph 2(b) of Resolution XII of the XXII Pan American Sanitary Conference, regarding strengthening the national focal points on women, health, and development; b) To develop training programs for all health personnel at different levels on the Women, Health, and Development Program, its objectives, content, and strategies, so that they will be able to attend to the comprehensive health needs of women; c) To significantly increase women's participation at the directing and decision-making levels within the health sector institutions; d) To continue to conduct the research necessary to design policies and implement programs that will substantially improve the current living conditions and health of women, giving priority to the subject areas recommended in the report of the Subcommittee. 2. To request the Director: a) To intensify efforts so that all the Organization's technical programs will develop activities aimed at fulfilling the eight strategies on women, health, and development approved by the XXII Pan American Sanitary Conference; b) To continue promoting collaboration with other international agencies, formalizing it through agreements and accords aimed at coordinating activities and mobilizing resources for the Women, Health, and Development Program; c) To incorporate the priority subject areas recommended by the Subcommittee into the research grant program of the Organization; d) To continue efforts to increase the participation of women in PAHO with a view to attaining the goal of 30% in professional and higher-level positions, as approved by Resolution XII of the XXII Pan American Sanitary Conference, and, at the same time, to increase the participation of women as temporary and short-term consultants, working with the national focal points on the identification of candidates; e) To increase mobilization of the resources required for implementing the approved regional strategies and for the promotion, execution, and dissemination of specific activities under the Women, Health, and Development Program at the country and regional levels; f) To report every two years to the Directing Council on the progress achieved in the eight strategies of the Women, Health, and Development Program. JSee Vol. III, p Document WHA40/1987/REC/1, 8-9. September 1988 OD 225, 122 CE103.R3 Having seen the report of the Special Subcommittee on Women, Health, and Development (Document CE103/ 25), To recommend the present draft resolution to the XXXIV Meeting of the Directing Council for its approval:' June 1989 OD 232, 79 'For text recommended by the Executive Committee and adopted by the Directing Council, see Resolution CD34.R5 below. CD34.R5 Having seen the report of the Special Subcommittee on Women, Health, and Development (Document CD34/16); and Having taken into account the previous resolutions adopted by the Governing Bodies of PAHO on women, health, and development, particularly Resolutions CSP22.R12' of the XXII Pan American Sanitary Conference and IX 2 of the XXXII Meeting of the Directing Council, Resolves, 1. To request that Member Governments: a) Strengthen and support the National Focal Point/ Group for the Program on Women, Health, and Development, which has multisectoral and multidisciplinary characteristics and decision-making and technical capacity, and facilitate the necessary resources so as to more adequately and effectively implement the Regional Strategies of the Program; b) Support the project "Women in Health and Development in Central America, Panama, and Belize," given its strategic importance as a means of stimulating the effective participation of women in the development process in the countries of the Region, and support and encourage the design and implementation of other projects related to the Women, Health, and Development Program, which are undertaken by either governmental or nongovernmental organizations. 2. To recommend that the Director: a) Promote and encourage the Member Governments of the Organization to support the National Focal Point/ Group for the Program on Women, Health, and Development, as a multisectoral and multidisciplinary entity with decision-making and technical capacity, so as to be able to coherently execute the objectives and regional strategies of the Program in the countries; b) Strengthen the Focal Point in the PAHO/WHO Country Representative Offices in order to dedicate time

47 34 1. PROGRAM PROGRAM and resources to the activities of the Program on Women, Health, and Development and provide greater support to the activities of the National Focal Point/Group; c) Include, beginning in 1989, a chapter on women, health, and development in the Scientific Publication Health Conditions in the Americas; d) Update in 1990, and every four years, the Scientific Publication entitled The Health of Women in the Americas, which thus far is the sole reference document in this field; e) Strengthen the mechanisms for recruiting and promoting women in professional and decision-making positions by expanding the PAHO Candidate Roster and by actively seeking out qualified women for high-level administrative and technical posts; also recommended is the identification of women in the counlries to participate in PAHO Advisory Committees, as well as in high-level scientific and technical conferences ancl seminars. 'See Vol. III, p See p. 32. September 1989 OD 232, TRAINING OF HEALTH PERSONNEL see Volume I, page 81 and Volume 11, page FELLOWSHIPS CD34.R17 CE103.R14 For previous resolutions, see Volume 1, page 84 and Volume II, page 79. Having seen Document CE103/21, "Analysis of PAHO's Fellowship Program," prepared at the request of the Executive Board of WHO (Resolution EB71.R6, 1983);' and Considering the Report of the Subcommittee on Planning and Programming of the Executive Committee (Document CE103/19), To recommend to the XXXIV Meeting of the Directing Council the adoption of a resolution along the following lines:2 June 1989 OD 232, 92 'EB71/1983/REC/1, For text recommended by the Executive Committee and adopted by the Directing Council after amending operative paragraphs 1(b) and l(c), see Resolution CD34.R17 below. Taking into account the importance of developing human resources for the health sector and the role of the Fellowship Program of PAHO in attending to the academic training needs in specific fields which are more developed outside many of the Member Countries, and in ensuring a broad program of continuing education for existing personnel; and Considering that the Fellowship Program, as a technical cooperation instrument, must be utilized in the context of the health systems and programs being developed within the framework of the health sector's policies, and closely linked to the technical work being carried out by the countries and the Organization, 1. To urge that Member Governments: a) Strengthen their activities in terms of development of policies and plans regarding human resources in health, including the use of fellowships; b) Promote the use of academic fellowships in those cases in which the necessary opportunities do not exist at the national level; c) Limit the award of short-term fellowships, both at the national and international levels, in accordance with the needs for advanced training in those fields that require formal education; d) Apply the prescribed mechanisms for selection and approval of fellows, through the National Fellovwships Committees, ensuring the participation of the techinical levels of the health services in such Committees.

48 1.11 REGIONAL CENTERS REGIONAL CENTERS To request that the Director: a) Maintain an up-to-date system for periodic review and acceptance of institutions which provide training to PAHO's fellows; b) Enforce the rules regarding fellowship awards, production, collection, and analysis of fellows' reports and outcome evaluation, and assure that fellowship hosts are provided sufficient information regarding the fellows' past experience and the expected outcome of the training; c) Continue promoting greater participation on the part of women in the fellowship program; d) Send this analysis of the fellowship program of the Region of the Americas to the Director-General of the World Health Organization for presentation to the Executive Board TEXTBOOK PROGRAM see Volume 1, page 89 and Volume II, page 79. September 1989 OD 232, RESEARCH PROMOTION AND DEVELOPMENT For previous resolutions, see Volume 1, page 96, Volume II, page 82, and Volume 111, page 34. CD32.R13 Having seen the report of the Advisory Committee on Health Research on the deliberations of that Committee's XXVI Meeting, held from 3 to 7 August 1987 at the Oswaldo Cruz Foundation, Rio de Janeiro, Brazil (Document CD32/23); and Cognizant of the importance of the Committee's recommendations to the Director for scientific and technological development in the health field in the countries of Latin America and the Caribbean, 1. To thank the Government of Brazil and especially the Oswaldo Cruz Foundation for their valuable collaboration with the Organization during the XXVI Meeting of its Advisory Committee on Health Research. 2. To take note of the recommendations made to the Director by the Advisory Committee on Health Research. 3. To recommend to the Director that he study carefully the report of the Committee and the recommendations therein with a view to their implementation in accordance with the priorities established for the quadrennium and the availability of resources. September 1987 OD 219, REGIONAL CENTERS For previous resolutions, see Volume 1, page 96, Volume II, page 83, and Volume lil, page 34.

49 36 1. PROGRAM PROGRAM PAN AMERICAN FOOT-AND-MOUTH DISEASE CENTER see Volume I, page 98 and Volume II, page To authorize the Director, in the framework of those negotiations and in consultation with the Government of Argentina, to adopt, before 31 December 1990, the legal and administrative measures that may be required to give effect to Article 7.2 of the existing agreement. 4. To request the Director to report on the outcome of this matter to the VII Inter-American Meeting, al: the Ministerial Level, on Animal Health (RIMSA), the 107th Meeting of the Executive Committee, and the XXXV Meeting of the Directing Council of the Pan American Health Organization. September 1'990 OD 238, PAN AMERICAN ZOONOSES CENTER For previous resolutions, see Volume I, page 101 and Volume II, page INSTITUTE OF NUTRITION OF CENTRAL AMERICA AND PANAMA see Volume I, page 102, Volume II, page 93, and Volume III, page 35. CSP23.R23 The Pan American Sanitary Conference, Recalling that the Government of the Argentine Republic and the Pan American Sanitary Bureau, Regional Office of the World Health Organization for the Americas, signed an Agreement for the Establishment and Operation of a Pan American Zoonoses Center at Buenos Aires, Argentina, on 10 August 1956; Mindful of the advisability of revising the agreement in effect for the last 34 years to bring it into line with new operating needs, and with negotiations going forward between the Government of Argentina and the Pan American Health Organization for a review of the CEPANZO agreement and a resolution of the financial situation; Bearing in mind that the Agreement calls for a substantial financial contribution from the Government of Argentina for operation of the Center; Aware that the financial commitments of the Government of Argentina for operation of the Center have not been completely met; and Cognizant that the Center has been operating in recent years at a deficit that the Pan American Health Organization has had to absorb by diverting funds from other activities to the detriment of other programs of the Organization, 1. To express satisfaction at the progress made in the negotiations between the Government of Argentina and the Pan American Health Organization for review of the CEPANZO Agreement. 2. To request the Government of Argentina and to instruct the Director to accelerate those negotiations, including those for resolving the financial situation, with a view to the conclusion of an agreement before 31 December PAN AMERICAN CENTER FOR HEALTH PLANNING see Volume I, page 55 and Volume II, page PAN AMERICAN CENTER FOR SANITARY ENGINEERING AND ENVIRONMENTAL SCIENCES see Volume II, page CARIBBEAN FOOD AND NUTRITION INSTITUTE see Volume II, page 97.

50 1.12 HEALTH INFORMATION HEALTH INFORMATION PAN AMERICAN CENTER FOR HUMAN ECOLOGY AND HEALTH see Volume 11, page 99, and Volume III, page CARIBBEAN EPIDEMIOLOGY CENTER see Volume I, page 104 and Volume II, page LATIN AMERICAN CENTER FOR PERINATOLOGY AND HUMAN DEVELOPMENT see Volume II, page LATIN AMERICAN AND CARIBBEAN CENTER FOR HEALTH SCIENCES INFORMATION (formerly REGIONAL LIBRARY OF MEDICINE AND THE HEALTH SCIENCES) see Volume I, page 96 and Volume II, page PAN AMERICAN CENTER FOR RESEARCH AND TRAINING IN LEPROSY AND TROPICAL DISEASES see Volume II, page OTHER CENTERS see Volume 1, page 104, Volume II, page 102, and Volume III, page HEALTH INFORMATION HEALTH STATISTICS CE105.R7 see Volume 1, page 66. Having examined Document CE105/14, "Scientific and Technical Health Information"; and Taking into account the importance of such information to address the health problems of the Americas, To recommend to the XXIII Pan American Sanitary Conference the adoption of a resolution along the following lines:' PAHO PUBLICATIONS AND June 1990 OD 238, 98 DOCUMENTATION SERVICES For previous resolutions, see Volume I, page 104. 'For text recommended by the Executive Committee and adopted by the Pan American Sanitary Conference, see Resolution CSP23.R20 below.

51 38 1. PROGRAM PROGRAM CSP23.R20 The Pan American Sanitary Conference, 1. Reports of the Directing Council Having examined Document CSP23/18, "Scientific and Technical Health Information," and bearing in mind the critical and growing importance of such information to the solution of health problems and the strengthening of health services in the countries of the Region; Recognizing the major contribution that the Organization has made through its publications and information programs to further communication for health in the Region; and Considering the vital role of information dissemination to the execution of PAHO's technical cooperation programs, 1. To urge that Member Governments: a) Assign high priority to scientific and technical health information; b) Further the creation and enhancement of national biomedical journals and other publications, favor the improvement and utilization of publications produced by the Organization, and consider, whenever possible, opportunities for intercountry information exchange; c) Strengthen and support national information networks. 2. To request that the Director: a) Strengthen PAHO's role in the development, coordination, and improvement of biomedical communications, particularly within the framework of the Organization's strategic orientation and program priorities; b) Assure that biomedical information generated by the Organization reach not only research and academic centers but that it permeate all levels of the health care system; c) Seek extrabudgetary funding necessary to accomplish the objectives of health information dissemination. September 1990 OD 238, 145 CD32.R5 see Volume 1. page Annual and Quadrennial Reports of the Director For previous resolutions, see Volume 1, page 105, Volume II, page 104, and Volume III, page 37. Having examined the Annual Report of the Director of the Pan American Sanitary Bureau for 1986 (Official Document 215); Bearing in mind the provisions of Article 9.C of the Constitution of the Pan American Health Organization; and Noting with satisfaction the changes in the Report's structure and content that make it a succinct and analytical document, 1. To take note of the Annual Report of the Director of the Pan American Sanitary Bureau for To commend the Director for his continued efforts to transform his report into a dynamic and significant working tool. 3. To thank the Director for his leadership and support to the Member Governments in the technical cooperation activities conducted by PAHO during September 1987 OD 219, 103 CD33.R HEALTH LEGISLATION see Volume 1, page 59. Having seen the Annual Report of the Director of the Pan American Sanitary Bureau for 1987 (Official Document 221); and Bearing in mind the provisions of Article 9.C of the Constitution of the Pan American Health Organization, REPORTS see Volume I, page To take note of the Annual Report of the Director of the Pan American Sanitary Bureau for To commend the Director for his continued efforts to transform his Report into a dynamic working tool, to provide a better understanding of the work accomplished by PAHO during the period covered, and to assist in the evaluation of the programming of PAHO's activities. 3. To thank the Director for his leadership and for his support to the Member Governments in the technical cooperation activities conducted by PAHO during September 1988 OD 2'25, 121

52 1.12 HEALTH INFORMATION 39 CD34.R8 CD32.R4 Having seen the Annual Report of the Director of the Pan American Sanitary Bureau for 1988 (Official Document 228); and Bearing in mind the provisions of Article 9.C of the Constitution of the Pan American Health Organization, 1. To take note of the Annual Report of the Director of the Pan American Sanitary Bureau for To commend the Director for his continued efforts to transform the report into a dynamic working tool, which provides a better understanding of the work accomplished by PAHO during the period covered and assists in the evaluation of the programming of PAHO's activities. 3. To thank the Director for his leadership and for his support to the Member Governments in the technical cooperation activities conducted by PAHO during CSP23.R3 September 1989 OD 232, 112 The Pan American Sanitary Conference, Having examined the Annual Report, 1989, and Quadrennial Report, , of the Director of the Pan American Sanitary Bureau on the activities of PAHO during the period between the XXII and XXIII Pan American Sanitary Conferences (Official Document 234); and Bearing in mind the provisions of Article 4.F of the Constitution of the Pan American Health Organization, 1. To take note of the Annual Report, 1989, and Quadrennial Report, , of the Director of the Pan American Sanitary Bureau. 2. To congratulate the Director for his constant efforts to make the Report a dynamic working tool that accurately reflects the work done by PAHO and is of use in evaluating the execution of the cooperation activities carried out during the period covered. 3. To thank the Director for his leadership and support to the Member Governments in the technical cooperation activities carried out by PAHO from 1986 to September 1990 OD 238, Annual Reports of the Chairman of the Executive Committee' For previous resolutions, see Volume 1, page 106, Volume II, page 105, and Volume 111, page 39. 'For list of Chairmen of the Executive Committee, see Section 3.3. Having seen the Annual Report of the Chairman of the Executive Committee (Document CD32/4) on the work of the Committee from October 1986 to date, the period during which the 98th and 99th Meetings were held; and Bearing in mind the provisions of Article 9.C of the Constitution of the Pan American Health Organization, 1. To take note of the Annual Report of the Chairman of the Executive Committee (Document CD32/4). 2. To congratulate the Chairman and the other members of the Committee on their excellent work. CD33.R3 September 1987 OD 219, 102 Having seen the Annual Report of the Chairman of the Executive Committee (Document CD33/8) on the work of the Committee from September 1987 to date, the period during which the 100th and 101st Meetings were held; and Bearing in mind the provisions of Article 9.C of the Constitution of the Pan American Health Organization, 1. To take note of the Annual Report of the Chairman of the Executive Committee (Document CD33/8). 2. To congratulate the Chairman and the other members of the Committee on their excellent work. CD34.R7 September 1988 OD 225, 120 Having seen the Annual Report of the Chairman of the Executive Committee (Document CD34/12) on the work of the Committee from September 1988 to date, the period during which the 102nd and 103rd Meetings were held; and Bearing in mind the provisions of Article 9.C of the Constitution of the Pan American Health Organization, 1. To take note of the Annual Report of the Chairman of the Executive Committee (Document CD34/12). 2. To congratulate the Chairman and the other members of the Committee on their excellent work. CSP23.R1 September 1989 OD 232, 112 The Pan American Sanitary Conference, Having considered the Annual Report of the Chairman of the Executive Committee (Document CSP23/3) on the work of the Committee from September 1989 to date, the

53 40 1. PROGRAM period during which the 104th and 105th Meetings were held; and Bearing in mind the provisions of Article 4.F of the Constitution of the Pan American Health Organization, 1. To take note of the Annual Report of the Chairman of the Executive Committee (Document CSP23/3). 2. To congratulate the Chairman and the other members of the Executive Committee on their excellent work. September 1990 OD 238, Reports of the Governments see Volume 1, page 107, Volume II, page 106, and Volume III, page WHO Expert Committee Reports see Volume 1, page SUPPLIES AND EQUIPMENT see Volume 1, page 110 and Volume II, page 108.

54 2. PROGRAM BUDGET See also Section (Assessments and Contributions). 2.1 BUDGET POLICY For previous resolutions, see Volume 1, page 113, Volume II, page 110, and Volume III, page 41. CD32.R16 Having seen a) the Director-General's Introduction to the proposed program budget for the biennium (Document PB/88-89), b) the document "Management of WHO's Resources" (Document EB81/PC/WP/2), and c) the Report presented by the Program Committee of the Executive Board on the discussions in its Twelfth Meeting on the subject of "Management of WHO's Resources and Review of the Organization's Structure" (Document EB81/PC/Conf. Doc. No. 1, Rev. 1) (Document CD32/11 and Add. I); and Considering Resolution WHA40.15,' in which the Fortieth World Health Assembly requested the Regional Committees to review the official documents on general policy matters relating to the need for measures to secure the best possible use of WHO's limited resources, and to report on the outcome of their deliberations to the Executive Board at its eighty-first session in January 1988, 1. To request the Director to transmit to the Executive Board of WHO at its Eighty-first Session in January 1988, the summary record of the discussions in the present Directing Council on the subject of "Management of WHO's Resources" (item 6.5 of the Agenda). 2. To affirm that full agreement exists between the principles embodied in the general policies for the management of WHO's resources and the current mandates and guidelines for the implementation of PAHO's cooperation policy in the Region as approved in Resolutions CE92.R15 2 on the managerial strategy for the optimal use of PAHO/WHO resources in direct support of Member Countries, CD31.R10 3 on the regional program budget policy, and CSP22.R21 4 on the orientation and program priorities for PAHO during the quadrennium , and in the introduction to the PAHO/WHO program budget for in Official Document To pledge the cooperation of the Region of the Americas in the effort to improve the use and management of WHO's resources. 4. To indicate to the Executive Board of WHO its concern over the feasibility of the proposed process contained in Document EB81/PC/Conf. Doc. No. 1, Rev. 1 for the appointment of Regional Directors and, more specifically, to point out its incompatibility with the present Constitution of the Pan American Health Organization. 'Document WHA40/1987/REC/1, See Vol. III, p See Vol. III, p See Vol. III, p. 6. CD33.R11 September 1987 OD 219, 115 Having examined Document CD33/26 on the program budget situation; Recognizing that Resolution VI' of the XXXII Meeting of the Directing Council (1987) requested the Director to 41

55 42 2. PROGRAM BUDGET report to the Directing Council on the status of the collection of quota contributions for 1988 and prior years; Noting Resolution IF2 adopted at the XXXII Meeting of the Directing Council, in which the Member Countries approved the appropriations for the Pan American Health Organization for ; and Considering Resolution III 3 of the same meeting, in which the Member Countries approved assessments for the biennial budget, 1. To urge all Member Countries to pay their full quota assessment to avoid a worsening of the budget situation and the consequent damage to the Organization's ability to fulfill its technical cooperation responsibilities. 2. To request the Director to take a flexible approach in effecting cuts in the program budget for in the event that the payments of Member Countries fail to provide adequate resources to execute it fully, drawing upon the priorities established by PAHO Governing Bodies and the views of Member Countries in relation to evolving health problems and needs. 3. To request that the Director continue to consult with the Subcommittee on Planning and Programming of the Executive Committee in order to assess the impact on the Organization's programs of any budgetary shortfall: that may occur throughout the current biennium. 'See p See p. 43. 'See p. 62. September 1988 ' OD 225, CONSIDERATION AND APPROVAL OF THE PROGRAM BUDGET For Fiscal Years 1947 through 1973, see Volume I, pages ; for 1972 through 1985, see Volume II, pages ; and for 1984 through 1989 see Volume III, pages FOR CE99.R5 1. PAHO ( ) For previous resolutions, see Volume II, page 131, and Volume III, page 43. Having considered the report of the Subcommittee on Planning and Programming (Document CE99/17); Having examined the proposed program budget of the Pan American Health Organization for the biennium (Official Document 210); and Bearing in mind Article 14.C of the Constitution of the Pan American Health Organization and Article III, paragraphs 3.5 and 3.6, of the PAHO Financial Regulations, 1. To thank the Subcommittee on Planning and Programming for its preliminary review of the report on the proposed program budget. 2. To express appreciation to the Director and his staff for the presentation of the proposed program budget for To compliment the Director for his efforts, justified in a moment of crisis, in restraining overall budget increases by the absorption of some cost increases and by continuing the level of Miscellaneous Income at the level of US$4,800,000 while, at the same time, proposing overall program growth in the country programs through the combined PAHO and WHO regular program budgets. 4. To request the Director to continue to refine the program proposals for presentation to the XXXII Meeting of the Directing Council, taking into account the recommendations and suggestions made by the Executive Committee during the review of Official Document To recommend to the XXXII Meeting of the Directing Council that it approve the proposed program budget of the Pan American Health Organization for the biennium , with an effective working budget of US$121,172,000, by adopting the corresponding appropriation and assessment resolutions. June 1987 OD 219, 76

56 2.2 CONSIDERATION AND APPROVAL OF THE PROGRAM BUDGET 43 CD32.R2 2. WHO Regional ( ) 1. To appropriate for the financial period an amount of US$138,806,000, as follows: see Volume III, page 45. Part I: Direction, Coordination, and Part II: Management... 15,800,500 Health System Infrastructure... 54,503,400 Part III: Health Science and Technology 35,380,100 Part IV: Program Support... 15,488,000 Effective Working Budget (Parts I-IV) ,172,000 Part V: Staff Assessment (Transfer to Tax Equalization Fund)... 17,634,000 Total-All Parts ,806, FOR That the appropriation shall be financed from: a) Assessments in respect to: Member and Participating Governments assessed under the scales adopted by the Organization of American States in accordance with Article 60 of the Pan American Sanitary Code or in accordance with Directing Council and Pan American Sanitary Conference resolutions ,0065,000 b) Miscellaneous Income... 4,8001,000 Total ,806,000 In establishing the contributions of Member and Participating Governments, their assessments shall be reduced further by the amount standing to their credit in the Tax Equalization Fund, except that credits of those Governments which levy taxes on the emoluments received from the Pan American Health Organization (PAHO) by their nationals and residents shall be reduced by the amounts of such tax reimbursements by the Organization. 3. That, in accordance with the Financial Regulations of PAHO, amounts not exceeding the appropriations noted under paragraph 1 shall be available for the payment of obligations incurred during the period 1 January 1988 to 31 December 1989, inclusive. Notwithstanding the provision of this paragraph, obligations during the financial period shall be limited to the effective working budget, i.e., Parts I-IV. 4. That the Director shall be authorized to transfer credits between parts of the effective working 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% of the part from which the credit is transferred may be made with the concurrence of the Executive Committee. All transfers of budget credits shall be reported to the Directing Council and/or the Conference. September 1987 OD 219, 99 CE103.R4 1. PAHO ( ) Having considered the report of the Subcommittee on Planning and Programming (Document CE103/19) and the supplementary information provided by the Director in Document CE103/22; Having examined the proposed program budget of the Pan American Health Organization for the biennium contained in Official Document 226; and Bearing in mind Article 14.C of the Constitution of the Pan American Health Organization and Article III, paragraphs 3.5 and 3.6, of the PAHO Financial Regulations, 1. To thank the Subcommittee on Planning and Programming for its preliminary review of and report on the proposed program budget. 2. To recommend to the XXXIV Meeting of the Directing Council that it approve the proposed program budget of the Pan American Health organization for the biennium , with an effective working budget of US$130,023,000, by adopting the corresponding appropriation and assessment resolutions. 3. To request the Director to continue to refine the program proposals for presentation to the XXXIV Meeting of the Directing Council, taking into account the recommendations and suggestions made by the Executive Committee during the review of Official Document To compliment the Director for his efforts, justified during times of financial crisis, in restraining overall budget increases by the absorption of some cost increases, while at the same time proposing program growth in the country programs through the combined PAHO and WHO regular program budgets. June 1989 OD 232, 81

57 44 2. PROGRAM BUDGET CD34.R1 2. WHO Regional ( ) 1. To appropriate for the financial period an amount of US$145,599,550 as follows: Part I: Direction, Coordination, and Management... 17,332,700 Part II: Health System Infrastructure... 58,269,100 Part III: Health Science and Technology 38,348,700 Part IV: Program Support... 16,072,500 Effective Working Budget (Parts I-IV) ,023,000 Part V: Staff Assessment (Transfer to Tax Equalization Fund).15,576,550 Total-All Parts ,599, That the appropriation shall be financed from: (a) Assessments in respect to: Member and Participating Countries assessed under the scales adopted by the Organization of American States in accordance with Article 60 of the Pan American Sanitary Code or in accordance with Directing Council and Pan American Sanitary Conference resolutions ,2999,550 (b) Miscellaneous income... 5,3001,000 Total ,599,550 In establishing the contributions of Member and Participating Countries, their assessments shall be reduced further by the amount standing to their credit in the Tax Equalization Fund, except that credits of those countries which levy taxes on the emoluments received from the Pan American Sanitary Bureau (PASB) by their nationals and residents shall be reduced by the amounts of such tax reimbursements by PASB. 3. That, in accordance with the Financial Regulations of PAHO, amounts not exceeding the appropriations noted under paragraph 1 shall be available for the payment of obligations incurred during the period 1 January 1990 to 31 December 1991, inclusive. Notwithstanding the provision of this paragraph, obligations during the financial period shall be limited to the effective working budget, i.e., Parts I-IV. 4. That the Director shall be authorized to transfer credits between parts of the effective working budget, provided that such transfer 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% of the part from which the credit is transferred may be made with the concurrence of the Executive Committee. All transfers of budget credits shall be reported to the Directing Council and/or the Conference. September 1989 OD 232, 104 CE101.R5 Having considered Document CE101/20, which contains a tentative request for US$65,027.,000 from the World Health Organization for the Region of the Americas for the biennium ; and Noting that in its last two meetings the Subcommittee on Planning and Programming has reviewed in general terms the program budget reductions implemented by the Director-General of WHO, 1. To thank the Subcommittee on Planning and Programming for its review. 2. To thank the Director for presenting a tentative WHO regular program budget proposal for the bierinium , which includes a 1.8% program increase in the funds allocated to country programs while at the same time proposing no overall program increase, especially in view of the $2,470,000 program decrease required in the program budget. 3. To recommend to the XXXIII Meeting of the PAHO Directing Council, XL Meeting of the WHO Regional Committee for the Americas, that it approve the proposal of $65,027,000, which includes $4,8663,000, or 8.1%, in cost increases over the revised allocation of $60,161,000, by adopting a resolution along the following lines:' June 1988 OD 225, 92 'For text recommended by the Executive Committee and adopted by the Directing Council, see Resolution CD33.R2 below. CD33.R2 Having considered Document CD33/3 and the tentative request for US$65,027,000 from the World Health Organization for the Region of the Americas for the bienínium , which includes cost increases of $4,866,000, or 8.1%, over the revised allocation; and Noting the recommendation of the 101st Meeting of the Executive Committee, To request the Director to transmit to the Director- General of WHO the request for $65,027,000 for the Region of the Americas for the biennium , for consideration by the WHO Executive Board and the World Health Assembly in September 1988 OD 225, 119

58 2.2 CONSIDERATION AND APPROVAL OF THE PROGRAM BUDGET FOR PAHO ( )' Conference, XLII Meeting of the Regional Committee of WHO for the Americas, that it approve the proposal of US$71,491,000, which includes US$6,464,000 or 9.9% in cost increases over the revised allocation of US$65,027,000, by adopting a resolution along the following lines:' 'PAHO's budget for the financial period will be discussed during the meetings of the Governing Bodies in WHO Regional ( ) June 1990 OD 238, 93 'For text recommended by the Executive Committee and adopted by the Pan American Sanitary Conference, see Resolution CSP23.R6 below. CE105.R3 Having considered Document CE105/16, which contains a tentative request for US$71,491,000 from the World Health Organization for the Region of the Americas for the biennium ; and Noting that the Subcommittee on Planning and Programming has reviewed in general terms the program budget, 1. To thank the Subcommittee on Planning and Programming for its review. 2. To thank the Director for presenting a tentative WHO regular program budget proposal for the biennium which includes a 0.6% program increase in the funds allocated to country programs while at the same time proposing no overall program increase. 3. To recommend to the XXIII Pan American Sanitary CSP23.R6 The Pan American Sanitary Conference, Having considered Document CSP23/11 and the tentative request for US$71,491,000 from the World Health Organization for the Region of the Americas for the biennium , which includes cost increases of US$6,464,000 or 9.9% over the revised allocation; and Noting the recommendation of the 105th Meeting of the Executive Committee, To request the Director to transmit to the Director- General of WHO the request for US$71,491,000 for the Region of the Americas for the biennium , for consideration by the WHO Executive Board and the World Health Assembly in September 1990 OD 238, 127

59 3. GOVERNING BODIES OF PAHO' see Volume 1, page PAN AMERICAN SANITARY CONFERENCE For previous resolutions, see Volume I, page 155, Volume II, page 134, and Volume 111, page 47. The Pan American Sanitary Conference has served as Regional Committee of the World Health Organization for the Americas since I July 1949, the date on which the Agreement between WHO and PAHO entered into effect. XI Conference (September 1942) PRESIDENTS OF THE PAN AMERICAN SANITARY CONFERENCE XII Conference (January 1947) XIII CONFERENCE (October 1950) XIV Conference (October 1954) XV Conference (September-October 1958) XVI Conference (August-September 1962) XVII Conference (September-October 1966) DR. JOAO DE BARROS BARRETO Brazil DR. EDMUNDO FERNÁNDEZ Venezuela DR. MANUEL A. ROBIOU Dominican Republic DR. SERGIO ALTAMIRANO P. Chile DR. GUILLERMO ARBONA United States of America DR. JOSÉ ALVAREZ AMÉZQUITA Mexico DR. ANTONIO ORDÓÑEZ PLAJA Colombia 1 See also complete reference list of meetings of the Governing Bodies of PAHO, Vol. 1, p. xv, Vol. II, p. xii, Vol. III, p. xii, and in this volume, page xii. XVIII Conference (September-October 1970) XIX Conference (September-October 1974) XX Conference (September-October 1978) XXI Conference (September 1982) XXII Conference (September 1986) XXIII Conference (September 1990) TIME AND PLACE DR. JosÉ RENÁN ESQUIVEL Panama DR. ENRIQUE AGUILAR PAZ Honduras MR. HERBERT J. PREUDHOMME Grenada DR. GASPAR GARCIA DE PAREDES Panama MR. JAKE EPP Canada DR. BRANFORD TAITT Barbados see Volume 1, page 156, Volume 11, page 134, and Volume ll, page

60 3.2 DIRECTING COUNCIL DIRECTINO COUNCIL RULES OF PROCEDURE' see Volume I, page 159 and Volume II, page 135. 'The text of the Rules of Procedure of the Conference appears in Basic Documents of the Pan American Health Organization, 15th ed, PAHO Official Document 240(1991), AGENDA For previous resolutions, see Volume 1, page 161, Volume II, page 136, and Volume III, page 48. gional Committee of WHO for the Americas, presented as Annex to Document CE105/3; and Bearing in mind the provisions of Article 7.F of the Constitution of the Pan American Health Organization and Rule 6 of the Rules of Procedure of the Conference, To approve the provisional agenda (Document CSP23/ 1) prepared by the Director for the XXIII Pan American Sanitary Conference, XLII Meeting of the Regional Committee of WHO for the Americas with the deletion of Item 4.2, "Report of the Advisory Subcommittee on Health Research," and with the addition of a new Item 6.4, "Headquarters Building." June 1990 OD 238, TECHNICAL DISCUSSIONS CE105.R18 Having examined the provisional agenda (Document CSP23/1) prepared by the Director for the XXIII Pan American Sanitary Conference, XLII Meeting of the Re- see Volume 1, page 162, Volume II, page 137, and Volume 111, page DIRECTING COUNCIL For previous resolutions, see Volume 1, page 165, Volume II1, page 139, and Volume III, page 49. The Pan American Sanitary Conference, through the Directing Council, has served as the Regional Office of the World Health Organization for the Americas since 1 July 1949, when the Agreement between PAHO and WHO came into effect. I Meeting (September 1947) II Meeting (October 1948) III Meeting (October 1949) IV Meeting (September 1950) V Meeting (September-October VI Meeting (September 1952) VII Meeting (October 1953) PRESIDENTS OF THE DIRECTING COUNCIL DR. ALBERTO ZWANCK Argentina DR. IGNACIO MORONES PRIETO Mexico DR. ANIBAL ALVAREZ LÓPEZ Peru DR. RICARDO CAPPELETTI Uruguay DR. NACIANCENO ROMERO 1951) Chile DR. CARLOS LUIS GONZÁLEZ Venezuela DR. HERNÁN URZÚA Chile VIII Meeting (September 1955) IX Meeting (September 1956) X Meeting (September 1957) XI Meeting (September 1959) XII Meeting (August 1960) XIll Meeting (October 1961) XIV Meeting (September 1963) XV Meeting (August-September 1964) DR. HÉCTOR A. COLL Argentina DR. CARLOS SOZA BARILLAS Guatemala DR. ALBERTO BISSOT, JR. Panama MR. HUMBERTO OLIVERO Guatemala DR. JOSÉ MACHADO VENTURA Cuba DR. LUTHER L. TERRY United States of America DR. JAVIER ARIAS STELLA Peru DR. JOSÉ ALVAREZ AMÉZQUITA Mexico

61 48 3. GOVERNING BODIES OF PAHO XVI Meeting (September-October 1965) XVII Meeting (October 1967) XVIII Meeting (October 1968) XIX Meeting (September-October 1969) XX Meeting (September-October 1971) XXI Meeting (October 1972) XXII Meeting (October 1973) XXIII Meeting (September-October 1975) XXIV Meeting (September-October 1976) XXV Meeting (September-October 1977) XXVI Meeting (September-October 1979) XXVII Meeting (September-October 1980) XXVIII Meeting (September-October 1981) XXIX Meeting (September-October 1983) XXX Meeting (September-October 1984) XXXI Meeting (September-October 1985) XXXII Meeting (September 1987) XXXIII Meeting (September 1988) XXXIV Meeting (September 1989) DR. RAYMUNDO DE BRITTO Brazil DR. MAXWELL P. AWON Trinidad and Tobago DR. EZEQUIEL HOLMBERG Argentina DR. SYLVIA TALBOT Guyana DR. JESSE L. STEINFELD United States of America DR. JUAN CONCHA GUTIÉRREZ Chile DR. R. A. CHAPMAN Canada DR. ABRAHAM SAIED Panama DR. GINÉS NAVARRO DíAZ DE LEÓN Mexico MR. ADÁN CAJINA Ríos Nicaragua DR. HUMBERTO GARCIA BARRIOS Venezuela DR. ROQUELINO RECINO MÉNDEZ Guatemala DR. MIGUEL COELLO FERNÁNDEZ Ecuador DR. HORACIO RODRíGUEZ CASTELLS Argentina DR. JUAN FRANCO PONCE Peru DR. KENNETH BAUGH Jamaica DR. GUILLERMO SOBERÓN ACEVEDO Mexico DR. RAÚL UGARTE ARTOLA Uruguay DR. RUBÉN VILLEDA BERMÚDEZ Honduras CE99.R1 Considering that the Director has proposed the dates 21 to 26 September 1987 for the XXXII Meeting of the PAHO Directing Council, XXXIX Meeting of the WHO Regional Committee for the Americas; and Bearing in mind Articles 12.A and 14.A of the Constitution of the Pan American Health Organization and Rule 1 of the Rules of Procedure of the I)irecting Council, To authorize the Director to convoke the XXXII Meeting of the PAHO Directing Council, XXXIX Meeting of the WHO Regional Committee for the Americas, to meet at the Headquarters building in Washington, D.C., from 21 to 26 September CE101.R1 June 1987 OD 219, 73 Considering that the Director has proposed the dates of 26 September to 1 October 1988 for the XXXIII Meeting of the PAHO Directing Council, XL Meeting of the WHO Regional Committee for the Americas; and Bearing in mind Articles 12.A and 14.A of the Constitution of the Pan American Health Organization and Rule 1 of the Rules of Procedure of the Directing Council, To authorize the Director to convoke the XXXIII Meeting of the PAHO Directing Council, XL Meeting of the WHO Regional Committee for the Americas, to meet at the Headquarters building in Washington, D.C., from 26 September to 1 October June 1988 OD 2:25, 87 CE102.R TIME AND PLACE For previous resolutions, see Volume 1, page 165, Volume II, page 140, and Volume III, page 50. Bearing in mind Article 14.A of the Constitution of the Pan American Health Organization and Rule 1 of the Rules of Procedure of the Directing Council; and Desirous of facilitating the preparations by the Member Governments for their participation in meetings of the Governing Bodies as far in advance as possible, To authorize the Director to convoke the XXXIV Meeting of the Directing Council of PAHO, XLI Meeting of the Regional Committee of WHO for the Americas, to meet at the Headquarters building in Washington, D.C., from 25 to 30 September October 1988 OD 232, 69

62 3.2 DIRECTING COUNCIL 49 CE106.R1 CE101.R16 Bearing in mind Article 14.A of the Constitution of the Pan American Health Organization and Rule 1 of the Rules of Procedure of the Directing Council, To authorize the Director to convoke the XXXV Meeting of the Directing Council of PAHO, XLIII Meeting of the Regional Committee of WHO for the Americas, to meet at the Headquarters building in Washington, D.C., from 23 to 28 September RULES OF PROCEDURE' September 1990 OD 237, 8 see Volume 1, page 168 and Volume II, page 142. Having examined the provisional agenda (Document CD33/1) prepared by the Director for the XXXIII Meeting of the PAHO Directing Council, XL Meeting of the WHO Regional Committee for the Americas, presented as Annex to Document CE101/5, Rev. 1; and Bearing in mind the provisions of Article 12.C of the Constitution of the Pan American Health Organization and Rule 7 of the Rules of Procedure of the Directing Council, To approve the provisional agenda (Document CD33/ 1) prepared by the Director for the XXXIII Meeting of the PAHO Directing Council, XL Meeting of the WHO Regional Committee for the Americas, with the addition of the following three items: Aedes albopictus; Medical Education; and Program Budget Situation, June 1988 OD 225, 106 'The text of the Rules of Procedure of the Directing Council appears in Basic Documents of the Pan American Health Organization, 15th ed. PAHO Official Document 240(1991), CE103.R AGENDA For previous resolutions, see Volume I, page 172, Volume II, page 144, and Volume III, page 51. Having examined the provisional agenda (Document CD34/1) prepared by the Director for the XXXIV Meeting of the Directing Council of PAHO, XLI Meeting of the Regional Committee of WHO for the Americas, presented as Annex to Document CE103/5, Rev. 3; and Bearing in mind the provisions of Article 12.C of the Constitution of the Pan American Health Organization and Rule 7 of the Rules of Procedure of the Directing Council, CE99.R2 To approve the provisional agenda (Document CD34/ 1) prepared by the Director for the XXXIV Meeting of the Directing Council of PAHO, XLI Meeting of the Regional Committee of WHO for the Americas. Having examined the provisional agenda (Document June 1989 OD 232, 97 CD32/1) prepared by the Director for the XXXII Meeting of the PAHO Directing Council, XXXIX Meeting of the WHO Regional Committee for the Americas, presented as Annex to Document CE99/5; and Bearing in mind the provisions of Article 12.C of the Constitution of the Pan American Health Organization and Rule 7 of the Rules of Procedure of the Directing Council, To approve the provisional agenda (Document CD32/ 1) prepared by the Director for the XXXII Meeting of the PAHO Directing Council, XXXIX Meeting of the WHO Regional Committee for the Americas. June 1987 OD 219, TECHNICAL DISCUSSIONS see Volume 1, page 173, Volume II, page 145, and Volume III, page 51.

63 50 3. GOVERNING BODIES OF PAHO 503.GOERIN BDIS F AH 3.3 EXECUTIVE COMMITTEE For previous resolutions, see Volume I, page 179, Volume II, page 152, and Volume III, page 53. CHAIRMEN OF THE EXECUTIVE COMMITTEE Ist Meeting (April-May 1947) 2nd Meeting (September 1947) 3rd Meeting (October 1947) 4th Meeting (May 1948) 5th Meeting (October 1948) 6th Meeting (October 1948) 7th Meeting (May 1949) 8th Meeting (October 1949) 9th Meeting (October 1949) 10th Meeting (April 1950) 11th Meeting (September 1950) 12th Meeting (October 1950) 13th Meeting (April 1951) 14th Meeting (September 1951) ISth Meeting (October 1951) 16th Meeting (April 1952) 17th Meeting (September 1952) 18th Meeting (September 1952) 19th Meeting (April 1953) 20th Meeting (October 1953) 21st Meeting (October 1953) 22na Meeting (April 1954) 23rd Meeting (October 1954) 24th Meeting (October 1954) 25th Meeting (April-May 1955) 26th Meeting (September 1955) 27th Meeting (September 1955) DR. THOMAS H. PARRAN United States of America DR. THOMAS H. PARRAN United States of America DR. HÉCTOR PRAGUER FRÓES BRAZIL DR. HÉCTOR PRAGUER FRóES Brazil DR. IGNACIO MORONES PRIETO Mexico DR. IGNACIO MORONES PRIETO Mexico DR. GUSTAVO ARGIL Mexico DR. ALBERTO ZWANCK Argentina DR. ALBERTO ZWANCK Argentina DR. ALBERTO ZWANCK Argentina DR. JUAN ALLWOOD PAREDES El Salvador DR. JUAN ALLWOOD PAREDES El Salvador DR. LUlS F. GALICH Guatemala DR. H. VAN ZILE HYDE United States of America DR. H. VAN ZILE HYDE United States of America DR. NACIANCENO ROMERO Chile DR. FELIPE GARCíA SÁNCHEZ Mexico DR. FELIPE GARCíA SÁNCHEZ Mexico DR. JUAN A. Ecuador MONTALVÁN DR. JOSÉ ZOZAYA Mexico DR. ALMIR DE CASTRO Brazil DR. GERARDO SEGURA Argentina DR. JOSÉ ZOZAYA Mexico DR. ENRIQUE ZACARIAS ARZA Paraguay DR. ALBERTO BISSOT, JR. Panama DR. FREDERICK J. BRADY United States of America DR. JORGE JIMÉNEZ GANDICA Colombia 28th Meeting (June 1956) 29th Meeting (September 1956) 30th Meeting (September 1956) 31st Meeting (June 1957) 32nd Meeting (September 1957) 33rd Meeting (September 1957) 34th Meeting (May 1958) 35th Meeting (September 1958) 36th Meeting (October 1958) 37th Meeting (May 1959) 38th Meeting (September 1959) 39th Meeting (September 1959) 40th Meeting (April 1960) 41st Meeting (August 1960) 42nd Meeting (August 1960) 43rd Meeting (May 1961) 44th Meeting (October 1961) 45th Meeting (October 1961) 46th Meeting (April 1962) 47th Meeting (September 1962) 48th Meeting (April 1963) 49th Meeting (September 1963) 50th Meeting (April-May 1964) 51st Meeting (September 1964) 52nd Meeting (April 1965) 53rd Meeting (October 1965) 54th Meeting (April 1966) DR. JORGE JIMÉNEZ GANDICA Colombia DR. JORGE JIMÉNEZ GANDICA Colombia DR. F-LIX HURTADO Cuba DR. FÉiLIX HURTADO Cuba DR. FiÉLIX HURTADO Cuba ENG. HUMBERTO OLIVE:RO Guatemala ENG. HUMBERTO OLIVE RO Guatemala ENG. HUMBERTO OLIVE RO Guatemala DR. CARLOS DíAZ COLLER Mexico DR. MIGUEL E. BUSTAMENTE Mexico DR. MIGUEL E. BUSTAMENTE Mexico DR. BICHAT RODRIGUES Brazil DR. BICHAT RODRIGUES Brazil DR. LuIs PATIÑO-CAMARGO Colombia DR. ELLIOT Ross JENNEY United States of Arnerica DR. ELLIOT Ross JENNEY United States of Arnerica DR. JAMES WATT United States of Arnerica DR. JAMES WATT United States of Arnerica DR. VICTORIO V. OLGUIN Argentina DR. FRANCISCO URCUYO MALIAÑO Nicaragua DR. LEONARDO BRAVO Chile DR. CARLOS QUIRÓS SALINAS Peru DR. CARLOS QUIRÓS SALINAS Peru DR. CHARLES L. WILLIAMS, JR. United States of America DR. CHARLES L. WILLIAMS, JR. United States of America DR. MANOEL JOSÉ FERREIRA Brazil DR. MANOEL JOSÉ FERREIRA Brazil

64 3.3 EXECUTIVE COMMITTEE EXECUTIVE COMMIUEE 51 55th Meeting (October 1966) 56th Meeting (April-May 1967) 57th Meeting (September 1967) 58th Meeting (October 1967) 59th Meeting (July 1968) 60th Meeting (October 1968) 61st Meeting (June-July 1969) 62nd Meeting (September 1969) 63rd Meeting (October 1969) 64th Meeting (June-July 1970) 65th Meeting (October 1970) 66th Meeting (July 1971) 67th Meeting (October 1971) 68th Meeting (July 1972) 69th Meeting (October 1972) 70th Meeting (July-August 1973) 71st Meeting (October 1973) 72nd Meeting (July 1974) 73rd Meeting (October 1974) 74th Meeting (June-July 1975) 75th Meeting (October 1975) 76th Meeting (June 1976) 77th Meeting (October 1976) 78th Meeting (June 1977) 79th Meeting (October 1977) 80th Meeting (June-July 1978) DR. ALBERTO E. CALVO Panama DR. ALBERTO E. CALVO Panama DR. ALBERTO E. CALVO Panama DR. ROBERTO ACOSTA BORRERO Colombia DR. GUILLERMO MOLINA DEFRANC Ecuador DR. ORONTES AVILÉS Nicaragua DR. ORONTES AVILÉS Nicaragua DR. ORONTES AVILÉS Nicaragua DR. VICTORIO V. OLGUíN Argentina DR. VICTORIO V. OLGUíN Argentina DR. ROGELIO VALLADARES Venezuela DR. ROGELIO VALLADARES Venezuela DR. BALTAZAR CARAVEDO Peru DR. BALTAZAR CARAVEDO Peru DR. HUGO V. ALQUÉRES BAPTISTA Brazil DR. ALIX THÉARD Haiti DR. EDUARDO ENZO GALARETTO Argentina DR. EVERARDO GONZÁLEZ GÁLVEZ Panama DR. ROBERTO PEREDA CHÁVEZ Cuba DR. ROBERTO PEREDA CHÁVEZ Cuba DR. ORONTES AVILÉS Nicaragua DR. ORONTES AVILÉS Nicaragua DR. GUSTAVO MORA PATIÑO Colombia DR. GUSTAVO MORA PATIÑO Colombia DR. RUBÉN M. CÁCERES Paraguay DR. RUBÉN M. CÁCERES Paraguay 81st Meeting (October 1978) 82nd Meeting (June-July 1979) 83rd Meeting (October 1979) 84th Meeting (June 1980) 85th Meeting (October 1980) 86th Meeting (June 1981) 87th Meeting (October 1981) 88th Meeting (June 1982) 89th Meeting (September 1982) 90th Meeting (June 1983) 91st Meeting (October 1983) 92nd Meeting (June 1984) 93rd Meeting (September 1984) 94th Meeting (October 1984) 95th Meeting (June 1985) 96th Meeting (September 1985) 97th Meeting (June 1986) 98th Meeting (September 1986) 99th Meeting (June 1987) 100th Meeting (September 1987) 101st Meeting (June 1988) 102nd Meeting (October 1988) 103rd Meeting (June 1989) 104th Meeting (September 1989) 105th Meeting (June 1990) 106th Meeting (September 1990) MR. MICHEL CAREAU Canada MR. MICHEL CAREAU Canada MR. MICHEL CAREAU Canada MR. MICHEL CAREAU Canada DR. RAMÓN ALVAREZ GUTIÉRREZ Mexico DR. RAMÓN ALVAREZ GUTIÉRREZ Mexico DR. MANUEL BORGOÑO DOMINGUEZ Chile DR. MANUEL BORGOÑO DOMINGUEZ Chile MS. LEA GUIDO Nicaragua Ms. LEA GUIDO Nicaragua DR. ARMANDO LÓPEZ SCAVINO Uruguay DR. ARMANDO LÓPEZ SCAVINO Uruguay DR. ABELARDO RAMIREZ Cuba DR. VIRGILIO MACíAS MURILLO Ecuador DR. VIRGILIO MACíAS MURILLO Ecuador DR. NORMAN GAY Bahamas DR. NORMAN GAY Bahamas DR. NORMAN GAY Bahamas DR. NORMAN GAY Bahamas DR. NORMAN GAY Bahamas DR. NORMAN GAY Bahamas DR. PLUTARCO NARANJO Ecuador DR. PLUTARCO NARANJO Ecuador DR. HÉCTOR LUIS BORGES Venezuela DR. HÉCTOR LUIS BORGES Venezuela DR. MANUEL ADRIANZA Venezuela

65 52 3. GOVERNING BODIES OF PAHO GOVERNING BODIES OP PAHO MEMBERSHIP For previous resolutions, see Volume I, page 181, Volume II, page 155, and Volume III, page 55. [CD32.R8] The Directing Council elected El Salvador, Panama, and Uruguay to the Executive Committee upon termination of the periods of office of Brazil, Colombia, and Honduras, and thanked the Governments of these countries for the services rendered to the Organization by their representatives on the Committee. September 1987 OD 219, 105 [CD33.R8] The Directing Council elected Canada, Trinidad and Tobago, and Venezuela to the Executive Committee upon termination of the periods of office of Argentina, the Bahamas, and Mexico, and thanked the Governments of these countries for the services rendered to the Organization by their representatives on the Committee. September 1988 OD 225, 125 [CD34.R4] The Directing Council elected Barbados, Brazil, and Haiti to the Executive Committee upon termination of the periods of office of Ecuador, Saint Lucia, and the United States of America, and thanked the Governments of these countries for the services rendered to the Organization by their representatives on the Committee. September 1989 OD 232, 109 [CSP23.R8] The XXIII Pan American Sanitary Conference elected Chile, Cuba, and the United States of America to the Executive Committee upon termination of the periods of office of El Salvador, Panama, and Uruguay, and thanked the Governments of these countries for the services rendered to the Organization by their representatives on the Committee. September 1990 OD 238, 128 Composition of the Executive Comnnittee from 1987 to 1991' Antigua and Barbuda Argentina Bahamas Barbados Belize Bolivia Brazil Canada Chile Colombia Costa Rica Terms From From From From Oct Oct Oct Oct to to to to Country Oct Oct Oct Oct Cuba /////// Dominica Dominican Republic Ecuador El Salvador Grenada Guatemala Guyana Haiti Honduras Jamaica Mexico Nicaragua Panama /////////////// ///////// Paraguay Peru St. Kitts and Nevis Saint Lucia /////// ////// St. Vincent and the Grenadines Suriname Trinidad and Tobago United States of America Uruguay Venezuela IFor the period 1947 to 1970, see Vol. I, p. 181; for 1971 to 1983, see Vol. 11I, p. 156; for 1984 to 1987, see Vol. III, p. 56.

66 3.3.2 TIME AND PLACE AGENDA 3.3 EXECUTIVE COMMITITEE EXECUTIVE CoMMITrEE 53 see Volume 1, page 183. see Volume 1, page 187. The time and place of the meetings of the Executive Committee are decided by the Director of PASB in consultation and agreement with the Chairman of the Executive Committee RULES OF PROCEDURE' see Volume 1, page 185 and Volume 11, page REPRESENTATION AT THE CONFERENCE AND THE COUNCIL see Volume 1, page 187 and Volume II, page 158. 'The text of the Rules of Procedure of the Executive Committee appears in Basic Documents of the Pan American Health Organization, 15th ed., PAHO Official Document 240(1991),

67 4. THE PAN AMERICAN HEALTH ORGANIZATION AND THE WORLD HEALTH ORGANIZATION 4.1 AGREEMENT BETWEEN PAHO AND WHO' see Volume 1, page 193. 'The text of the Agreeinent appears in Basic Documents of the Pan American Health Organization, 15th ed., PAHO Official Document 240 (1991), WHO REGIONAL COMMIITEE FOR THE AMERICAS see Volume 1, page 195 and Volume 11, page STUDY OF WHO'S STRUCTURES IN LIGHT OF ITS FUNCTIONS see Volume II, page WHO RESOLUTIONS OF INTEREST TO THE REGIONAL COMMITTEE' see Volume 1, page 196 and Volume II, page 163. 'WHO Resolutions were considered, but no resolutions were adopted PAHO REPRESENTATIVES ON THE JOINT COORDINATING BOARD OF THE WHO SPECIAL PROGRAM FOR RESEARCH AND TRAINING IN TROPICAL DISEASES see Volume 11, page 167 and Volume III, page PAHO REPRESENTATIVES ON THE POLICY AND COORDINATION ADVISORY COMMITTEE OF THE SPECIAL PROGRAM OF RESEARCH, DEVELOPMENT AND RESEARCH TRAINING IN HUMAN REPRODUCTION see Volume III, page WHO MEETINGS see Volume 1, page 199, Volume II page 167, and Volume III, page

68 5. CONSTITUTIONAL AND LEGAL MATTERS see Volume 1, page AMENDMENTS TO THE CONSTITUTION see Volume 1, page 200 and Volume II, page BASIC DOCUMENTS' see Volume I, page 205 and Volume II, page 169. 'The text of the Basic Documents of the Pan American Health Organization appears in PAHO Official Document 240 (1991). 5.2 MEMBER GOVERNMENTS see Volume 1, page ADMISSION OF NEW MEMBER GOVERNMENTS see Volume 1, page 207, Volume II, page 170, and Volume III, page PRIVILEGES AND IMMUNITIES see Volume 1, page ASSOCIATE MEMBERS see Volume 1, page

69 56.5. CONSTITUTIONAL AND LEGAL MATFERS 56 5 COSTIUTINAL ND EGA MATER 5.3 OBSERVERS see Volume 1, page 212, Volume II, page 173, and Volume III, page NAME AND OFFICIAL INSIGNIA NAME OF THE ORGANIZATION CD33.R OFFICIAL INSIGNIA see Volume I, page 213. For previous resolutions, see Volume 1, page 213. Having considered Document CD33/4 and Resolution XIII' of the 101st Meeting of the Executive Committee; and Believing it desirable to adopt an official flag [or the Pan American Health Organization, to be flown on the premises of the Organization and to be displayed elsewhere on ceremonial and other appropriate occasions, 1. To adopt and approve as the official flag of the Pan American Health Organization the design described in Document CD33/4. 2. To request the Director to adopt a flag code and to draw up regulations concerning the use of the flag and the protection of its dignity, and taking into account the relationship between the Pan American Health Organization and the World Health Organization. September 1988 OD 225, 141 'See this page. CE101.R13 Having considered Document CE101/18 on adopting a Pan American Health Organization flag; and Believing it desirable to adopt an official flag for the Pan American Health Organization, To recommend to the XXXIII Meeting of the Directing Council adoption of a resolution along the following lines:' June 1988 OD 225, 103 'For text recommended by the Executive Committee and adopted by the Directing Council, after amending operative paragraph 2, see Resolution CD33.R21 below. CE103.R13 Having considered Document CE 103/10 on the acloption of a new official seal of the Pan American Health Organization; and Believing it desirable to adopt a new seal of the Pan American Health Organization, To recommend to the XXXIV Meeting of the Directing Council the adoption of a resolution along the following lines:' June 1989 OD :232, 91 'For text recommended by the Executive Committee and adopted by the Directing Council, see Resolution CD34.R18 below.

70 5.5 HEALTH REGULATIONS HEALTH REGULATIONS 57 CD34.R18 Having considered Document CD34/5 and Resolution XIII' of the 103rd Meeting of the Executive Committee; and Believing it desirable to adopt a new seal of the Pan American Health Organization, 1. To adopt the distinctive design presented in Docu- ment CD34/5 as the official seal of the Pan American Health Organization. 2. To entrust the custody of such seal to the Director of the Bureau. 'See p. 56. September 1989 OD 232, HEALTH REGULATIONS PAN AMERICAN SANITARY CODE' see Volume I, page INTERNATIONAL HEALTH REGULATIONS see Volume 1, page INTERNATIONAL TRANSPORTATION OF HUMAN REMAINS 'The text of the Pan American Sanitary Code appears in the Basic Documents of the Pan American Health Organization, 15th ed., PAHO Official Document 240 (1991), 1-6. see Volume 1, page 215.

71 6. COOPERATION WITH OTHER ORGANIZATIONS see Volume 1, page ORGANIZATION OF AMERICAN STATES' see Volume I, page 218. 'The text of the Agreement between the OAS and PAHO appears in Basic Documents of the Pan American Health Organization, 15th ed., PAHO Official Document 240 (1991), INTER-AMERICAN DEVELOPMENT BANK see Volume I, page

72 6.3 UNITED NATIONS AND OTHER ORGANIZATIONS UNITED NATI0NS AND OTHER ORGANIZATIONS COORDINATION WITH THE UNITED NATIONS AND OTHER ORGANIZATIONS For previous resolutions, see Volume 1, page 223 and Volume II, page 176. CSP23.R18 The Pan American Sanitary Conference, Considering Resolution 44/211,' adopted by the United Nations General Assembly in December 1989, and its possible implications for execution of the technical cooperation activities of the World Health Organization and the Pan American Health Organization; Considering the structure and functions of the Regional Offices of the World Health Organization, and particularly of the Pan American Health Organization, Regional Office for the Americas of the World Health Organization; Considering the management strategies of the Pan American Health Organization, the process of decentralization to the countries, and the Technical Cooperation Programming System developed in conjunction with the countries; and Bearing in mind that the topic will be discussed by the Executive Board of WHO in January 1991, coordination of activities with the other agencies of the system. 6. To inform the Director-General of WHO on the content of the discussions held in the Conference so that they may be taken into account in his reply to the United Nations. September 1990 OD 238, 143 'Official Records of the General Assembly, Forty-fourth Session, agenda item 86, document A/RES/44/ To take note of the terms of Resolution 44/211 concerning the development of the technical cooperation of PAHO/WHO in the Region of the Americas. 2. To express concern at the possible consequences of Resolution 44/211 for cooperation activities in the health field, especially in regard to the sectoral specificity of resources and actions, the globalization and centralization of decisions for the allocation and use of resources, and the participation of sectoral institutions, and of the health ministries in particular, in the process. 3. To express firm support for retention of the purposes, functions, and responsibilities of the World Health Organization as set forth in its Constitution and in the mandates of the World Health Assembly, for which it is essential that it remain financially autonomous. 4. To express the wish that mechanisms be sought for improving the needed coordination between the different agencies and programs of the United Nations system in their cooperation with the Member States and the desired efficiency and effectiveness of those activities, without impairing cooperation with Latin America and the Caribbean in the health sector, or the role of PAHO/WHO and the health sector in each country in that cooperation. 5. To recommend to the Director that the information to be presented to the United Nations bring out the degree of decentralization of technical cooperation in health in the Region of the Americas, and also the advancement of UNITED NATIONS CHILDREN'S FUND see Volume 1, page 224 and Volume II, page INTERNATIONAL LABOR ORGANIZATION see Volume 1, page 225.

73 60 6. COOlPERATION WITH OTHER ORGANIZATIONS 60 6.COEAIN IHOHRORAI 6.4 NONGOVERNMENTAL ORGANIZATIONS see Volume 1, page PRINCIPLES GOVERNING RELATIONSHIP see Volume 1, page 225, Volume II, page 178, and Volume III, page 65. can Federation of Nursing Professionals and to inform them of the rights and obligations attached to these relations. 3. To request the Chairman of the Executive Committee to inform the XXXIII Meeting of the Directing Council of PAHO of this decision. June 1988 OD 225, 105 'See Vol. II, p ORGANIZATIONS IN OFFICIAL RELATIONS WITH PAHO For previous resolutions, see Volume 1, page 226, Volume II, page 180, and Volume III, page 65. CE103.R6 Having studied the report of the permanent subcommittee of the Executive Committee charged with reviewing the list of nongovernmental organizations in official relations with PAHO; and Taking into consideration Article 1.9 of Resolution XX' of the XX Pan American Sanitary Conference (1978), CE101.R15 Having seen the report presented by the Standing Subcommittee of the Executive Committee charged with reviewing the working relations of inter-american nongovernmental organizations with the Pan American Health Organization, and particularly the applications presented by the Inter-American College of Radiology, the Latin American Confederation of Biochemistry, and the Pan American Federation of Nursing Professionals; and Mindful of the provisions of Resolution XX' of the XX Pan American Sanitary Conference, 1. To authorize the establishment of officiial working relations between PAHO and the Inter-American College of Radiology, the Latin American Confederation of Biochemistry, and the Pan American Federation of Nursing Professionals. 2. To request the Director to convey this decision to the Inter-American College of Radiology, the Latin American Confederation of Biochemistry, and the Pan Ameri- 1. To confirm PAHO's official relations with the Latin American Association of Pharmaceutical Industries (AL- IFAR), the Latin American Federation of Hospitals, the Latin American Federation of the Pharmaceutical Industry (FIFARMA), the Pan American Federation of Associations of Medical Schools (FEPAFEM), the Latin American and Caribbean Association of Public Health Education (ALAESP), the Latin American Union against Sexually Transmitted Diseases (ULACETS), the Inter-American College of Radiology (ICR), the Latin American Confederation of Clinical Biochemistry, and the Pan American Federation of Nursing Professionals (FEPPEN). 2. To request the Director to inform the above-mentioned organizations about this resolution. 'See Vol. II, p June 1989 OD 232, 82

74 6.5 OTHER ENTITIES OTHER ENTITIES see Volume 11, page COORDINATION OF INTERNATIONAL COOPERATION IN THE HEALTH FIELD IN THE AMERICAS see Volume II, page 183, and Volume III, page 67.

75 7. FINANCIAL AND ADMINISTRATIVE MATTERS 7.1 FINANCIAL MATTERS FINANCIAL REGULATIONS AND RULES' 1. Scale of Assessment see Volume I, page 228, Volume II, page 185, and Volume IIl, page 69. For previous resolutions, see Volume I, page 234, Volume I1, page 189, and Volume III, page 69. 'The text of the Financial Regulations and Rules of the Pan American Health Organization appears in Basic Documents of the Pan American Health Organization, 15th ed., PAHO Official Document 240 (1991), CD32.R ASSESSMENTS AND CONTRIBUTIONS For previous resolutions, see Volume 1, page 233, Volume II, page 187, and Volume III, page 69. Whereas, Member Governments appearing in the scale adopted by the Organization of American States (OAS) are assessed according to the percentages shown in that scale in compliance with Article 60 of the Pan American Sanitary Code; and Whereas, other Member and Participating Governments are assessed on the basis of percentages which would be assigned to such countries if they were subject to the OAS scale, To establish the assessments of the Member and Participating Governments of the Pan American Health Organization for the financial period in accordance with the scale of quotas shown below and in the corresponding amounts. 62

76 7.1 FINANCIAL MATTERS 63 (1) (2) (3) (4) (5) (6) (7) Adjustment for taxes imptosed by Actual Member percentage Governadjusted ments to Credit on emolu- PAHO from Tax ments of OAS member- Gross Equaliza- PASB Net scale ship assessment tion Fund Staff assessment Country % % (USS) (USS) (USS) (USS) Antigua and Barbuda ,800 3,526 23,274 Argentina ,300,018 1,223,800-8,076,218 Bahamas ,402 10,580 69,822 Barbados ,804 12,344 81,460 Bolivia ,810 29, ,832 Brazil ,645,124 1,532,396-10,112,728 Chile , , ,426 Colombia ,232, ,232 20,000 1,090,622 Costa Rica ,810 29, ,832 Cuba ,460, ,212-1,268,456 Dominica ,800 3,526-23,274 Dominican Republic ,810 29, ,832 Ecuador ,810 29, ,832 El Salvador , ,832 Grenada ,202 5,290-34,912 Guatemala ,810 29, ,832 Haiti ,810 29, ,832 Honduras ,810 29, ,832 Jamaica ,810 29, ,832 Metico ,737,194 1,149,738-7,587,456 Nicaragua ,810 29, ,832 Panama ,810 29, ,832 Paraguay , ,832 Peru ,030 88, ,860 St. Kitts and Nevis ,398 1,762-11,636 Saint Lucia ,202 5,290-34,912 St. Vincent and the Grenadines ,800 3,526-23,274 Suriname Tnnidad and Tobago ,810 29, ,832 United States of America ,132,280 10,807,880 5,000,000 76,324,400 Uruguay ,622 59, ,666 Venezuela ,475, ,976 _- 3,886,826 Subtotal ,612,182 16,397,860 5,020, ,234,322 Other Member Governments Lquivalent pircentage Belize ,602 7,052-46,550 Canada ,750,592 1,151,500 1,000 7,600,092 Guyana ,810 29, ,832 Participating Governments France ,810 29, ,832 Kingdom of the Netherlands ,402 10,580-69,822 United Kingdom ,602 7,052 _- 46,550 Subtotal ,393,818 1,236,140 1,000 8,158,678 Total Assessments- All countries ,006,000 17,634,000 5,021, ,393,000 (2) This column shows the current OAS scale and equivalent percentages applicable to other Member and Participating Governments which are not included the OAS scale. (3) This column shows actual percentages in respect to assessments of Member and Participating Governments of the Pan American Health Organization for (6) This culumn includes estimated amounts to be received by the respective Member Governments in in respect of taxes levied by them on staff members' emoluments received from PASB, adjusted for any difference between the estimated and actual for prior years. September 1987 OD 219, 100 scale in compliance with Article 60 of the Pan American Sanitary Code; and Whereas, other Member and Participating Countries are assessed on the basis of percentages which would be assigned to such countries if they were subject to the OAS scale; now, therefore, To establish the assessments of the Member and Participating Countries of the Pan American Health Organization for the financial period in accordance with the scale of quotas shown below and in the corresponding amounts. (1) (2) (3) (4) (5) (6) (7) Actual Adjustment for percentage taxes adjusted Credit imposed by to from Member PAHO Tax Governments OAS member- Gross Equaliza- on emoluments Net scale ship assessment tion Fund of PASB Staff assessment Country % % (USS) (USS) (USS) (USS) Antigua and Barbuda , Argentina ,736,788 1, , Bahamas ,346 74,834 Barbados ,306 Bolivia ,510 26, ,030 Brazil ,192, ,602 10,838,428 Chile , , Colombia ,290, ,304 10,000 1,157,450 Costa Rica ,510 26, ,030 Cuba ,784 1,359,480 Dominica ,114 24,946 Dominican Republic , ,030 Ecuador ,510 26, ,030 El Salvador ,510 26, ,030 Grenada ,674 37,416 Guatemala , ,030 Haiti , ,030 Honduras ,510 26, ,030 Jamaica ,510 26, ,030 Mexico ,147,530 1,015,592 8, Nicaragua ,510 26, ,030 Panama , ,030 Paraguay ,510 26, ,030 Peru , Saint Kitts and Nevis ,558 12,472 Saint Lucia ,090 4,674 37,416 St. Vincent and the Grenadines ,060 3, Suriname ,388 20, ,138 Trinidad and Tobago ,510 26, ,030 United States of America , , ,000, ,726 Uruguay , ,056 Venezuela ,686, ,258 4, Subtotal , ,634 3,010, ,989,918 Other Member Countries Belize ,120 6,230 49,890 Canada ,161, , ,149,408 Guyana , ,030 Participating Countries France ,510 26, ,030 Netherlands , ,834 United Kingdom ,890 Subtotal ,834, ,916 5,000 8, TOTAL ,576,550 3,015, ,738,000 CD34.R2 Whereas, Member Countries appearing in the scale adopted by the Organization of American States (OAS) are assessed according to the percentages shown in that Notes: Column (2) shows the current OAS scale and equivalent percentages applicable to other Member and Participating Governments which are not included in the OAS scale. Column (3) shows actual percentages in respect to assessments of Member and Participating Governments of the Pan American Health Organization for Column (6) includes estimated amounts to be received by the respective Member Governments in in respect of tases levied by them on staff members' emolumentsreceived from PASB. adjusted for any difference between the estimated and actual for prior years. September 1989 OD 232, 105

77 64 7. FINANCIAL AND ADMINISTRATIVE MATrERS FINANCIAL AND ADMINISTRATIVE MATFERS CE99.R3 2. Collection of Contributions For previous resolutions, see Volume 1, page 235, Volume II, page 194, and Volume III, page 71. Having considered the report of the I)irector on the collection of quota contributions (Document CE99/13 and Add. I) and the report provided on Member Governments in arrears in the payment of their quota contributions to the extent that they are subject to the application of Article 6.B of the Constitution of the Pan American Hlealth Organization; Noting the provisions of Resolution I 1 of the XXII Pan American Sanitary Conference with respect to the application of Article 6.B of the PAHO Constitution, relating to the suspension of voting privileges of Member Governments that fail to meet their financial obligations; and Noting with concern that there are three Member Governments subject to the application of Article 6.B that have not to date met their commitments for the liquidation of their arrears, 1. To take note of the report of the Director on the collection of quota contributions (Document CE 99/13 and Add. I). 2. To thank the Member Governments that have already made payments for 1987 and to urge the other Member Governments to pay their outstanding quota contributions as early as possible, so that the work of the Organization can continue and the financial burden of its program can be shared fairly among all Members. 3. To congratulate the Government of Hiaiti for its successful effort in reducing its outstanding quota assessments owed from previous years. 4. To recommend to the XXXII Meeting of the Directing Council that the voting restrictions contained in Article 6.B of the PAHO Constitution be strictly applied to those Member Governments who by the opening of that Meeting have not either made additional and substantial payments towards their payment commitments or evidenced their intent to make such payments by formal communication to the Secretariat. 5. To request the Director to continue to inform the Member Governments of any balances due andi to report to the XXXII Meeting of the Directing Council on the status of the collection of quota contributions. 'See Vol. III, p. 74. CD32.R6 June 1987 OD 219, 74 Having considered the report of the Director on the collection of quota contributions (Document CD32/16 and Add. I) and the concerns expressed by the 99th Meeting of the Executive Committee' with respect to the stalus of the collection of quota contributions; Noting the report of the Working Party on the application of Article 6.B of the PAHO Constitution, relating to the suspension of voting privileges of Member Governments that fail to meet their financial obligations to the Organization; and Recognizing that, in the case of the two Member Governments subject to Article 6.B, the Government of the Dominican Republic has submitted a revised and acceptable deferred payment plan and has made an initial payment under this plan, and the Government of Bolivia has indicated its intent to pay its 1984 quota assessment and part of its 1985 quota assessment in 1987, 1. To take note of the report of the Director on the collection of quota contributions (Document CD32/16 and Add. I). 2. To express appreciation to Member Governinents that have already made payments in 1987, and to urge all Member Governments in arrears to fulfill their financial obligations to the Organization as soon as possible. 3. To congratulate the Government of Haiti and the Government of Paraguay for their successful efforts in reducing their outstanding quota assessments for previous years. 4. To permit the Government of the Dominicani Republic to vote at this meeting, and to endorse the acceptance of that Government's revised deferred payment plan. 5. To permit the Government of Bolivia to vote at this meeting in view of its commitment to effect a substantive quota payment in To request the Director: a) To continue to monitor the implementation of special payment agreements made by Member Governrnents in arrears for the payment of prior years' quota assessments; b) To advise the Executive Committee of Member Governments' compliance with their quota payment commitments; c) To report to the XXXIII Meeting of the Directing Council on the status of the collection of quota cont:ributions for 1988 and prior years. 'See Resolution CE99.R3 on this page. CE101.R3 September 1987 OD 219, 103 Having considered the report of the Director on the collection of quota contributions (Document CE101/11 and Add. I) and the report on Member Governments in arrears in the payment of their quota contributions to the extent that they are subject to the application of Article 6.B of the Constitution of the Pan American Health Organization;

78 7.1 FINANCIAL MATTERS 65 Noting the provisions of Resolution VI' of the XXXII Meeting of the Directing Council on the application of Article 6.B of the PAHO Constitution, regarding the suspension of voting privileges of Member Governments that fail to meet their financial obligations; and Noting with concern that six Member Governments may be subject to the application of Article 6.B of the Constitution on the opening date of the XXXIII Meeting of the Directing Council, 1. To take note of the report of the Director on the collection of quota contributions (Document CE101/11 and Add. I). 2. To thank the Member Governments that have already made their payments for 1988 and to urge the other Member Governments to pay their outstanding quota contributions as soon as possible, so that the work of the Organization can continue and the financial burden of its program can be shared fairly among all members. 3. To recommend to the XXXIII Meeting of the Directing Council that the voting restrictions contained in Article 6.B of the PAHO Constitution be strictly applied to Member Governments that by the opening of that Meeting have not made substantial additional payments towards fulfilling their commitments nor stated their intention of doing so by formal communication to the Secretariat. 4. To request the Director to continue to inform the Member Governments of any balances due and to report to the XXXIII Meeting of the Directing Council on the status of the collection of quota contributions. 2. To express appreciation to Member Governments that have already made payments in 1988, and to urge all Member Governments in arrears to promptly meet their financial obligations to the Organization. 3. To congratulate the Government of Haiti and, in particular, the Government of Paraguay, for continuing to successfully reduce the amounts of their outstanding quota assessments. 4. To permit the Governments of Bolivia and Suriname to vote at this meeting in view of their initial payment efforts and commitment to make additional payments. 5. To permit the Government of the Dominican Republic to vote at this meeting and to encourage it to make every possible effort to meet its full payment commitment for To request the Director to: a) Continue to monitor the implementation of special payment agreements made by Member Countries in arrears for the payment of prior years' quota assessments; b) Advise the Executive Committee of Member Countries' compliance with their quota payment commitments; c) Report to the XXXIV Meeting of the Directing Council on the status of the collection of quota contributions for 1989 and prior years. 'See Resolution CE101.R3 on page 64. September 1988 OD 225, 123 June 1988 OD 225, 89 'See p. 64. CE103.R1 CD33.R7 Having considered the report of the Director on the collection of quota contributions (Document CD33/15 and Add. I) and the concerns expressed by the 101st Meeting of the Executive Committee' with respect to the status of the collection of quota contributions; Noting the report of the Working Party on the application of Article 6.B of the PAHO Constitution, regarding the suspension of voting privileges of Member Governments that fail to meet their financial obligations to the Organization (Document CD33/15, Add. II); and Recognizing that, in the case of the three Member Governments subject to Article 6.B, the Governments of Bolivia, the Dominican Republic, and Suriname either had made payments towards their outstanding quota commitments or had formally indicated their intent to make such payments during the remainder of 1988, 1. To take note of the report of the Director on the collection of quota contributions (Document CD33/15 and Add. I). Having considered the report of the Director on the collection of quota contributions (Document CE103/12 and Add. I) and the report provided on Member Governments in arrears in the payment of their quota contributions to the extent that they can be subject to the application of Article 6.B of the Constitution of the Pan American Health Organization; Noting the provisions of Article 6.B of the PAHO Constitution, relating to the suspension of voting privileges of Member Governments that fail to meet their financial obligations and the potential application of these provisions to eight Member Governments; and Noting with concern that there are 29 Member Governments who have not made any payments towards their 1989 quota assessments and that amounts currently due from prior year assessments have increased in comparison with 1988, 1. To take note of the Report of the Director on the collection of quota contributions (Document CE103/12 and Add. I). 2. To thank the Member Governments that have already made payments for 1989 and to urge the other Member Governments to pay their outstanding quota contributions as soon as possible. 3. To recommend to the XXXIV Meeting of the Directing Council that the voting restrictions contained in

79 66 7. FINANCIAL AND ADMINISTRAT`IVE MATITERS FINANCIAL ANO ADMINISTRATIVE MATrERs Article 6.B of the PAHO Constitution be strictly applied to those Member Governments who by the opening of that Meeting have not made additional and substantial payments towards their payment commitments. 4. To request the Director to continue to inform the Member Governments of any balances due and to report to the XXXIV Meeting of the Directing Council on the status of the collection of quota contributions. CD34.R3 June 1989 '3D 232, 77 Having considered the report of the Director on the collection of quota contributions (Document CD34/19 and Add. I) and the concerns expressed by the 103rd Meeting of the Executive Committee' with respect to the status of the collection of quota contributions; Noting the report of the Working Party on the application of Article 6.B of the PAHO Constitution relating to the suspension of voting privileges of Member Governments that fail to meet their financial obligations to the Organization (Document CD34/19, Add. II); and Recognizing that, in the case of the seven Member Governments subject to Article 6.B, Bolivia, Nicaragua, and Suriname had submitted acceptable deferred payment plans to the Secretariat prior to the opening of the XXXIV Meeting of this Council, 1. To take note of the report of the Director on the collection of quota contributions (Document CD34/19 and Add. I). 2. To express appreciation to Member Governments that have already made payments in 1989, and to urge all Member Governments in arrears to meet promptly their financial obligations to the Organization. 3. To congratulate Haiti for its continued payment effort toward decreasing its quota arrears for prior years. 4. To endorse the Article 6.B Working I>arty's recommendation to permit Bolivia, Nicaragua, and Suriname to vote at this meeting of the Directing Council. 5. To approve the recommendation of the Working Party that the voting privileges of any Member Government subject to the application of Article 6.B be suspended until an acceptable plan of payment has been submitted to the Secretariat, and to note that Guatemala and Peru have now complied with this requirement. 6. To request the Director to notify the Dominican Republic that its voting privileges will be suspended effective with the commencement of the XXIII Pan American Sanitary Conference unless all payments scheduled under the payment plan approved in 1987 have been received by the Secretariat. 7. To request the Director to notify Guya.na that its voting privileges will be suspended effective wit:h the commencement of the XXIII Pan American Sanitary Conference unless a specific and acceptable plan of deferred payments is received by the Secretariat and that voting rights will be automatically restored by this action. 8. To endorse the Working Party's recommendation that all deferred payment plans be considered firm commitments by the countries concerned and not be modified in the future. 9. To request that the Director: a) Continue to monitor the implementation of special payment agreements made by Member Governments in arrears for the payment of prior years' quota assessments; b) Advise the Executive Committee of Member Governments' compliance with their quota payment commitments; c) Report to the XXIII Pan American Sanitary Conference on the status of the collection of quota contributions for 1990 and prior years. 'See Resolution CE103.RI on page 65. CE105.R1 September 1989 OD 232, 108 Having considered the report of the Director on the collection of quota contributions (Document CE105/21 and Add. I) and the report provided on Member Governments in arrears in the payment of their quota contributions to the extent that they can be subject to the applicalion of Article 6.B of the Constitution of the Pan American Health Organization; Noting the provisions of Article 6.B of the PAHC) Constitution relating to the suspension of voting privileges of Member Governments that fail to meet their financial obligations and the potential application of these provisions to nine Member Governments; and Noting with concern that there are 26 Member Governments who have not made any payments toward their 1990 quota assessments and that amounts currently due from prior year assessments have increased in comparison with those of 1989, 1. To take note of the report of the Director on the collection of quota contributions (Document CE105/21 and Add. 1). 2. To thank the Member Governments that have already made payments for 1990 and lo urge the other Member Governments to pay their outstanding quota contributions as soon as possible. 3. To recommend to the XXIII Pan American Sanitary Conference that the voting restrictions contained in Article 6.B of the PAHO Constitution be strictly applied to those Member Governments who by the opening of that meeting have not complied with the provisions of Resolution III' of the XXXIV Meeting of the Directing Council as they apply to their quota payment situations. 4. To request the Director to continue to inform the Member Governments of any balances due and to report to the XXIII Pan American Sanitary Conference on the status of the collection of quota contributions. 'See this page. June 1990 OD 238, 91

80 7.1 FINANCIAL MATTERS FINANCIAL MATTERS 67 CSP23.R4 The Pan American Sanitary Conference, WORKING CAPITAL FUND Having considered the report of the Director on the collection of quota contributions (Document CSP23/21 and Add. I) and the concerns expressed by the 105th Meeting of the Executive Committee with respect to the status of the collection of quota contributions; Noting the report of the Working Party on the application of Article 6.B of the PAHO Constitution relating to the suspension of voting privileges of Member Governments that fail to meet their financial obligations to the Organization (Document CSP23/21, Add. I); and Recognizing that, in the case of the eight Member Governments subject to Article 6.B, Guyana, through its payments action, is no longer subject to Article 6.B, and Nicaragua and Suriname have made serious efforts to meet their commitments under their approved deferred payment plans; and Further noting that the Dominican Republic, Guatemala, Honduras, and Peru have now submitted reasonable and acceptable plans of payment in accordance with their economic situation, 1. Holding Account see Volume 1, page 241 and Volume II, page 203. see Volume II, page REVOLVING AND SPECIAL FUNDS see Volume 1, page 245, Volume II, page 206, and Volume III, page To take note of the report of the Director on the collection of quota contributions (Document CSP23/21 and Add. I). 2. To thank the Member Governments that have already made payments in 1990 and to urge all Member Governments in arrears to meet promptly their financial obligations to the Organization. 3. To congratulate Guyana for its payment effort to reduce its quota arrears for prior years. 4. To endorse the Article 6.B Working Party recommendation to permit the Dominican Republic, Guatemala, Honduras, Nicaragua, Peru, and Suriname to vote at this Pan American Sanitary Conference. 5. To request the Director to notify Antigua and Barbuda that its voting privileges will be suspended effective with the commencement of the XXXV Meeting of the Directing Council unless a specific and acceptable plan of deferred payments is received by the Secretariat, and that voting privileges will be automatically restored by this action. 6. To endorse the Working Party's recommendation that all deferred payment plans be considered firm commitments by the countries concerned and not be modified in the future. 7. To request that the Director: a) Continue to monitor the implementation of special payment agreements made by Member Governments in arrears for the payment of prior years' quota assessments; b) Advise the Executive Committee of Member Governments' compliance with their quota payment commitments; c) Report to the XXXV Meeting of the Directing Council on the status of the collection of quota contributions for 1991 and prior years. September 1990 OD 238, Emergency Voluntary Fund see Volume II, page Revolving Fund for the Expanded Program on Immunization see Volume II, page 206 and Volume III, page 75. See also Section (Expanded Program on Immunization) ADDITIONAL INCOME SOURCES AND PROGRAMS 1. Pan American Health and Education Foundation 2. Other see Volume 1, page 259 and Volume II, page 208. see Volume II, page 209.

81 68 7. FINANCIAL AND ADMINISTRATIVE MATTERS ACCOUNTS AND EXTERNAL AUDIT CE101.R4 CE99.R4 1. Approval of Annual Financial Report of the Director and Report of the External Auditor For previous resolutions, see Volume I, page 259, Volume II, page 212, ancl Volume III, page 76. Having examined the Interim Financial Report for the Year 1986 (Official Document 214); Noting with concern the slow rate of quota payments to the Organization and to the PAHO Centers; and Recognizing that the Organization continues to be in a sound financial situation, 1. To take note of the Interim Financial Report of the Director for the Year 1986 (Official Document 214). 2. To transmit the Interim Financial Repori: of the Director for the Year 1986 to the XXXII Meeting of the Directing Council. 3. To express concern over the impact that the delayed payment of quota assessments has on the future financial status of the Organization and its Centers. 4. To congratulate the Director for his efforts to maintain the Organization in a sound financial position. CD32.R7 June 1987 OD 219, 75 Having examined the Interim Financial Report of the Director for the Year 1986 (Official Document 214); Noting the report of the 99th Meeting of the Executive Committee on its review of the financial statements and schedules of the Organization as contained in Official Document 214; and Expressing concern over the rate of quota payments during 1986, while recognizing that, in spite of this, the Organization has continued to maintain a satisfactory financial situation, 1. To take note of the Interim Financial Report of the Director for the Year 1986 (Official Document 214). 2. To endorse the comments and concerns expressed by the 99th Meeting of the Executive Committee in its report on the financial condition of the Organization as of 31 December 1986, and in particular the concern expressed with respect to the impact that the delayed payment of quota assessments has on the financial status of the Organization and its Centers. 3. To commend the Director for having maintained the Organization in a satisfactory financial condition. September ) 219, 104 Having examined the Financial Report of the Director for , contained in Official Document 220, and having heard the report presented by the External Auditor on the accounts of the Organization for this financial period, 1. To transmit the Financial Report of the Director, including the Report of the External Auditor for (Official Document 220), to the XXXIII Meeling of the Directing Council. 2. To recommend to the XXXIII Meeting of the Directing Council approval of a resolution along the following lines:' June 1988 OD 225, 90 'For text recommended by the Executive Committee and adopted by the Directing Council, see Resolution CD33.R1 below. CD33.R1 Having examined the Financial Report of the Director and the Report of the External Auditor for (Official Document 220) on the accounts of the Organization; Noting the comments and concerns expressed by the External Auditor on the bank and imprest accounts, the new Headquarters office building, monitoring and evaluation, and control of manpower; and Expressing satisfaction that the Organization has; continued to maintain a balanced financial condition, 1. To take note of the Financial Report of the Director for To thank the External Auditor for presenting a. clear and comprehensive report for the biennium and to request the Director to encourage careful attention to the matters of concern expressed by the External Auditor. 3. To express concern over the low rate of quota payments to the Caribbean Food and Nutrition Institute (CFNI) and to the Institute of Nutrition of Central America and Panama (INCAP), and to urge the governinents that are members of CFNI and INCAP to make every effort to pay their outstanding quota contributions as early as possible, so that the work of these Centers can continue and the financial burden of their programs be shared fairly among all participants in the Centers. 4. To request the Director to monitor carefully the financial situation of CFNI and INCAP, and to devise alternative policies should the quota situation fail to improve over the current biennium. 5. To request the Director to review and evaluate thoroughly the relationship between the Organization and the Pan American Health and Education Foundation (PAHEF) and to report his findings through the Subcommittee on Planning and Programming for consideration by the Executive Committee in June 1989.

82 7.1 FINANCIAL MATTERS FINANCIAL MA1TERS To endorse the Director's proposal to credit the surplus of US$859,500 from operations in to the Miscellaneous Income Account to help assure adequate funding of the Regular Budget. 7. To congratulate the Director on his efforts to maintain a balanced financial condition for the Organization. CE103.R2 September 1988 OD 225, 118 Having examined the Interim Financial Report of the Director for the Year 1988 (Official Document 227 and Add. I); Expressing concern over the decreased rate of quota payments received in 1988 in comparison with previous years while acknowledging that the Organization has continued to be in a sound financial situation as of 31 December 1988; and Noting that the Institute of Nutrition of Central America and Panama has received a qualified audit opinion from the Organization's External Auditor on the completeness and accuracy of its financial statements and financial position at the end of 1988, Expressing concern over the slow rate of quota payments toward 1988 quota assessments for the Organization; Noting that the Institute of Nutrition of Central America and Panama has received a qualified audit opinion from the Organization's external auditor on the completeness and accuracy of its financial statements and financial position at the end of 1988; and Recognizing that the Organization continues to maintain a sound financial position, 1. To take note of the Interim Financial Report of the Director for 1988 (Official Document 227 and Add. I). 2. To endorse the comments and concerns expressed by the 103rd Meeting of the Executive Committee in its report on the financial condition of the Organization as of 31 December 1988, and in particular the concern expressed with respect to the impact that the delayed payment of quota assessments has on the financial status of the Organization and its Centers. 3. To congratulate the Director on having maintained the Organization in a sound financial position. September 1989 OD 232, To take note of the Interim Financial Report of the Director for the Year 1988 (Official Document 227 and Add. I). 2. To transmit the Interim Financial Report of the Director for the year 1988 to the XXXIV Meeting of the Directing Council. 3. To express concern over the possible impact of delayed payment of quota assessments on the Organization's activities in 1988/1989 and future periods. 4. To request the Director to continue efforts to correct the financial management situation that existed at the Institute of Nutrition for Central America and Panama during To congratulate the Director for his success in maintaining the Organization in a sound financial position. June CD34.R9 The Directing Courncil, l -, n - min the Ir i 1 ilaviiina IA.iilllgu,... l.i rtll. - i tn., laiiai 1 1 -il1 Director for 1988 (Official Document 227 and Add. I); CE105.R2 Having examined the Financial Report of the Director for the period as contained in Official Document 233; and Taking note of the report presented by the External Auditor on the accounts of the Organization for this financial period, 1. To transmit the Financial Report of the Director and the Report of the External Auditor for the period (Official Document 233) to the XXIII Pan American Sanitary Conference. 2. To thank the External Auditor for presenting a clear and comprehensive report for the biennium OD 232, To note that the financial condition of the Caribbean Epidemiology Center (CAREC), the Caribbean Food and Nutrition Institute (CFNI), and the Institute of Nutrition of Central America and Panama (INCAP) has improved and to encourage the governments that are members of these institutions to continue efforts to pay their outstanding quota contributions as early as possible. 4. To endorse the Director's proposal to credit the surplus of US$962,201 to reduce the quotas of Member Governments in relation to the Biennial Program Budget for To congratulate the Director on his successful efforts to maintain a sound and balanced financial position for the Organization. June 1990 OD 238, 92

83 70 7. FINANCIAL AND ADMINISTRATIVE MATrrERS CSP23.R5 The Pan American Sanitary Conference, CD32.R14 Having examined the Financial Report of the Director and the Report of the External Auditor for (Official Document 233) on the accounts of the Pan American Health Organization; Noting the presentation by the External Auditor on the satisfactory condition of the Organization's accounts and the Organization's continued compliance with the Financial Regulations and legislative authority; and Expressing satisfaction that the Organization has continued to follow sound financial practices and to maintain a stable fiscal standing, 1. To take note of the Financial Report of the Director and the Report of the External Auditor for (Official Document 233). 2. To express appreciation to the External Auditor for the thoroughness of his audit reviews during the past biennium and for presenting a clear and concise report on the condition of the Organization's accounts and accuracy of the financial statements for To request that the Governments that are members of the Caribbean Epidemiology Center, the Caribbean Food and Nutrition Institute, and the Institute of Nutrition of Central America and Panama continue to strengthen their efforts to pay their outstanding quota assessments as early as possible. 4. To endorse the Director's proposal to credit the surplus of US$962,201 to reduce the quotas of Member Governments in relation to the biennial program budget for To thank the Director for his continuing efforts and success in maintaining a sound financial position for the Organization. September 1990 OD 238, 126 Bearing in mind that it has been the practice of the Pan American Health Organization and the World Health Organization to have the same External Auditor, and that the holder of the office of Comptroller and Auditor General of the United Kingdom of Great Britain and Northern Ireland, who has been appointed External Auditor of the World Health Organization for the financial periods and , has expressed a willingness to continue to serve as External Auditor of the Pan American Health Organization, 1. To appoint the holder of the Office of Comptroller and Auditor General of the United Kingdom of Great Britain and Northern Ireland External Auditor of the accounts of the Pan American Health Organization for the financial periods and , and to request that he conduct his audits in accordance with the principles set forth in Article XII of the PAHO Financial Regulations, with the provision that, should the need arise, he may designate a representative to act in his absence. 2. To express its thanks to Sir Gordon Downey, K.C.B., for the work he has performed for the Organization. September 1987 OD 219, Appointment of External Auditoir For previous resolutions, see Volume 1, page 261, Volume II, page 216, and Volume III, page TRAVEL see Volume 1, page 262 and Volume II, page ADMINISTRATIVE AND STAFF MATTERS STAFF RULES AND REGULATIONS see Volume 1, page 263 and Volume II, page Amendments to the Staff Rules and Regulations For previous resolutions. see Volume 1. page 266, Volume II, page 218, and Volume III, page 78.

84 7,2 ADMINISTRATIVE AND STAFF MATf~ERS ADMINISTRATIVE AND STAFF MATTERS 71 CE99.R10 Having considered the amendments to the Staff Rules of the Pan American Sanitary Bureau submitted by the Director in the Annex to Document CE99/3; Recognizing the need for uniformity of conditions of employment of PASB and WHO staff; and Bearing in mind the provisions of Staff Rule 020, To confirm the amendments to the Staff Rules of the Pan American Sanitary Bureau submitted by the Director in the Annex to Document CE99/3, with effect from 1 January 1987 concerning the assessment rates for salaries for the general services category, and with effect from 1 April 1987 concerning the assessment rates for salaries for the professional categories, and in consequence the schedule of salaries for the professional and higher categories posts. CE99.R13 June 1987 OD 219, 82 Having considered Document CE99/16 entitled "Hiring Under Local Conditions of Employment for the Mobilization of National Resources," which describes the discussions and conclusions of the April 1987 Meeting of the Subcommittee on Planning and Programming of the Executive Committee of PAHO; Recalling Resolution XIX' of the XXII Pan American Sanitary Conference; and Bearing in mind the provisions of Staff Rules and 020, N 350 National staff selected for posts in the Bureau should normally devote the whole of their time to the Organization. National staff wishing to seek employment elsewhere in addition to the position for which they have been selected in the Bureau must receive prior approval of the Director. N 530 National staff shall be compensated in accordance with the rules of the national social security system in the event of illness, accident, or death attributable to the performance of their official duties on behalf of the Bureau. Where there is no such scheme available, the Bureau shall provide reasonable compensation. N 630 National staff shall not be dismissed as a result of misconduct before they have been notified of the charges made against them and been given an opportunity to reply to those charges. Such notification shall be in writing, and unless the urgency of the situation prevents, the individual shall be given a reasonable time to submit the reply. 2. To request the Director to implement this Annex to the Staff Rules on a limited basis pending a full review of this new system to be completed and presented to the Executive Committee in To request the Director to establish a mechanism for monitoring the implementation of this new system, and to provide the Executive Committee with an interim report in 1988 and a full report prior to 31 May 1989 on the implementation of these amendments, together with his recommendations on this subject. 'See Vol. III, p. 79. June 1987 OD 219, To confirm, with effect from 1 July 1987, the Annex to the Staff Rules of the Pan American Sanitary Bureau concerning hiring under local conditions of employment for the mobilization of national resources, submitted by the Director in Document CE99/16, Annex II, but with the following substituted text: CE101.R11 N 330 All national staff shall be selected on a competitive basis by means of selection committees established in each locality. Selection committees normally should be composed of three staff members: the supervisor serving as representative of the receiving unit, one staff member serving as representative of the staff, and one serving as an independent staff member. Selections must be approved by the Director or his delegated representative. N 340 No person closely related by blood or marriage to an existing staff member of the Bureau shall be appointed unless an exception has been obtained from the Director. When exceptions are made, such persons should not be assigned within the same line of authority. Having considered the amendments to the Staff Rules of the Pan American Sanitary Bureau submitted by the Director in the Annex to Document CE101/14; Recognizing the need for uniformity in conditions of employment of PASB and WHO staff; and Bearing in mind the provisions of Staff Rule 020, To confirm the amendments to the Staff Rules of the Pan American Sanitary Bureau submitted by the Director in the Annex to Document CE101/14, effective 1 April 1987 concerning the definition of terminal remuneration; effective 1 July 1987 concerning the increase in the financial incentive; effective 1 January 1988 concerning a) the restructuring of the assignment allowance and the payment of an enhanced assignment allowance resulting from the introduction of a

85 72 7. FINANCIAL AND ADMINISTRATIVE MATTERS FINANCIAL AND ADMINISTRATIVE MATTERS mobility element, and b) a change in the reimbursement of boarding costs in conjunction with the education grant; and effective 1 April 1988 concerning the rates of staff assessment. CE103.R7 June 1988 CID 225, 102 Having considered the amendments to the Staff Rules of the Pan American Sanitary Bureau submitted by the Director in the Annex to Document CE103/9; Recognizing the need for uniformity of conditions of employment of PASB and WHO staff; and Bearing in mind the provisions of Staff Rule 020, To confirm the amendments to the Staff Rules of the Pan American Sanitary Bureau submitted by the Director in the Annex to Document CE103/9, with effect from 1 January 1989, concerning dependents' allowance for professional and higher-graded staff, education grant, special education grant for disabled children, maternity leave, and abolition of post and reduction in force. CE105.R16 June 1989 OD 232, 83 Having considered the amendments to the Staff Rules of the Pan American Sanitary Bureau submitted by the Director and contained in the Annexes to ]Documents CE105/5 and CE105/5, Add. I; Recognizing the need for uniformity of conditions of employment of PASB and WHO staff; and Bearing in mind the provisions of Staff Rule 020, 1. To confirm the amendments to the Staff Rules of the Pan American Sanitary Bureau submitted by the Director in the Annex to Document CE105/5, with effect from 1 January 1990 concerning the retirement age, and with effect from 1 July 1990 concerning: a) The salary scale applicable to staff in posts in the professional and higher categories; b) The amount of dependents' allowances for disabled children; c) The requirements regarding service time: to qualify for additional steps in the salary scale; and d) The discontinuation of the 18-month home leave cycle. 2. To confirm the amendments to the Staff Rules submitted by the Director in the Annex to Document CE105/ 5, Add. I, with effect from 1 July 1990 concerning: a) Definition of "terminal remuneration"; b) Determination of salary on promotion; c) Rates of staff assessment for professional and higher categories; d) Post adjustment; e) Dependents' allowances with respect to disabled children of staff in the professional and higher categories; f) Education grant for staff members in designated official stations; g) Mobility and hardship allowance and assignment grant; h) Calculation of separation payments and the commutation of accrued annual leave; i) Normal age of recruitment; and j) Other revisions and deletions in the Staff Rules resulting from the amendments submitted for confirmation. CE105.R17 June 1990 OD 238, 111 Having considered the report of the Director regarding the action taken to date for the implementation of Resolution XIX' of the XXII Pan American Sanitary Conference on hiring under local conditions of employment for the mobilization of national resources (Document CE105/ 6); Considering the views expressed by the Executive Committee at its meetings since the introduction of the subject in 1986; and Bearing in mind Resolution XVI z of the 103rd Meeting of the Executive Committee, 1. To take note of the progress report presented by the Director in Document CE105/6 for implementation of Resolution XIX of the XXII Pan American Sanitary Conference. 2. To reiterate the principles enunciated in Resolution XIX of the XXII Pan American Sanitary Conference and to endorse the related criteria/guidelines described in Document CE105/6. 'See Vol. III, p. 79. 'See p RECRUITMENT AND SERVICE June 1990 OD 238, Recruitment of International Staff see Volume 1, page 269.

86 7.2 ADMINISTRATIVE AND STAFF MATTERS ADMINISTRATIVE AND STAFF MATrERS Study of Conditions of Employment see Volume 1, page Field Service Allowances see Volume I, page Language Allowance 3. Hiring Under Local Conditions of Employment See also Section (Amendments to the Staff Rules and Regulations). 3. Cost-of-Living Adjustment see Volume I, page 274. For resolutions on this sub- CE103.R16 ject, see Volume 1, page 275. Having considered the report of the Director entitled "Hiring Under Local Conditions of Employment for the Mobilization of National Resources" (Document CE103/ 14); Having noted the report of the Twelfth Meeting of the Subcommittee on Planning and Programming of the Executive Committee in relation to the subject; and Bearing in mind Resolution XIX' of the XXII Pan American Sanitary Conference, 1. To take note of the report presented by the Director concerning the personnel system established in accordance with Resolution XIX of the XXII Pan American Sanitary Conference. 2. To request the Director to continue his efforts to monitor the implementation of the personnel system, on the basis of the content of Document CE103/14, and to present a progress report to the Executive Committee at its 105th Meeting in To request the Director, during this period, to develop criteria/guidelines to determine the kinds of posts which should remain within the United Nations Common System in relation to the implementation of the new national contract system. 4. Pending a full review of the matter, to be completed prior to 31 May 1991, for analysis by the Executive Committee in its 107th Meeting, to extend the trial period until 30 September 1991 to allow the Secretariat to obtain additional experience with the system and to develop the guidelines. 'See Vol. III, p SALARIES AND ALLOWANCES June 1989 OD 232, 95 see Volume 1, page Study of Salaries and Other Compensations see Volume 1, page 275, Volume II, page 223, and Volume III, page 81. See also Section (Amendments to Staff Rules and Regulations). 5. Salaries of Nonclassified Staff Members (Director, Deputy Director, Assistant Director) CE99.R11 For previous resolutions, see Volume 1, page 276, Volume II, page 223, and Volume IIl, page 81. Considering the revision made to the staff assessment rates for the professional and higher categories in graded posts, effective 1 April 1987; Taking into account the recommendations of the seventy-ninth session of the WHO Executive Board' to the Fortieth World Health Assembly related to the remuneration of the Regional Director, the Deputy Director-General, and the Director-General; and Bearing in mind Staff Rule 3.1 of the Pan American Sanitary Bureau and Resolution XYX of the XX Meeting of the Directing Council, 1. To approve the proposal of the Director, effective 1 April 1987, to: a) Establish the salary of the Deputy Director at US$53,887 (single rate) per annum; b) Establish the salary of the Assistant Director at US$52,887 (single rate) per annum.

87 74 7. FINANCIAL AND ADMINISTRATIVE MATTERS 2. To recommend to the Directing Council al: its XXXII Meeting that it establish the salary of the Director at US$58,938 (single rate) per annum, effective 1 April June 1987 OD 219, 83 'Resolution EB79.R10. Document EB79/1987/REC/1, See Vol. II, p To recommend to the Directing Council at its XXXIII Meeting that it establish the salary of the Director at US$58,892 (single rate) per annum, effective 1 April June 1988 OD 225, 102 'Resolution EB81.R2. Document EB81/1988/REC/1, 1. 2 See Vol. II, p CD32.R15 Considering the revision made to the schedule of salaries of the professional and higher categories of staff in graded posts, effective 1 April 1987; Taking into account the decision by the Executive Committee at its 99th Meeting to adjust the salaries of the Deputy Director and the Assistant Director (Resolution XI);' Having noted the recommendation of the Executive Committee concerning the salary of the Director of the Pan American Sanitary Bureau (Resolution XI); and Bearing in mind the provisions of Staff Rule 330.3, To establish the net salary of the Director of the Pan American Sanitary Bureau at US$58,938 (single rate) per annum, effective 1 April 'See p. 73. September 1987 OI) 219, 114 CD33.R20 Considering the revision made to the schedule of salaries of the professional and higher categories of staff in graded posts, effective 1 April 1988; Taking into account the decision by the Executive Committee at its 101st Meeting to adjust the salaries of the Deputy Director and the Assistant Director (Resolution XII'); Having noted the recommendation of the Executive Committee concerning the salary of the Director of the Pan American Sanitary Bureau (Resolution XII); and Bearing in mind the provisions of Staff Rule 330.3, To establish the net salary of the Director of the Pan American Sanitary Bureau at US$58,892 (single rate) per annum, effective 1 April 'See this page. September 1988 OD 225, 140 CE105.R10 CE101.R12 Considering the revision made to the staff assessment rates for professional and higher categories in graded posts, effective 1 April 1988; Taking into account the recommendation of the Eightyfirst session of the WHO Executive Board' to the Fortyfirst World Health Assembly related to the remuneration of the Regional Director, the Deputy Director-General, and the Director-General; and Bearing in mind Staff Regulation 3.1 of the Pan American Sanitary Bureau and Resolution XX 2 of the XX Meeting of the Directing Council, 1. To approve the proposal of the Director., effective 1 April 1988, to: a) Establish the salary of the Deputy Director at US$53,891 (single rate) per annum; b) Establish the salary of the Assistant Director at US$52,891 (single rate) per annum. Considering the revision made to the schedule of salaries for the professional and higher categories in graded posts, effective 1 July 1990; Taking into account the recommendation of the Eightyfifth Session of the WHO Executive Board' to the Fortythird World Health Assembly relatecl to the remuneration of the Regional Director, the Deputy Director-General, and the Director-General; and Bearing in mind Staff Regulation 3.1 of the Pan American Sanitary Bureau and Resolution XX 2 of the XX Meeting of the Directing Council, 1. To approve the proposal of the Director, effective 1 July 1990, to: a) Establish the annual net salary of the Deputy Director at US$67,000 (dependency rate) and US$60,485 (single rate); b) Establish the annual net salary of the Assistant Director at US$66,000 (dependency rate) and US$59,485 (single rate). 2. To recommend to the XXIII Pan American Sanitary

88 7.3 PAHO HEADQUA1RTERS PAHO HEADQUARTERS 75 Conference that it establish the annual net salary of the Director at US$73,942 (dependency rate) and US$65,370 (single rate), effective 1 July June 1990 OD 238, PENSION FUND see Volume I, page 279. 'Resolution EB85.R10. Document EB85/1990/REC/1, 8. 2 See Vol. II, p DIRECTOR OF PASB For previous resolutions, see Volume I, page 282, Volume II, page 226, and Volume III, page 81. CSP23.R21 The Pan American Sanitary Conference, Considering the revision made to the schedule of salaries for the professional and higher categories of staff in graded posts, effective 1 July 1990; Taking into account the decision by the Executive Committee at its 105th Meeting to adjust the salaries of the Deputy Director and the Assistant Director (Resolution CE105.R10); Having noted the recommendation of the Executive Committee concerning the salary of the Director of the Pan American Sanitary Bureau (Resolution CE105.R10); and Bearing in mind the provisions of Staff Rule 330.3, To establish the annual net salary of the Director of the Pan American Sanitary Bureau at US$73,942 (dependency rate) and US$65,370 (single rate), effective 1 July September 1990 OD 238, 146 CSP23.R7 The Pan American Sanitary Conference, Bearing in mind Articles 4.E and 21.A of the Constitution of the Pan American Health Organization, which provide that the Pan American Sanitary Bureau shall have a Director elected at the Conference by the vote of a majority of the Governments of the Organization; Bearing in mind Article 4 of the Agreement between the World Health Organization and the Pan American Health Organization and Article 52 of the Constitution of the World Health Organization, which establish the procedure for the appointment of Regional Directors of the World Health Organization; and Satisfied that the election of the Director of the Bureau has been held in accordance with the established procedures, 1. To declare Dr. Carlyle Guerra de Macedo elected Director of the Pan American Sanitary Bureau for a period of four years to begin 1 February To submit to the Executive Board of the World Health Organization the name of Dr. Carlyle Guerra de Macedo for appointment as Regional Director for the Americas. September 1990 OD 238, TAX EQUALIZATION / see Volume I, page OTHER OFFICIALS see Volume I, page PAHO HEADQUARTERS see Volume I, page 284.

89 76 7. FINANCIAL AND ADMINISTRATIVE MATIrERS FINANCIAL AND ADMINISTRATIVE MAHERS BUILDINGS AND INSTALLATIONS FOR HEADQUARTERS CE99.R14 For previous resolutions, see Volume I, page 285, Volume II, page 227, and 'Volume lli, page 82. Having reviewed Document CE99/8 which reports on actions taken by the Secretariat in relation to the PAHO Building Fund; and Bearing in mind Resolutions XI and XI[' of the XXXI Meeting of the Directing Council, To approve the major maintenance and repair projects for 1988 (June 1988-May 1989) as proposed in Document CE99/8, that is: 1. Recaulking the fins and windows of the IHeadquarters Building: US$135, Reconfiguring the air conditioning system for the Headquarters Building: US$60,000. 'See Vol. III, p. 83. CE103.R17 June 1987 OD 219, 88 Having reviewed Document CE103/8, which reports on actions taken by the Secretariat in relation to the approved projects financed by the PAHO Building Fund, and describes additional project requirements, To approve the major maintenance and repair projects for the period June 1990-May 1991 described in D)ocument CE103/8, that is, replacement of the air-handling units and associated equipment at PAHO Headquarters at an estimated cost of US$293,000 and the replacement and upgrading of the emergency systems at an estimated cost of US$326,000, for which the total charge to the PAHO Building Fund is estimated to be US$464,250. CE105.R11 June 1989 O]D 232, 96 Having reviewed Document CE105/9, which reports on actions taken by the Secretariat in relation to the approved projects financed by the PAHO Building Fund, and describes additional project requirements, 1. To approve the proposed phases of the project on air handling units and associated air rnovement equipment, as described in Document CE105/9, and to increase the funds for this project by US$200,000 for the asbestos removal from the surrounding structures of the air handling units and for monitoring of these activities; the charge to the PAHO Building Fund will be US$150, To approve the project to replace the roof of the conference room and the second-floor corridor in the PAHO-owned office building in Peru at an estimated cost of US$22,000, for which the charge to the PAHO Building Fund will be US$16,500. CSP23.R22 June 1990 OD 238, 103 The Pan American Sanitary Conference, Having considered Document CSP23/26; Considering that the Headquarters Building is 25 years old and will need a significant expenditure for maintenance and repair in the 1990s; Taking into account that the Organization is already renting significant amounts of office space, with additional needs, at increased cost, expected in 1992; and Bearing in mind that there is little land or office space available in the area of the present Headquarters Building, 1. To authorize the Director: a) To examine the options for alternative quarters for the Headquarters of the Pan American Health Organization, including the options of construction of a new Headquarters Building, the purchase of an existing building, the leasing of a building, or continuation of the current arrangement of partial ownership and partial leasing of quarters; b) With the concurrence of the Executive Committee, to enter, as appropriate, into contractual arrangements for alternative quarters, provided that there is no adverse impact on the regular budget of the Organization and provided that a suitable site can be determined; c) To enter into contracts for the sale or lease of the Headquarters Building and other real property assets, if necessary, in order to proceed in implementing contractual arrangements for alternative quarters, as approved by the Executive Committee. 2. To instruct the Executive Committee to establish a three-country working party to assist the Secretariat in preparing a specific detailed proposal for the Executive Committee for its consideration and approval as soon as practical, in accordance with the decisions of this Conference as set forth above. 3. To instruct the Executive Committee to report its decision to the XXXV Meeting of the Directing Council. September 1990 OD 238., 147

90 7.4 ADMINISTRATIVE STUDIES 77 CE106.R2 Taking into account the information presented by the Director at the XXIII Pan American Sanitary Conference concerning the condition and the long-term adequacy of space in the present Headquarters Building; Considering that the XXIII Pan American Sanitary Conference, in Resolution CSP23.R22', has given authority to the Director in relation to alternative quarters for the Headquarters Building; and Recognizing that any new contractual arrangements for the Headquarters must not have adverse impact on the regular budget of the Organization, 1. To appoint the Representatives of Barbados, Chile, and the United States of America to constitute a Working Party to assist the Secretariat, in accordance with Resolution CSP23.R22 of the XXIII Pan American Sanitary Conference, in preparing specific detailed proposals for consideration by the Executive Committee. 2. To ask the Director to convene the Working Party, with supplemental advisors as necessary, as soon as practical in order to make recommendations to the 107th Meeting of the Executive Committee. 'See page 76. September 1990 OD 237, BUILDINGS AND INSTALLATIONS FOR AREA' AND FIELD OFFICES 'Up to 1976 called Zone Offices. see Volume I, page 294 and Volume II, page ADMINISTRATIVE STUDIES see Volume 1, page ADMINISTRATIVE RATIONALIZATION see Volume I, page 297.

91 8. PAHO/WHO COUNTRY OFFICES see Volume 1, page 299, Volume II, page 234, and Volume III, page

92 9. MISCELLANEOUS 9.1 AWARDS For previous resolutions, see Volume I, page 300, Volume II, page 235, and Volume III, page 87. CE99.R9 CE101.R14 Having examined the report of the Award Committee of the PAHO Award for Administration, 1987 (Document CE99/12, Add. I); and Bearing in mind the provisions of the Procedure and Guidelines for conferring the PAHO Award for Administration as approved by the XVII Pan American Sanitary Conference (1970)' and amended by the XX Pan American Sanitary Conference (1978)2 and the XXVII Meeting of the Directing Council (1980), 3 1. To note the decision of the Award Committee to confer the PAHO Award for Administration, 1987, on Dr. John E. F. Hastings of Canada. 2. To transmit the report of the Award Committee of the PAHO Award for Administration (Document CE99/ 12, Add. I) to the XXXII Meeting of the Directing Council. June 1987 OD 219, 82 Having examined the report of the Award Committee of the PAHO Award for Administration (Document CE101/12, Add. I); and Bearing in mind the provisions of the Procedure and Guidelines for conferring the PAHO Award for Administration as approved by the XVIII Pan American Sanitary Conference (1970)' and amended by the XX Pan American Sanitary Conference (1978)2 and the XXVII Meeting of the Directing Council (1980), 3 1. To note the decision of the Award Committee to confer the PAHO Award for Administration, 1988, on Dr. Guido Miranda Gutiérrez, of Costa Rica, for his outstanding contribution to administration and teaching in the areas of health and social security. 2. To transmit the report of the Award Committee of the PAHO Award for Administration (Document CE101/ 12, Add. I) to the XXXIII Meeting of the Directing Council. June 1988 OD 225, 104 'Resolution XVIII. See Vol. 1, p Resolution XVII. See Vol. II, p Resolution V. See Vol. II, p 'Resolution XVIII. See Vol. I., p Resolution XVII. See Vol. II, p Resolution V. See Vol. II, p

93 80 9. MISCELLANEOUS MISCELLANEOUS CE103.R5 CE105.R9 Having examined the report of the Award Committee of the PAHO Award for Administration (Document CE103/16, Add. I); and Bearing in mind the provisions of the Procedure and Guidelines for conferring the PAHO Award for Administration as approved by the XVIII Pan American Sanitary Conference (1970)' and amended by the XX Pan American Sanitary Conference (1978)2 and by the XXVII Meeting of the Directing Council (1980), 3 1. To note the decision of the Award Committee to confer the PAHO Award for Adminstration, 1989, on Dr. David Bersch Escobar of Colombia, for his outstanding work in research, training, and management in the area of health administration. 2. To transmit the report of the Award Committee of the PAHO Award for Administration (Document CE103/ 16, Add. I) to the XXXIV Meeting of the Directing Council. June 1989 OD 232, 81 Having examined the report of the Award Committee of the PAHO Award for Administration (Document CE105/20, Add. I); and Bearing in mind the provisions of the Procedure and Guidelines for conferring the PAHO Award for Administration, as approved by the XVIII Pan American Sanitary Conference (1970)' and amended bv the XX Pan American Sanitary Conference (1978)2 and by the XXVII Meeting of the Directing Council (1980), 3 1. To note the decision of the Award Committee to confer the PAHO Award for Administration, 1990, on Dr. Pedro A. de Armas H., of Venezuela, for his outstanding work in the area of health administration. 2. To transmit the report of the Award Committee of the PAHO Award for Administration (Document CE105/ 20, Add. I) to the XXIII Pan American Sanitary Conference. June 1990 OD 238, 102 'Resolution XVIII. See Vol. 1, p Resolution XVII. See Vol. II, p Resolution V. See Vol. II, p 'Resolution XVIII. See Vol. 1, p Resolution XVII. See Vol. II, p 'Resolution V. See Vol. II, p PUBLIC INFORMATION AND SPECIAL EVENTS For previous resolutions, see Volume 1, page 301, Volume II, page 239, and Volume III, page 88. CD32.R1 CD33.R12 Considering that the National Institutes of Health (NIH) of the United States of America is celebrating its 100th anniversary in 1987; Recognizing the significant contribution that NIH has made throughout its history to the pursuit of knowledge for the health and well-being of the peoples of the Americas; and Recognizing the close collaboration that exists between NIH and the Pan American Health Organizat:ion, 1. To honor the National Institutes of Health for its outstanding achievements in health research, training, and development. 2. To memorialize the centennial year of the National Institutes of Health with the presentation of a special commemorative plaque. September 1987 OD 219, 98 Having taken note of Document CD33/29 on the World Conference on Medical Education and its "Declaration of Edinburgh" on the reform of medical education; and Bearing in mind the proposed plan of action for implementing the respective recommendations at the institutional and national levels, 1. To thank the Pan American Federation of Associations of Medical Schools and, through it, the World Federation of Medical Education, for the report submitted, underscoring the reorientation of medical education towards the goal of health for all by the year To urge Member Countries to give special consideration and support to the recommendations and concepts embodied in the "Declaration of Edinburgh." September 1988 OD 2,25, 129

94 9.2 PUBLIC INFORMATION AND SPECIAL EVENTS PUBLIC INFORMATION ANO SPECIAL EVENTS CONGRATULATIONS, EXPRESSIONS OF SYMPATHY, ETC. For previous resolutions, see Volume 1, page 302, Volume II, page 241, and Volume III, page 89. CD33.R4 CD34.R6 Noting with regret the damage caused by Hurricane Gilbert to Jamaica, Haiti, the Cayman Islands, Dominican Republic, Cuba, Mexico, and the United States of America; Noting, further, the damage suffered by the health sector of Jamaica and the assistance rendered by PAHO to that country; Recalling that one of PAHO's objectives is to cooperate with Member Countries to combat disease and foster the physical and mental health of the peoples of the Hemisphere; Bearing in mind that among PAHO's activities is the provision of emergency aid and assistance to Member Countries in times of natural disasters; and Considering that the United Nations General Assembly has adopted the reduction of disasters as the topic for the forthcoming decade, 1. To request the Director to convey the sympathy of the Member Countries of PAHO to the Government and people of Jamaica and of the other affected countries. 2. To commend the Director for making available assistance from the Organization. 3. To urge Member Countries to: a) Render assistance to those countries affected by Hurricane Gilbert; b) Consider emergency preparedness of the health sector as a development priority for the allocation of national and international resources in the context of the forthcoming Decade on Disaster Reduction. 4. To request the Director to continue to assist Jamaica in assessing the damage to the health sector and in developing and supporting plans for the rehabilitation and reconstruction of the health system. September 1988 OD 225, 120 Considering the devastation to several small island countries in the Caribbean and several towns and cities in the United States of America and the immediate adverse effects on human health and welfare, as well as the destruction of crops, facilities, and infrastructure in these countries and the long-term consequences for their productive capacity and balance of payments; and Noting the decision of the Heads of Government of the Caribbean Community countries at their Tenth Meeting in July 1989 to institutionalize arrangements within the framework of their Community to enable quick responses to be made to their Member Countries in the event of natural disasters, according to their respective capacities, 1. To express deep sympathy to the Governments and people of those countries which have suffered damage, loss of life, and injury as a result of the recent Hurricane Hugo. 2. To commend the Director for his usual immediate and sensitive response on behalf of the Organization to the urgent needs in the afflicted countries, especially in the smaller countries, and to acknowledge the expression of appreciation for those efforts by the Representatives of those countries in this Meeting of the Directing Council. 3. To request that the Director: a) Intensify the efforts of this Organization in assisting its members which are frequently affected by natural disasters in their activities geared to better preparedness, in emergency relief, and in long-term rehabilitation and reconstruction of their health and medical facilities and services where necessary; b) Explore further possibilities, within the program and budget for the current and the next biennium, for increasing the support of the Organization in the relief and reconstruction efforts necessitated as a result of Hurricane Hugo. September 1989 OD 232, 111

95

96 INDEXES

97

98 NUMERICAL INDEX RESOLUTIONS OF THE PAN AMERICAN SANITARY CONFERENCE Resolution CSP23.R9 CSP23.R10 CSP23.R11 CSP23.R12 CSP23.R13 CSP23.R14 CSP23.R15 CSP23.R16 Page Resolution CSP23.R17 CSP23.R18 CSP23.R19 CSP23.R20 CSP23.R21 CSP23.R22 CSP23.R23 RESOLUTIONS OF THE DIRECTING COUNCIL Resolution CD33.R3 CD33.R4 CD33.R5 CD33. R6 CD33. R7 CD33.R8 CD33.R9 CD33.R10 CD33.R11 CD33.R12 CD33.R13 CD33.R14 CD33.R15 CD33.R16 CD33.R17 CD33.R18 CD33.R19 CD33.R20 CD33.R21 CD33. R22 Page 39 24, Resolution CD34.R1 CD34.R2 CD34.R3 CD34.R4 CD34.R5 CD34.R6 CD34.R7 CD34.R8 CD34.R9 CD34.R10 CD34.Rll CD34.R12 CD34.R13 CD34.R14 CD34.R15 CD34.R16 CD34.R17 CD34.R18 85 Resolution Page CSP23.R1 CSP23.R2 CSP23.R3 CSP23.R4 CSP23.R5 CSP23.R6 CSP23.R7 CSP23.R8 39 4, Page Resolution Page CD32.R1 CD32.R2 CD32.R3 CD32.R4 CD32.R5 CD32.R6 CD32.R7 CD32.R8 CD32.R9 CD32.R10 CD32.Rll CD32.R12 CD32.R13 CD32.R14 CD32.R15 CD32.R16 CD33.R1 CD33.R2 Page ,

99 86 NUMERICAL INDEX RESOLUTIONS OF THE EXECUTIVE COMMITTEE Resolution Page Resolution Page Resolution Page CE99.RI 48 CE101.R12 74 CE103.R17 76 CE99.R2 49 CE101.R13 56 CE103.R18 49 CE99.R3 64 CE101.R14 79 CE99.R4 68 CE101.R15 60 CE105.R1 66 CE99.R5 42 CE101.R16 49 CE105.R2 69 CE99.R6 7 CE101.R17 25 CE105.R3 45 CE99.R7 31 CE101.R18 26 CE105.R4 4 CE99.R8 24 CE101.R19 8 CE 105.R5 12 CE99.R9 79 CE105.R6 15 CE99.R10 71 CE102.R1 48 CE105.R7 37 CE99.R11 73 CE105.R8 18 CE99.R12 10 CE103.R1 65 CE105.R9 80 CE99.R13 71 CE103.R2 69 CE105.R10 74 CE99.R14 76 CE103.R3 33 CE105.R11 76 CE99.R15 20 CE103.R4 43 CE105.R12 5 CE103.R5 80 CE105.R13 21 CE101.R1 48 CE103.R6 60 CE105.R14 31 CE101.R2 32 CE103.R7 72 CE105.R1l5 29 CE101.R3 64 CE103.R8 19 CE105.R16 72 CE101.R4 68 CE103.R9 11 CE105.R17 72 CE101.R5 44 CE103.R10 14 CE105.R18 47 CE101.R6 11 CE103.R11 16 CE105.R19 30 CE101.R7 13 CE103.R12 17 CE101.R8 3 CE103.R13 56 CE106.R1 49 CE101.R9 28 CE103.R14 34 CE106.R2 77 CE101.R10 22 CE103.R15 6 CE101.R11 71 CE103.R16 73

100 ALPHABETICAL INDEX Accidents, prevention of, see Volume II Accounts and external audit, Acquired immunodeficiency syndrome (AIDS), Administrative and staff matters, Administrative studies, see Volume I administrative rationalization, see Volume I Admission of new Member Governments, see Volumes I, II, and III Aedes aegypti, 7-9 Aedes albopictus, 7-9 Agenda Directing Council, 49 Executive Committee, see Volume I Pan American Sanitary Conference, 47 Agreement between OAS and PAHO, see Volume I Agreement between WHO and PAHO, see Volume I Agreements border health, see Volumes I and II with Member Governments, see Volume I with other entities, see Volume II AIDS, see Acquired immunodeficiency syndrome ALAESP, see Latin American and Caribbean Association of Public Health Education Alcoholism, see Mental health ALIFAR, see Latin American Association of Pharmaceutical Industries Allowances, salaries and, Andean Subregion, Joint Plan of Action, 3-4 Animal health, see Volumes I, II, and III Area and Field Offices, see PAHO/WHO Country Offices see also Volumes I and II Armas H., Pedro A. de, 80 Assessments and contributions, collection of contributions, scale of, see also Program budget; Volumes I, II, and III Assistant Director of PASB, salary of, Awards, Bacterial, viral, and mycotic diseases, 7-9 Basic Documents, see Volumes I and II Bersch Escobar, David, 80 Biomedical communications, see Latin American and Caribbean Center for Health Sciences Information Blindness, 17 Blood and blood derivatives, see Volumes II and III Border health agreements, see Volumes I and II Budget, see Program budget Building (Reserve) Fund, see Volume I Buildings and installations for Area and Field Offices, 77 see also Volumes I and II for Headquarters, Canadian International Development Agency, Canadian Public Health Association, Cancer, see Noncommunicable disease prevention and control Cardiovascular diseases, CAREC, see Caribbean Epidemiology Center Caribbean Community, 25, 81 see also Volume III Caribbean Cooperation in Health, see Volume III Caribbean Epidemiology Center, see Volumes I, II, and III Caribbean Food and Nutrition Institute, see Volumes II and III CARICOM, see Caribbean Community Cartagena Agreement, see Volume III Central American Health Initiative, 3 CEPANZO, see Pan American Zoonoses Center CEPIS, see Pan American Center for Sanitary Engineering and Environmental Studies Chagas' disease, 6 see also Volumes I and II Charter of Punta del Este, see Volume I Chemical substances, control of, see Volume III Cholera, see Volumes I and II Chronic and degenerative diseases, see Volumes I and II CICAD, see Inter-American Drug Abuse Control Committee Cigarette smoking, control of, CLAP, see Latin American Center for Perinatology and Human Development Collection of contributions, Communicable diseases, prevention and control, 5-15 Community participation and primary health care, see Volume II see also local health systems Community Water Supply Fund, see Volume I Conference of Ministers Responsible for Health in the Caribbean, see Volume III 87

101 88 ALPHABETICAL INDEX Congratulations, expressions of sympathy, 81 Constitutional and legal matters, amendments to the Constitution, see Volumes I and II Basic Documents, see Volumes I and I1 Contadora Group, see Volume III Cooperation with other organizations, Coordinating Committee of the Codex Alimentarius, see Volume III Coordination between institutions, Coordination of international cooperation, see 'Volumes II and III Coordination with the United Nations and other agencies, 59 Cost-of-living adjustment, see Volume I Declaration of Alma-Ata, see Volume II Declaration of the Presidents of America, see Volume I Dengue, 7-9 Dental health, see Volumes I and II Deputy Director of PASB, salary of, Diagnostic, therapeutic, and rehabilitative technology, see Volumes I, II, and III Diarrheal diseases, see Volumes I and II Directing Council, agenda, 49 officers, Rules of Procedure, 49 Technical Discussions, see Volumes I, II, and III time and place of meetings, Director of PASB election of, 75 reports annual and quadrennial, financial, salary, Disabled, health of, 31 Disasters, see Emergency assistance Downey, Gordon, 70 Drugs abuse, prevention of, essential, production policy and marketing, see Volumes I, II, and III trafficking, 27 ECDC, see Economic cooperation among developing countries Economic cooperation among developing countries, see Volumes II and III Education, see Health education Elderly, health care of, see Health of adults Emergency assistance, Emergency Preparedness and Disaster Relief Coordination Program of PAHO, Emergency Revolving Fund, see Volume I Emergency Voluntary Fund, see Volume II Employment conditions, study of, see Volume I Environmental health, promotion and development of, EPI, see Expanded Program on Immunization Epidemiological surveillance, 5-6 Equipment, see Supplies and equipment Eradication/elimination of diseases, 5-6 Evaluation and long-term planning, see Volumes 1, II, and III of the Pan American Centers, see Volumes I, II, and III Executive Committee, agenda, see Volume I annual reports, of the Chairman, membership, 52 officers, representation at the Conference and the Council, see Volumes I and II Rules of Procedure, 53 time and place of meetings, see Volume I Expanded Program on Immunization, Revolving Fund, see Volumes II and III Extension of coverage, see Volume II External auditor appointment, 70 report of, Extrabudgetary funds and resources, see Volumes I, II, and III Fellowships, FEPAFEM, see Pan American Federation of Associations of Medical Schools Field service allowances, see Volume I FIFARMA, see Latin American Federation of the Pharmaceutical Industry Financial and administrative matters, Financial regulations and rules, see Volumes I, II, and III Financial Report of the Director and Report of the External Auditor, Five-Year Regional Plan of Action on Women in lhealth and Development, see Volumes II and III Fluoridation, of salt and water, see Volumes I and II Food and Agriculture Organization of the United Nations (FAO), see Volume II Food and nutrition, Food safety, see Volumes I, II, and III Foot-and-mouth disease and other zoonoses, 6, 12 see also Volumes I, II, and III Funds and resources emergency, voluntary, see Volume II extrabudgetary, see Volumes I, II, and III revolving and special, see Volumes I, II, and III working capital, see Volumes I and II General directives for PAHO program, 1-7 General programs of work covering a specific period, 4-5 Governing Bodies of PAHO, list of meetings, xii Hastings, John E. F., 79 Headquarters, PAHO, buildings and installations, Health of adults, see Volumes II and III Health for All by the Year 2000, strategies, 2 see also Technical cooperation among developing countries Health of the disabled, 31 Health education, see Volumes I and II Health of the elderly, see Volumes II and III Health information, Health legislation, national, see Volume I Health and Peace for Development and Democracy in Central America, 3

102 ALPHABETICAL INDEX 89 ALPHABETTCAL INDEX 89 Health personnel migration of, see Volume I training of, Health planning and administration, Health and population dynamics, see Volume I Health promotion, see Health protection and promotion Health protection and promotion general, specific population groups, Health regulations, see Volume I Health and socioeconomic development, Health statistics, see Volume I Health systems and services, development of, Health and youth, Hepatitis, see Volume III Hipólito Unanue Agreement, 4 HIV, see Human immunodeficiency virus Holding Account, see Volume II Hospitals, maintenance and engineering, see Volume II Housing, sanitary control of, see Volumes I and II Human immunodeficiency virus (HIV), Human resources, development of, see Volumes I and II Hurricane Gilbert, 24-25, 81 Hurricane Hugo, 25, 81 Hypertension, see Volume II IDB, see Inter-American Development Bank IICA, see Inter-American Institute for Cooperation on Agriculture ILO, see International Labor Organization Immunization, see Expanded Program on Immunization INCAP, see Institute of Nutrition of Central America and Panama Income sources and programs, see Volumes I and II Influenza, see Volume I Insignia, official, PAHO, Institute of Nutrition of Central America and Panama, see Volumes I, II, and III Inter-American College of Radiology, 60 Inter-American Commission of Women, see Volume II Inter-American Council of Psychiatric Associations, see Volumes I1 and III Inter-American Development Bank, see also Volumes I, II, and III Inter-American Drug Abuse Control Committee (OAS), 27 Inter-American Meeting, at the Ministerial Level, on Animal Health I and II, see Volume II III and IV, see Volume III see also Zoonoses; Veterinary public health Inter-American Meetings, at the Ministerial Level, on Foot-and-Mouth Disease and Zoonoses Control, 36 see also Volumes I and II; Zoonoses; Veterinary public health International Conference on Primary Health Care-Declaration of Alma-Ata, see Volume II International Drinking Water Supply and Sanitation Decade, see Volumes II and III International health regulations, see Volume I International Labor Organization, see Volume I International Program on Chemical Safety, see Volume III International transportation of human remains, see Volume I International Year of Disabled Persons, 31 Iodine deficiency diseases, 6 Joint Coordinating Board of the WHO Special Program for Research and Training in Tropical Diseases, PAHO representation on, see Volumes II and III Joint Plan of Action, Andean Subregion, 3-4 Laboratory, technology, see Volumes II and III Language allowance, staff, see Volume I Latin American Association of Pharmaceutical Industries, 60 Latin American and Caribbean Association of Public Health Education, 60 Latin American and Caribbean Center for Health Sciences Information, see Volumes I and II Latin American Center for Educational Technology in Health, see Volume III Latin American Center for Perinatology and Human Development, see Volume II Latin American Confederation of Biochemistry, 60 Latin American Confederation of Clinical Biochemistry, 6 Latin American Federation of Hospitals, 60 Latin American Federation of the Pharmaceutical Industry, 60 Latin American Union against Sexually Transmitted Diseases, 60 see also Volume III Leprosy, 6 see also Volumes I and II Local health systems, development of, Long-range health programs, plans of, and other program criteria, see Volume I Long-term planning and evaluation, see Volumes I, II, and III Macedo, Carlyle Guerra de, 75 Malaria, 6-7 Maternal and child health, including family planning, 4, Maternal mortality, reduction of, 29 Measles, 6, 14 Medical care administration, see Volumes I and II coordination with social security services and other institutions, see Volumes I and III hospital planning and administration, see Volumes I and II Meetings Directing Council, Executive Committee, Pan American Sanitary Conference, Member Governments admission to membership, see Volumes I, II, and III agreements with, see Volume I associate members, see Volume I privileges and immunities, see Volume-I reports of, see Volumes I, II, and III Member States of PAHO, see Member Governments Meningitis, see Volume II Mental health, including drug abuse, Migration of health personnel, see Volume I

103 90 ALPHABETICAL INDEX 90 ALPHABETICAL INDEX Ministers of Health, special meetings, see Volumes I and II Ministers of Health of the Andean Area, 27 Rome Declaration (1989), 18 Miranda Gutiérrez, Guido, 79 Mycoses, see Volume I Name, official, PAHO, see Volume I National health committees, see Volume I National health plans, see Volumes I and II National Institutes of Health (United States), 80 Noncommunicable disease, prevention and control, Nongovernmental organizations organizations in offical relations with PAHO, 60 principles governing relation, see Volumes 1, II, and III Nursing, see Volumes 1, II, and III Nutrition, see Caribbean Food and Nutrition Institute; Food and nutrition; Institute of Nutrition of Central America and Panama OAS, see Organization of American States Observers, see Volumes 1, II, and III Occupational health, see Workers' health Official insignia, PAHO, Oral health, see Dental health Organization of American States, agreement with PAHO, see Volume I Inter-American Drug Abuse Committee, 27 Program of Technical Cooperation and meetings of the Inter-American Economic and Social Council, see Volume I see also Volumes I and II Orientation and program priorities for , 4-5 Oswaldo Cruz Foundation, 35 PAHEF, see Pan American Health and Education Foundation PAHO Advisory Committee on Health Research (formerly PAHO Advisory Committee on Health Research), 35 see also Volumes II and III PAHO/WHO Country Offices, see Volumes 1, II, and III PANAFTOSA, see Pan American Foot-and-Mouth Disease Center Pan American Center for Health Planning, see Volumes I and II Pan American Center for Human Ecology and Health, see Volumes II and III Pan American Center for Research and Training in Leprosy and Tropical Diseases, see Volume II Pan American Center for Sanitary Engineering and Environmental Sciences, see Volume II Pan American Federation of Associations of Medical Schools, 60, 80 Pan American Federation of Nursing Profes:sionals, 60 Pan American Foot-and-Mouth Disease Center, see Volumes 1, II, and III Pan American Health and Education Foundation, 68 see also Volumes I and II Pan American Sanitary Code, see Volume I Pan American Sanitary Conference, agenda, 47 officers, 46 Rules of Procedure, 47 Technical Discussions, see Volumes 1, II, and III time and place of meetings, see Volumes 1, II, and III Pan American Zoonoses Center, 36 Parasitic diseases, 6-7 Pension fund, see Volume I Personnel, see Staff Plague, see Volume I Plan of Action, see Volumes II and III Planning and Programming Subcommittee, Policy and Coordination Advisory Committee of the Special Program of Research, Development and Research Training in Human Reproduction (WHO), PAHO representation on, see Volume III Policy decisions, major, 1-4 Poliomyelitis, 6, 9, Pollution, control (including chemical safety), see Volumes I and III Portugal, observer at PAHO meetings, see Volume III Presidents of America, Declaration of, see Volume I Prevention and control communicable diseases, 5-15 noncommunicable diseases, Primary health care and community participation, see Volume II International Conference on (Alma-Ata, 1978), see Volume II see also Local health systems Principles of Pan American Health, studies on, see Volume I Priority health needs in Central America and Panama, 2-3 Program budget budget policy, consideration and approval for , see Volume I for , see Volume II for , see Volume III for , see also Assessments and contributions Publications and documentation, Public information and special events, 80 Quarantine, special surveillance measures and, see Volumes I and II Quota assessment, scale of, collection of, see also Volumes I, II, and III Real Estate Fund, 76 see also Volumes 1, II and III Regional centers, see also under individual centers Regional Forward-Looking Strategies on Women, Health, and Development, see Volume III Regional Initiative on Maternal and Child Health, 4 Regionalization studies, see Volume 1 Regional Library of Medicine and the Health Sciences (BIREME), see Latin American and Caribbean Center for Health Sciences Information Regional Plan of Action for the Reduction of Maternal Mortality in the Americas, 29 Rehabilitative technology, see Volumes 1, 11, and III Reorganization of the PASB, see Volume I