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UNITED NATIONS NATIONS UNIES

W O R L D H E A L T H O R G A N I Z A T I O N

EXECUTIVE BOARD Thirteenth Session

ORGANISATION MONDIALE DE LA SANTÉ

E B 1 3 / 5 3 C o r r . l Z 1 2 January 1954 ORIGINAL: ENGLISH

ALLOCATION OF RESOURCES AS BETWEEN REGIONS

A p p e n d i x 4 to E B 1 3 / 5 3 has now b e e n r e v i s e d to include statistics e x t r a c t e d from the m o s t recent p u b l i c a t i o n s of t h e United Nations Statistical Office.

The attached corrigendum should, t h e r e f o r e , be substituted for t h e original A p p e n d i x 4 t o the d o c u m e n t .

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APPENDIX 4 Statement of Population, A n n u a l N a t i o n a l Income and Per Capita I n c o m e *

in r e o e n t y e a r s , l y Region and Country

Region/Country Population N a t i o n a l Income

(Thousands) (Million U S

Per Capita Income (US .3)

AFRICA. . ;

Belgian Congo 11,463 727 63

Liberia . 1 , 6 4 8 62 38

Kenya 5,680 288 51

Northern R h o d e s i a 1 , 8 8 6 90 48

Southern Rhodesia 2,022 204 1 0 1

Uganda 5,187 238 4 6

U n i o n of South A f r i c a 1 2 , 3 2 0 3,119 253 ..

Total - AFRICA. 40,206 4,728 Ш

A M E R I C A S

A r g e n t i n a 16,555 5,722

346

Bolivia 3,990

221

55

Brazil . 49,340 5,530

112

Canada 14,009 16,367 1,168'

Chile 5,709 1,070

188....

Colombia 11,260 2,857 254

Costa R i e a 837 105 125

Cuba ’ 5,199 1,550 296

Dominican Republic 2,277

170

75

Ecuador 3,378 134 40

E l Salvador 2,150 197 9 2

Guatemala 3,784 293 77

H a i t i 3,750 150 40

Honduras 1 , 3 2 6

110

83

J a m a i c a 1 , 4 0 3 238

170

Mexico 25,706 3,445 I34

Nicaragua 1,184 105 89

Panama ' 7 6 4 1 4 0

I83

Paraguay- 1 , 3 0 4 109 84

Peru 8,240

820 100

Surinam 219 42 I92

United States of America 154,353 277,554 1,798

Uruguay- 2,353 779 3 3 1

Venezuela 5,071

2,328

459

Total - A M E R I C A S 324,161

320,036

99

* Figures have b e e n extracted from the following statistical publications of the U n i t e d Nations; N a t i o n a l and Per Capita Incom^Sj Seventy Countries (Series E . N o . l ) , M o n t h l y Bulletin of Statistics, N o v . 1953, The 1952•Statistical Y e a r B o o k , and in some instances have b e e n obtained direct from the United Nations Statistical O f f i c e .

(3)

5 8 4 “ 2 0 7 , 5

12,000

17,180

7,297

3 ^ 6 , 0 0 0

79,260

18.313

4 8 0 , 0 5 0

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V ,

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S O U T H - E A S T A S I A

Afghanistan Burma

C e y l o n I n d i a I n d o n e s i a T h a i l a n d

T o t a l - S O U T H - E A S T ASIA.

E U R O P E A l b a n i a A u s t r i a

B e l g i u m i B u l g a r i a

Сzechoslovakia ‘,

Denmark

F i n l a n d F r a n c e

G e r m a n y ( W e s t e r n Z o n e ) G r e e c e

H u n g a r y I c e l a n d I r e l a n d I t a l y L u x e m b o u r g M o n a c o N e t h e r l a n d s N o r w a y P o l a n d P o r t u g a l R o u m a n i a S p a i n S w e d e n S w i t z e r l a n d T u r k e y

U n i t g d K i n g d o m U S S B

Y u g o s l a v i a

T o t a l • E U R O P E

EB13/55 Corr. 1 • page ЗО *

A P P E N D I X k

R e g i o n / C o u n t r y P o p u l a t i o n N a t i o n a l I n c o m e P e r C a p i t a ( T h o u s a n d s ) ( M i l l i o n U S I n c o m e (US $ )

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(4)

150,334 9,900

630.401 38,286 EASTERN MEDITERRANEAN

Cyprus Egypt Ethiopia

Iran Iraq Israel Jordan Lebanon Libya Pakistan Saudi Arabia Syria

Yemen

Total EASTERN MEDITERRANEAN

WESTERN PACIFIC Australia Cambodia China Japan

Korea (South) Laos

Malaya New Zealand Philippines Viet Nam

Total - WESTERN PACIFIÇ

Region/Ccimtry Population ABBENDIX 4

• ^ National Income Per Capita iTnoiisands) (Million U S ^ " Income (US $)

8 9 Ü 0 4 5 0 5 9

0 9 8 7 5 2

9 5 4 4 3 11 7 96 5 3 6

О О

О 4 4 8 2 3 2

1 1

3 4

5 0 3 0 6 0 0 4 5 0 7

0

8407

9

1 0 4 2 5 0 0

0

4 0 0 0 9 0 6 2 1 8

0

4

5

057

4

111

1

21 1

1'

73 6 3 4

3 6

2 5 4 8 8 4o

1

3 6 4 о о 8 о

7 6 > *| о 4 о

721 850 904 7 12 12

1 1

ГЧ03098 7 760 3 5 9 о 8 9

4 6 О! 4 5 1

,

г О

Л

12 9 3 6

833401519

2

6 8 2

1

2

208559055100

2

I

l :880 2

3540 6

2 0 ; 1 0丨

3 :

8

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0 0 7 0 5 0 6 4 4

0 1 6 6 4

8 1 3 8 C V 5 3 4 о 8 4 4 6

(5)

UNITED NATIONS NATIONS UNIES

W O R L D H E A L T H O R G A ^ S A T O N MONDIALE

O R G A N I Z A T I O N DELAbAlNic

A L L O C A T I O N OF R E S O U R C E S A S B E T W E E N R E G I O I ©

A s t u d y of G u i d i n g P r i n c i p l e s G o v e r n i n g the D e t e r m i n a t i o n of R e g i o n a l A l l o c a t i o n s

T a b l e of C o n t e n t s

~ P â S ê I N T R O D U C T I O N

1 . P u r p o s e 1

2 . B a c k g r o u n d of d i s c u s s i o n 1

3 . C o n s t i t u t i o n a l a s p e c t s 2

4 . G u i d i n g p r i n c i p l e s p r o v i d e d b y a d e c i s i o n of the E x e c u t i v e B o a r d

5 . G u i d a n c e p r o v i d e d b y "The G e n e r a l P r o g r a m m e of W o r k

c o v e r i n g a S p e c i f i c Period" 4

6 . T h e guiding p r i n c i p l e s of " C o n c e n t r a t i o n a n d C o - o r d i n a t i o n

of E f f o r t " 4

7. Summary: Existing guiding principles 5

I N T E R狐T I O N A X C O N S I D E R A T I O N S

8 . I n f l u e n c e on a l l o c a t i o n of resources and sources of funds .. 6

9 . T i m i n g i n t h e r e c e i p t of r e s o u r c e s 8

R E G I O N â L A N D M T I O M L C O N S I D E R A T I O N S 1 0 . D i f f e r e n c e s b e t w e e n r e g i o n s

1 1 . T h e c o n s i d e r a t i o n of a single c o u n t r y

1 2 . T h e a s s e s s m e n t of special factors i n t h e a l l o c a t i o n of ^

resources

C O N C L U S I O N 12

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A P P E N D I C E S • A p p e n d i x 1

E x t r a c t from Minutes of Standing Committee on A d m i n i s t r a t i o n and.Finance a t ninth session of Executive B o a r d , on s u b j e c t of allocations t o regions

( E B 9 / A F / M i V l O R e v . l ) A p p e n d i x 2

E x t r a c t s from Minutes of meeting of Standing Committee on A d m i n i s t r a t i o n a n d F i n a n c e at eleventh session of Executive B o a r d relating to allocations to regions (EBll/AFAiri/9 R e v . l a n d E B l l / A F / M i n / Ю R e v . l ) .

Appendix 3

T a b l e on A c t u a l Obligations for R e g i o n a l Activities (including regional offices) for the years 1949 t o 1 9 5 2 and of Estimated Obligations for 1953 and 1954 under b o t h R e g u l a r and T e c h n i c a l Assistance f u n d s , w i t h d e t a i l e d summaries of obligations incurred each year for the p e r i o d 1949 to 1953; b y regions and c o u n t r i e s .

A p p e n d i x 4

S t a t e m e n t of p o p u l a t i o n , national income a n d per capita i n c o m e , b y region a n d c o u n t r y . .

(7)

EB13/48 page 2541

AIIjOCATION O F R E S O U R C E S A S B E T W E E N R E G I O N S

A S t u d y of G u i d i n g Principles G o v e r n i n g the D e t e r m i n a t i o n of R e g i o n a l A l l o c a t i o n s

I N T R O D U C T I O N 1 , P u r p o s e

T h i s s t u d y examines some of the guiding p r i n c i p l e s w h i c h m i g h t b e b o r n e i n m i n d i n d e t e r m i n i n g r e g i o n a l allocations a n d d i s c u s s e s t h e i r advantages a n d l i m i t a t i o n s .

2„ B a c k g r o u n d of d i s c u s s i o n

A t its eleventh s e s s i o n , t h e E x e c u t i v e B o a r d d e c i d e d1 " . . . that the D i r e c t o r - G e n e r a l a n d the E x e c u t i v e B o a r d s h o u l d continue to s t u d y t h e guiding p r i n c i p l e s

governing allocations t o regions" a n d r e q u e s t e d t h e D i r e c t o r - G e n e r a l "to s u b m i t a r e p o r t o n t h i s s u b j e c t t o the B o a r d a t its t h i r t e e n t h session" •

It w i l l b e r e c a l l e d t h a t this complex p r o b l e m h a d a l s o b e e n d i s c u s s e d b y t h e S t a n d i n g C o m m i t t e e on A d m i n i s t r a t i o n and F i n a n c e during t h e n i n t h s e s s i o n of the E x e c u t i v e B o a r d .2 T h e r e c o r d of this discussion, extracted f r o m the r e l e v a n t m i n u t e s , is a t t a c h e d as A p p e n d i x 1 , a n d t h e record, of the discussions in t h e

S t a n d i n g Committee during the eleventh s e s s i o n of the E x e c u t i v e B o a r d〕 is a t t a c h e d as A p p e n d i x 2 . A s the documents indicating the allocations m a d e or e x p e c t e d t o b e m a d e a t the time of the n i n t h a n d e l e v e n t h sessions of the E x e c u t i v e B o a r d do n o t r e f l e c t the l a t e s t r e v i s e d estimates of o b l i g a t i o n s , the documents r e f e r r e d t o a t t h a t time are n o t a t t a c h e d . Instead t h e r e is a t t a c h e d , as A p p e n d i x 3, a d o c u m e n t w h i c h t a k e s a c c o u n t of t h e s e later developments a n d includes similar i n f o r m a t i o n r e g a r d i n g a c t u a l obligations for the y e a r s prior to 1 9 5 1 w h i c h w e r e n o t i n c l u d e d i n the d o c u m e n t s u b m i t t e d t o the E x e c u t i v e B o a r d a t its e l e v e n t h s e s s i o n . A p p e n d i x 3 a l s o includes two s t a t e m e n t s showing the a c t u a l obligations i n c u r r e d d u r i n g the y e a r s 1949 to 1 9 5 2 a n d the estimated obligations for the year 1953 b y r e g i o n s a n d countries in r e s p e c t of f i e l d activities under R e g u l a r and T e c h n i c a l A s s i s t a n c e f u n d s r e s p e c t i v e l y . 泰

1 HeeolfetAon E B 1 1 . R 7 1 , O f f . R e o . W á H l ^ O r g . 4 6 , 3 9

2 EB9/AF/itiVlO

3 EBia/AF/Min/9 and 10 ReVol

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A s w a s indicated during t h e discussions in the Standing Committee o n A d m i n i s t r a t i o n and Finance (Appendix 1 ) , of the ninth session of the Executive B o a r d , there are

m a n y complexities in endeavouring to achieve reasonable e q u i t y in the allocation as b e t w e e n regions of the available resources of the Organization in a n y one year.

T h e r e c o r d of the discussions which resulted i n the request of the Executive Board r e f e r r e d to a b o v e , and of w h i c h the relevant extract is a t t a c h e d as A p p e n d i x 2y likewise indicates some of the considerations w h i c h m u s t necessarily b e borne in m i n d ,

3 . Constitutional aspects

A r t i c l e s 34 a n d 55 of the Constitution require t h e Director-Generai to prepare and s u b m i t to the Executive Board "the a n n u a l budget estimates of the Organization".

Such estimates m u s t contain recommendations as to the specific u s e s to w h i c h the funds^ w h i c h it w o u l d b e necessary t o make available t o the D i r e c t o r - G e n e r a l , should be p u t , should the relevant a n n u a l programme and b u d g e t estimates submitted b y the Director-General b e approved b y the Health A s s e m b l y , i n accordance w i t h Article 56 of the Constitution• It follows that the submission b y the Director-General of these estimates implies the submission of specific allocations•

4 . G u i d i n g principles provided b y a decision of the Executive B o a r d

W i t h the development of the regional organizations the proposals regarding allocations have necessarily b e e n r e l a t e d to the requirements of the individual regions w i t h due r e g a r d for the following considerations which the Executive B o a r d , at its second s e s s i o n , agreed should be taken into a c c o u n t as a "guiding principle in the approval of programmes for the rendering of a d v i s o r y and demonstration services to governments»1 1 1

"(a) Decisions, plans or programmes of the W o r l d H e a l t h A s s e m b l y or Executive Board;

(b) D e c i s i o n s , plans or programmes of the United Ifetions or … ..

specialized a g e n c i e s , if they relate to the subject of a request;

1 O f f , R e c , W l d H l t h O r g , 1 4 , p . 17

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EB13/54 Add. 2 page 52

(с) T h e i m p o r t a n c e of the problaTi to the whole h e a l t h p r o g r a m m e of t h e ( ) r e q u ^ i n g c o u n t r y . (If n o p l a n e x i s t s , a s s i s t a n c e m a y b e o f f e r e d

i n d e v e l o p i n g a p l a n p r e l i m i n a r y to f u r t h e r c o n s i d e r a t i o n ) ;

T h e a b ii i t v of the c o u n t r y i t s e l f t o p r o v i d e t h e services r e q u i r e d

( ) I s m e a s S e d b y the a v a i l a b i l i t y of t r a i n e d p e r s o n n e l , of m e a n s of t r a x n x n g p e r s o n n e l or of f o r e i g n currency;

(e) T he p r o b a b i l i t y of a c h i e v i n g s u c c e s s f u l a n d u s e f u l r e s u l t s ;

(f) R e c o m m e n d a t i o n s of e x p e r t c o m m i t t e e s , to w h i c h p r o b l e m s m y b e r e f e r r e d ; (s) R e a s o n a b l e a s s u r a n c e of s a t i s f a c t o r y c o - o p e r a t i o n o n the p a r t of t h e

( g) g o v e r m e n ? t h r o u g h o u t the p r o g r a m m e . ( N o r m a l l y , t h e g o v e r n m e n t w i l l b e e ^ c S d t o c o n S i b u t e t o the p r o g re b y m e e t i n g such c o s t s w x t h x n t h e c o u n t r y as c a n b e m e t i n d o m e s t i c currency)j

(h) R e a s o n a b l e a s s u r a n c e f r o m the g o v e r n m e n t , w h e r e a p p r o p r i a t e , t h a t the

、 )p r o g r a m e w i l l be c o n t i n u e d , e s p e c i a l l y t h a t t h e g o v e r m e n t h a s or w x U e s t a b l i s h , a h e a l t h o r g a n i z a t i o n w i t h p e r s o n n e l a n d f i n a n c i a l s u p p o r t a d e q u a t e t o contimie the p r o g r a m m e ;

(i) T h e d e s i r a b i l i t y of m a k i n g e v e r y e f f o r t to аззтлге equitable d i s t r i b u t i o n , if the r e q u e s t s s h o u l d e x c e e d Ше a v a i l a b l e b u d g e t . (This m a y Ъе

a c c o m p l i s h e d b y p r o g r e s s i v e l y stricter a p p l i c a t i o n of t h e g u i d i n g p r i n c i p l e s ) « "

T h e r e p o r t of t h e E x e c u t i v e B o a r d o n its s t u d y of r e g i o n a l i z a t i o n1 d e s c r i b e s i n d e t a i l the p r o c e d u r e s w h i c h h a v e b e e n e s t a b l i s h e d w i t h r e g a r d to the p r e p a r a t i o n

o f the ашш1 b u d g e t e s t i m a t e s of t h e O r g a n i z a t i o n a n d the exercise of c o n t r o l over t h e d i s t r i b u t i o n a n d use of f u n d s a p p r o p r i a t e d a n n u a l l y b y the W o r l d H e a l t h A s s e m b l y o n the b a s i s of the b u d g e t e s t i m a t e s as approved» T h i s r e p o r t w a s

s u b m it t e d t o a n d c o n s i d e r e d b y t h e S i x t h W o r l d H e a l t h A s s e m b l y w h i c h i n R e s o l u t i o n 職 6 。 4 4 e x p r e s s e d , inter a l i a , i t s s a t i s f a c t i o n w i t h the d e v e l o p m e n t o f the

o r g a n i z a t i o n a l s t r u c t u r e a n d f u n c t i o n i n g of the r e g i o n a l o f f i c e s , a n d r e q u e s t e d t h e D i r e c t o r - G e n e r a l "to p r o v i d e . • … g u i d a n c e to the r e g i o n a l offices o n s p e c i f i c p r o g r a m m e s , a s s i s t a n c e i n l o n g - t e r m p l a n n i n g , a n d c o n t r o l a n d c o - o r d i n a t i o n of

r e g i o n a l p r o g r a m m e s to e n s u r e t h a t t h e y conform t o the p r i n c i p l e s a n d p o l i c i e s e s t a b l i s h e d b y t h e H e a l t h A s s e m b l y , t h e E x e c u t i v e B o a r d a n d t h e D i r e c t o r - G e n e r a l . "

(10)

5 . Guidance p r o v i d e d b y "The G e n e r a l Prograimne of W o r k c o v e r i n g a S p e c i f i c Period"

T h e W o r l d H e a l t h A s s e m b l y i n its d e l i b e r a t i o n s a n d r e s o l u t i o n s h a s m a d e i t clear t h a t a l l the r e c o g n i z e d h e a l t h n e e d s of the countries of üie w o r l d c a n n o t b e m e t f r o m r e s o u r c e s i m m e d i a t e l y a v a i l a b l e or l i k e l y to b e m a d e a v a i l a b l e w i t h i n the f o r e s e e a b l e f u t u r e . The f r a m e r s of the C o n s t i t u t i o n foresaw; h o w e v e r , t h a t a s p e c i f i c p e r i o d c o u l d b e s e t w i t h i n w h i c h t h e m o r e o r d e r l y u s e of f u n d s p r o v i d e d o n a n a n n u a l b a s i s c o u l d b e m a d e . I n e x e r c i s e , t h e r e f o r e , of its f u n c t i o n s i n this c o n n e x i o n u n d e r the C o n s t i t u t i o n , p r o p o s a l s w e r e m a d e b y the E x e c u t i v e B o a r d a t its f i f t h a n d s e v e n t h

‘' i s e s s i o n s under the s u b j e c t " G e n e r a l I ^ o g r a m m e of W o r k covering a s p e c i f i c P e r i o d . "

In t h e s e p r o p o s a l s , w h i c h w e r e s u b s e q u e n t l y a p p r o v e d b y t h e T h i r d a n d F o u r t h W o r l d о

H e a l t h A s s e m b l i e s广 the f o l l o w i n g g e n e r a l p r i n c i p l e s w e r e outlined:

"(a) A l l c o u n t r i e a . … s h o u l d p a r t i c i p a t e i n t h e w o r k of the O r g a n i z a t i o n . (b) S e r v i c e s p r o v i d e d to g o v e r n m e n t s to a s s i s t t h e m i n d e v e l o p i n g their

h e a l t h services s h o u l d n o t n o r m a l l y be o p e r a t i o n s c a r r i e d out d i r e c t l y b y the O r g a n i z a t i o n , S u c h services a n d d e m o n s t r a t i o n p r o g r a m m e s w i l l c l e a r l y be joint operations b y the goverraient a n d W H O . T h e s e s e r v i c e s w i l l b e s u p p l i e d t o g o v e r n m e n t s o n l y o n their s p e c i f i c r e q u e s t .

(c) S e r v i c e s should b e s u c h as to f o s t e r t h e g r e a t e s t p o s s i b l e degree of self- r e l i a n c e and i n i t i a t i v e in n a t i o n a l a n d c o m m u n i t y h e a l t h services a n d b e suitable for i n t e g r a t i o n i n t o the s o c i a l , c o n s t i t u t i o n a l a n d a d m i n i s t r a t i v e s t r u c t u r e of t h e p e o p l e and g o v e r n m e n t c o n c e r n e d .

(d) Ш 0 . s h o u l d n o t as a rule c a r r y out d i r e c t m e d i c a l or s c i e n t i f i c r e s e a r c h

: a s s u c h , b u t s h o u l d endeavour to stimulate a n d t o c o - o r d i n a t e w o r k done i n t h e s e f i e l d s .

(e) S e r v i c e s s h a l l b e a v a i l a b l e to a l l M e m b e r States w i t h o u t discrimination."

. . . � • : . . - . . . . .

6 . T h e guiding p r i n c i p l e of " C o n c e n t r a t i o n and C o - o r d i n a t i o n of Effort"

T h e F o u r t h W o r l d H e a l t h A s s e m b l y f o u n d that "the r e s o l u t i o n s of the G e n e r a l A s s e m b l y a n d the E c o n o m i c a n d S o c i a l C o u n c i l of t h e U n i t e d N a t i o n s o n the s u b j e c t of

c o n c e n t r a t i o n of. e f f o r t a n d r e s o u r c e s , a n d the s u g g e s t e d c r i t e r i a for p r i o r i t i e s

• b e t w e e n prograjntnes, are i n g e n e r a l a c c o r d w i t h t h e p o l i c y of the Organization."

1 O f f . R e o . W l d H l t h O r g . 2 5 , p a r a . 1 , 6 , p . 2 a n d O f f . R e c , W l d H l t h O r g . 32,. p . 55

2 R e s o l u t i o n WHA.3.1, O f f , R e c : W l d H l t h O r g , 2 8 , p . 1 5 a n d R e s o l u t i o n ША4.2_, O f f . R e c . W l d H l t h O r g . 3 5 , p . 17 — . •

3 R e s o l u t i o n 4 為 O f f , R e c , W l d H l t h Org» 35, p . 20

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EB13/53 page 5

F o l l o w i n g R e s o l u t i o n E B 8 / R . 2 8 of the E x e c u t i v e B o a r d ,1 the D i r e c t o r - G e n e r a l h a s b e e n r e q u i r e d , i n p l a n n i n g his p r o g r a m m e a n d b u d g e t e s t i m a t e s :

it (x) t o b e a r in m i n d the R e s o l u t i o n of the F o u r t h W o r l d H e a l t h Assembly- c o n c e r n i n g c o n c e n t r a t i o n of e f f o r t and r e s o u r c e s , a n d t o co-ordinate p r o p o s e d i n t e r n a t i o n a l l y - a s s i s t e d h e a l t h p r o g r a m m e s for countries i n t o r e g i o n a l h e a l t h p r o g r a m m e s , a n d such r e g i o n a l h e a l t h prograjnmes i n t o a n a p p r o p r i a t e l y- b a l a n c e d w o r l d h e a l t h p r o g r a m m e , g i v i n g c o n s i d e r a t i o n to t h e r e c o m m e n d a t i o n s a n d c o m m e n t s of the r e g i o n a l committees;

(2) t o continue to c o - o p e r a t e w i t h the A d m i n i s t r a t i v e C o m m i t t e e o n C o -

o r d i n a t i o n for the p u r p o s e of c o - o r d i n a t i n g i n t e r n a t i o n a l h e a l t h p r o g r a m m e s ...j (3) t o continue to c o - o p e r a t e a t t h e p l a n n i n g l e v e l w i t h U N I C E F a n d t h e

g o v e r n m e n t s c o n c e r n e d , to d e v e l o p a p p r o p r i a t e i n t e r n a t i o n a l h e a l t h p r o g r a m m e s for w h i c h such g o v e r n m e n t s h a v e p l a c e d or p r o p o s e t o p l a c e r e q u e s t s w i t h UNICEF for r e q u i r e d supplies

(4) to r e v i e w r e q u e s t s s u b m i t t e d b y g o v e r n m e n t s i n o r d e r t o a s c e r t a i n w h e t h e r the p r o p o s e d p r o j e c t s c a n b e i m p l e m e n t e d in c o - o p e r a t i o n w i t h the g o v e r n m e n t s and c o n t i n u e d b y t h e m a f t e r the w i t h d r a w a l of i n t e r n a t i o n a l a s s i s t a n c e ]

(5) to i n c l u d e f e l l o w s h i p s as a c o n ^ o n e n t p a r t of a p p r o p r i a t e p r o j e c t e o r , w h e r e the O r g a n i z a t i o n ' s p a r t i c i p a t i o n in a p r o j e c t c o n s i s t s in p r o v i d i n g f e l l o w s h i p s o n l y , to indicate t h i s i n the p r o g r a m m e for t h e country concerned;

a n d

(6) to indicate l o c a l f u n d s e x p e c t e d to b e c o n t r i b u t e d to e a c h c o u n t r y a c t i v i t y b y the g o v e r n m e n t concerned."

7 . S u m m a r y : E x i s t i n g guiding p r i n c i p l e s

T h e g e n e r a l p r o g r a m m e of w o r k for a specific p e r i o d a p p r o v e d b y the H e a l t h A s s e m b l y a n d t h e studies a n d r e s o l u t i o n s of the E x e c u t i v e B o a r d have t h u s b e c o m e

t h e guiding p r i n c i p l e s u p o n w h i c h the D i r e c t o r- G e n e r a l ' s a n n u a l p r o g r a m m e a n d b u d g e t estimates h a v e b e e n b a s e d . I n p l a n n i n g h i s p r o g r a m m e s a n d i n framing h i s r e l a t e d b u d g e t e s t i m a t e s , however^ the D i r e c t o r- G e n e r a l m u s t n e c e s s a r i l y r e l y prdjnarily u p o n t h e advice of the R e g i o n a l D i r e c t o r s and t h e r e c o m m e n d a t i o n s of t h e R e g i o n a l

C o m m i t t e e s . T h e r e a r e , of c o u r s e , factors o t h e r t h a n g u i d i n g p r i n c i p l e s w h i c h are t a k e n into c o n s i d e r a t i o n b y the R e g i o n a l C o m m i t t e e s , the R e g i o n a l D i r e c t o r s a n d the

1 O f f . R e c . W l d H l t h O r g。 3 6 , p« 8

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Direc七or^GeneraiU W h e t h e r or n o t these f a c t o r s can b e p r o p e r l y w e i g h e d and evaluatedp and, i f * s o , whether, or not they should supplant guiding principles

as a means of allocating r e s o u r c e s w i l l be e x a m i n e d i n w h a t f o l l o w s . F o r purposes of clarity of exposition and ease of discussion^ t h e y are p r e s e n t e d i n two b r o a d groups, viz5 international c o n s i d e r a t i o n s , a n d r e g i o n a l a n d national considerations.

INTERNATIONAL CONSIDERATIONS

8 , Influence on a l l o c a t i o n of r e s o u r c e s and sources of funds

International considerations relate m a i n l y to the e f f e c t s , on t h e programme cf W H O、 of funds m a d e available t o W H O from outside the n o r m a l sources envisaged in t h e C o n s t i t u t i o n . In a d d i t i o n , there is -the influence of funds p r o v i d e d to countries to m e e t health needs i n the form of b i l a t e r a l or m u l t i l a t e r a l a s s i s t a n c e . C o n s i d e r a t i o n of the t o t a l programme of work i n t h e international h e a l t h field m a t e r i a l l y affect the allocation of W H O resources b e t w e e n regions a n d to countries w i t h i n r e g i o n s .

I n implementing the provisions of the C o n s t i t u t i o n , the Health A s s e m b l y directs the use of a l l the f i n a n c i a l resources available t o the O r g a n i z a t i o n . However^

'hhere are limitations on the use of some of these r e s o u r c e s • Those m a d e available under the United Nations Expanded Programme of T e c h n i c a l A s s i s t a n c e for the

E c o n o m i c D e v e l o p m e n t of Under-developed Countries are l i m i t e d i n the u s e to w h i c h t h e y m a y be p u t b y certain resolutions of the Economic and S o c i a l C o u n c i l , In a d d i t i o n the T e c h n i c a l A s s i s t a n c e B o a r d makes decisions b i n d i n g on the agencies w h i c h receive T e c h n i c a l A s s i s t a n c e funds^ regarding the distribution of these r e s o u r c e s b e t w e e n r e g i o n s} b e t w e e n individual countries w i t h i n regions a n d b e t w e e n projects w i t h i n a c o u n t r y . W H O m u s t , t h e r e f o r e , take into consideration the a i m s a n d objects of the E x p a n d e d Programme i n developing the programme to b e f i n a n c e d from T e c h n i c a l A s s i s t a n c e f u n d s . O n the other h a n d , the resolutions o?

t h e E c o n o m i c and S o c i a l C o u n c i l , r e f e r r e d to a b o v e , make clear t h a t t h e r e g u l a r p r o g r a m m e and the E x p a n d e d Programme are clearly r e l a t e d and should b e c o - o r d i n a t e d . O n t h e subject of "Co-ordination of Effort" the guiding p r i n c i p l e s annexed to t h e r e l e v a n t r e s o l u t i o n o f t h e Economic and S o c i a l C o u n c i l r e a d in p a r t as follows: 1

• • r I I. i ттттвя^шттят^тш • _ mm^mmmm • » . _

S c o n o m i c a n d S o c i a l C o u n c i l R e s o l u t i o n 222A.(3X) of 15 A u g u s t 1 9 4 9 , as amended b y R e s o l u t i o n 433A(XI\T) of 1 1 June 1952 (Handbook of Basic D o c u m e n t s , page 1 5 6 )

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EB13/54 Add. 2 page 7

"(1) The projects falling within the competence of participating organizations should be carried out b y them., and the co-ordination of their work should be e f f e c t e d , w i t h due regard t o their constitutions and the.relations established between t h e m .

(2) The work undertaken b y the participating organizations under the expanded technical assistance programme should be suitable for integration w i t h their n o r m a l w o r k .

(3) Arrangements should b e m a d e for requests for assistance w i t h i n the sphere of two or more organizations to be h a n d l e d jointly b y the

organizations concerned, a n d

there

should be co-ordination among the participating organizations at the planning l e v e l before commitments b y t h e m are entered into w i t h governments."

It follows t h a t5 w h i l s t the regular programmes m u s t continue to be planned and implemented w i t h i n the framework of the "General Programme of W o r k for a Specific Period" a n y additional work which ths Organization m a y b e able to carry out w i t h i n the resources made available to it under the U n i t e d Nations E x p a n d e d Programme of Technical Assistance m u s t b e such a s to conform to the "General Programme of W o r k "

and a s s i s t t h e Organization in the attainment of the m a i n objective prescribed i n the Constitution»

A n o t h e r limiting consideration arises from the respective responsibilities

of unicEF

and the W o r l d Health Organization i n the international field w h i c h have b e e n defined b y agreement in accordance with the principles governing the co-operative relationship between Ш 0 a n d UNICEF recommended b y the Joint Committee on H e a l t h

P o l i c y .1 The subsequent development of co-operative programmes b e t w e e n UNICEF and W H O f o r m e d the subject of a r e p o r t to the F i f t h W o r l d H e a l t h A s s e m b l y w h i c h , i n

R e s o l u t i o n Ш 1 5 Л 1 ; approved "the principle that Ш 0 should a s s u m e , subject to the limitation of its f i n a n c i a l r e s o u r c e s , the responsibility for the employment of^the technical personnel needed for joint activities to be initiated in the future."

W h i l s t , t h e r e f o r e , co-ordination and co-operation i n the planning and iniplementation

o f joint activities continues to be a cardinal principle of the relations b e t w e e n WHO a n d U N I C E F , the fluctuations i n the amount of the resources available t o W H O

1 Off,, Rec„ M i d H l t h Orgp 22, p。 4 8

2 O f f , Recо W l d H l t h O r g , 4 2 , p。 4 2

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have r e s u l t e d i n t h e d e f e r m e n t of the f u l l i m p l e m e n t a t i o n of the d e c i s i o n of the Health A s s e m b l y . It h a s clearly b e e n n e c e s s a r y to take into c o n s i d e r a t i o n r e q u i r e m e n t s

i n r e s p e c t of j o i n t activities in d e t e r m i n i n g t h e d i s t r i b u t i o n of t h e available r e s o u r c e s b e t w e e n r e g i o n s a n d , w i t h i n r e g i o n s , b e t w e e n i n d i v i d u a l c o u n t r i e s .

In e n d e a v o u r i n g t o exercise the f u n c t i o n " t o act as t h e d i r e c t i n g and

c o - o r d i n a t i n g authority on i n t e r n a t i o n a l h e a l t h work" e n t r u s t e d to it b y A r t i c l e 2 of t h e C o n s t i t u t i o n , t h e W o r l d H e a l t h O r g a n i z a t i o n is b o u n d a l s o , in d e t e r m i n i n g t h e a l l o c a t i o n of r e s o u r c e s b e t w e e n r e g i o n s , to t a k e into consideraticn a s s i s t a n c e r e n d e r e d in t h e i n t e r n a t i o n a l h e a l t h f i e l d to i n d i v i d u a l countries Ъу m u l t i l a t e r a l a n d b i l a t e r a l a g e n c i e s .

9 . T i m i n g i n the r e c e i p t of r e s o u r c e s

T h e O r g a n i z a t i o n k n o w s , w i t h i n r e a s o n a b l e l i m i t s , the r e g u l a r r e s o u r c e s it w i l l h a v e available for a given y e a r some e i g h t e e n m o n t h s prior to the o p e r a t i n g y e a r . A p p r o x i m a t e l y s i x m o n t h s in advance of the o p e r a t i n g y e a r the H e a l t h A s s e m b l y approves t h e p r o g r a m m e and b u d g e t estimates for that y e a r , r e f l e c t i n g the a l l o c a t i o n as b e t w e e n r e g i o n s of the r e g u l a r funds a p p r o p r i a t e d . H o w e v e r , it is only after t h e p r o g r a m m e for the b u d g e t y e a r h a s b e e n p l a n n e d t h a t t h e n a t u r e and e x t e n t of t h e coiranitments of W H O for n e w joint p r o g r a m m e s w i t h UNICEF for t h a t y e a r are k n o w n . It is n o t

u n t i l after t h e Health A s s e m b l y has a p p r o p r i a t e d funds for t h e r e g u l a r p r o g r a m m e s for the ensuing y e a r t h a t the funds to b e m a d e a v a i l a b l e to W H O u n d e r the E x p a n d e d

P r o g r a m m e are k n o w n . S i m i l a r l y , at t h e time of p l a n n i n g of t h e r e g u l a r p r o g r a m m e s , l i t t l e or n o t h i n g is k n o w n of the resources w h i c h m a y b e m a d e a v a i l a b l e to countries under b i l a t e r a l or m u l t i l a t e r a l a s s i s t a n c e for t h e W H O o p e r a t i n g y e a r .

H a v i n g r e g a r d , t h e r e f o r e , to the d i f f i c u l t i e s of d e t e r m i n i n g , d u r i n g t h e p l a n n i n g s t a g e s , the t o t a l a m o u n t of the r e s o u r c e s l i k e t y to become a v a i l a b l e to t h e Organization and those l i k e l y to b e m a d e available f r o m other sources t o m e e t t h e h e a l t h needs of countries a n d r e g i o n s , it is impossible to b a s e allocations of the Orgaiization's r e s o u r c e s o n e ^ e c t a t i o n s as to the t o t a l funds f r o m outside sources to be m a d e a v a i l a b l e to c o u n t r i e s in any given y e a r .

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EB13/54 Add. 2 page 9

R E G I O M L A N D M T I O M L C O N S I D E R A T I O N S 1 0 . D i f f e r e n œ s b e t w e e n r e g i o n s

T h e p o i n t n e e d not b e l a b o u r e d t h a t there is m u c h d i s s i m i l a r i t y b e t w e e n r e g i o n s

a n d “the health p r o b l e m s of r e g i o n s . I n some W H O r e g i o n s , or p a r t s of t h e m , f o r m a l organizations f o r t h e p r o m o t i o n of joint h e a l t h p r o g r a m m e s have e x i s t e d f o r some y e a r s . In others t h e y are m o r e r e c e n t , b u t in b o t h c a s e s t h e y are i m p o r t a n t factors to be c o n s i d e r e d . W h i l e g e o g r a p h i c a l d i f f e r e n c e s a r e of some c o n s e q u e n c e , t h e y are p e r h a p s not as i n ç o r t a n t , i n programme planning a n d p e r f o r m n c e , as are the p o l i t i c a l , e c o n o m i c a n d s o c i a l f a c t o r s t h r o u g h idiich the f e l t n e e d s of a r e g i o n or a c o u n t r y are e x p r e s s e d . T h e s e d i f f e r e n c e s i n c u l t u r a l p a t t e r n s also a f f e c t the range a n d r a t e of a c c e p t a n c e of p r o g r a m m e s d e s i g n e d to improve the t o t a l h e a l t h of the p e o p l e

c o n c e r n e d . Under t h e s e c i r c u m s t a n c e s , i t is h a r d l y p o s s i b l e to p r e d i c t the o p t i m u m ajnount of assistance to b e p r o v i d e d . I t m a y b e h o p e d t h a t t r i a l a n d error s l o w l y w o r k i n g up f r o m f i e l d e x p e r i e n c e , through l o c a l governments a n d the S e c r e t a r i a t t o the A s s e m b l y , m a y i n time p r o v i d e some a n s w e r s .

I n a d d i t i o n to the differences w h i c h lie in the r e g i o n s t h e m s e l v e s , t h e offices of Ш 0 , w h i c h serve the r e g i o n s , have n o t developed unifarinly in time nor s t r u c t u r e . In t e r m s of a l l o c a t i o n of r e s o u r c e s , the time factor is more important t h a n s t r u c t u r e . T h o s e r e g i o n a l offices w h i c h w e r e organized r e l a t i v e l y late e x p e c t t o be a f f o r d e d o p p o r t u n i t y to achieve a s q u i c k l y as p o s s i b l e a n o r g a n i z a t i o n a l l e v e l a p p r o p r i a t e to their t a s k . A standard p a t t e r n of r e g i o n a l offices c o u l d b e d e v i s e d a n d r e s o u r c e s a l l o c a t e d w i t h i n the limits i m p o s e d b y such a p a t t e r n . O n e e f f e c t of such a p l a n w o u l d b e to impose a strangling r i g i d i t y o n r e g i o n a l p r o g r a m m e s .

1 1 . T h e c o n s i d e r a t i o n of a single c o u n t r y

It is w e l l a c c e p t e d t h a t n a t i o n a l c o n s i d e r a t i o n s , t a k e n s i n g l y , c a n n o t , in the l a s t a n a l y s i s , b e p e r m i t t e d to influence m a t e r i a l l y the p r o p o r t i o n of such r e s o u r c e s w h i c h s h a l l b e m a d e t o a n y p a r t i c u l a r r e g i o n . N e v e r t h e l e s s , it is the sun of such considerations w h i c h , together w i t h i n t e r n a t i o n a l a n d r e g i o n a l f i n d i n g s , m u s t b e given due w e i g h t i n r e l a t i o n to tho sum of s i m i l a r considerations i n r e s p e c t of the other r e g i o n s .

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It i s the r i g h t and the r e s p o n s i b i l i t y of n a t i o n a l g o v e r n m e n t s t o a d v a n c e a n d j u s t i f y t h e i r r e q u e s t s f o r a share of the r e s o u r c e s of Ш 0 . T h e a d e q u a c y of t h e s e j u s t i f i c a t i o n s w o u l d p r o v i d e one b a s i s for the a l l o c a t i o n of r e s o u r c e s w i t h i n r e g i o n s a n d b e t w e e n r e g i o n s . R e g a r d l e s s of w h e t h e r or not d e t a i l e d justifications s h o u l d i n c l u d e f a c t o r s w h i c h m a y b e o b j e c t i v e l y m e a s u r e d , a l l justifications should b e as c o m p r e h e n s i v e as p o s s i b l e . A m o n g the r e a s o n s w h i c h s h o u l d b e p r e s e n t e d i n s u p p o r t of a r e q u e s t are the following:

(1) T h e h e a l t h needs of the c o u n t r y and the r e l a t i v e importance of t h e problems r e q u i r i n g s o l u t i o n .

(2) T h e a b i l i t y of the c o u n t r y to a b s o r b a s s i s t a n c e a n d s u s t a i n a c t i v i t i e s s t a r t e d w i t h i n t e r n a t i o n a l a s s i s t a n c e .

(3) The stage of d e v e l o p m e n t of n a t i o n a l health s e r v i c e s a n d t h e n e x t l o g i c a l step i n t h e i r d e v e l o p m e n t .

(4) C o n t i n u i t y of d e v e l o p m e n t i n the h e a l t h f i e l d w i t h due r e g a r d t o the i n t e g r a t i o n of n a t i o n a l a n d i n t e r n a t i o n a l s e r v i c e s .

(5) T h e e v a l u a t i o n of the r e s u l t s of p r e v i o u s efforts on the p a r t of n a t i o n a l as w e l l as i n t e r n a t i o n a l a g e n c i e s .

(6) The r e l a t i v e progress i n the h e a l t h field in terms of the c u l t u r a l b a c k g r o u n d • .

(7) Interest of the g o v e r n m e n t as e x p r e s s e d i n t e r m s of s p e c i f i c r e q u e s t s f o r i n t e r n a t i o n a l a s s i s t a n c e •

(8) A s s i s t a n c e r e q u e s t e d a n d r e c e i v e d f r o m other s o u r c e s .

12, T h e a s s e s s m e n t of s p e c i a l f a c t o r s i n the a l l o c a t i o n of r e s o u r c e s

I t h a s b e e n suggested that c e r t a i n r e a s o n s f o r justifying t h e use of resources are u n i v e r s a l l y more important t h a n others a n d t h a t in some w a y t h e y c o u l d b e

o b j e c t i v e l y m e a s u r e d and combined to p r o v i d e a single factor w h i c h w o u l d b e u s e d to j u s t i f y more p r e c i s e l y , t h a n is now the c a s e , the a l l o c a t i o n s of the r e s o u r c e s of W H O t o r e g i o n s a n d t o countries w i t h i n r e g i o n s •

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EB13/54 Add. 2 page 11

T h e r e s o u r c e s w h i c h are available to a requesting tíountry are tangible a n d to a certain degree measurable • • Statistics are a v a i l a b l e , b u t p r o b a b l y in a v a r y i n g degree of coiïç>rehensiveness and a c c u r a c y> on p o p u l a t i o n s , n a t i o n a l i n c o m e ,

p e r capita national income^ governmental e x p e n d i t u r e s , etc» Some of t h i s infor- m a t i o n is shown i n A p p e n d i x 4 . H o w e v e r} raw d a t a of this k i n d w o u l d n e e d consider- able refinement before it could b o used t o m e a s u r e the r e l a t i v e abundance or

scarcity of r e s o u r c e s • For e x a m p l e , a figure i n d i c a t i n g t h e average p e r capita income w o u l d n o t indicate how m a n y persons receive m u c h less t h a n tho average p e r capita i n c o m e . Nor d o e s national income n e c e s s a r i l y m e a s u r e national w e a l t h m u c h of w h i c h m i g h t lie u n t a p p e d for t a x p u r p o s e s . Nor are data available t o compare, b e t w e e n c o u n t r i e s , the nmnbers of p e o p l e w h o cannot be p r o v i d e d with h e a l t h

services f r o m n a t i o n a l resources•

No objective criteria exists on the basis of w h i c h the degree of t e c h n i c a l development of a n i n d i v i d u a l country relative to another can b e a s s e s s e d . Per capita p r o d u c t i o n or u t i l i z a t i o n of certain b a s i c commodities such as i r o n a n d s t e e l , s a l t,ge n e r a t e d horse-power^ e t c . , have b e e n used t o m e a s u r e relative

i n d u s t r i a l i z a t i o n . T h e s e data m i g h t be u s e d to discriminate b e t w e e n e c o n o m i c a l l y developed a n d under^developed countries^ b u t they are h a r d l y a u s e f u l means of comparing t h e health n e e d s of economically u n d e r - d e v e l o p e d r e g i o n s or c o u n t r i e s .

A s indicated previously^ the equitable a l l o c a t i o n of the O r g a n i z a t i o n1 s resources is complicated b y the d i v e r s i t y of such r e s o u r c e s now available to

countries w h i c h a r e entitled to receive t h e m . T h e w i l l i n g n e s s of a c o u n t r y to a c c e p t such a i d , the nature and extent of such aid t o the m a n y recipients are generally k n o w n , b u t the book-keeping required t o m a k e this information p r e c i s e f o r purposes of strict comparability w o u l d b e a tremendous t a s k .

It m a y b e argued t h a t the extent of international assistance should b e a r some r e l a t i o n to the p r o p o r t i o n of its revenues devoted b y a particular government to health services w i t h i n its own t e r r i t o r y . In so far as it m a y be possible t o a p p l y such a criterion the question arises as t o Tôiat factors should b e considered and the weights t o be a s s i g n e d to t h e m . Some of the possible factors w h i c h m i g h t b e considered are:

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(a) t h e o v e r a l l r e s o u r c e s at t h e d i s p o s a l .of t h e n a t i o n a l government;

(b) t h e e x t e n t to w h i c h t h e g o v e r n m e n t h a s u s e d or is w i l l i n g t o u s e s u c h r e s o u r c e s ¡ á n d

(c) t h e p r o p o r t i o n of t h e p u b l i c r e v e n u e s w h i c h are d e v o t e d to h e a l t h s e r v i c e s . W h a t e v e r f a c t o r s are c o n s i d e r e d a n d w h a t e v e r w e i g h t s m a y b e a s s i g n e d t o one or o t h e r of t h e s e f a c t o r s , i t w o u l d s e e m t o b e p o s s i b l e to a p p l y t h e same w e i g h t s

•to a l l c o u n t r i e s , i n a s m u c h as t h i s c o u l d give r i s e t o a n o m a l i e s w h e n r e l a t e d t o .the r e a l n e e d s of i n d i v i d u a l c o u n t r i e s .

T h e p r o b l e m of d e c i d i n g t h e r e l a t i v e i m p o r t a n c e of n e e d s and t h e a m o u n t s to Ъе p r o v i d e d f o r e a c h is n o t u n i q u e t o t h e W o r l d H e a l t h O r g a n i z a t i o n .

I n p r i v a t e b u s i n e s s , m a n a g e m e n t m a k e s a n e n l i g h t e n e d g u e s s as to w h i c h u s e s w i l l r e t t r n m o s t p r o f i t s . E v e n i n t h i s r e a l m w h e r e s e l f - i n t e r e s t m ^ r be t h e

e x c l u s i v e f a c t o r a n d o b j e c t i v e m e a s u r e s are a p p l i e d , t h e r e s u l t s are f a r f r o m c e r t a i n . L i k e w i s e i n t h e f i e l d of g o v e r n m e n t a l e ^ e n d i t u r e s , t h e h e a d of a n a d m i n i s t r a t i v e service c a n o n l y p r e s e n t h i s b e s t estimate o f t h e v a r y i n g n e e d s of h i s d e p a r t m e n t and t h e l e g i s l a t o r s either r e j e c t or a c c e p t h i s p r o p o s a l s o n t h e b a s i s o f w h a t t h e y c o n s i d e r is t h e g e n e r a l p u b l i c g o o d .

C O N C L U S I O N

I t w o u l d s e e m t h a t no l i s t of f a c t o r s c a n , at t h i s t i m e , b e d e v i s e d w h i c h c o u l d b e u n i f o r m l y a p p l i e d t o m e a s u r e , for a l l p r o j e c t s , a l l c o u n t r i e s a n d a l l r e g i o n s , the a l l o c a t i o n of a v a i l a b l e r e s o u r c e s . In t h e I n t r o d u c t i o n t o t h i s s t u d y , it h a s b e e n shown t h a t c e r t a i n g u i d i n g p r i n c i p l e s h a v e b e e n d e v e l o p e d t o enable t h e O r g a n i z a t i o n t o a s s e s s t h e r e l a t i v e i m p o r t a n c e and u r g e n p y o f r e q u e s t s to share in scarce r e s o u r c e s . T h e s e g u i d i n g p r i n c i p l e s are of a q u a l i t a t i v e r a t h e r t h a n q u a n t i t a t i v e n a t u r e . T h q r hs^ve p r o v e n t o b e r e a s o n a b l y e f f e c t i v e in p r a c t i c e a n d t h e i r a p p l i c a t i o n s h o u l d b e c o m e m o r e e f f i c i e n t a n d a c c e p t a b l e as k n o w l e d g e a n d e x p e r i e n c e is g a i n e d i n t h e i r u s e .

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EB13/54 Add. 2 page 13

A P P E N D I X 1

E x t r a c t f r o m M i n u t e s of S t a n d i n g C o m m i t t e e on A d m i n i s t r a t i o n a n d F i n a n c e a t N i n t h S o s s i e n of E x e c u t i v e B o a r d , ш s u b j e c t of A l l o c a t i o n s t o R e g i o n s

(EB9/AF/Mii3/10 R e v . 1 )

. • -、: •

...

The C H A I R M A N s a i d t h a t a document h a d - b e e n c i r c u l a t e d to the c o m m i t t e e giving t h e

estimated all<x5ations to the regions for the years' 1950 through 1953, in response to

t h e request; m a d e a t a p r e v i o u s m e e t i n g b y Dr» M a c k e n z i ee

D r . M â C K E N Z Î E s a i d t h a t h e w a s very g r a t e f u l t o the S e c r e t a r i a t f o r p r o d u c i n g t h i s d o c u m e n t so q u i c k l y . H e f e l t t h a t the c o m m i t t e e s h o u l d m a k e e v e r y e f f o r t t o a s s i s t t h e D i r e c t o r - G e n e r a l i n the d i f f i c u l t t a s k of d e t e r m i n i n g t h e a l l o c a t i o n s t o t h e r e g i o n s . H e c o n s i d B r e d t h a t the e s t i m a t e d a l l o c a t i o n f o r E u r o p e f o r 1 9 5 3 w a s a d e q u a t e , b u t t h o u g h t t h a t t h e e s t i m a t e d a l l o c a t i o n f o r A f r i c a s e e m e d r a t h e r s m a l l Ъу c o m p a r i s o n w i t h t h e a l l o c a t i o n s t o t h e other r e g i o n s .

The D I R E C T O R - Œ N E R A L s a i d t h a t the q u e s t i o n of b u d g e t a r y a l l o c a t i o n s t o t h e , r e g i o n s w a s ше w h i c h m i g h t p r e s e n t a c e r t a i n d a n g e r to t h e O r g a n i z a t i o n itself; it w a s n o t

desirable t h a t t h i s m a t t e r should be d i s c u s s e d in t h e H e a l t h A s s e m b l y , since t h e r e w a s a r i s k t h a t i t m i g h t d i v i d e the A s s e m b l y i n t o c l i q u e s c,f g o v e r n m e n t a l d e l e g a t e s , e a c h of w h i c h w a s a t t e m p t i n g to c b t a i n a greater a l l o c a t i o n f o r i t s r e g i o n s j i t w c u l d , h o w e v e r , b e h e l p f u l f o r t h e m a t t e r to b e d i s c u s s e d i n t h e p r e s e n t c o m m i t t e e a n d , if n e c e s s a r y , i n t h e E x e c u t i v e B o a r d , since i n n e i t h e r case w e r e t h e m e m b e r s r e p r e s e n t i n g t h e i n t e r e s t s of their c o u n t r i e s .

A t t e m p t s h a d b e e n m a d e a t v a r i o u s t i m e s to e s t a b l i s h criteria f o r d e t e r m i n i n g t h e a m o u n t s of the a l l o c a t i o n s . It h a d b e e n s u g g e s t e d t h a t a l l o c a t i o n s s h o u l d b e r e l a t e d to t h e size cf' a s s e s s m e n t s a g a i n s t the g o v e r n m e n t s i n the r e g i o n ; t h i s w o u l d r e s u l t i n t h e tJnited S t a t e s of A m e r i c a r e c e i v i n g o n e - t h i r d of t h e t o t a l a l l o c a t i o n s . It h a d b e e n

s u g g e s t e d t h a t a l l o c a t i o n s s h o u l d b e m a d e o n a b a s i s of p o p u l a t i c n j t h i s w o u l d r e s u l t i n a v e r y l a r g e p r o p o r t i o n of t h e a l l o c a t i o n s b e i n g d e v o t e d t o India a n d C h i n a . It h a d finally- b e e n s u g g e s t e d t h a t a l l o c a t i o n s m i g h t b e r e l a t e d to the a m o u n t s of d i s e a s e in t h e countries c o m p o s i n g t h e regionj t h i s p r e s e n t e d t o o m a n y d i f f i c u l t i e s of a s t a t i s t i c a l n a t u r e .

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A p p e n d i x 1

S i n c e i t h a d n o t b e e n f o u n d p o s s i b l e t o e s t a b l i s h d e f i n i t e c r i t e r i a , e a c h

a l l o c a t i o n w a s b a s e d o n a v a r i e t y of factors; f i r s t , t h e stage of d e v e l o p m e n t of t h e c o u n t r i e s i n t h e regionj s e c o n d l y , t h e c a p a c i t y of e a c h cçjintry f o r a b s o r b i n g a s s i s t a n c e , t h i r d l y , t h e m a n b e r of p e o p l e i n e a c h c o u n t r y w h o w e r e a t a stage o f t e c h n i c a l a n d

e d u c a t i o n a l d e v e l o p m e n t e n a b l i n g t h e m t o t a k e a d v a n t a g e of services s u p p l i e d f r o m o u t s i d e . T h e l a s t two f a c t o r s w e r e of g r e a t i m p o r t a n c e i n v i e w o f the c o n s i d e r a b l e f u n d s f o r

a s s i s t a n c e w h i c h w e r e a v a i l a b l e u n d e r b i l a t e r a l t e c h n i c a l a s s i s t a n c e arid U N I C E F ; it h a d b e e n f o u n d t h a t W H O h a d f r e q u e n t l y b e e n o b l i g e d t o m a k e a c o n s i d e r a b l e o u t l a y o n t r a i n i n g i n orc^er t o enable a c o u n t r y t o t a k e a d v a n t a g e of t h e a s s i s t a n c e f u n d s a t i t s d i s p o s a l .

I n the c a s e of t h e A f r i c a n R e g i o n , t h e a b s o r p t i v e c a p a c i t y f o r f u n d s a n d servioes w a s n o t v e r y g r e a t a t present; i t w a s b e l i e v e d t h a t i n 1 9 5 3 t h e r e g i o n w o u l d b e a b l e t o h a n d l e a p p r o x i m a t e l y ше-third o f a m i l l i o n d o l l a r s a s a n a l l o c a t i o n f r o m the r e g u l a r b u d g e t j t h i s w a s s i m p l y a n estimate since i t w a s n o t p o s s i b l e to d e t e r m i n e w h a t s e r v i c e s w o u l d b e r e q u e s t e d b y g o v e r n m e n t s i n t h e r e g i o n j it w a s quite p r o b a b l e t h a t b y 1 9 5 4 t h e a b s o r p t i v e c a p a c i t y of t h e r e g i o n w e u l d h a v e i n c r e a s e d a n d t h e

a l l o c a t i o n w o u l d c o n s e q u e n t l y h a v e to i n c r e a s e a l s o .

The f i g u r e s f o r t h e a l l o c a t i o n s i n the d o c u m e n t b e f o r e t h e c o m m i t t e e h a d b e e n d r a w n u p o n t h e b a s i s of t h e r a t i o b e t w e e n r e g i o n s of t h e r e q u e s t s w h i c h h a d b e e n r e c e i v e d f r c m g o v e r n m e n t s a n d t h e r e q u e s t s o f t h e R e g i o n a l D i r e c t o r s . O u t o f t h e s e a l l o c a t i o n s , t h e a d m i n i s t r a t i o n w o u l d m a k e a n a r b i t r a r y a l l o c a t i o n t o the R e g i o n a l D i r e c t o r s of t h e l a r g e r p a r t of t h e s u m , r e t a i n i n g a small p a r t w h i c h c o u l d , if n e c e s s a r y , b e g i v è n t o t h e r e g i o n s o n the b a s i s o f n e e d . It h a d b e e n f o u n d t h a t s u c h a p r o c e d u r e w a s n e c e s s a r y a n d t h e r e s p o n s i b i l i t y f o r it l a y w i t h the D i r e c t o r - G e n e r a l .

D r . M A C K E N Z I E t h a n k e d t h e D i r e c t o r - G e n e r a l f o r h i s v e r y c l e a r statement a n d s u g g e s t e d t h a t , i n v i e w of t h i s s t a t e m e n t , it m i g h t n e b b e n e c e s s a r y to d i s c u s s t h e m a t t e r f u r t h e r .

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EB13/54 Add. 2 page 15 APPENDIX 2

Extracts from M i n u t e s of Meeting of Standing Committee on Administration and Finance at Eleventh Session of Executive Board relating to Allocations

to Regions (EBll/AF/Min/9 R e v . l and EBll/AF/Min/lO Rev.l)

EBll/AF/Min/9 R e v . l

D r . K A R U N A R A T N E said there was a need for the formulation of principles in allocations to the various regions, particularly since funds from the regular budget and Technical Assistance funds were not apportioned on a proportionate basis or on any- considered criteria.

He formally proposed that some criteria should be laid down for the guidance of the Director-General in allocating funds; primary consideration should be g i v e n , in M s opinion, to the health needs of a particular area and to health problems which might have world-wide repercussions.

D r . van den BERG supported the above p r o p o s a l . He suggested that the Director- General be requested to prepare a document as a basis for discussion at a future session of the Standing Committee.

D r . ALLWOOD-PAREDES said that the guiding principle in the formulation of criteria for the distribution of funds should be the wishes c£ governments and their ability to absorb programmes, n a m e l y , their potentiality to absorb not only W H O programmes but those of bilateral and multilateral a g e n c i e s . Good results could not be accomplished merely by an equal distribution of funds.1 1'

'Dr. D O R O L L E , speaking on the question of allocations to the regions, said that a comparative table for the years 1951 to 1954 would be circulated at the afternoon meeting (document EB11/P&B/7), together w i t h an extract from t h e relevant minutes of the discussion held a year a g o . A t that t i m e , the Director-General had welcomed consideration of the p r o b l e m , although he felt that discussion should be limited to the Executive Board or Standing Committee, whose members acted in a personal c a p a c i t y and not as government representatives. In the discussion on the subject b y the

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A p p e n d i x 2

S t a n d i n g Committee on Administration and Finance at the ninth session of the Executive B o a r d , the Director-General had emphasized the difficulty, if not impossibility, of drawing up sound criteria for allocations to the r e g i o n s . He had drawn attention to the difficulty of attempting to formulate criteria based on population or on the amount of a country's contribution to W H O , and had suggested that t h e only practical coarse w a s to attempt to estimate actual needs of countries and their capacity of absorption.

Those were guiding principles on w h i c h the distribution of funds w a s b a s e d , it being understood that such estimates m u s t be subject to revision in the light of experience.

W h i l e agreeing that discussion of the problem would be u s e f u l , he again stressed t h a t it should be confined to a meeting of the Board or of the Standing Committee.“

EBll/AF/Min/10 Rev.l

D r . HURTADO supported D r . Karunaratne1 s proposal that a study should be made of the m e t h o d of allocating resources t o the r e g i o n s . That w a s one of the most important and difficult functions of the Director-General and the Standing Committee m i g h t be able to assist him b y suggesting criteria for the allocation.

B r . KARUNARATNE said that at a first glance document EB11/P&B/7 (Allocations to r e g i o n s ) , which had just been circulated, did not appear to be sufficiently comprehen- s i v e . He therefore p r o p o s e d that the Secretariat should prepare a more detailed study for consideration at a subsequent session of the B o a r d .

D u r i n g the ensuing discussion on procedure, D r . Karunaratne proposed that t h e Director-General be asked t o prepare a detailed study of t h e programme of allocations to regions and t h a t the item be placed o n the agenda of the Sixth W o r l d Health A s s e m b l y .

D r . TURBOTT and D r . LEROUX felt t h a t it would be dangerous to submit the matter for discussion in the W o r l d Health Assembly without its first having b e e n considered by the B o a r d .

D r . HURTADO considered that it would be extremely dangerous t o give the impression that certain matters were being withheld from the World Health A s s e m b l y . The Health

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