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 .
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
55Brazil . 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
75Ecuador 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
83J 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
459Total - 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 .
5 8 4 “ 2 0 7 , 5抖
12,000
17,180
7,297
3 ^ 6 , 0 0 0
79,260
18.313
4 8 0 , 0 5 0
ТО12阶7200卫訂 6 6U 5 о 8 1
• V , •
« r
Э2
11 ^
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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3 5 5
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I n c l u d i n g t h e B y e l o r u s s i a n S S R a n d t h e U k r a i n i a n S S R
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 一 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 21
2
208559055100
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8
3 11
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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
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
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 . .
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
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
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 r讓e 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 之 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 . "
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 職 4 為 O f f , R e c , W l d H l t h Org» 35, p . 20
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
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 )
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 hP 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
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 .
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 .
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 •
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:
(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 .
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 .
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 .
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
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