ORGANISATION MONDIALE DE LA SANTÉ 24 November 1975
EXECUTIVE BOARD INDEXED
Fifty-seventh Session
Provisional agenda item 12,2
Report on the twenty-seventh session REGIONAL COMMITTEE FOR THE AMERICAS
The Director-General has the honour to present to the Executive Board the report on the twenty-seventh session of the Regional Committee for the Americas/XXIII Meeting of the
Directing Council of P A H 0ol This report is preceded by an introduction which summarizes the discussion and action taken at this m e e t i n g .
1 Document CD23/FR.
I N T R O D U C T I O N
T h e X X I I I M e e t i n g of the D i r e c t i n g C o u n c i l of the Pan A m e r i c a n H e a l t h O r g a n i z a t i o n , X X V I I M e e t i n g of the R e g i o n a l C o m m i t t e e of the W o r l d H e a l t h O r g a n i z a t i o n for the A m e r i c a s , w a s h e l d in W a s h i n g t o n , D . C . , from 29 S e p t e m b e r to 8 O c t o b é r 1 9 7 5 , T h e following G o v e r n m e n t s w e r e r e p r e s e n t e d : A r g e n t i n a , B a h a m a s , B a r b a d o s , B o l i v i a , B r a z i l , C a n a d a , C h i l e , C o l o m b i a , C o s t a R i c a , C u b a , D o m i n i c a n R e p u b l i c , E c u a d o r , El S a l v a d o r , F r a n c e , G u a t e m a l a , G u y a n a , H a i t i , H o n d u r a s , J a m a i c a , K i n g d o m of t h e N e t h e r l a n d s , M e x i c o , N i c a r a g u a , P a n a m a , P a r a g u a y , T r i n i d a d and T o b a g o , U n i t e d K i n g d o m , U n i t e d S t a t e s of A m e r i c a , U r u g u a y and V e n e z u e l a . T h e E x e c u t i v e C o m m i t t e e w a s r e p r e s e n t e d by its C h a i r m a n , Dr R o b e r t o P e r e d a C h a v e z (Cuba), and by two o t h e r m e m b e r s of the C o m m i t t e e , Dr R o b e r t de Caires (United S t a t e s of A m e r i c a ) a n d Dr E v e r a r d o G o n z á l e z G á l v e z ( P a n a m a ) .
T h e M e e t i n g w a s also a t t e n d e d b y the D i r e c t o r - G e n e r a l o f the W o r l d H e a l t h O r g a n i z a t i o n , a n d b y o b s e r v e r s from the O r g a n i z a t i o n of A m e r i c a n S t a t e s , the I n t e r - A m e r i c a n D e v e l o p m e n t B a n k , the U n i t e d N a t i o n s C h i l d r e n1s F u n d , the U n i t e d N a t i o n s D e v e l o p m e n t F u n d , the F o o d and A g r i c u l t u r e Organization' o f the U n i t e d N a t i o n s , a n d ten n o n - g o v e r n m e n t a l o r g a n i z a t i o n s .
T h e D i r e c t i n g C o u n c i l b e g a n its w o r k u n d e r the p r o v i s i o n a l p r e s i d e n c y of Dr R o b e r t o P e r e d a C h a v e z , C h a i r m a n of the E x e c u t i v e C o m m i t t e e , w h o o f f i c i a t e d pending the e l e c t i o n of the f o l l o w i n g as O f f i c e r s of the M e e t i n g : P r e s i d e n t - Dr A b r a h a m Saied (Panama)； V i c e
P r e s i d e n t s - Dr J o r g e T o r r e s N a v a r r o (Bolivia) and Dr K e n n e t h M c N e i l l (Jamaica)； R a p p o r t e u r - Dr Pablo S a l c e d o N a d a l (Venezuela)； a n d S e c r e t a r y ex o f f i c i o - Dr H é c t o r R . A c u n a ( D i r e c t o r , P A S B ) . Dr A d á n G o d o y J i m e n e z (Paraguay) a n d Dr A n t o n i o J0 A l v a r e z A l v a r e z ( E c u a d o r ) w e r e a p p o i n t e d Presidents pro t e m p o r e •
T h e C o u n c i l h e l d 11 p l e n a r y s e s s i o n s , in a d d i t i o n to the i n a u g u r a l a n d c l o s i n g s e s s i o n s . T h e G e n e r a l C o m m i t t e e h e l d t h r e e sessions a n d the C o m m i t t e e on C r e d e n t i a l s five s e s s i o n s . Four w o r k i n g groups w e r e e s t a b l i s h e d a n d w e r e e n t r u s t e d w i t h the study of c e r t a i n i m p o r t a n t items among the 37 o n the a g e n d a . In the c o u r s e of the m e e t i n g , 32 r e s o l u t i o n s w e r e a p p r o v e d . I n a u g u r a l session
T h e i n a u g u r a l a d d r e s s w a s g i v e n b y Dr A b r a h a m Saied of P a n a m a , P r e s i d e n t E l e c t of the C o u n c i l , w h o said： " T h e p e o p l e s of the A m e r i c a s h a v e r e a l i z e d the i m p o r t a n c e and s t r e n g t h of a u n i t e d A m e r i c a n c o m m u n i t y e n g a g e d in a v i g o r o u s and c o o p e r a t i v e fight to r e s o l v e c o m m o n p r o b l e m s and thus a t t a i n c o l l e c t i v e goals • • • If the e n t h u s i a s t i c p a r t i c i p a t i o n of a l l in the u n p o s t p o n a b l e task of c o m m u n i t y d e v e l o p m e n t and w e l l b e i n g is to be e n s u r e d , then the p e o p l e s m u s t see this task as a s o l u t i o n for their m o s t i m p o r t a n t problems a n d . . • it m u s t b e b a s e d on d e c i s i o n s taken by all . . . W e b e l i e v e , at the level of the i n t e r n a t i o n a l c o m m u n i t y , in a u n i t e d , i n t e r d e p e n d e n t and e g a l i t a r i a n A m e r i c a , free from t u t e l a g e a n d
p a t e r n a l i s m . In v i e w of the p r o g r e s s of science and t e c h n o l o g y , t h e r e can be no j u s t i f i c a t i o n w h a t s o e v e r for the p e r s i s t e n c e of large p o p u l a t i o n groups s t i l l leading a p r e c a r i o u s
e x i s t e n c e " .
R e f e r r i n g to the m a l n u t r i t i o n p r o b l e m , Dr S a i e d p o i n t e d o u t that the s o l u t i o n m u s t be sought " t h r o u g h g r e a t e r o p p o r t u n i t i e s for e d u c a t i o n a n d w e l l b e i n g , i n c r e a s e d food p r o d u c t i o n , a c h a n g e in the s t r u c t u r e s g i v i n g r i s e to m a l n u t r i t i o n a n d , in p a r t i c u l a r , t h r o u g h a fairer and m o r e s a t i s f a c t o r y d i s t r i b u t i o n of w e a l t h at the n a t i o n a l , r e g i o n a l a n d w o r l d l e v e l " .
H e a d d e d , in c o n c l u s i o n : "It is for us to r e v i e w the d e g r e e of j u s t i c e in the r e l a t i o n s b e t w e e n all the c o u n t r i e s of this c o n t i n e n t , and b e t w e e n our g o v e r n m e n t s and the p e o p l e s , so as to find together the r o a d w h i c h w i l l lead us to a s o l u t i o n of the p r o b l e m s facing this g e n e r a t i o n • • • L e t us d e v o t e all our energies and r e s o u r c e s to the i n t e g r a l d e v e l o p m e n t of our p e o p l e s " .
T h e m e e t i n g w a s then a d d r e s s e d by Dr T h e o d o r e C o o p e r , A s s i s t a n t S e c r e t a r y for H e a l t h , U n i t e d States D e p a r t m e n t of H e a l t h , E d u c a t i o n and W e l f a r e , w h o s t r e s s e d that "It is a p e r i o d of t r o u b l e d e c o n o m i e s and i n f l a t i o n , p a r t i c u l a r l y in the a r e a of h e a l t h c a r e . It is also a p e r i o d in w h i c h our c i t i z e n s h a v e come i n c r e a s i n g l y to e x p e c t q u a l i t y c a r e a n d the r i g h t to
good h e a l t h . Science has m a d e startling a d v a n c e s and m a n y important b r e a k t h r o u g h s in recent d e c a d e s . O r g a n i z a t i o n such as ours seek to facilitate the t r a n s l a t i o n of this a c q u i r e d k n o w l e d g e and these t e c h n i q u e s into w e l l - b e i n g for our citizens 。 。 • W e n e e d to take a care- ful look at the progress m a d e in ongoing p r o g r a m m e s , scrutinize c a r e f u l l y their place in our c u r r e n t p r i o r i t i e s and m a k e a c r i t i c a l e v a l u a t i o n as to their success or p o t e n t i a l success in p l a n n i n g for the f u t u r e .
1 1. e . T h e challenges of lowering infant m o r t a l i t y levels, of finding answers to the c a u s e s and treatment of chronic d i s e a s e s , a n d of extending e n v i r o n m e n t a l c o n t r o l systems are k e y p r o b l e m s and key problem areas in improving health m a i n t e n a n c e levels in the H e m i s p h e r e . T h e o r g a n i z a t i o n , financing and d e l i v e r y of h e a l t h c a r e , h e a l t h m a n p o w e r training and develop- m e n t , and s t a n d a r d - s e t t i n g , are policy issues that confront us a l l .
"• . . W h a t w e do during this X X I I I D i r e c t i n g C o u n c i l , the decisions w e m a k e , and our a c t i o n s in the coming year should n o t be just a public record that simply shows w e e x i s t . O u r d e c i s i o n s h e r e m u s t be the catalyst for action w h i c h w e either w i l l b e proud： of or m u s t a n s w e r for in the future."
T h e n e x t speaker w a s M r A l e j a n d r o O r f i l a , S e c r e t a r y - G e n e r a l of the O r g a n i z a t i o n of
A m e r i c a n S t a t e s， who said: "The i m p o r t a n c e of the Pan A m e r i c a n H e a l t h O r g a n i z a t i o n , w h i c h is both a b r a n c h of OAS and a R e g i o n a l O f f i c e of the W o r l d Health O r g a n i z a t i o n , b e c o m e s clearly a p p a r e n t w h e n w e realize the c h a l l e n g e s p o s e d by the p r e s e n t situation in the Continent for t h o s e w h o bear any r e s p o n s i b i l i t y in its m a n a g e m e n t • W h a t is at stake in the programmes and a c t i v i t i e s discussed h e r e is n o t h i n g less than the possibility of raising the quality of life of the i n h a b i t a n t s of the A m e r i c a s w h o in so m a n y sectors are still w a i t i n g to see their just e x p e c t a t i o n s of a b e t t e r existence f u l f i l l e d " .
M r O r f i l a then m e n t i o n e d the fields in w h i c h both o r g a n i z a t i o n s are c o o p e r a t i n g at present and those in w h i c h they could do so in the f u t u r e .
In c o n c l u s i o n h e said： "Already in m y i n a u g u r a l address I a l l u d e d to the need to tighten the links w i t h the s p e c i a l i z e d b o d i e s of the O r g a n i z a t i o n and m y i n t e n t i o n to do so • • • It is i n this s p i r i t , and m i n d f u l of our r e s p o n s i b i l i t y towards this C o n t i n e n t for w h o s e progress and w e l l b e i n g w e are c o m m i t t e d to do our u t m o s t , that I should like to express to the D i r e c t i n g Council m y b e s t w i s h e s for the success of this M e e t i n g " .
T h e fourth speaker w a s Dr H a l f d a n M a h l e r , D i r e c t o r - G e n e r a l of the W o r l d Health
O r g a n i z a t i o n : "I think p a r t i c u l a r l y in this year it is m y d u t y " , said Dr M a h l e r , "to try to see h o w you and your o r g a n i z a t i o n could relate p r o d u c t i v e l y to a new economic o r d e r , or as I c e r t a i n l y w o u l d prefer to call it, a new development o r d e r , in our s o c i a l l y irrational w o r l d
• • • I w o u l d like to express m y views around the theme of 'Health for A l l by the Year 2 0 0 01. Is such a n o b j e c t i v e m e r e w i s h f u l t h i n k i n g , a Utopian d r e a m , or is it a r e a l i s t i c goal or just a n o t h e r c o n s e r v a t i v e estimate? • • • I do n o t propose to w a i t . I p r o p o s e u r g e n t action now to a c h i e v e in 25 years • • • w h a t h a s h i t h e r t o not been a c h i e v e d at a l l .
• • the m o s t i m p o r t a n t criteria for appropriate w a y s of attaining such health are their r e l e v a n c e to social progress and their economic feasibility; and the first p r i n c i p l e , I t h i n k , is that the social d i s t r i b u t i o n of h e a l t h resources is just as i m p o r t a n t as their q u a n t i t y and q u a l i t y . F a r too o f t e n , resource's are allocated to c e n t r a l i n s t i t u t i o n s , b e c o m i n g p r o p o r t i o n a t e l y scantiet in direct r e l a t i o n s h i p to the d i s t a n c e from the big cities u n t i l they are n o n - e x i s t e n t or v i r t u a l l y n o n - e x i s t e n t in r u r a l a r e a s .
1 1. • • T h e second p r i n c i p l e follows c l o s e l y from the first p r i n c i p l e , n a m e l y that of s o c i a l p e n e t r a t i o n . It is n e c e s s a r y that w e now start a l l o c a t i n g r e s o u r c e s to the social p e r i p h e r y a n d b y a d e t e r m i n e d effort w e ensure that socially p e r i p h e r a l populations partici- p a t e fuliy in identifying their own problems and in finding solutions for them . . . W e m u s t e n c o u r a g e communities to take the i n i t i a t i v e in developing simple h e a l t h m e t h o d s of their o w n , such as seeking local solutions for w a t e r supplies and w a s t e s d i s p o s a l , for protection of h o u s e s a g a i n s t insects and r o d e n t s , and for the provision of e l e m e n t a r y h e a l t h c a r e . I am c o n v i n c e d that it is p o s s i b l e to train l o c a l l y - r e c r u i t e d h e a l t h agents so that they participate u n d e r s u i t a b l e supervision in providing a m i n i m a l standard • • • M a n y people h a v e expressed
fears to m e that such a r r a n g e m e n t s w o u l d d e p r i v e the m e d i c a l a n d n u r s i n g p r o f e s s i o n s of their t r a d i t i o n a l f u n c t i o n s . I do not t h i n k s o , b e c a u s e w h a t has b e e n s u g g e s t e d is that t h e s e p r o f e s s i o n s b r o a d e n their f u n c t i o n s a n d a p p l y their k n o w l e d g e and skills to the m o s t p r e s s i n g s o c i a l n e e d s .
’’• • • It is a b s o l u t e l y d i s p e n s a b l e for m i n i s t r i e s to s e t in m o t i o n and m a i n t a i n a
c o n t i n u i n g p r o c e s s of p l a n n i n g , p r o g r a m m i n g , i m p l e m e n t i n g , m o n i t o r i n g , c o n t r o l l i n g , e v a l u a t i n g a n d r e p l a n n i n g • • • T h e m e t h o d o l o g y has been k e p t v e r y s i m p l e , and its aim is o n l y to d e v e l o p your c a p a c i t y w i t h i n y o u r c o u n t r i e s to e s t a b l i s h for y o u r s e l v e s t h e reason for y o u r h e a l t h n e e d u n d e r d e v e l o p m e n t a n d , b y y o u r s e l v e s， t h r o u g h a p r o c e s s that is b o t h r a t i o n a l a n d c o n s o n a n t w i t h your c u l t u r e , to d e c i d e on the m o s t a p p r o p r i a t e p o l i c i e s a n d p r o g r a m m e s for d e v e l o p i n g t h e h e a l t h of all your p e o p l e .
" . . . I think i t is m y o b l i g a t i o n , as D i r e c t o r - G e n e r a l , to b r i n g to your u r g e n t a t t e n t i o n the n e e d to d e p a r t from c o n v e n t i o n a l w a y s , a n d to find a d e q u a t e s o l u t i o n s for t h e d e p r e s s i n g h e a l t h s i t u a t i o n of m o s t of the w o r l d1s c i t i z e n s , I a m , h o w e v e r , q u i t e d i s t u r b e d a n d d e e p l y c o n c e r n e d about a l l e g a t i o n s that h a v e b e e n m a d e that w h a t I aiii p r o p o s i n g are i n f e r i o r s o l u t i o n s for the developing c o u n t r i e s。 To m y m i n d , t h e s e p r o p o s a l s a r e in no w a y i n f e r i o r , n o r n e e d a t all the p r i n c i p l e s o n w h i c h they a r é based b e a p p l i e d to the d e v e l o p i n g w o r l d a l o n e . I t is not h e a l t h t e c h n o l o g y per se that is being q u e s t i o n e d . W H O w i l l c o n t i n u e to c o l l a b o r a t e in the t r a n s f e r of s o - c a l l e d m o d e r n t e c h n o l o g y w h e n e v e r it s e e m s r e a s o n a b l e a n d s i g n i f i c a n t l y u s e f u l for y o u " .
A s r e g a r d s c o l l a b o r a t i o n w i t h the c o u n t r i e s , Dr M a h l e r g a v e an a s s u r a n c e that W H O w o u l d n e v e r t r e s p a s s o n n a t i o n a l a u t h o r i t y , and s a i d that the O r g a n i z a t i o n w o u l d like to e m p h a s i z e in the field of t e c h n i c a l c o o p e r a t i o n those f u n c t i o n s that c o u l d be the k e y to h e a l t h d e v e l o p m e n t . H e c o n c l u d e d in the f o l l o w i n g w o r d s : " . • • If each i n d i v i d u a l M e m b e r S t a t e in this R e g i o n h a s the p o l i t i c a l c o u r a g e b o t h to r e o r i e n t its o w n i n t e r n a l h e a l t h p r i o r i t i e s a c c o r d i n g to t h e i r social r e l e v a n c e for the total n a t i o n a l p o p u l a t i o n a n d at t h e s a m e time to d e m a n d i n t e r n a t i o n a l s o l i d a r i t y for g l o b a l h e a l t h p r o m o t i o n , then I h a v e n o t the s l i g h t e s t d o u b t that w e s h a l l r e a c h this g o a l b e f o r e the y e a r 2 0 0 0м,
T h e session c o n c l u d e d w i t h an a d d r e s s by Dr H e c t o r R . A c u ñ a , D i r e c t o r of t h e Pan A m e r i c a n S a n i t a r y B u r e a u , w h o said: " I h a v e the h o n o u r a n d the p l e a s u r e to a d d r e s s for the f i r s t t i m e the D i r e c t i n g C o u n c i l of the P a n A m e r i c a n H e a l t h O r g a n i s a t i o n in the c a p a c i t y of D i r e c t o r of PASВ w h i c h , in its a l m o s t 73 years of e x i s t e n c e , has c o o p e r a t e d w i t h the c o u n t r i e s o f t h e A m e r i c a s in p r o m o t i n g a n d c o o r d i n a t i n g their e f f o r t s to c o m b a t d i s e a s e , p r o l o n g l i f e a n d h e l p
b r i n g a b o u t the p h y s i c a l a n d m e n t a l i m p r o v e m e n t of their i n h a b i t a n t s • • • T h e Pan A m e r i c a n S a n i t a r y Bureau is r e c o g n i z e d to b e the m o s t e f f e c t i v e c h a n n e l for the t r a n s f e r o f h e a l t h t e c h n o l o g y from the m o r e d e v e l o p e d to the less d e v e l o p e d c o u n t r i e s . F u r t h e r m o r e , to a n i n c r e a s i n g extent it is s t i m u l a t i n g and p r o m o t i n g the a d a p t a t i o n of that i m p o r t e d t e c h n o l o g y to the e c o n o m i c , s o c i a l a n d c u l t u r a l c o n t e x t o f the less p r i v i l e g e d c o u n t r i e s a n d , e v e n m o r e i m p o r t a n t , p r o m o t i n g the v a l u e s a n d r e s o u r c e s of t h e d e v e l o p i n g c o u n t r i e s t h e m s e l v e s in the e s t a b l i s h m e n t of their o w n m e t h o d s and t e c h n i q u e s . T h i s w i l l h e l p to r e s o l v e the p r o b l e m s w h i c h a r i s e , since i m p o r t e d t e c h n o l o g y has o n l y b e e n a b l e to do so p a r t i a l l y and s o l e l y for the b e n e f i t of s e l e c t e d g r o u p s of t h e p o p u l a t i o n " .
• • T h e c o u n t r i e s of the A m e r i c a s h a v e r e c o g n i z e d t h e p r e s s i n g n e e d to f i n d s o l u t i o n s for their problems u s i n g their o w n techniques and to do so t h e y h a v e u n i t e d their e f f o r t s and their l i m i t e d r e s o u r c e s to set u p r e g i o n a l c e n t r e s , a d m i n i s t e r e d b y the B u r e a u , w h o s e m a i n f u n c t i o n s are r e s e a r c h , d i s s e m i n a t i o n of i n f o r m a t i o n a n d k n o w l e d g e , and m a n p o w e r t r a i n i n g "#
Dr A c u n a p o i n t e d out that PASВ runs no less than 10 Pan A m e r i c a n C e n t r e s of this t y p e i n the fields of n u t r i t i o n , s a n i t a t i o n , e n g i n e e r i n g , z o o n o s e s , e t c .
H e w e n t on to say • . W e h a v e drawn u p the p r o p o s a l that o u r R e g i o n m u s t m a k e as its c o n t r i b u t i o n to the e s t a b l i s h m e n t o f the Sixth G e n e r a l P r o g r a m m e of W o r k of W H O . T h a t p r o p o s a l has. b e e n b u i l t u p on the b a s i s of the T e n - y e a r H e a l t h Plan for the A m e r i c a s a n d t h e i n f o r m a t i o n sent us b y M e m b e r G o v e r n m e n t s c o n c e r n i n g a n a l y s e s of their n a t i o n a l p o l i c i e s a n d s t r a t e g i e s " . Dr A c u ñ a s t a t e d that the p r i o r i t y areas of m a j o r c o n c e r n to o u r c o u n t r i e s , a n d s p e c i f i c a l l y the p r o p o s a l to e x t e n d the n e t w o r k of h e a l t h s e r v i c e s to that p a r t o f the
p o p u l a t i o n lacking t h e m , w e r e the p r o g r a m m e s for c o m m u n i c a b l e d i s e a s e c o n t r o l , m a t e r n a l a n d child h e a l t h , n u t r i t i o n , a n d i m p r o v e m e n t of e n v i r o n m e n t a l c o n d i t i o n s .
1 1. • • W e are c o n t i n u i n g to p r o v i d e t e c h n i c a l a s s i s t a n c e i n t h e t r a d i t i o n a l forms w h i c h h a v e p r o v e d f u i t f u l ; n e v e r t h e l e s s , in a c c o r d a n c e w i t h t h e w i s h e s of h e a l t h m i n i s t r i e s , the c o n t i n u a l l y i n c r e a s i n g r e q u i r e m e n t s of s o c i a l s e c u r i t y s y s t e m s a n d t h e d e c i s i o n s of the
G o v e r n i n g B o d i e s of the O r g a n i z a t i o n • • • w e h a v e seen that it is n e c e s s a r y to r e s t r u c t u r e the O r g a n i z a t i o n so as to a d a p t its f u n c t i o n s to g r o w i n g n e e d s a n d to a d o p t n e w t y p e s of t e c h n i c a l assistance m o r e in l i n e w i t h a c t u a l c o n d i t i o n s i n the c o u n t r i e s • • • W e i n t e n d to see that the t e c h n i c a l a s s i s t a n c e p r o v i d e d b y t h e O r g a n i z a t i o n is n o t r e s t r i c t e d to the p a t e r n a l i s t a d v i c e of the p a s t . T h e O r g a n i z a t i o n m u s t p l a y t h e p a r t of a r e a l a s s o c i a t e a n d s h a r e r e s p o n s i b i l i t y b o t h i n f o r m u l a t i n g a n d i n i m p l e m e n t i n g a n d e v a l u a t i n g c o u n t r y h e a l t h p r o g r a m m e s， u n d e r the
d i r e c t i o n a n d a u t h o r i t y of t h e p a r t i c u l a r g o v e r n m e n t c o n c e r n e d . 、
"Furthermore, a l t h o u g h t h e O r g a n i z a t i o n h a s c o l l a b o r a t e d w i t h c o u n t r i e s in t r a i n i n g p r o f e s s i o n a l s a n d t e c h n i c i a n s a b r o a d t h r o u g h a F e l l o w s h i p s P r o g r a m m e w h i c h i n the last 15 years has t r a i n e d m o r e t h a n 15 0 0 0 h e a l t h p r o f e s s i o n a l s a n d t e c h n i c i a n s for the c o u n t r i e s of t h e C o n t i n e n t , the timfe h a s c o m e to i n t e n s i f y o u r e f f o r t s to e n a b l e t h e c o u n t r i e s to t r a i n the t h o u s a n d s of p r o f e s s i o n a l s , t e c h n i c i a n s a n d a u x i l i a r i e s t h e y n e e d to c a r r y t h e b e n e f i t s of t h e h e a l t h s e r v i c e s i n t o t h e m o s t r e m o t e p a r t s of e v e r y c o u n t r y " .
I n c o n c l u s i o n , Dr Acurîa said： • . w e a r e c o n f r o n t e d b y a r e a l c h a l l e n g e , a n d to c o p e w i t h i t t h e o r g a n i z a t i o n r e q u i r e s t h e g u i d e , a d v i c e a n d s u p p o r t of the G o v e r n i n g B o d i e s so as to reach s t i l l h i g h e r l e v e l s of a c h i e v e m e n t in this u n d e r t a k i n g , w h i c h goes b e y o n d the l i m i t s o f s o c i a l d e v e l o p m e n t in its s e a r c h to i m p r o v e t h e q u a l i t y of h u m a n l i f e " .
A n n u a l r e p o r t of t h e D i r e c t o r of PASВ
The Delegates studied the Annual Report 1974 of the Director of P A SВ (Official d o c u m e n t 136)， giving an a c c o u n t o f the a c t i v i t i e s of the O r g a n i z a t i o n d u r i n g t h a t y e a r . T h e C o u n c i l took note of t h e R e p o r t a n d c o m m e n d e d t h e D i r e c t o r a n d the s t a f f of the B u r e a u for t h e w o r k a c c o m p l i s h e d ( R e s o l u t i o n V I I ) •
Budget and finance
A p p r o p r i a t i o n s for РАНО， 1 9 7 6
I n R e s o l u t i o n I , t h e C o u n c i l a p p r o p r i a t e d for the f i n a n c i a l y e a r 1976 a n a m o u n t of U S $ 3 0 7 6 5 6 8 7 , b r o k e n d o w n as f o l l o w s :
P r o g r a m m e of S e r v i c e s $11 8 8 1 0 3 2 D e v e l o p m e n t o f t h e I n f r a s t r u c t u r e 8 877 215 A d m i n i s t r a t i v e D i r e c t i o n 4 642 8 2 0 G o v e r n i n g B o d i e s 4 2 9 538 I n c r e a s e to A s s e t s 600 0 0 0 S p e c i a l F u n d for H e a l t h P r o m o t i o n 250 0 0 0 E f f e c t i v e W o r k i n g B u d g e t $26 680 605 S t a f f A s s e s s m e n t ( t r a n s f e r to T a x E q u a l i z a t i o n F u n d ) 4 0 8 5 0 8 2 T o t a l $30 765 687 I t a l s o a g r e e d t h a t the a p p r o p r i a t i o n s h o u l d b e f i n a n c e d from: (a) A s s e s s m e n t s in r e s p e c t o f M e m b e r Governments a n d P a r t i c i p a t i n g G o v e r n m e n t s , a m o u n t i n g to $30 365 6 8 7 , a n d
(b) M i s c e l l a n e o u s i n c o m e , a m o u n t i n g to $400 0 0 0 ,
A l l РАНО/таО Fundsа 1976
T h e O r g a n i z a t i o n ' s total b u d g e t for 1 9 7 6 , c o m p r i s i n g the a p p r o p r i a t i o n s of РАНО and those of W H O (Region of the A m e r i c a s ) , a m o u n t s to $59 738 200， the o r i g i n of the funds b e i n g as follows:
1 . РАНО R e g u l a r Budget $26 680 605 2 . O t h e r РАНО funds:
C o m m u n i t y W a t e r S u p p l y F u n d 977 015 G r a n t s and other c o n t r i b u t i o n s to РАНО
I N C A P and r e l a t e d grants 2 160 000 O t h e r grants and c o n t r i b u t i o n s 4 241 242 Pan A m e r i c a n H e a l t h and E d u c a t i o n F o u n d a t i o n 1 155 161 3 . W H O R e g u l a r B u d g e t 11 758 000
O t h e r W H O F u n d s :
U n i t e d N a t i o n s D e v e l o p m e n t P r o g r a m m e 6 850 885 U n i t e d N a t i o n s F u n d for P o p u l a t i o n A c t i v i t i e s 5 586 942 G r a n t s a n d other c o n t r i b u t i o n s to W H O 328 350 T o t a l $59 738 200 A m o n g the i m p o r t a n t a p p r o p r i a t i o n s m a d e in the 1976 b u d g e t w e r e the following:
$15 995 404 for s p e c i f i c health care p r o g r a m m e s , i n c l u d i n g the campaign a g a i n s t c o m m u n i c a b l e diseases as w e l l as m a t e r n a l and child h e a l t h and family w e l f a r e a c t i v i t i e s , n u t r i t i o n , etc,；
$14 568 965 for e n v i r o n m e n t a l s a n i t a t i o n , w h i c h inçludes w a t e r supply s e r v i c e s , sewage d i s p o s a l , a n i m a l h e a l t h , etc.; $3 961 818 for additional services; $10 101 140 for the health systems p r o g r a m m e and $3 839 058 for the d e v e l o p m e n t of h u m a n r e s o u r c e s .
Budget of the W o r l d H e a l t h O r g a n i z a t i o n for the R e g i o n of the A m e r i c a s for 1977
T h e C o u n c i l r e v i e w e d and took n o t e of the changes in the b u d g e t estimates of the W o r l d H e a l t h O r g a n i z a t i o n for the R e g i o n of the A m e r i c a s for 1977 w h i c h h a v e o c c u r r e d since prepara- tion of W H O O f f i c i a l R e c o r d s No> 220， as r e f l e c t e d in РАНО O f f i c i a l D o c u m e n t 134 and s u m m a r i z e d in document CD23/7 (Resolution I I I ) .
O t h e r financial a n d a d m i n i s t r a t i v e decisions
T h e C o u n c i l took n o t e (Resolution VI) of the F i n a n c i a l R e p o r t of the D i r e c t o r and the R e p o r t of the E x t e r n a l A u d i t o r for fiscal year 1974 (Official D o c u m e n t 135)； e s t a b l i s h e d the assessments of the M e m b e r G o v e r n m e n t s and participating G o v e r n m e n t s of РАНО for 1976
(Resolution II)； c o n s i d e r e d the r e p o r t on the c o l l e c t i o n of q u o t a contributions from M e m b e r G o v e r n m e n t s ( R e s o l u t i o n V)； and fixed a new level for the salary of the Director of the Pan A m e r i c a n S a n i t a r y B u r e a u (Resolution X X ) • It also took n o t e of the amendments to the Staff R u l e s of the Pan A m e r i c a n S a n i t a r y Bureau (Resolution X I X ) , and of the report of the D i r e c t o r on buildings and i n s t a l l a t i o n s , expressing s a t i s f a c t i o n w i t h the progress m a d e in the
construction of the Z o n e V O f f i c e in B r a s i l i a , B r a z i l , and thanking the G o v e r n m e n t of Peru for its important c o n t r i b u t i o n s to the m a i n CEPIS b u i l d i n g and its annexes in L i m a (Resolution X I I ) • A c t i v i t i e s of the E x e c u t i v e C o m m i t t e e
A f t e r examining the A n n u a l R e p o r t of the Chairman of the E x e c u t i v e Committee on the w o r k of the Committee from O c t o b e r 1974 to the p r e s e n t , during w h i c h period the 73rd and 74th m e e t i n g s w e r e h e l d , the D i r e c t i n g Council commended the C h a i r m a n and the m e m b e r s of the
C o m m i t t e e for t h e i r e x c e l l e n t w o r k ( R e s o l u t i o n I V ) . D i s c u s s i o n s d u r i n g t h o s e M e e t i n g s
i n d i c a t e d a w i l l i n g n e s s and d e s i r e o n the p a r t of t h e D i r e c t o r of PASВ a n d the C o m m i t t e e that the l a t t e r s h o u l d p l a y a m o r e a c t i v e r o l e in d e t e r m i n i n g the p o l i c i e s a n d p r o g r a m m e s of the O r g a n i z a t i o n . T h e f u n c t i o n s of the C o m m i t t e e w e r e e x a m i n e d b y the C o u n c i l , w h i c h w e l c o m e d t h e two a d d i t i o n a l m e m b e r s d e s i g n a t e d b y the C o m m i t t e e to a t t e n d the m e e t i n g s of the D i r e c t i n g C o u n c i l , w i t h a v i e w to p a r t i c i p a t i n g a c t i v e l y in t h e m a n d p r o v i d i n g a n y o r i e n t a t i o n w h i c h m i g h t b e n e c e s s a r y ( R e s o l u t i o n X X V I I I ) . T h e E x e c u t i v e C o m m i t t e e w a s a l s o u r g e d , as p a r t of i t s c o n s t i t u t i o n a l f u n c t i o n s , to s e e k c o n c r e t e w a y s of p a r t i c i p a t i n g m o r e f u l l y w i t h the D i r e c t o r a n d h i s staff in a n a l y s i n g the m a i n s e c t o r s of p o l i c y , p r o g r a m m e s , a n d a s p e c t s of s p e c i a l i m p o r t a n c e , i n c l u d i n g n e w a p p r o a c h e s .
T h e C o m m i t t e e w a s also r e q u e s t e d to u n d e r t a k e s u c h s t u d i e s and e v a l u a t i o n s as it m i g h t d e e m n e c e s s a r y to i m p r o v e the w o r k o f the O r g a n i z a t i o n .
T h e G o v e r n m e n t s of B a h a m a s , C o l o m b i a a n d C o s t a R i c a w e r e e l e c t e d to the E x e c u t i v e C o m m i t t e e for a p e r i o d of t h r e e y e a r s o n t h e t e r m i n a t i o n of t h e p e r i o d s of o f f i c e of H a i t i , M e x i c o a n d P a n a m a ( R e s o l u t i o n X V )。
P r e s e n t a t i o n to Dr A b r a h a m H o r w i t z， D i r e c t o r E m e r i t u s of PASВ
D u r i n g t h e 8th p l e n a r y s e s s i o n , the p r e s e n t a t i o n t o o k p l a c e to D r H o r w i t z , D i r e c t o r E m e r i t u s of P A S B , of a p a r c h m e n t c o n f i r m i n g this a p p o i n t m e n t a n d a g o l d m e d a l b e a r i n g t h e w o r d s : " A b r a h a m H o r w i t z , D i r e c t o r of the P a n A m e r i c a n S a n i t a r y B u r e a u 1 9 5 9 - 1 9 7 5 - in
r e c o g n i t i o n of his w o r k on b e h a l f of the h e a l t h of t h e C o n t i n e n t1 1,
D r Acuiîa, D i r e c t o r of P A S B , s t r e s s e d s o m e of the o u t s t a n d i n g a s p e c t s of the e x c e l l e n t w o r k d o n e b y D r H o r w i t z during h i s p r o f e s s i o n a l c a r e e r , w h i c h h e c o m m e n c e d as a p h y s i c i a n a n d
e d u c a t i o n i s t in C h i l e , his c o u n t r y of o r i g i n , w h e r e h e d i s t i n g u i s h e d h i m s e l f in the a c a d e m i c w o r l d as P r i n c i p a l of the P u b l i p H e a l t h S c h o o l of t h e U n i v e r s i t y of C h i l e a n d as A s s i s t a n t D i r e c t o r i n the N a t i o n a l H e a l t h S e r v i c e .
D r A c u n a said： "We all k n o w the w o r k d o n e b y Dr H o r w i t z at the h e a d of the Pan A m e r i c a n S a n i t a r y 'Bureau, w o r k w h i c h w i l l r e m a i n as a l a s t i n g a n d s h i n i n g e x a m p l e of d e v o t e d e f f o r t in t h e s e r v i c e of the h e a l t h of t h e p e o p l e s of t h e A m e r i c a s .
"As s o o n as h e r e t i r e d f r o m the O r g a n i z a t i o n Dr H o r w i t z d e v o t e d h i m s e l f to a t h o r o u g h s t u d y of a p r o b l e m w h i c h h a d long i n t e r e s t e d h i m : m a l n u t r i t i o n . T h i s s u b j e c t is o n e of g r e a t i m p o r t a n c e for t h e r e a l i z a t i o n of the a s p i r a t i o n s of the c o u n t r i e s of the C o n t i n e n t a n d I am g l a d to k n o w t h a t it is b e i n g a n a l y s e d b y an e x p e r t of the c a l i b r e of D r H o r w i t z •
" D r H o r w i t z , w e w i s h y o u e v e r y s u c c e s s i n this a n d any o t h e r a c t i v i t i e s y o u m a y u n d e r t a k e a n d w e t h a n k y o u for a l l y o u h a v e d o n e for o u r O r g a n i z a t i o n a n d the p e o p l e s of t h e A m e r i c a s1 1.
A f t e r r e c e i v i n g the p a r c h m e n t a n d the m e d a l from t h e P r e s i d e n t of t h e C o u n c i l , Dr H o r w i t z e x p r e s s e d h i s g r a t i t u d e , s a y i n g : "who c o u l d r e m a i n u n m o v e d o n s e e i n g h i s e f f i g y o n a m e d a l d u r i n g h i s l i f e t i m e and r e c e i v i n g t h e t r i b u t e of t h o s e r e p r e s e n t i n g t h e p e o p l e s h e l o v e s , r e s p e c t s a n d h a s servedi For that r e a s o n a l o n e , this c e r e m o n y w o u l d c a l l for m y g r a t i t u d e " • D r H o r w i t z p u t f o r w a r d v a r i o u s i d e a s and o b s e r v a t i o n s o n the h e a l t h s i t u a t i o n a n d its p r o b l e m s b o t h i n the A m e r i c a s a n d all o v e r t h e w o r l d , m e n t i o n i n g , a m o n g o t h e r p o i n t s , t h a t h u m a n
b e i n g s h a v e c o m e to b e the f u n d a m e n t a l f a c t o r in e c o n o m i c d e v e l o p m e n t a n d w e l l b e i n g .
R e f e r r i n g to m a l n u t r i t i o n , h e m e n t i o n e d its s e r i o u s c o n s e q u e n c e s a l r e a d y i n p r e g n a n c y , w i t h p o s s i b l e i m p a i r m e n t of the m i n d , l e a r n i n g c a p a c i t y and b e h a v i o u r of t h e c h i l d leading to p o o r s c h o o l p e r f o r m a n c e a n d lower p r o d u c t i v i t y of t h e a d u l t , all this w i t h the a c c o m p a n y i n g q u o t a of a c t u a l a n d living d e a t h s。 H e said t h a t , if w e a g r e e that the m o s t u r g e n t t a s k o f the w o r l d t o d a y is to r e d u c e w a n t a n d that that is the task to w h i c h g o v e r n m e n t s a n d i n t e r n a t i o n a l o r g a n i z a t i o n s s h o u l d g i v e p r i o r i t y a t t e n t i o n , then the r o l e of РАНО a n d W H O b e c o m e s of p a r t i c u l a r s i g n i f i c a n c e .
H e a g a i n t h a n k e d t h e M i n i s t e r s a n d D e l e g a t e s for t h e i r r e c o g n i t i o n of w o r k w h i c h , h e s a i d : "is to the c r e d i t of a l l the M e m b e r s of P A S B , a n d W H O , as w e l l as the o f f i c i a l s of your G o v e r n m e n t s , p a r t i c u l a r l y t h o s e w i t h s e e m i n g l y m o r e m o d e s t f u n c t i o n s . T h e s u c c e s s of h e a l t h
as a social action calls for a m i x t u r e of k n o w l e d g e , t e c h n i q u e s , w i s d o m and f e e l i n g . I t r u s t , and fervently d e s i r e , that the great progress m a d e in your countries over the last 16 years w i l l spread u n t i l it reaches every i n h a b i t a n t , both today and in the f u t u r e . T h e longer this a d v a n c e continues the greater w i l l be m y m o r a l s a t i s f a c t i o n " •
H e a l t h services for the rural and u n d e r s e r v e d p o p u l a t i o n
T h e need to encourage the p r o v i s i o n and expansion of integrated h e a l t h services in order to m e e t the needs of all the peoples and give r e c o g n i t i o n to their fundamental rights w a s considered b y the C o u n c i l , as it already had been by the W o r l d H e a l t h A s s e m b l y . This n e e d , w h i c h also includes the attainment of the goals of the T e n - Y e a r Health Plan for the A m e r i c a s , led the Council to r e q u e s t PASВ (Resolution X X I ) to give the h i g h e s t p r i o r i t y to the expansion of health services designed to provide total c o v e r a g e , in k e e p i n g w i t h the life patterns and needs of the communities served, at the same time promoting direct c o m m u n i t y i n v o l v e m e n t in local health a c t i v i t i e s . G o v e r n m e n t s w e r e urged to m a k e explicit in their health programmes the decision to expand and improve rural health services and u s e all the possible m a n p o w e r resources of the community served through continuous efforts to train p r o f e s s i o n a l , technical and auxiliary p e r s o n n e l in a c c o r d a n c e w i t h local n e e d s . G o v e r n m e n t s w h i c h had already initiated programmes should share w i t h other countries information and e x p e r i e n c e on the progress m a d e or alternative procedures u s e d , in collaboration w i t h P A S B . G o v e r n m e n t s w e r e also requested to promote effective coordination w i t h those other components of socioeconomic development that are intimately related to the w e l l b e i n g of the rural p o p u l a t i o n .
International W o m e n ' s Year
T h e o b j e c t i v e of the International W o m e n ' s Year (1975) is to p r o m o t e equality as w e l l as to change traditional attitudes and to integrate w o m e n into the d e v e l o p m e n t a l p r o c e s s ,
especially through greater participation in p l a n n i n g , deciding and implementing the p o l i c y a d o p t e d .
T h e Council u r g e d Governments (Resolution X ) to assign h i g h p r i o r i t y to the p r o m o t i o n and protection of w o m e n1 s h e a l t h , together w i t h employment and educational o p p o r t u n i t i e s , and particularly to m e e t i n g their needs in the rural a r e a s , in order to ensure their o w n w e l f a r e and that of their f a m i l i e s . ]T h e Council also urged them to give high p r i o r i t y to the
inclusion of w o m e n in planning, d e c i s i o n - m a k i n g , execution and evaluation of h e a l t h programmes at all levels and to promote increased participation by w o m e n in the m e e t i n g s of the G o v e r n i n g Bodies of the O r g a n i z a t i o n . T h e Council recommended the Director to e n c o u r a g e greater
participation by w o m e n in the h e a l t h sector, including increased r e p r e s e n t a t i o n at the decision- m a k i n g levels in P A S B .
Health and youth
T h e health of the young people of the Region merits special attention because of their increasing n u m b e r s , the characteristics acquired by the pathology of youth during the develop- m e n t p r o c e s s , and the capacity of young people to promo te h e a l t h and social w e l f a r e activities for their own benefit and that of the family and the c o m m u n i t y . For this reason the C o u n c i l endorsed R e s o l u t i o n VIII of the 74th M e e t i n g of the E x e c u t i v e C o m m i t t e e on h e a l t h and youth and the priority w h i c h the Governments should assign to the health care of young p e o p l e . It also recommended to the Governments that they establish a diagnosis of h e a l t h conditions of the youth in their countries w i t h a view to initiating a p p r o p r i a t e programmes for the promotion of the health of young p e o p l e . T h e C o u n c i l thanked the D i r e c t o r for the i n f o r m a t i o n supplied and instructed h i m to prepare an intersectoral action plan for the purpose of promoting the technical and financial assistance of international a g e n c i e s , g o v e r n m e n t a l and n o n g o v e r n m e n t a l , and of national institutions w i s h i n g to participate in this important task (Resolution X I V ) . Sixth General Programme of W o r k of W H O for the Period 1978-1983
T h e Council approved (Resolution X V I I I ) the report of the Director on the Contribution of the Region of the Americas to the Sixth G e n e r a l Programme of W o r k of W H O for 1978-1983 and requested the Director to transmit it to the D i r e c t o r - G e n e r a l of WHO so that h e m i g h t take it into account in preparing the above-mentioned P r o g r a m m e ,
A t the s a m e t i m e , t h e C o u n c i l c o n f i r m e d that t h e p r i o r i t y o b j e c t i v e s p r o p o s e d b y the R e g i o n of the A m e r i c a s for the P r o g r a m m e w e r e i d e n t i c a l w i t h t h e p r i o r i t y a r e a s of the T e n - Y e a r H e a l t h P l a n for the A m e r i c a s .
I n t h a t p l a n t h e M i n i s t r i e s ó f h e a l t h r e c o g n i z e d as a f u n d a m e n t a l o b j e c t i v e the e x t e n s i o n of t h e c o v e r a g e of t h e h e a l t h s e r v i c e s , g i v i n g p r i o r i t y to the c o n t r o l of c o m m u n i c a b l e d i s e a s e s , m a t e r n a l a n d c h i l d h e a l t h , n u t r i t i o n a n d e n v i r o n m e n t a l i m p r o v e m e n t . T h e C o u n c i l a g a i n u r g e d M e m b e r G o v e r n m e n t s to i n c r e a s e t h e i r e f f o r t s to a c h i e v e c o v e r a g e b y t h e s e s e r v i c e s , p o i n t i n g o u t t h a t in this e n d e a v o u r the m a x i m u m u s e s h o u l d b e m a d e of the a v a i l a b l e a n d p o t e n t i a l r e s o u r c e s t h r o u g h p r o g r a m m i n g , e v a l u a t i o n a n d i n f o r m a t i o n , i n t e r n a l c o o r d i n a t i o n of the c o m p o n e n t s of the h e a l t h s e c t o r , t h e u s e of m u l t i s e c t o r a l a p p r o a c h e s , a n d a n a l y s i s of f i n a n c i n g .
C o m m u n i c a b l e a n d n o n - c o m m u n i c a b l e d i s e a s e s M a l a r i a
W h e n e x a m i n i n g t h e X X I I I R e p o r t of the D i r e c t o r o n the s t a t u s of m a l a r i a e r a d i c a t i o n i n t h e A m e r i c a s , the C o u n c i l b o r e in m i n d t h e r e s o l u t i o n s of the G o v e r n i n g B o d i e s of PASВ a n d R e s o l u t i o n W H A 2 8 . 8 7 of t h e 2 8 t h W o r l d H e a l t h A s s e m b l y o n that s u b j e c t , as w e l l as the
r e c o m m e n d a t i o n s a p p r o v e d b y the D i r e c t o r s o f the N a t i o n a l M a l a r i a E r a d i c a t i o n S e r v i c e s of the Americas in Quito, Ecuador, in April 1975. Concern was expressed regarding the financial d i f f i c u l t i e s t h a t c o n f r o n t c e r t a i n c o u n t r i e s in d e v e l o p i n g their a n t i - m a l a r i a p r o g r a m m e s as w e l l as t h e d e t e r i o r a t i o n of the e p i d e m i o l o g i c a l s i t u a t i o n of m a l a r i a in s o m e c o u n t r i e s • T h e Council recommended to the Governments and to the D i r e c t o r ( R e s o l u t i o n XXII) that they p r o m o t e the development of malaria control methodologies better adapted to the epidemiological and e c o n o m i c c o n d i t i o n s in e a c h c o u n t r y . PASВ s h o u l d i n c r e a s e its c o o p e r a t i o n w i t h those g o v e r n m e n t s w h i c h r e q u e s t i t . F u r t h e r m o r e , t h e G o v e r n m e n t s s h o u l d t a k e steps to f a c i l i t a t e t h e p r o c u r e m e n t a n d e n s u r e t h e t i m e l y s u p p l y of e q u i p m e n t a n d m a t e r i a l s for the e f f i c i e n t c o n d u c t of the p r o g r a m m e • T h e D i r e c t o r w a s a u t h o r i z e d to c o n v e n e a c o o r d i n a t i o n m e e t i n g w i t h i n t e r n a t i o n a l , b i l a t e r a l l o a n a n d t e c h n i c a l a s s i s t a n c e a g e n c i e s in o r d e r to s t u d y the
p o s s i b i l i t i e s of f i n a n c i n g m a l a r i a p r o g r a m m e s . A e d e s a e g y p t i s i t u a t i o n i n t h e A m e r i c a s
A f t e r c o n s i d e r i n g t h e r e p o r t o n t h e A e d e s a e g y p t i s i t u a t i o n i n the R e g i o n , a n d n o t i n g that t h e S c i e n t i f i c A d v i s o r y C o m m i t t e e o n D e n g u e h a d b e e n e x p a n d e d to i n c l u d e e x p e r t s o n y e l l o w f e v e r a n d A e d e s a e g y p t i， t h e C o u n c i l r e q u e s t e d the D i r e c t o r ( R e s o l u t i o n X X I I I ) to e n t r u s t the s a i d C o m m i t t e e w i t h a s t u d y of t h e p r e s e n t A e d e s a e g y p t i s i t u a t i o n i n the A m e r i c a s a n d a r e v i e w of t h e p r e s e n t РАНО p o l i c y i n the l i g h t of t h e r e c e n t s c i e n t i f i c a d v a n c e s i n t h e c o n t r o l of y e l l o w f e v e r and d e n g u e a n d the r e i n f e s t a t i o n w i t h A e d e s r e p o r t e d b y s e v e r a l c o u n t r i e s w h i c h h a d p r e v i o u s l y a c h i e v e d e r a d i c a t i o n .
N o n - c o m m u n i c a b l e d i s e a s e s
A s a r e s u l t of c o n t r o l of c o m m u n i c a b l e d i s e a s e s , i n c r e a s e s r e c o r d e d in life e x p e c t a n c y at b i r t h a n d e n v i r o n m e n t a l c h a n g e s , c a r d i o v a s c u l a r d i s e a s e s , d i a b e t e s m e l l i t u s a n d c a n c e r are a m o n g t h e p r i n c i p a l c a u s e s of death» N e v e r t h e l e s s , m a n y c o u n t r i e s h a v e n o t yet f o r m u l a t e d d e f i n i t e p o l i c i e s i n r e g a r d to p r o g r a m m e s for the c o n t r o l of these d i s e a s e s , d e s p i t e the
g o a l s c o n t a i n e d in t h e T e n - Y e a r H e a l t h P l a n , In v i e w of this s i t u a t i o n , the C o u n c i l r e q u e s t e d t h e D i r e c t o r to c o l l a b o r a t e w i t h t h e c o u n t r i e s in e p i d e m i o l o g i c a l s t u d i e s e n a b l i n g them to d e f i n e t h e e x t e n t of the p r o b l e m ( R e s o l u t i o n X X I V ) . T h e B u r e a u s h o u l d p r o m o t e a n d c o o r d i n a t e i n t e r - c o u n t r y p r o g r a m m e s , its s p e c i f i c c o m m u n i t i e s a n d on r e s t r i c t e d s c a l e , w i t h a v i e w to d e m o n s t r a t i n g t h e f e a s i b i l i t y a n d e f f e c t i v e n e s s of e p i d e m i o l o g i c a l s t u d i e s a n d p r e v e n t i v e and t h e r a p e u t i c m e a s u r e s . F u r t h e r m o r e , t h e C o u n c i l r e c o m m e n d e d to t h e G o v e r n m e n t s that they e s t a b l i s h n o n - c o m m u n i c a b l e d i s e a s e t e c h n i c a l u n i t s w i t h a v i e w to p r o g r a m m i n g a n d c o o r d i n a t i n g c o n t r o l a c t i v i t i e s at n a t i o n a l l e v e l .
Foot-and-mouth disease and zoonoses control
The Council noted the Final Report of the VIII Interamerican Meeting on Foot-and-Mouth Disease and Zoonoses Control and thanked the Ministers of Agriculture for their efforts to improve the health of the peoples of the Americas through the control and prevention of those diseases。 The Council also expressed appreciation to the Ministers of Agriculture for their willingness to contribute voluntarily as partial remedial assistance to the financial problems being experienced by the Panamerican Foot-and-Mouth Disease and Zoonoses Centres. It also supported the requests made by Governments to the IDB for financial assistance to the Centres so as to enable them to continue or expand the technical assistance they give to the countries for the control of diseases of human and animal health importance0
Technical discussions
In Resolution XXXI the Directing Council took note of the Final Report of the Technical Discussions on "Methodologies for the Formulation of National Food and Nutrition Policies and Their Intersectoral Implementation" held during the current M e e t i n g . It was recognized that there had been no substantial improvement in regard to the problems of food and nutrition in the Region despite the efforts of the Governments, and that they might even grow worse as a result of the instability of world economy。 The problem is bound up with many causal factors directly related to the production, consumption and biological use of foods.
The Council recommended to the Member Governments that they intensify their efforts for the formulation and implementation of national food and nutrition policies and recommended to the M i n i s t e r s of H e a l t h that they s t r e n g t h e n t e c h n i c a l n u t r i t i o n s e r v i c e s a t the c e n t r a l l e v e l and increase those at the intermediate and local level, as integral part of general health activities. The Council requested the Director to intensify technical assistance to the countries for establishing nutritional vigilance systems and training personnel in nutrition.
In another decision on the Technical Discussions (Resolution XXVII) the Council agreed with the Executive Committee that the Technical Discussions had an intrinsic and significant value in the development of the programmes of the Organization, and consequently resolved to c o n t i n u e h o l d i n g them at each Meeting of the C o n f e r e n c e or the C o u n c i l . The D i r e c t i n g C o u n c i l n o t e d w i t h s a t i s f a c t i o n the s t u d y , the documents and t h e recommendations of the E x e c u t i v e Committee which i t i n s t r u c t e d to c o n t i n u e to study the matter thoroughly。
A s concerns the Technical Discussions to be held during the XXIV Meeting of the Directing Council of РАНО, XXVIII Meeting of the Regional Committee of WHO for the Americas, the Council selected the topic "Development of the health service infrastructure with due regard to the need for extension of coverage" (Resolution XXVI)•
N u r s i n g
The Council examined the report on the situation of nursing personnel resources and their preparation and absorption into the health services. It recommended Governments to make more adequate estimates of nursing personnel and to carry out more effective planning and implemen- tation for their provision and absorption into the services through: (a) the establishment of mechanisms that result in effective coordination of health, education and economic activities;
(b) the creation of ал appropriate system of information on availability in the nursing
services; (c) the preparation of nursing personnel with the capacity to produce, in turn, the category and quantity of nursing personnel resources needed, and (d) the creation of posts for absorbing the graduates of all programmes.
O t h e r r e s o l u t i o n s
РАНО Award for Administration, After considering the Report of the Award Committee of the РАНО Award for Administration, the Council declared M r Dennis Sanchez Acutta of Costa Rica the winner of the 1975 A w a r d , for his work in the field of administrative systems of health programmes in his country (Resolution IX)• The purpose of the Award is to encourage better administrative management and to promote a high level of competence in health service
administration.
Text books and medical instruments programmée The Council expressed its satisfaction at the progress m a d e to date in these programmes, it emphasized the need to expand them so as to serve the greatest possible number of students, and requested the Director to continue
negotiations with the Interamerican Development Bank and explore all other potential sources of financing (Resolution XIII)•
Evaluation of the Ten-Year Health Plan for the A m e r i c a s , It was recognized that the participation of all the countries was essential if the evaluation of the Ten-Year Health Plan for the Americas was to have real m e a n i n g , and the Council consequently requested those
countries that had not yet been able to establish the initial frame of reference to forward the n e c e s s a r y information to РАНО as soon as possible. The Council also requested the Director to assist the countries at their request and to take steps to systematize and analyse this information and distribute the results of these operations in the first quarter of 1976 (Resolution X X X ) .
Meetings of the Directing Council, After considering the report of the Working Group set u p to study the possibility of reducing the length of Meetings of the Directing Council, it was decided to request the Director to prepare a study of the constitutional, statutory and
financial implications of each of the measures suggested and any others that are deemed appropriate for shortening the number of days of Directing Council sessions. The topic will be included in the agenda of the 76th Meeting of the Executive Committee, which will examine this matter and submit its final recommendations to the next Meeting of the Directing Council (Resolution X V I ) .
N o t e was taken of the kind invitation of the Government of Mexico to hold the XXIV M e e t i n g of the Directing Council, XXVIII Meeting of the Regional Committee of WHO for the A m e r i c a s , in Mexico。 The Council thanked the Mexican Government for its invitation, which it accepted w i t h pleasure (Resolution XXV)。
PAN AMERICAN HEALTH
ORGANIZATION
WORLD HEALTH ORGANIZATION
XXIII Meeting
Washington, D . C . September-October 1975
XXVII Meeting ANNEXE I
ANNEX I ANEXO I
CD23/2, R e v . 2 7 October 1975 7 octubre 1975 7 octobre 1975
LIST LISTA LISTE
OF PARTICIPANTS DE PARTICIPANTES DES PARTICIPANTS
ARGENTINA ARGENTINE
Representative 一 Representante - Représentant
D r . Pedro Rolan Yáñez
Director General de los Servicios Sociales del Congreso de la Nación
Buenos Aires
Adviser - Asesor - Conseiller
D r . Raül Charles Leon
Jefe de Relaciones Sanitarias Internacionales Secretaría de Estado de Salud Pública
Buenos Aires
BAHAMAS
Representative 一 Representante - Représentant
M r s . Margaret E. McDonald Permanent Secretary
Ministry of Health N a s s a u , New Providence
Alternate - Suplente - Suppléant
D r . Henry Podlewski
Acting Chief Medical Officer Ministry of Health
Nassau， New Providence
BARBADOS LA BARBADE
Representative 一 Representante • Représentant
The H o n . D r . L . Erskine Sandiford Minister of Health and Welfare Ministry of Health and Welfare Bridgetown
Alternates - Suplentes - Suppléants
M r . Alwyn S . Howell Permanent Secretary
Ministry of Health and Welfare Bridgetown
D r . Jean Lenore Harney Chief Medical Officer
Ministry of Health and Welfare Bridgetown
BOLIVIA BOLIVIE
Representative 一 Representante - Représentant
Cne 1. San. DAEM Joree Torres Navarro Ministro de Prevision Social y
Salud Publica
Ministerio de Prevision Social y Salud Publica
La Paz
Alternate - Suplente - Suppléant
D r . Luis Alberto Valle Ureña Jefe Médico de la Caja Petrolera
Paraestatal La Paz
BRAZIL BRASIL BRESIL
Representative - Representante - Représentant
D r . Paulo de Almeida Machado Ministro de Estado da Saude Ministerio de Saude
Brasilia, D.F.
Alternates 一 Suplentes - Suppléants
D r . Osvaldo Lopes da Costa
Director do Instituto Presidente Castello Branco
Ministerio da Saude Río de Janeiro, GB
D r . Sergio Raymundo Negrao de Souza Franco Chefe de Gabinete do Ministro da Saude Ministerio da Saude
Brasilia, D . F .
CANADA
Representative 一 Representante - Représentant
D r . Arnold J. de Villiers Director General
International Health Services
Department of National Health and Welfare Ottawa, Ontario
Alternate 一 Suplente - Suppléant Dr. W . G . Bruce Casselman
Senior Medical Adviser
International Health Services
Department of National Health and Welfare Ottawa, Ontario
Advisers - Asesores - Conseillers
D r . Michel Careau
First Secretary and Alternate Permanent Observer Mission of Canada to the Organization
of American States Washington, D . C.
D r . D . G. Chapman
Assistant Director General Foods Directorate
Department of National Health and Welfare Ottawa, Ontario
CHILE CHILI
Representative 一 Representante - Représentant
Dr. Luis Givovich
Viceministro de Salud Pública Ministerio de Salud Publica
Santiago
Alternate - Suplente - Suppléant
Srta, Cecilia Gallardo
Segundo Secretario de la Delegación de Chile ante la OEA
Washington, D.C.
COLOMBIA COLOMBIE
Representative 一 Representante - Représentant
D r . Haroldo Calvo Nuñez Ministro de Salud Pública Ministerio de Salud Pública Bogotá
Alternate 一 Suplente - Suppléant
Dr. Gustavo Mora
J e f e , Oficina de Relaciones Internacionales Ministerio de Salud Publica
Bogotá
COSTA RICA
Representative - Representante - Représentant
Dr. Hermán Weinstok W . Ministro de Salud Ministerio de Salud
San José
Alternate - Suplente 一 Suppléant Dr. Lenin Saenz Jimenez
Director de la Unidad Sectorial de Planificaci6n de la Salud Ministerio de Salud
San José
CUBA
Representantive 一 Rep res en tan te - Représentant D r . José Otero Molina
Viceministro Primero
Ministerio de Salud Pdblica La Habana
Alternates - Suplentes - Suppléants
D r . Ramon Martínez Rodríguez
Epidemiólogo, Dirección Nacional de Epidemiología
Ministerio de Salud Publica La Habana
L i c . Elíseo Zamora Hernández
Dirección de Organismos y Conferencias Internacionales
Ministerio de Relacionès Exteriores La Habana
Advisers 一 Asesores 一 Conseillers
Lic. Jesus Zenen Buergo Concepción
Primer Secretario de la Misión Permanente de Cuba ante las Naciones Unidas
New York, N . Y .
Sr. Julio Cubría Peregrino
Segundo Secretario de la Misión Permanente de Cuba ante las Naciones Unidas
New York, N.Y-
DOMINICAN REPUBLIC REPUBLICA DOMINICANA REPUBLIQUE DOMINICAINE
Representative 一 Representante - Représentant
Dr• Marco A . de Peña
Representante Permanente de la República Dominicana ante la OEA
Washington, D . C .
Alternate 一 Suplente - Suppléant
D r . Luis Raul Betances
Representante Permanente Alterno de la República Dominicana ante la OEA
Washington, D . C .
