regional committee
PAN AMERICAN
WORLD
)s)
SANITARY
HEALTH
\*,,~2 /ORGANIZATION
ORGANIZATION
IX Meeting VIII Meeting
Antigua Guatemala September 1956
CD9/16
(
16 August 1956 ORIGINAL: SPANISH
Topic 25: FINANCIAL RESOURCES OF THE PAN AMERICAN SANITARY ORGANIZATION
REPORT OF THE RAPPORTEUR DESIGNATED BY RESOLUTION IV OF THE 28th MEETING
OF THE EXECUTIVE COmmfITTEE
I take pleasure in presenting the following general statement on "Financial Resources of the Pan American Sanitary Organization," in compliance with Resolution IV of the 28th Meeting of the Executive
Committee, approved at the eighth plenary session held on 8 June 1956 in the International Conference Suite of the Department of State of the United States Government, Washington, D.C.
1. General Considerations
The above-mentioned resolution was the outcome of a detailed analysis made by the Executive Committee, in plenary session, of the Proposed Program and Budget of the Organization for 1957 (Official Documents No. 12 and Document CE28/8) submitted by the Director of the Bureau for consideration by the Committee, pursuant to Article 12-C of
the PASO Constitution.
In examining the topic before us, it is fitting to point out the close relation that exists between the concept of program and the concept of budget. The program, as such, represents the future plans and projects of the Organization, whereas the budget contains the appropriations re-quired to carry out the program. This relation gives rise to two distinct methods of work, which we shall describe briefly here.
Theoretically, the program of activities to be carried out by the
PASO should be planned solely on the basis of the importance of the
Organization in the international field and of the fundamental objectives
it pursues. Planning of this kind would cover the basic projects to be undertaken in all parts of the Continent, with priorities assigned accord-ing to the importance and urgency of the different activities, and would certainly include the over-all programs of eradication, which the PASO, under continental and world-wide agreements, has pledged itself to carry
out, replacing the classic system of control followed in the past.
Page 2
This approach to planning would mean that the health experts would draw up a proposal for an over-all program of public health,
independently of the financial implications. The latter would be dealt with by another group of experts in finance and economics, who would make the evaluation of the program. The evaluation would have
to include not only the direct costs of carrying out all phases of the program but also the administrative and operational costs of all
serv-ices needed for the execution of the work. The sum of the two evaluation figures would represent the total amount of the budget, which would thus have been properly and soundly calculated. In other words, it is possible first to study, analyze, and draft a given program and then to consider what financial resources are needed to execute it.
The second method represents the opposite approach. First, a study is made of the available resources, taking into.account all sources of income, and then the amount of money to be.invested is de-termined. It is then decided what kind of program can be undertaken with that amount. In short, the services to be rendered are determined according to the amount of funds available to pay for them. According to this method one starts from the money available and arrives at the program, while according to the first method one starts from the estab-lished program and arrives at the amount required to carry it out.
2. Member Government Contributions to PASO
The Pan American Sanitary Bureau, in its early history, limited its activities to the exchange of information, to giving advisory
services, and to outlining field practices in matters of public health. Even in that initial period the Bureau achieved a brilliant record of accomplishments in the Continent, through the efforts of a number of outstanding representatives who, despite financial.limitations, worked with perseverance and courage, facing such great health problems as bubonic plague and other scourges.
After these early years, and after consolidating its initial efforts, the Bureau embarked on a new phase under the leadership of Dr. Hugh S. -Cumming, that distinguished figure of the.United States Public Health Service who lent his prestige and devoted service to the
Pan American health agency. Meanwhile, however, the Bureau continued to occupy but a few small rooms in the building of the Pan American Union.
Consolidated as an instrument of international public law, the Pan American Sanitary. Organization, at the XII Pan American Sanitary Conference (11-24 January 1947), was given new form and impetus. At that time the Bureau came under the leadership of Dr. Fred L. Soper who, as its Director, charted the course to be followed. The
CD9/16 (Eng.) Page 3
All the American republics form part of PASO, and the Pan American Sanitary Conference is the supreme public health forum in the Hemisphere. The Directing Council of PASO is the representative body of the Conference and is fully empowered to act for it. The Executive Committee, a permanent organ of the Council comprising one third of the Member Governments, is the body that sets in motion the resolutions and decisions of the Conference and of the Council. Finally, the Pan American Sanitary Bureau is the permanent, central administrative body charged with putting into practice the decisions of the governing bodies of the Organization.
All this constitutes a system, broad in scope, possessing maximum possibilities, and capable of meeting fully the general public health needs arising in our Hemisphere. With this criterion in mind, an examina-tion was made of PASOts development over the years, and this gave rise to the system of contributions from the Member Governments, a compulsory quota system being established for this purpose. Over a period of years some changes have occurred and the amounts have naturally increased. For. 1956 the figures were:
Country Percentage
-M-r-
Amount Argentina Bolivia Brazil 7.40 0.31 8.02 Chile Colombia-Costa Rica1.82 2 49 0.24 155,400.00 6,510.00 168;420.00 38,220.00 52,290.00 5,040.00 Cuba Dominican Republic Ecuador
E1l Salvador Guatemala Haiti Honduras Mexico Nicaragua Panama Paraguay Peru 1.82 0.31 0.24
38, ?20.00 6,510.00 5,040.00 0.37 0.43 0.24 7,770.00 9,030.00 5,040.00 0.24 4.86 0.24 5,040.00 102,060.00 5,040.00 0.31 0.24-1.09 6,510.00 5,040.00 22,890.00 United States Uruguay Venezuela
Contributions on behalf of the France
Netherlands United Kingdom
66.00 1.09 -2.24
territories 100.00
territories of:
1,386,000.00 22,890.00 47,040o.00
$,2,100,OO.00
$ 5,044.00
Page 4
It does not matter that,- because of different circumstances,. some delay occurs in the payment of these quotas;' the fact is, the percentage..':
of quota collections has increased considerably and the, very efficient system of tthe Working Capital Fund provides the necessary financial reserve t'o guarantee contiinuation of the work of PASO.
.-n..All these.measures strengthened the Organization internationally,. and 'when at the San :Franc.isco Conference the plan.was put forward to set.. up a world agency for public health, on a motion presented by Drs. Szeming Sze. and Paula..Souza,. the.. representatives of China and Brazil, the PASB already had. 'aUn outstanding record behind it --, one that -.later. enabled it',.. to stave off the attacks: of. those who,' during the.-International--Health Conference (New, York, '19 June-22-July'1946), sought to put an end to the .Bureau' s gallant 'histor. ....
Without dwell:in -g further on what happened at,that New York meeting, we shall recal' that ''the PASO,' by virtue of the agreement of 24 May -1949 with the WHO, took charge of the public health activities of that organiza-tion in the Americas and since that time has served as the Regional
Committee of the WHO for the Western Hemisphere. In this capacity, the PASO receives a portion of the quotas contributed by the governments to the budget -of the WHO. I recently had occasion to take up this matter,. including, the"' origin of the international health agencies and the role played by, ;the Americas in world healith,.in a speech delivered before the National Heal'th Board of Cuba, during the World Health Day celebrations on 7 April 1956 (Annex I).
3. Sources of PASO Income
The PASO derives its principal, income from the annual quota contribu-tions 'of the Member Governmentso
The total quotas for the fiscal year 1955 were $2,100,000; for 1956 they. totalled $2,200,000. These amounts represent the PASO's chief.revenue and serve as the basis for implementing,:the Organization's annual program.· Therefcre, 'the PASO system follows the method that goes from the financial possibilities to the program.
The "second source of income is the contribution from the WHO, which. in the bu'dget appears under the column "World Health Organization." The -WHO, which also derives its income from Member Government quotas, distri-butes-the funds it receives among the rzegions comprising it, in accordance· with the Programs it has been decided to carry out.
Page 5
spread themselves too thin; it has even been denied that health problems are in themselves sufficiently important to be included among those given priority in a technical assistance program looking toward economic ends. Those who held such an erroneous view never stopped to consider the many diseases that weaken or destroy man's activity and that this activity is the true measure of a nation's economic potential, based on its capacity to produce. A good example is malaria, which causes the loss of thousands upon thousands of man-hours of work, greatly limiting the national
productivity and leading to serious economic.difficulties. *We have taken a disease as an example. Let us now take a country: Venezuela, which offers a perfect case of clear understanding of the economic repercussions of this disease. Venezuela made a thorough statistical study of those re-percussions and organized an extremely active campaign to combat malaria, starting first with the classic measures of control and later achieving a decisive victory under the present system of eradication.
The Expanded Program of Technical Assistance, which originated in the United Nations, specifically in the Economic and Social Council,
is essentially different from the specialized agencies in that it derives its funds from voluntary contributions made by the governments, rather than from annually assessed quotas. Despite the voluntary nature of the contributions, very large sums are collected and these are administered by special bodies (Technical Assistance Conference, Technical Assistance Board, and Technical Assistance Committee), under ECOSOC.
Technical Assistance funds were at first distributed on the follow-ing percentage basis:
FAO (United Nations Food and Agriculture
Organization) 29%
UN (United Nations) 23%
WHO (World Health Organization) 22%
UNESCO (United Nations Educational, .Scientific
and Cultural Organization) 14%
ILO (International Labour Organisation) 11%
ICAO (International Civil Aviation
Organiza-tion) 1%
100%
The 22 per cent allotted to the WHO, therefore, constituted a third source of income for the PASO, as regional organization of the WHO, and the sums received from this source appear in the budget under the column
Page 6
The Technical Assistance contribution to the WHO, which in 1952 amounted to $3,816,000, was reduced'Tin 1953 to $3,575,387 and in 1954 dropped to $3,195,241, reductions which' proportionately affected WHO's contribution'to the programs of PASO, endangering the completion of some and -eliminating the possibility of undertaking new ones., In July 1954, ECOSOC- (Resolution 542 BII-.VIII) approved a new system' of-programs by
countries, and in so doing established a direct relationship'between the governments'and the Technical Assistance representatives, with the con-sequent limitation of WHO's functions and a further reduction of the health activities financed with Technical Assistance funds.
The'risks inherent in this situation and the insecurity to which it gives rise have been the subject of much discussion in the LEkecutive Committee and the Directing Council, and were taken up also at the XIV Pan American Sanitary Conference in Santiago, Chile, in 1954.t The
Director of the Bureau has called attention to the participation of non-technical, predominantly political agencies in the management of funds that are-to be used for .technical activities, such as those to-be al-loted for public health -- an intervention that is-most inadvisable and, to say the least, quite cumbersome.
In the'case of both quota assessments and'voluntary contributions of the governments, the funds come from the countries themselves and we can assert that the best, the most productive, system would be to channel them exclusively through the specialized agencies. This matter was discussed at length at the XIV Pan American Sanitary Conference, when Topic 25 on "Unification of Action in Public Health Programs in the Region of the Americas," was taken up. I take the liberty of recom-mending the reading of Document CSP14/34 and its annex, Document
CE22/16, which contains a chart entitled "Chanhels of Government Funds through International Organizations." Because of the clarity of the statements made and the timely interest of this report, we attach it hereto as Annex II. The Director of the Bureau has repeatedly called attention to the dangers inherent in the system now being applied, and he even prepared a splendid argument for consideration by the Tenth Inter-American Conference (Caracas, Venezuela, .1954), where unfortunate-ly it was not possible to take up the matter.
In addition to the sources of funds we have indicated -- quotas of PASO Member Governments, contribution of the WHO, and Technical As-sistance funds -- there is another column in the PASO budget entitled "Other Extrabudgetary Funds," which lists other freely contributed funds such as those given by the United Nations Children's Fund (UNICEF) in collaborating in the health programs in the Americas,
'. Conclusions '
Page 7
This is in part due to the fact that the problem has been handled with: a certain amount of vacillation. The XIV Pan American Sanitary Conference debated the issue at great length and appointed a special working party, of which I had the honor to form part, which drew up a full proposed resolution (Annex III) -- one that was defended especially by the delega-tions of Ecuador and Cuba. But the Conference, in deference to arguments that in our opinion did not hold great weight, did not adopt that text as a decision of the Conference and agreed only to publish it in the proceedings of the meeting. And the fact remains that, two years after the Conference, we are still discussing the same issue and still seeking ways to resolve it.
We should like to draw the Directing Council's special attention to a matter so essential to our Organization's development, and we insist on our repeated recommendation that it is absolutely imperative to consider this matter in all its scope. loWe recommend that the representatives again examine the documents presented at the various meetings of the Organization and that they review in the minutes the opinions voiced during the discus-sions that were held. These documents and minutes, with which the repre-sentatives are already familiar and have had previous occasion to examine and discuss, are listed in Annex IV, at the end of our report, and we would request that they be kept in mind when this topic is considered. We trust that the Secretariat will have copies available for consultation by the representatives, so as to facilitate the discussion by the full
Council.
Today, as yesterday, we are convinced of the need for our public
health bodies yesterday the Conference, today the Directing Council
--to make a categorical declaration, in an express recommendation --to the Member C'ovc-rnments, indicating the advisability of their instructing their political representatives in the United Nations, and consequently in ECOSOC, to seek authorization of a revision of the entire system of the Expanded Program of Technical Assistance. And we believe this is the
appropriate time for a specific request to be made that the governments demand of the United Nations a special convocation of the Technical Assistance Conference. If this is consented to, the governments should designate as their representatives plenipotentiaries who are well in-formed of all aspects of the matter, through a thorough study of full documentation which the Director of the Pan American Sanitary Bureau will place at the disposal of the Ministers of Public Health and of Foreign Affairs of the Member Governments of the Organization.
Page 8
examining also its great politico-health repercussions, without this signifying, as some have claimed, that we are overstepping our author-ity as sanitarians to intervene in the field of politics in general.
Dr. FMlix Hurtado
Member of the Executive Committee of the PASO
ANNEX I Page 1
SPEECH DELIVERED BY DR. FELIX HURTADO BEFORE THE NATIONAL HEALTH BO~AD OF THE REPUBLIC OF CUBA, AT THE WORLD HEALTH DAY CEIEBRATION
ON 7 APRIL 1956
As Dr. Carlos Salas, Cuba's Iinister of Public Health, so aptly pointed out on opening this ceremony, we are commemorating today, 'as World Health Day, the 7th' of April 1948, the date on which the World
Health Organization, with the ratification of its Constitution by the required minimum of twenty-six nations, attained full stature and ac-quired juridical status as a specialized agency of the United Nations.
This is a fitting occasion, we feel, to review the origins and development of this inspiring institution, today the most outstanding in the field of international health activities.
To find the earliest expressions of that spirit of solidarity which is the force behind united efforts in the field of health, we must go back to the latter half of the nineteenth century and the first historic developments of significance to world health. At that time in Europe, the continent devoted to the "philosophy of spirit," these developments were the inevitable result of the ravages left in the wake of devastating epidemics of disease. Think back, for example, to the appalling invasion of Europe by cholera in 1817 and in subsequent years.
In 1851, as the result of these scourges, the sanitarians of the day convened in Paris for the so-called First International Sanitary Conference, which was essentially a European gathering. This meeting, the first of its kind, was no more than an expression of the nations' growing anxiety, and it adopted no resolutions or measures leading to concrete action. Matters remained unchanged until 1859, when the public health group met again in Paris for the Second International
Sanitary Conference. The meeting met with little success, forced as it was to interrupt its activities as the result of the Crimean War.
Seven years later, in 1866, Napoleon III, who had by then taken an interest in the Suez Canal project, made the proposal, accepted by Turkey, that the Third International Sanitary Conference take place in
Constantinople. The following Conference, held in Vienna in 1874, dealt chiefly with navigation control on the Danube. These, then, were the first four international health meetings, which were essentially
ANNEX I Page 2
For the first time in 1881 the United States of America lent its support to these international activities, convoking in Washington the Fifth.International Sanitary Conference. The agenda was.devoted almost .entirely to problems -reiated[-to yellow fever-.; A noteworthy event' was the appearance 'at the.Conference of our iilusi'rious- country-man Carlos J. Finlay, who was attending as-representative of the Gov-ernment of Spain.
The next.Conference took place in Venice in 1892,.and the
delegates imet' again'in that city in 1893. The governments, fearful of the ravages of. epidemics and acting on'the.repeated recommendations and.-requests of the previous Conf.erence authorized. this .Venice,Conference of 1893 to .conclude,' in. the form of an international commitment, the first sanitary. convention to be drawn up in.,Europe.' One'. cannot' fail to. recognize'that this was a step along the same course as' that charted by the South American governments in establishing the first true sanitary conventio~n in the world, at their historic meetings in Lima.in 1888. Very possibly' it was this A merican precedent that led the governments of Europe to take the action they' did at the Internati'nal Sanitary Conference in Venice. in 1893, that is, five years after the Lima
meetings . '
t We can thus'see, ladies and-gentlemen, how the American Cbntinent took the-initiative in creating. the' world's first instrument' of public international' law in matters of health. 'This instrument served also
as an. inspiration to private international law, which in the field of public health was developing along Various lines in the different coun-tries, 'but in which the'Americas again took the lead, as it was' an American country,, Cuba,..which was the first of all nations to-raise the health and welfare service to ministerial rank, in' 1909, under the title of Ministry of Public Health and Welfare. Continuing 'the
progres-sive poliby i:n the 'development of. international public health law, .again an Americ'an country, Cub'a, took the' initiative of giiring ambassadorial rank to its..representative and official in charge of international health affairs.
The Ameriban Continent has been outstanding in its constant concern with publio-health, which has become an established tradition, one in which, from many points of view, the, Hemisphere has shown it-self a pioneer. This course led to the establishment of a continent-wide agency, the Pan American Sanitary Bureau, a permanent body governed by the peribodic forum of the Pan' Ame'rican Sanitary. Conferences.' Brought into being by American international law in. 1902, this institution
ANNEX I Page 3
We have thus far reviewed the general historical background of public health internationalism as anriinstrument for action based on' scientific doctrine, and it is clear that America has developed the ideal instrument for coordination in the field of public health. Europe had at that time fine scientific research centers, 'bureaus., leagues, committees, etc.,- specially devoted to' health studies. Yet with the outbreak of great wars, which disrupted and even destroyed what had been built up, the scientific centers and, indeed, Europet's institutions in general could not escape their devastating' effects. We refer, of course, to the void opened by the War of-1l914, wh'ich interrupted our own Pan American'-Sanitary Conferences, and to World War II, that global upheaval which, even after the end of armed con-flict, could not be-·said to be really over. With the cold'war ever present, we continue to be faced by the threat of a new and terrible, outburst.
At the close of World War II, the nations-mobilized their forces
-in a jo-int search for a new road to peace and security; a search that ultimately gave rise to the United 'Nation· Organization, a second" and much improved version of the League of Nations. The League, estab1lished in Geneva after the War of 1914, was the great-hope of President Wilson and, in one of its roles of closest interest~t' us, was the agency which established the world-renowned Committee on Health. "-Taking part 'in that Committee were the most brilliant figures in pubic' health and preven-tive medicine of the day) including our own eminent countryman Dr. Domingo Ramos.
With the flames of World lWar II not yet completely' extinguished and a Europe in ruins still smoldering, the nations set 'out to take
-stock of the-destruction. Experts gave impressive figures on the ex-tent of the reconstruction required, and people spoke in terms of'
months, years, and even decades of toil. In the midst of, that spectacle, which among other things clearly led to the great postwar psy'chosis, the bases were gradually laid for'a doctrine-of universal solidarity. Along this path, hopes were reborn, ideals revived, plans surged ahead, and formulas were put forward: world unity, world government. Men of good will worked for this goal; human rights were studied and restated; the' Atlantic Charter was drawn up; and a great world statute was being-formulated: the United Nations Charter.
Many preparatory conferences and-meetings were required before ' these achievements were realized.': The crisis in food supply and the ravages left by hunger and malnutrition led almost'immediately to the
ANNEX I Page 4
discussions in defense of the caloric group, among th:m the glucocides and, especially, sucrose. At this conference, which was a scientific meeting but one that also had strong political and economic implica-tions, we vigorously defended that group of foods because of their action in strengthening glucose reserves, which when depleted or lost in the hungry individual prevent him from using successfully the protein foods. Naturally, we finally gained acknowledgment of the importance of sugar in human nutrition, so that it was accorded the highest priority. At the same time, demands were made for measures to protect the product's manufacture, for world sugar production then totalled no more than
twenty-three million tons, a figure far below world requirements.
The preparatory conference at Hot Springs was followed by another meeting at Chapultepec, which was to serve as the trial fc'um needed to make possible the great assembly of the United Nations later held in
San Francisco. It was at this Mexico conference in 1944 that Mr.
Stettinius, United States Secretary of State, referred in his inaugural address to hunger, ignorance, and disease as the basic causes of human misfortunes, and it was there that specific reference was made to the need for an organized system to safeguard human health. These principles were later restated and considered in full at the assembly in San
Francisco, where Drs. Szeming Sze and Paula Souza, the delegates of China and Brazil, put forward the motion to establish a single, world-wide organization for health. Unanimously supported by the assembly, the motion was referred as a specific recommendation to the Economic
and Social Council of the United Nations. The necessary action was taken whon by a later decision of the Council, the Technical Preparatory Committee for the World Health Organization met in Paris to draft a program and proposed constitution for the new organization, drafts that were later to be discussed and approved by the Health Conference held in New York in 1946.
The initiative taken by the delegates of China and Brazil are worthy of all our praise and were of great historical significance. In connection with that motion, nonetheless, there are some special com-ments we would like to make. Drs. Sze and Souza, without giving the details of their motion, submitted the general idea to the San Francisco delegates, who, in turn, referred it to the Economic and Social Council for action, possibly at the sole discretion of the Council members. Such were the prescribed channels to be followed by these world-wide groups. The Economic and Social Council set up the Preparatory Committee of Paris, composed of freely selected members, all of them, fortunately, outstanding representatives of the science of public health.
ANNEX I Page 5
in terms of what the British called "short-term" and "long-term"'plans, and advocates of the' two distinct methods clashed in heated debate, although both worked toward the same goal of reconstruction. But what was'to be reconstructed? Cities totally or virtually destroyed by bomb-'
ings; a succession of "Coventries" which posed grave social and economic problems; devaluated currenties, some of them worth no more than the paper they'were written on ... all of this; yes, but all of it little
compared to the -"human" values shattered by this war. The mutilated youth left in its wake were enough to show the formidable impact of this
conflict on the minds of millions of human beings. In a'word; the great-est measure of the devastation was the impact on humanity itself. Why, then, was this aspect not the subject of urgent and immediate study at the preparatory and subsidiary meetings of the.United Nations? Why did we not look back to the studies on eugenics and homoculture, which
certainly, although indeed from the scientific and theoretical point of view they originated in England and France, had gained even before the war firm-status in our own Continent, a-status ensured at the First Pan American Conference on Eugenics and Homoculture of 1927, which so wisely provided for the establishment of a permanent office of eugenics and homoculture, with headquarters in the city of'Havana.
Gentlemen, the science of genetics has made great strides, un-ravelling many mysteries of heredity, and it is' essential that we turn to it for a study of our human status and .'the alterations it may have suffered, so as to open wide fiel7T of study where body and psyche may thrive together in' a union for integral health.
The Preparatory Committee of Paris, in truth, devoted all its time to the organizational structure of the hew World Health Organization, but left.untouched certain fundamental objectives, some of them'deserving of immediate and urgent attention, such as those we have just described. And we can add that another salient feature of that Committee was its exaggerated unitary outlook, one that seemed to ignore what other institu-tions had already done in the health field, especially as regards the American Continent and its politico-health institutions, which were given not the slight'est acknowledgment.
Under these conditions, the International Health Conference opened in New York in 1946, with the task of studying, discussing, and approving
a constitution and organic statutes for the World'Health Organization. The European delegations soon took command of the situation, and the theses they put forth seemed close indeed to a principle of "public health totalitarianism." For the great debate in New York was over the move made to give the future'agency a single central command -- unilateral, rigid, and absolute in its control. Those delegations were opposed and
even hostile to the possibility of accepting any measure of regional auto-nomy, which, according to them, would have weakened the strength and
CD9/16 (Eng.) ANNEX I
Page 6
It is interesting to reread the minutes of those historic sessions. The conflict was great and some of the delegates earned for themselves exceptional credit for which we owe them recognition today. Let us look at the record. The United States delegation leaned somewhat toward the European line of thought, but when it came to the matter of the immediate future of the Pan American Sanitary Organization, the chief of that delega-tion, Dr. Thomas Parran, presented a motion which gave full historic
recognition to the work of the Pan American Sanitary Bureau and offered an appropriate formula for incorporating the Bureau into the new world agency. Unfortunately, Dr. Parran's motion was not successful. The controversy was heated and the debate sometimes stormy. The eminent sanitarian Dr. Carlos Paz SoldAn, of the Peruvian delegation, left in the records of that assembly the most eloquent defense and most ardent expression of the Pan American spirit. It could not have been otherwise, for he was one of those who knew best America's distinguished role in public health and he described it brilliantly. Unfortunately, however,
the full weight of his argument was often lost at those meetings.
Simultaneous interpretation was not yet perfected to the point it'is today, and the eloquence of this speaker's Spanish suffered much in translation into the language of Shakespeare. And as this leader had little command of English, the force of his views had little chance of reaching the many groups that met outside the sessions. A Paraguayan delegate who acted as Paz Soldan's right hand had the mastery of English but, unfor-tunately, neither the Paraguayan leader's mastery of the problem nor his full knowledge of American public health. He was able, however, to take a strong stand during the major debates and on occasion to stave off the all-out attacks against the Pan American line of defense, replying to unjustified indictments of the American Continent's participation in international health which, through inexplicable tolerance on the part of the chair, a European delegate had been permitted to make. It was a pity indeed that others, with a mastery of both language and subject, left no record in the minutes of -that meeting. And even more unfortunate was the weakening in the Pan American line, following the positions taken by the delegations of Mexico, Venezuela, and Brazil. Nevertheless, the reasons in support of maintaining the Pan American Sanitary Bureau were so clearly evident that the tide finally turned. But just as the matter was to be put to a vote, one that would have been completely favorable
to the Pan American thesis, the vote was blocked. Delegate Evang of Norway, the leading opponent of that thesis, clearly understood the situation, and through sheer parliamentary skill, and as the voting began, he proceeded to introduce an incidental motion, followed by a new formula, which prolonged the debate and finally gained acceptance
by the assembly. With the reluctance I have to giLo up a cause I believe in, I wonder why the vote was not taken. Why was a point of order not raised
ANNEX I Page 7
I could not fail to comment this morning,. gentlemen, on these stirring scenes at the New 'York Conference, where we came -close to losing r.ecognition for almost fifty years of continuous work in public health accomplished by our Pan American institution. What happened thereafter can be summarized briefly. In the Interim Committee of eighteen countries entrusted, until the convening of the First World Health Assembly, with the management, of the world organization, we felt the last brunt.of the. treatment given.the Pan American thesis, for none
-of the' countries which stood for that principle formed part -of that Committee, with the exception of Peru, in the person of Paz Soldan (and we would have reached our limit had he not been included). It is noteworthy, also, that the impressive group of figures, led by Stampar, who so vigorously and formidably opposed the need for recog-nizing regionalization and its progress -- a group who were the
centralizers a outrance, later filled pages of the records of the WHO Executive Board and Assembly sessions in defending and supporting
the regional system in force today, and pointing, consequently, to the risks of centralization.
And so it is now, ladies and gentlemen, that the World Health Organization has devoloped fulily and operates effectively, divided administratively into six regions, among them the Region of the
Americas, which is comprised of the Pan American Sanitary Organization, our splendid continent-wide agency. Cuba reaffirms its deepest adherence to this Pan American agency and, through it, lends its enthusiastic sup-port, on the world scale, to the World Health Organization, of which Cuba is a Member State. We are undertaking our national public health plans with a sense of international responsibility, and we are working to carry out that responsibility: We are complying fully with the International Sanitary Regulations, and we are laying the bases for a public health reorganization that will lead us to the front lines in the battle for eradication of major infecto-contagious diseases. We have pledged ourselves to eradicate smallpox, bringing to the remotest areas the protection of vaccination. For, as the American sanitarian Victor Gessel said, in his famous motto: All detractors of vaccine have died of smallpox. We are now bending every effort to complete the program already undertaken to eradicate Adess aegvpti, and we look forward to the doy wher. the last aegypti will. be extterminated, to gain absolute protection against yellow iever. In the same way we must convert our present system of malaria control to the universal method recommended by the World Health Assembly: eradication of malaria.
ANNEX I Page 8
and a wide field for experimental 'practice -- all of which implies the immediate reorganization of the National Public Health School. This is an immediate objective of our Minister, Dr. Carlos Salas Humara, tobe fulfilled with the inspiration and the earnest hopes of the President of the Republic, General Fulgencio Batista.
You may be certain that the "School of Public Health of Cuba," ranking equally with the others existing in the Continent, will soon become a reality.
ANNEX II
A N E X II
(Document CSP14/34:
Pan American Sanitary Organization
a
)XIV
Pan American
VI Meeting
Conference
Committee
Santiago, Chile
October, 1954':
CSP14/34 (Eng.) 16 October 1954 ORIGINAL: ENGLISH
Topic 25: UNIFICATION OF ACTION IN PUBLIC HEALTH PROGRAMS
'IN THE REGION OF THE AMERICAS
In accord with Resolution XVI of the VII Meeting of the Directing Council, the Director of the Pan American
Sanitary Bureau made a study of the channeling of government funds to international health programs through various or-ganizations and discussed the problem Aih representatives of'various governments in both the health and foreign
rela-tions ministries. The Director attended the Tenth Inter-American Conference in Caracas early in the year prepared
to present the problem for consideration but found no suitable occasion to do so.
The situation is peculiarly difficult because decisions are taken at various levels in government and by varying re-presentations of governments in different international meet-ings.
The Director is particularly concerned over recent action (July 1954) of the Economic and Social Council provid-ing that beginnprovid-ing in 1955 Technical Assistance funds should be devoted to over-all country programs to be negotiated directly between a representative of the United Nations and the government concerned with limitation of function for the World Health Organization and other specialized agencies to
giving technical advice on individual projects. The result of this action will, in most instances, be a further reduction of health activities financed from Technical Assistance funds and will have a retrograde action on attempts to unify pro-grams. It is disconcerting to learn that this action of ECOSOC was strongly supported by representatives of many of the same governments which approved Resolution XVI of the VII Meeting of the Directing Council, which indicates that "It is
considered advantageous for the public health programs for the Americas to be concentrated in the American agency created especially for that purpose, namely, the Pan American Sanitary Organization, which also acts as a regional organization of the
World Health Organization".
CSP14/34 (Eng.) Page 2
It will be seen from the table accompanying Document CE22/16 that the various international funds supported by
governments have been in large part maintained by contribu-tions of the United States Government.
While the' Director believes that the present situation
is.unstable and'will not be continued over a long period of
time, it is, however, apparent that only as health authorities emphasize to other departments of national governments the difficulty of the present situation can corrective measures
be -taken.- The :alt.erati'ons' in the ' .present,.situation must be
brought about through,,a:ction.taken at the· international p:6--"
litical level.
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Attadhment :- Document CE22/16
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executive committee of working party of the directing council the regional committee
PAN AMERICAN'
WORLD
-\;-
i
SANITARY
HEALTH
-/ *ORGANIZATION
ORGANIZATION
22nd Meeting Washington, D. C.
April 1954
I
CE22/16 (Eng.)
19 April 1954 ORIGINAL: ENGLISH
Topic 10:
PRLIMINARY
STATEMENT ON UNIFICATION OF ACTION ININTERNATIONAL HEALTH IN THE AMERICAS
In accord with Resolution XVI of the VII Meeting of the Directing Council, the Director has begun a study of
unifica-tion of internaunifica-tional health activities.
The approach is through analysis of the channels of fi-nancial contributions from the American Republics to
interna-tional health activities and of the interference of various bodies in determining how these are employed. The
accompany-ing chart shows how assessed and voluntary contributions of governments, all or part of which are destined for health ac-tivities, are diverted through various agencies within the framework of the United Nations and the Organization of
Ameri-can States.
The assessed contributions are 100% for international health activities and go directly to the World Health Organi-zation and to the Pan American Sanitary OrganiOrgani-zation. The activities of these two Organizations are coordinated by the
Pan American Sanitary Bureau, since it serves as the Regional Office of the World Health Organization.
The voluntary contributions, whether made through UN or OAS are intended only partially for health.
CE22/16 (Eng.) Page 2
Despite the obviously complicated channels of some of the health funds and the multiplicity of sources there is no duplication or overlapping in the health projects of
interna-tional agencies. In the Americas all of these projects, except for--health aspects of the American International Institute for the Protection of Childhood Program, are under the supervision of PASB, thus automatically assuring complete coordination in their implementation.
There is, however, no uniformity in the basis of
operations financed from assessed and voluntary contributions. The programs financed by the assessed contributions of Member States to the World Health Organization and to the Pan Ameri-can Sanitary Organization-are subject to approval of the World Health Assembly and of the Pan American Sanitary Conference, respectively, both composed of technical representatives of
the Health Services of Member States -- the same Health Ser-.
vices with which these two Organizations collaborate on field projects. The collaboration of PASO and EVHO is harmonious, without appreciable duplication of effcrt, and altogether an outstanding example of integration of activities of world-wide and regional' organizations.
Voluntary contributions on the other hand.s come through the channels shown, with the intervention of numerous non-technical bodies, influencing the choice of programs, adminis-trative procedure and even at times, technical orientation.
CHANNELS OF GOVERNMENT FUNDS THROUGH INTERNATIONAL ORGANIZATIONS
NEGOCIATING NATIONS iC A.O. C A CAROERE
NATI I TIONAL UNIF CATNA.I FOOD
E~X~EC U T~IVIEAN ..L. IT D 'CIV AND SOCIA'L
FOR ExT~n
GE E ORGANIZATION IT GELOARAL PRO
?BDE~nR NC EAC ES |Rv g \ANR 0
I.)S~~~~~ POLICYw B.R.D.
NICEF TEPCOJtA L|
IPROJECTS PRJECTO' J CD
nI
jAFGHANISTAN CENTRAL AMERICA HAITI IRAO PAKISTAN ,TBOLIVIA '(AND MEXICO AND INDIA ISRAEL PHILIPPINES
BRAZIL PANAMA) INDONESIA LEBANON TURKEY BURMA CEYLON IRAN LIBYA URUGUAY
COLOMBIA YUGOSLAVIA
ECUADOR
EGYPT
.... 'c;F r~~:UN WHO
|TECHIC AL RECUW .AR PA.S.B. ASSASSISSAA PROJECTS I PROJECTS TI OES PROJECrs I
ORGANIZATIral"~
EERAL G ENRL OF ;.
COUNCIL ASSENDO C)NFEOENCE SEML AMERICAN S
/ \ / / \ INTER-A:EI \I"ERNATIO RIRMER
ERNTIDNAL IENERL RINEREANRIGN TTTENTRAECN ITRAEIA INSTITUTESECRETARY GENERAL OAS AD OCL
FOR RE I E I ISTICA OF
BOARD SCIENCESOF A
DIRECTOR' \ CUNCIL Illllgi
OIFHO
I EEOCRPT SCIENCES ||AMERICAN
CEIE\ i L \ / UNION
\~~~~~~~~~~~~~ERTR /\ // \ ACRL
STITUTE E AR ISTITUTE NE
| 5 OR~~~~~~MOVEMENT OF HEALTH FUNDS
O.A.S.| | RRA |
I.
I | r I IEGNU PRDORAMSNEICATLADED
5ROEO EAL T AE I TRE
PROJECTS AMERICAS~
JULY. 1954
PAN AMERICAN SANITARY ORGANIZATION
GUATEMALA LIMA RIO DE JANEIRO SANTIAGO
RECAPITULATICON OF-ALL FUNDS
PLEDGES OR ASSESSMENTS
Country Argentina Bolivia Brazil Chile Colombia Costa Rica Cuba Dominican Repul Ecuador E1 Salvador Guatemala Haiti Honduras Mexico Nicaragua Panama Paraguay Peru United States Uruguay Venezuela Sub-Total PASO 1947-195a (dollars) 734,160.41 61,462.60 1,081,762.70 205,044.62 235,174.49 23,067.19 175,499.85
blic 39,132.96
48,624.47 38,689.51 55,477.99 44,508.27 27,223.83 471,013.92 23,376.56 26,523.18 26,599.70 148,906.31 of Amerda 8)0O3,998.69 90,882.25 165,939.82 11,730,069.32 WHO (dollars) 879,110.00 38,774.00 879,110.00 213,838.00 7,504.00 19,389.00 121,628.00 23,758.00 23,264.00 23,758.00 23,264.00 19,801.00 19,389.00 300,957.00 17,376.00 17,326.00 19,389.00 93,062.00 16,986,308.00 85,308.00 126,717.00 19,939,030.00
OAS/TA
Y
1951-1954 (dollars) 263,571.00 14,776.00 534,000.00 104,739.00 132,702.00 12,000.00 68,572.00 23,275.43 25,426.00 18,284.00 15,000.00 8,000.00 10,143.00 49,758.29 14,000.00 10,856.00 10,000.00 17,428.57 3,427,310.03 65,930.00 64,305.07 4,890,076.39
UW/TA 31
(dollars) 285,714.28 14,027.06 1,283,256.21 168,591.79 376,020.00 21,000.00 150,000.00 16,000.00 21,661.46 23,000.00 27,500.00 42,000.00 33,600.00 104,046.24 9,999.00 9,000.00 18,000.00 22,000.00 50,614,132.00 263,823.53 112,447.76 53,615,810.33
UNICEF
21
1947-1954 (dollars) 30,000.00 562,000.00 146,ooo.00 42,000.00 30,000.00 15,000.00 290,000.00 14,000.00 20,000.00 11,000.00 18,000.00 40,000.00 24,000.00 345,497.00 97,231,000.00 1,000,000.00 100,000.00 99,918,497.00 Voluntary Contributions Brazil Chile El Salvador Mexico Venezuela Sub-Total Total 250,000.00 1,857.462, 538.79 194,689.64 74,404.77
523,490.66
12 5359.98 19,939,030.00 4,890,076.39 53,615,810.33 99,918,497.00
TOTAL (dollars) 2,162,555.69 159,039.66 4,340,128.91 838,213.41 793,400.49 105,456.19 530,699.85 392,166.39 132,975.93 123,731.51 132,241.99 132,309.27 130,355.83 925,775.45 91,742.56 63,705.18 73,988.70 626,893.88 176,262,748.72 1,505,943.78 569,409.65 190,093,483.04 250,000.00 1,857.46 2,538.79 194,689,64 74,404.77 523,s90.66 190,616,973.70
1Less thn 1% for public healthe
Y 22% for public health.
Percentage for health projects varies widely throughout world but in Latin America it is approximately 50%.
CD'e0%
0*
TOP
CD9/16 (Eng.) ANNEX III
ANN BEX III
(Document CSP14/90:
Pan American Sanitary Organization
XIV Pan American
VI
Meeting
g
Sanitary
Regional
Conference
Committee
Santiago, Chile
October, 1954'
CSP14/90- (Eng.) 2'0 October 1954 ORIGINAL: SPANISH
Topic 35: TECHNICAL ASSISTANCE PROGRAMS
DRAFT RESOLUTION
(Presented by the Working Party appointed at the Ninth Plenary Session and composed of the Delegates of: the United States,
Uruguay, Ecuador and Cuba)
THE XIV PAN AMERICAN SANITARY CONFERENCE,
CONSIDERING:
That Resolution WHA.7.41of the Seventh World Health
Assembly, May 1954, states that the fluctuations from year to year in the amount of Technical Assistance funds made available
to the WHO disrupt planned programs under all resources of the
Organization, are inimical to the steady planning and
implementation of individual projects, and retard the approved general program of work for a specific period; and
The difficult situation the present programs of the Organization financed with funds from Technical Assistance are facing due to the rules established by resolutions of ECOSOC, and bearing in mind the observations made by
representatives of several countries and the information supplied by the Director of the PASB in this matter,
RESOLVES:
1. To take note of all the information referring to the resolutions related to the United Nations Expanded Program of Technical Assistance, and to instruct the Director of the Pan American Sanitary Bureau to notify the Member Governments, on behalf of the Conference, of this situation, with the
CSP14/90 (Eng.)
Page 2
recommendation that they give their most careful consideration ·to this matter, on the basis of the most complete information provided by their technical health departments, to enable them to give the most suitable instructions to their representatives
at the United. Nations ,in · order to promote an adequate
revision of the resolutions of ECOSOC referring to the Expanded Program of Technical Assistance.
·
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i ii
ANNEX IV
List of Documents
I. Documents
CSP14/21
CE25/27, Rev. 1 CD8/11, p. 9
CD8/37 CD8/51
II. Minutes
CSP14/97, p. 19 CSP14/98, p. 53 CE22/61, p. 16 CE25/44, p. 101 CE26/8, pp. 3-6, 16
CD8/38 and Corr., pp. 4-21
CD8/41, pp. 5-16, 18
CD8/59, pp. 16-21 CE28/25, pp. 9-17 CE28/26, pp. 2-3
III. Resolutions
CD7/R.XVI (Doc. CD7/47, p. 29) CE25/R.XIV (Doc. CE25/42, p. 23)
