Report of 56th Session of The World Health Assembly: briefing

Meeting report

HEALTH PORTFOLIO COMMITTEE
4 June 2003
REPORT OF 56^TH SESSION OF THE WORLD HEALTH ASSEMBLY: BRIEFING

Chairperson: Mr. L. Ngculu (ANC)

Documents handed out
Report of the 56th Session of the World Health Assembly

SUMMARY
The Committee heard that the Assembly secretariat took the decision that the Commonwealth troika would be meeting in late December to deliberate on the fate of Zimbabwe's membership. In which case, the Committee was told, the secretariat was of the view that until that time Zimbabwe remains suspended from the Commonwealth and hence could not be allowed to attend the meeting. The Committee further heard that SADC members registered their protest on this ruling but were nonetheless obliged to respect the secretariat's ruling.

MINUTES
The Chair informed the committee that the Minister was held up in a cabinet meeting and that she could not attend but instead the Director General would instead tender the briefing on her behalf. The Chair also recognised the presence of the Deputy Minister of Health. He invited the D-G Dr Ayanda Ntsabula to address the meeting.

56^th Session of World Health Assembly
Dr Ntsaluba Director General for Department of Health presented members with an abridged report of the 56^th session of the World Health Assembly noting that a complete report would be finalised and handed over to members in due course. He pointed out that participants at the Assembly shared information on best practices in addition to identifying means of overcoming major constraints and obstacles to success. Participants also highlighted essential policy interventions and action strategies and examined the role played by health and other sectors. Appropriate recommendations were made to the WHO and the Healthy Environment for Children Alliance to take forward its work.

Dr Ntsaluba noted that in total 35 resolutions were adopted by the Assembly. He singled out a resolution on Intellectual Property rights, innovation and public health, which was adopted and is of great interest to South Africa. The resolution urges member states to ensure that pharmaceutical patent policies do not work against public health. The resolution echoed the Doha Declaration on public health. He also singled out a resolution on Traditional medicines which encouraged member states to adopt the WHO traditional medicine strategy which advocated for national polices and regulation. Other measures in this area were drug safety monitoring systems; measures to protect and preserve traditional medical knowledge and plant resources.

Discussion
The Deputy Minister drew member's attention to the fact that The D-G is held in high regard internationally for his leadership style and that this is an honour to the country. He applauded the D-G for his remarkable leadership credentials that has earned the country a good name in the international community.

Ms Baloyi (ANC) thanked the D-G for the solid leadership reputation, which he has built, and one that is recognized internationally. She pointed out that it would be better to study the full report so as to be able to see the extent to which the adopted resolutions impacted on the country' health policies. Why did the Department seek to learn lessons from developed countries whilst making no mention of developing countries in view of South Africa's dual economic structures?


Dr Ntsaluba replied that in terms of drawing experience on the movement of health professionals, the Department was focusing on the UK and Canada since these were the two destinations to which these professionals migrate. He pointed out that there was ample opportunity within which the continent interacts to share experience. He singled out the ratification of the NEPAD strategy as one forum where views on the challenges facing health systems in Africa were ventilated. South Africa is a member of the tripartite Agreement with Cuba, Mali and Rwanda, which shares experience on how best to harness resources and skills for better health care systems.

Dr Jassat (ANC) asked if Zimbabwe was allowed to attend the Assembly meeting.

Dr Ntsaluba explained that the Assembly secretariat took the decision that the Commonwealth troika would be meeting in late December to deliberate on the fate of Zimbabwe's membership. The secretariat was of the view that until that time Zimbabwe remained suspended from the Commonwealth and hence could not be allowed to attend the meeting. He reported that SADC members registered their protest to this ruling but were nonetheless obliged to respect the secretariat's ruling.

Dr Jassat said that he was happy with the proposed standards on tobacco but questioned why no similar measures were taken against alcohol consumption, which in any event results in violence and death.

Dr Ntsaluba said that no specific resolution was made around alcohol consumption but noted that a similar initiate that looked at healthy lifestyles was still at the very preliminary level. This particular initiative address issue related to harmful practices like alcohol consumption but that the WHO was not yet confident to put it on the table in the form of a resolution.

Dr Jassat noted that the Bush administration had committed a sum of $10.5 billion for the fight against Aids in Africa and the Caribbean. He wondered whether there were any conditions attached for instance purchasing medicines from the US drug multilaterals.

Dr Ntsaluba replied that he was unaware of any such conditions. He noted, however, that the Minister had sought clarity on the nature of conditions attached to the release of these funds and was told that the criteria was severity of disease and a rollout of specific programmes that would require support.

Dr Jassat asked if any reference had been made to the needless death of children in Iraq due to the UN sanctions against that country.

Dr Ntsaluba replied that there was no resolution regarding the situation in Iraq but that a statement issued by the SADC Ministers made reference to this issue but tried not to be judgemental. He explained that a call for a resolution would not have been timely in the circumstances.

Dr. Cachalia acknowledged the fact that drug companies play a pivotal role in research and development in which case they should be supported in every possible way. He however registered strong objection to the 20 year period in which patent rights are protected noting that this period was unnecessarily long since the drug companies would have long recouped their costs and made huge profits before the timeframe lapsed.

Dr Ntsaluba concurred that the 20-year period patent protection was a contentious issue that would be addressed by the study commissioned by the WHO on the matter. He pointed out that part of the thinking was for a provision that there must be mechanisms that allowed for the export of generic medicines to the developing world. He added that another suggestion was that of a tier system which made provision for lower prices to the developing world. He however cautioned that there was a limit to which the WHO could intervene and that beyond that the international trading system kicks in.

The Chair promised to interact with the Director General as a follow-up to the issues arising from the main report. He pointed out that there was need for considerable reflection to go into the $10 billion to be released by the US especially the impact of these funds on the Department's resources. He asked members to look into the possibility of engaging the US health attaché on this specific issue. He joined other members in hailing the D-G's impeccable leadership qualities and the co-operation he continued to give to the Committee.

The meeting was adjourned.

Appendix
NOTES FOR THE PORTFOLIO COMMITTEE

ABRIDGED REPORT OF THE 56^TH SESSION OF THE WORLD HEALTH ASSEMBLY HELD IN GENEVA FROM 18 TO 28 MAY 2003

Herewith an abridged report of the 56^th session of the World Health Assembly as requested. A complete report will be finalized shortly.

MINISTERIAL ROUNDTABLES
Ministers participated in roundtables on healthy environments for children (environments in which they live, learn and play).

1. They shared information on best practices; identified means of overcoming major constraints and obstacles to success; highlighted essential policy interventions and action strategies; examined the role of health and other sectors and made recommendations to WHO and the Healthy Environments for Children Alliance to take forward its work.

RESOLUTIONS

2. In total 35 resolutions were adopted by the Assembly. A full list is given in Annexure A. This report focuses only on those resolutions deemed of importance to South Africa.

TECHNICAL AND HEALTH MATTERS

3. WHO Framework Convention on Tobacco Control (FCTC): The Assembly unanimously adopted, the FCTC as annexed to Resolution WHA56.1.
4. The FCTC is the first international treaty negotiated under the auspices of World Health Organization (WHO).
5. Among other measures, the FCTC requires countries to impose restrictions on tobacco advertising, sponsorship and promotion, put in place price and non-price measures to reduce the supply and demand for tobacco, establish packaging and labeling measures as well as take measures to protect the environment.
6. The FCTC will be open for signature at the WHO headquarters (Geneva) from 16 to 22 June 2003 and thereafter at the UN headquarters (New York) from 30 June 2003 to 29 June 2004.
7. Forty countries are required to ratify the FCTC for its entry into force.
8. International Conference on Primary Health Care, Alma-Ata: twenty-fifth anniversary: The 1978 Alma-Ata meeting identified primary health care as the key to the achievement of health for all.
9. A resolution in this regard was adopted. The resolution
   requests the Director-General to celebrate the Alma-Ata Declaration by convening a meeting to examine the lessons of the past quarter century and identify future strategies.
10. Tropical diseases, including Pan African tsetse and trypanosomiasis eradication campaign: The Assembly adopted a resolution that urges Members States and international organizations to provide support to African Members in their efforts to eradicate tsetse flies.
11. Strategy for child and adolescent health development: The Assembly adopted a resolution entitled Strategy for child and adolescent health and development, which, is aimed at reducing death of children (1.8 million in 2000).
12. The strategy is also aimed at decreasing the 1.4 million adolescent deaths each year.
13. Seven priority areas were identified for action, including nutrition and preventable, treatable communicable diseases, which caused over half the deaths in children under five.
14. Member States were urged to make neonatal health, child survival and adolescent health and development a priority.
15. Another resolution deals with the reducing global measles mortality. The resolution calls for the strengthening of national immunization programmes and disease-surveillance systems.
16. WHO medicines strategy: A resolution on Intellectual property rights, innovation and public health was adopted. The resolution echoes the Doha Declaration on TRIPS and public health in which, the Ministerial Council agreed that the TRIPS Agreement does not and should not prevent Members from taking measures to protect public health and effectively urging Member States to ensure that pharmaceutical patent policies do not work against public health.
17. In terms of this resolution WHO will set up a time-limited body by January 2004. The main purpose of this body will be to analyze intellectual property rights, innovation and public health so as to gain a better understanding of the linkages between these concepts.
18. Another resolution on Traditional medicine encourages Member States to adopt the WHO traditional medicine strategy which advocates for: national policies and regulations; drug-safety monitoring systems; measures to protect and preserve traditional medical knowledge and plant resources and, where appropriate, the intellectual property rights of traditional practioners.
19. WHO's contribution to the follow-up of the United Nations General Assembly special session on HIV/AIDS: The Assembly adopted a resolution entitled Global health-sector strategy for HIV/AIDS. The strategy provides a list of core components, the aim of which is to achieve a balance between prevention and health promotion activities on the one hand and the provision of treatment and care on the other.
20. The resolutions calls upon Member States to implement the strategy as appropriate to national circumstances as part of national, multisectoral responses to the HIV/AIDS epidemic. It further calls upon the Director-General of WHO to provide support to the Member States.
21. World Summit on Sustainable Development (WSSD): A resolution entitled: Strategic approach to international chemicals
    management: participation of global health partners was adopted. This strategy addresses one of the Commitments from the Johannesburg Plan of Implementation. It calls for contributions to work in this area from the health sector, in addition to the environment and other sectors. The Assembly expects the strategic approach to be finalized by 2005 or 2006.
22. World report on violence and health: The Assembly adopted a resolution, which calls up-on Member States to develop national plans to ensure more targeted and co-ordinated action to prevent violence by all sectors of society.
23. The resolution further calls for better data collection to ensure a more accurate description of the magnitude of the problem and those most affected; improved services for victims of violence including social and legal support; and, a greater focus on addressing the root causes of violence.
24. Elimination of avoidable blindness: A resolution on the Elimination of avoidable blindness urges Member States to set up a national Vision 2020 plan in partnership with WHO by 2005 and to start implementing it by 2007. Vision 2020 the Right to Sight is a global initiative launched in 1999 to eliminate avoidable blindness.
25. Joint FAO/WHO evaluation of the work of Codex Alimentarius Commission: A resolution entitled Joint FAO/WHO evaluation of the work of the Codex Alimentarius Commission that was adopted, calls for increased participation of the health sector in the Codex Alimentarius Commission and a more active role for WHO in the management of Codex Alimentarius Commission in order to protect consumers' health.
26. Revision of International Health Regulations: The Assembly adopted a resolution on the revision of the International Health Regulations, the international law which governs public health;
27. The resolution confirms and underlines the World Health Organization's (WHO) authority to verify disease outbreaks from all available official and unofficial sources, and, when necessary to determine the severity of an outbreak through on-the-spot investigations to ensure it is appropriately controlled.
28. Work on revising the International Health Regulations will continue until a final draft is presented to the World Health Assembly in 2005.
29. Strengthening health systems in developing countries: The resolution: The role of contractual arrangements in improving health systems' performance, which was adopted, urges Member States to ensure that contractual arrangements adopt rules and principles that are in harmony with national health policy.
30. This resolution further requests the Director-General of WHO to create an evidence base that will enable Member States to evaluate the impact of different types of contractual arrangements.

FINANCIAL MATTERS

31. Appointment of the External Auditor: Our Auditor-General, Mr. Shauket Fakie, was nominated for election to the position of External Auditor for WHO alongside seven other national Auditors General. The Comptroller and Auditor-General of India was elected and appointed the External Auditor of WHO for the financial periods 2004-2005 and 2006-2007.
32. Programme budget: An effective working budget of US $880 111 000 for WHO was agreed covering the 2004-2005 biennium. This represents an increase in the overall level of the budget of 2.9%.
33. The African region of WHO receives the biggest share (22%) of the budget in comparison with other regions. There is also an increase in the budget allocation to WHO country offices.
34. Assessments for 2004-2005: The Assembly decided to adopt the latest available United Nations scale of assessment for assessed contributions of Member States.
35. The UN scale of assessment has an effect of increasing the contributions of some Member States. South Africa's contributions will go up by 366 thousand US dollars.
36. Adjustment mechanism: The Assembly further decided to establish an adjustment mechanism (financial relief fund) to compensate those Member States that will experience an increase in their contribution.

STAFFING MATTERS

37. Representation of developing countries in the Secretariat: The Assembly adopted a resolution that contains measures to correct the imbalances in the distribution of posts in the WHO Secretariat between developing and developed countries.

OTHER MATTERS

38. Appointment of the Director-General of the WHO: Dr Jong-Wook Lee, 58, a medical doctor and national of the Republic of Korea (South Korea) was elected Director-General of WHO. Dr Lee has worked for nearly 20 years in WHO.
39. The Member States also expressed their profound gratitude to Dr Gro Harlem Brundtland, the out-going Director-General, for her "outstanding and visionary managerial, political and technical leadership, characterized by integrity, strength, endurance and determination."
40. Health conditions of, and assistance to, the Arab population in the occupied Arab territories, including Palestine: A resolution entitled Health conditions of, and assistance to, the Arab
    population in the occupied Arab territories, including Palestine
    calls up on the WHO Director-General to take immediate steps to guarantee the free movement of health workers, emergency services and patients, and the provision of medicines and medical supplies to Palestinian health facilities.

 

41. Member States also requested the establishment of a fact-finding committee to assess the deterioration of the health situation in the occupied Palestinian Territory.

Annexure A

LIST OF RESOLUTIONS ADOPTED BY THE 56^TH SESSION OF THE WORLD HEALTH ASSEMBLY

WHA56.1
WHO Framework Convention on Tobacco Control

WHA56.2
Appointment of the Director-General

WHA56.3
Contract of the Director-General

WHA56.4
Expression of appreciation to Dr Gro Harlem Brundtland

WHA56.5
Health conditions of, and assistance to, the Arab population in the occupied Arab territories, including Palestine

WHA56.6
International Conference on Primary Health Care, Alma-Ata: twenty-fifth anniversary

WHA56.7
Pan African tsetse and trypanosomiasis eradication campaign

WHA56.8
Appointment of the External Auditor

WHA56.9
Unaudited interim financial report on the accounts of WHO for 2002

WHA56.10
Members in arrears in the payment of their contributions to an extent which would justify invoking Article 7 of the Constitution

WHA56.11
Arrears in payment of contributions: Kazakhstan

WHA56.12
Assessments for 2002 and 2003

WHA56.13
Real Estate Fund

WHA56.14
Real Estate Fund: Regional Office for Africa

WHA56.15
Assignment of the Democratic Republic of Timor Leste to the South-East Asia Region

WHA56.16
Reassignment of Cyprus from the Eastern Mediterranean Region to the European Region

WHA56.17
Human resources: gender balance

WHA56.18
Salaries of staff in ungraded posts and of the Director-General

WHA56.19
Prevention and control of influenza pandemics and annual epidemics

WHA56.20
Reducing global measles mortality

WHA56.21
Strategy for child and adolescent health and development

WHA56.22
Strategic approach to international chemicals management: participation of global health partners

WHA56.23
Joint FAO/WHO evaluation of the work of the Codex Alimentarius Commission

WHA56.24
Implementing the recommendations of the World report on violence and health

WHA56.25
The role of contractual arrangements in improving health systems' performance

WHA56.26
Elimination of avoidable blindness

WHA56.27
Intellectual property rights, innovation and public health

WHA56.28
Revision of the International Health Regulations

WHA56.29
Severe acute respiratory syndrome (SARS)

WHA56.30
Global health-sector strategy for HIV/AIDS

WHA56.31
Traditional medicine

WHA56.32
Appropriation resolution for the financial period 2004-2005

WHA56.33
Scale of assessments for the financial period 2004-2005

WHA56.34
Adjustment mechanism

WHA56.35
Representation of developing countries in the Secretariat