Considering that the National Institutes of Health (NIH) of the United States of America is celebrating its 100th anniversary in 1987;

 Recognizing the significant contribution that NIH has made throughout its history to the pursuit of knowledge for the health and well-being of the peoples of the Americas; and

 Recognizing the close collaboration that exists between NIH and the Pan American Health Organization,

1. To honor the National Institutes of Health for its outstanding achievements in health research, training, and development.

2. To memorialize the centennial year of the National Institutes of Health with the presentation of a special commemorative plaque.

In establishing the contributions of Member and Participating Governments, their assessments shall be reduced further by the amount standing to their credit in the Tax Equalization Fund, except that credits of those Governments which levy taxes on the emoluments received from the Pan American Health Organization (PAHO) by their nationals and residents shall be reduced by the amounts of such tax reimbursements by the Organization.

3. That, in accordance with the Financial Regulations of PAHO, amounts not exceeding the appropriations noted under paragraph 1 shall be available for the payment of obligations incurred during the period 1 January 1988 to 31 December 1989, inclusive. Notwithstanding the provision of this paragraph, obligations during the financial period 1988–1989 shall be limited to the effective working budget, i.e., Parts I–IV.

4. That the Director shall be authorized to transfer credits between parts of the effective working budget, provided that such transfers of credits between parts as are made do not exceed 10% of the part from which the credit is transferred. Transfers of credits between parts of the budget in excess of 10% of the part from which the credit is transferred may be made with the concurrence of the Executive Committee. All transfers of budget credits shall be reported to the Directing Council and/or the Conference.

 Whereas, Member Governments appearing in the scale adopted by the Organization of American States (OAS) are assessed according to the percentages shown in that scale in compliance with Article 60 of the Pan American Sanitary Code; and

 Whereas, other Member and Participating Governments are assessed on the basis of percentages which would be assigned to such countries if they were subject to the OAS scale,

 To establish the assessments of the Member and Participating Governments of the Pan American Health Organization for the financial period 1988–1989 in accordance with the scale of quotas shown below and in the corresponding amounts.

 Having seen the Annual Report of the Chairman of the Executive Committee (Document CD32/4) on the work of the Committee from October 1986 to date, the period during which the 98th and 99th Meetings were held; and

 Bearing in mind the provisions of Article 9.C of the Constitution of the Pan American Health Organization,

1. To take note of the Annual Report of the Chairman of the Executive Committee (Document CD32/4).

2. To congratulate the Chairman and the other members of the Committee on their excellent work.

 Having examined the Annual Report of the Director of the Pan American Sanitary Bureau for 1986 (Official Document 215);

 Bearing in mind the provisions of Article 9.C of the Constitution of the Pan American Health Organization; and

 Noting with satisfaction the changes in the Report's structure and content that make it a succinct and analytical document,

1. To take note of the Annual Report of the Director of the Pan American Sanitary Bureau for 1986.

2. To commend the Director for his continued efforts to transform his report into a dynamic and significant working tool.

3. To thank the Director for his leadership and support to the Member Governments in the technical cooperation activities conducted by PAHO during 1986.

 Having considered the report of the Director on the collection of quota contributions (Document CD32/16 and Add. I) and the concerns expressed by the 99th Meeting of the Executive Committee1 with respect to the status of the collection of quota contributions;

 Noting the report of the Working Party on the application of Article 6.B of the PAHO Constitution, relating to the suspension of voting privileges of Member Governments that fail to meet their financial obligations to the Organization; and

 Recognizing that, in the case of the two Member Governments subject to Article 6.B, the Government of the Dominican Republic has submitted a revised and acceptable deferred payment plan and has made an initial payment under this plan, and the Government of Bolivia has indicated its intent to pay its 1984 quota assessment and part of its 1985 quota assessment in 1987,

1. To take note of the report of the Director on the collection of quota contributions (Document CD32/16 and Add. I).

2. To express appreciation to Member Governments that have already made payments in 1987, and to urge all Member Governments in arrears to fulfill their financial obligations to the Organization as soon as possible.

3. To congratulate the Government of Haiti and the Government of Paraguay for their successful effort in reducing their outstanding quota assessments for previous years.

4. To permit the Government of the Dominican Republic to vote at this meeting, and to endorse the acceptance of that Government's revised deferred payment plan.

5. To permit the Government of Bolivia to vote at this meeting in view of its commitment to effect a substantive quota payment in 1987.

6. To request the Director:

a) To continue to monitor the implementation of special payment agreements made by Member Governments in arrears for the payment of prior years' quota assessments;

b) To advise the Executive Committee of Member Governments' compliance with their quota payment commitments;

c) To report to the XXXIII Meeting of the Directing Council on the status of the collection of quota contributions for 1988 and prior years.

 Having examined the Interim Financial Report of the Director for the Year 1986 (Official Document 214);

 Noting the report of the 99th Meeting of the Executive Committee on its review of the financial statements and schedules of the Organization as contained in Official Document 214; and

 Expressing concern over the rate of quota payments during 1986, while recognizing that, in spite of this, the Organization has continued to maintain a satisfactory financial situation,

1. To take note of the Interim Financial Report of the Director for the Year 1986 (Official Document 214).

2. To endorse the comments and concerns expressed by the 99th Meeting of the Executive Committee in its report on the financial condition of the Organization as of 31 December 1986, and in particular the concern expressed with respect to the impact that the delayed payment of quota assessments has on the financial status of the Organization and its Centers.

3. To commend the Director for having maintained the Organization in a satisfactory financial condition.

Elected El Salvador, Panama, and Uruguay to the Executive Committee upon termination of the periods of office of Brazil, Colombia, and Honduras, and thanked the Governments of these countries for the services rendered to the Organization by their representatives on the Committee.

 Having seen the report of the Special Subcommittee on Women, Health, and Development (Document CD32/14 and Annex I);

 Bearing in mind the previous resolutions approved by the Governing Bodies of PAHO on women, health, and development, particularly Resolution XII, adopted by the XXII Pan American Sanitary Conference; and

 Mindful of Resolution WHA40.91 approved by the Fortieth World Health Assembly,

1. To urge the Member Countries:

a) To complete their plans for carrying out during the biennium 1988–1989 programs and activities that will implement the Regional Strategies on women, health, and development approved in Resolution XII of the XXII Pan American Sanitary Conference;

b) To continue strengthening the national focal points in accordance with the guidelines laid down in the document "Structure and Functions of the National Focal Point of the Program on Women, Health, and Development," approved by the Subcommittee;

c) To review and revise their health policies for both the public sector and the social security system with a view to providing real access for all women to comprehensive health services;

d) To study the national legislation and adjust it for attainment of the goal of equality for women in the quality and coverage of the health services available to them;

e) To develop and integrate within comprehensive health services specific programs for women which especially address the aspects of financing, quality, coverage, and proper use of technology, and provide solutions to distinctively women's problems;

f) To conduct the operations research needed to better identify the health problems of women, their specific needs as seekers of services, and their situation as providers thereof, chiefly in the areas cited in the recommendations of the Subcommittee's report.

2. To request that the Director:

a) Continue his efforts to increase the representation of women in PAHO so as to attain the goal of 30% in professional and higher posts, as approved by Resolution XII of the XXII Pan American Sanitary Conference, and also to increase the representation of women as temporary consultants, coordinating with the national focal points for the identification of candidates;

b) Promote in all areas of the Organization and the countries increased participation by women in regional meetings, fellowships, training activities, and technical and scientific meetings of all kinds;

c) Increase the mobilization of the resources needed to apply the approved regional strategies and to promote, execute, and disseminate specific activities under the Program on Women, Health, and Development in the countries and throughout the Region;

d) Support the conduct of research, particularly in the areas recommended in the Subcommittee's report;

e) Inform the Directing Council every two years on the activities and progress made in the prevention of maternal mortality and in guaranteeing all women maternity without risk.

 Having examined the document presented by the Director on the progress of the Emergency Preparedness and Disaster Relief Coordination Program (Document CD32/13), together with the conclusions of the meeting on International Health Relief Assistance held in Costa Rica in March 1986;

 Considering Resolutions X, XXXVI, XL, and XXIII of the XXIV, XXVI, XXVII, and XXXI Directing Council Meetings, respectively, on the Emergency Preparedness and Disaster Relief Coordination Program;

 Convinced that, although the health preparedness activities of the countries affected by earthquakes and volcanic eruptions in 1985–1987 have contributed to minimize the loss of human lives and to improve the coordination of relief assistance from the international community, additional efforts are required from the governments of disaster-prone countries to increase their level of readiness; and

 Concerned that the prompt and generous assistance provided to disaster-stricken nations by other Member Countries and by the international community be more attuned to the actual health needs and priorities,

1. To thank the Director of the Pan American Sanitary Bureau for the progress report on the Emergency Preparedness and Disaster Relief Coordination Program and to endorse the recommendations approved at the Meeting on International Health Relief Assistance, held in San José, Costa Rica, 10–12 March 1986, included in Document CD32/13, particularly those recommendations regarding the need for all potential donors to consult with the health authorities of the affected country before sending health relief assistance and the need to place priority on cooperation between neighboring countries whenever additional medical personnel or resources are needed for disaster management.

2. To urge Member Countries:

a) To strengthen their health emergency preparedness programs prior to a disaster by allocating the necessary personnel and budget, to the extent possible, according to the vulnerability of the country to natural disasters, chemical or nuclear accidents, or other emergency situations likely to affect the public health;

b) To attach the highest priority to the rapid and objective assessment of health needs following a sudden disaster, and to notify PAHO promptly of the results.

3. To request the Director, within available resources:

a) To strengthen technical cooperation with Member Countries for the development of their health emergency preparedness programs and for the assessment of their health needs in the case of a disaster;

b) In response to the need for disaster relief, to disseminate to potential donors, Member Countries and others, in consultation with the health authorities of a disaster-affected country and in coordination with WHO and with the Office of the United Nations Disaster Relief Coordinator (UNDRO), timely and authoritative information indicating the type of health assistance that may be appropriate, as well as that which is considered unnecessary or counterproductive;

c) To disseminate widely the recommendations approved at the San José Meeting on International Health Relief Assistance.

 Having seen the report "Coordination of Social Security and Public Health Institutions" for the period 1984–1987 (Document CD32/17);

 Noting that in various countries of the Region lack of functional and operational coordination still persists among the institutions of the health sector, and particularly between the ministries of health and social security institutions, and that this has unfavorable repercussions on the health care of the population and on the efficient and equitable use of the health resources of those countries; and

 Recognizing the growing significance and importance of the health care programs being carried out by social security institutions in Member Countries, as well as their potential to help in the attainment of universal health care coverage in this Region,

1. To accept the report on "Coordination of Social Security and Public Health Institutions" (Document CD32/17).

2. To reiterate to Member Governments the recommendations included in Resolution XXXIV of the XXVIII Meeting of the Directing Council (1981) and Resolution XV of the XXX Meeting of the Directing Council (1984), especially that governments "include representatives of social security agencies and other health sector institutions in delegations to the meetings of the Organization's Governing Bodies."

3. To recommend to the governments of Member Countries where problems of coordination persist between ministries of health and social security institutions that they adopt a strategy with a clearly defined program of activities to:

a) Extend social security coverage to the entire population as a way to avoid "separate clienteles" for ministry of health and social security programs, aiming at universal health care coverage and the establishment of truly integrated national health policies, based on the strategy of primary health care and the principles of the goal of health for all by the year 2000;

b) Improve the efficiency of resource use by formulating and adopting joint investment plans; information, programming, and budgeting processes: the selection, incorporation, and use of medical technology; and the organization of supply, maintenance, and other support components; to this end they should also promote functional integration between ministries of health and social security institutions by developing common systems for the organization and administration of services at the local level;

c) Make rational use of health sector financing by coordinating the resources provided by contributions from social security and those allocated from public budgets, and also by tightening production costs and adjusting outlays to priorities;

d) Study alternative ways of increasing the amounts received in the aforementioned forms of financing, in view of the rising costs of the sector;

e) Work jointly toward the strengthening of health infrastructures and develop firm decentralization policies that permit use of financing at the local level and participation by the public, private, and teaching sectors in order to achieve functional integration of the services network and conciliation of their respective outlooks in the particular circumstances of each country.

4. To urge Member Governments to use and to share experiences regarding coordination of health sector institutions in the Region, which may serve as a reference in the selection of alternative methods for organizing and financing health services.

5. To request the Director, subject to the policies and resources of the Organization, to:

a) Promote the inclusion of social security entities in the technical cooperation programs of PAHO at the national level:

b) Encourage the exchange of experiences among countries and groups of countries through the preparation of case studies to analyze the legal, organizational, financial, and operational aspects of the health services, while emphasizing institutional coordination aspects within the sector;

c) Establish an appropriate mechanism, such as an advisory group, to assist the Organization in the promotion of improved coordination between ministries of health and social security institutions;

d) Strengthen PAHO's working relationship with international organizations involved in activities related to social security, and with other intergovernmental agencies, to improve technical cooperation activities in this area;

e) Circulate among the Governments information that would be of interest, either presently available or generated in the future, in the area of country studies, analyses of experience, and any other data relating to the aforementioned coordination problems:

f) Promote the follow-up of measures taken for the evaluation of progress achieved, and include this subject in his Annual Report.

 Having reviewed Document CD32/10 on acquired immunodeficiency syndrome (AIDS) in the Americas and Resolution WHA40.261 of the Fortieth World Health Assembly;

 Recognizing that the AIDS epidemic presents an unprecedented immediate and long-term threat to public health in the Region of the Americas, requiring urgent, coordinated action;

 Aware that, under these conditions, special efforts must be made to prevent and control the spread of the disease, yet concerned that these efforts reaffirm human dignity; protect human rights while stressing the social responsibilities of individuals; foster political commitment to health; strengthen health systems based on the primary care approach; and protect freedom of travel, interpersonal communication, and international commerce;

 Fully supporting the global response to this problem which is being implemented through the WHO Special Program on AIDS, and recognizing its responsibilities as WHO Regional Committee for the Americas to review annually the situation in the Americas, to monitor the use of regional resources, and to report annually to the Director-General of WHO; and

 Aware of the impact AIDS has on health services,

1. To urge Member Countries:

a) To develop, implement and sustain strong national AIDS prevention and control programs along the model recommended by the WHO Special Program on AIDS, adapted to individual national contexts;

b) To strengthen national epidemiologic surveillance activities in order to improve national programs;

c)  To mobilize and coordinate the use of national and international resources for the prevention and control of AIDS while assuring that national health systems are maintained and strengthened in order to combat this epidemic;

d) To provide accurate information to their citizens about AIDS, strengthening health information through all mass media and health promotion activities, and promoting responsible, appropriate public action to reduce the transmission of the virus and to provide compassionate responses to those with the disease;

e) To continue permitting freedom of international travel, without restrictions based on human immunodeficiency virus (HIV) infection status;

f) To provide periodic situation and progress reports to PAHO/WHO, as requested;

g) To make every effort to develop the Special Program on AIDS within the framework of the policy for health system development and strengthening, making use of the AIDS crisis to promote the needed changes in health services.

2. To request the Director, within available resources:

a) To coordinate regional AIDS prevention and control activities with the global program in the establishment of a PAHO/WHO Special Program on AIDS;

b) To provide urgently needed technical support to national AIDS prevention and control programs, including support for implementing, strengthening, and maintaining surveillance systems with appropriate laboratory support services; transmission prevention and control programs; health professional training programs; and research activities needed to define the epidemiology of AIDS;

c) To develop AIDS control activities, especially those related to health care, together with the development and strengthening of health systems;

d) To promote, coordinate, and conduct epidemiologic studies and related research in order to support regional control efforts;

e) To disseminate information to the Member Countries concerning technological advances in combating AIDS, epidemiological information about the regional situation, and other information vital for the conduct of national AIDS prevention and control programs;

f) To develop mechanisms to facilitate the interinstitutional exchange of technical and resource information at the operational level;

g) To provide annual reports on the regional situation and the use of regional resources to the WHO Regional Committee for the Americas;

h) To take further steps as may be needed, within his authority, to combat this epidemic.

 Having seen the report of the Advisory Committee on Health Research on the deliberations of that Committee's XXVI Meeting, held from 3 to 7 August 1987 at the Oswaldo Cruz Foundation, Rio de Janeiro, Brazil (Document CD32/23); and

 Cognizant of the importance of the Committee's recommendations to the Director for scientific and technological development in the health field in the countries of Latin America and the Caribbean,

1. To thank the Government of Brazil and especially the Oswaldo Cruz Foundation for their valuable collaboration with the Organization during the XXVI Meeting of its Advisory Committee on Health Research.

2. To take note of the recommendations made to the Director by the Advisory Committee on Health Research.

3. To recommend to the Director that he study carefully the report of the Committee and the recommendations therein with a view to their implementation in accordance with the priorities established for the quadrennium 1987–1990 and the availability of resources.

 Bearing in mind that it has been the practice of the Pan American Health Organization and the World Health Organization to have the same External Auditor, and that the holder of the office of Comptroller and Auditor General of the United Kingdom of Great Britain and Northern Ireland, who has been appointed External Auditor of the World Health Organization for the financial periods 1988–1989 and 1990–1991, has expressed a willingness to continue to serve as External Auditor of the Pan American Health Organization,

1. To appoint the holder of the Office of Comptroller and Auditor General of the United Kingdom of Great Britain and Northern Ireland External Auditor of the accounts of the Pan American Health Organization for the financial periods 1988–1989 and 1990–1991, and to request that he conduct his audits in accordance with the principles set forth in Article XII of the PAHO Financial Regulations, with the provision that, should the need arise, he may designate a representative to act in his absence.

2. To express its thanks to Sir Gordon Downey, K.C.B., for the work he has performed for the Organization.

 Considering the revision made to the schedule of salaries of the professional and higher categories of staff in graded posts, effective 1 April 1987;

 Taking into account the decision by the Executive Committee at its 99th Meeting to adjust the salaries of the Deputy Director and the Assistant Director (Resolution XI);

 Having noted the recommendation of the Executive Committee concerning the salary of the Director of the Pan American Sanitary Bureau (Resolution XI); and

 Bearing in mind the provisions of Staff Rule 330.3,

 To establish the net salary of the Director of the Pan American Sanitary Bureau at US$58,938 (single rate) per annum, effective 1 April 1987.

 Having seen a) the Director-General's Introduction to the proposed program budget for the biennium 1988–1989 (Document PB/88–89), b) the document "Management of WHO's Resources" (Document EB81/PC/WP/2), and c) the Report presented by the Program Committee of the Executive Board on the discussions in its Twelfth Meeting on the subject of "Management of WHO's Resources and Review of the Organization's Structure" (Document EB81/PC/Conf. Doc. No. 1, Rev. 1) (Document CD32/11 and Add. I); and

 Considering Resolution WHA40.15,1 in which the Fortieth World Health Assembly requested the Regional Committees to review the official documents on general policy matters relating to the need for measures to secure the best possible use of WHO's limited resources, and to report on the outcome of their deliberations to the Executive Board at its eighty-first session in January 1988,

1. To request the Director to transmit to the Executive Board of WHO at its Eighty-first Session in January 1988, the summary record of the discussions in the present Directing Council on the subject of "Management of WHO's Resources" (item 6.5 of the Agenda).

2. To affirm that full agreement exists between the principles embodied in the general policies for the management of WHO's resources and the current mandates and guidelines for the implementation of PAHO's cooperation policy in the Region as approved in Resolutions CE92.R15 on the managerial strategy for the optimal use of PAHO/WHO resources in direct support of Member Countries. CD31.R10 on the regional program budget policy, and CSP22.R21 on the orientation and program priorities for PAHO during the quadrennium 1987–1990, and in the introduction to the PAHO/WHO program budget for 1988–1989 in Official Document 210.

3. To pledge the cooperation of the Region of the Americas in the effort to improve the use and management of WHO's resources.

4. To indicate to the Executive Board of WHO its concern over the feasibility of the proposed process contained in Document EB81/PC/Conf. Doc. No. 1, Rev. 1 for the appointment of Regional Directors and, more specifically, to point out its incompatibility with the present Constitution of the Pan American Health Organization.