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

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 1990 to 31 December 1991, inclusive. Notwithstanding the provision of this paragraph, obligations during the financial period 1990–1991 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 transfer 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 Countries 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 Countries are assessed on the basis of percentages which would be assigned to such countries if they were subject to the OAS scale; now, therefore,

 To establish the assessments of the Member and Participating Countries of the Pan American Health Organization for the financial period 1990–1991 in accordance with the scale of quotas shown below and in the corresponding amounts.

 Having considered the report of the Director on the collection of quota contributions (Document CD34/19 and Add. I) and the concerns expressed by the 103rd 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 (Document CD34/19, Add. II); and

 Recognizing that, in the case of the seven Member Governments subject to Article 6.B, Bolivia, Nicaragua, and Suriname had submitted acceptable deferred payment plans to the Secretariat prior to the opening of the XXXIV Meeting of this Council,

1. To take note of the report of the Director on the collection of quota contributions (Document CD34/19 and Add. I).

2. To express appreciation to Member Governments that have already made payments in 1989, and to urge all Member Governments in arrears to meet promptly their financial obligations to the Organization.

3. To congratulate Haiti for its continued payment effort toward decreasing its quota arrears for prior years.

4. To endorse the Article 6.B Working Party's recommendation to permit Bolivia, Nicaragua, and Suriname to vote at this meeting of the Directing Council.

5. To approve the recommendation of the Working Party that the voting privileges of any Member Government subject to the application of Article 6.B be suspended until an acceptable plan of payment has been submitted to the Secretariat, and to note that Guatemala and Peru have now complied with this requirement.

6. To request the Director to notify the Dominican Republic that its voting privileges will be suspended effective with the commencement of the XXIII Pan American Sanitary Conference unless all payments scheduled under the payment plan approved in 1987 have been received by the Secretariat.

7. To request the Director to notify Guyana that its voting privileges will be suspended effective with the commencement of the XXIII Pan American Sanitary Conference unless a specific and acceptable plan of deferred payments is received by the Secretariat and that voting rights will be automatically restored by this action.

8. To endorse the Working Party's recommendation that all deferred payment plans be considered firm commitments by the countries concerned and not be modified in the future.

9. To request that the Director:

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

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

c) Report to the XXIII Pan American Sanitary Conference on the status of the collection of quota contributions for 1990 and prior years.

Elected Barbados, Brazil, and Haiti to the Executive Committee upon termination of the periods of office of Ecuador, Saint Lucia, and the United States of America, 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 CD34/16); and

 Having taken into account the previous resolutions adopted by the Governing Bodies of PAHO on women, health, and development, particularly Resolutions CSP22.R12 of the XXII Pan American Sanitary Conference and IX of the XXXII Meeting of the Directing Council,

1. To request that Member Governments:

a) Strengthen and support the National Focal Point/Group for the Program on Women, Health, and Development, which has multisectoral and multidisciplinary characteristics and decision-making and technical capacity, and facilitate the necessary resources so as to more adequately and effectively implement the Regional Strategies of the Program;

b) Support the project "Women in Health and Development in Central America, Panama, and Belize," given its strategic importance as a means of stimulating the effective participation of women in the development process in the countries of the Region, and support and encourage the design and implementation of other projects related to the Women, Health, and Development Program, which are undertaken by either governmental or nongovernmental organizations.

2. To recommend that the Director:

a) Promote and encourage the Member Governments of the Organization to support the National Focal Point/Group for the Program on Women, Health, and Development, as a multisectoral and multidisciplinary entity with decision-making and technical capacity, so as to be able to coherently execute the objectives and regional strategies of the Program in the countries;

b) Strengthen the Focal Point in the PAHO/WHO Country Representative Offices in order to dedicate time and resources to the activities of the Program on Women, Health, and Development and provide greater support to the activities of the National Focal Point/Group;

c) Include, beginning in 1989, a chapter on women, health, and development in the Scientific Publication Health Conditions in the Americas;

d) Update in 1990, and every four years, the Scientific Publication entitled The Health of Women in the Americas, which thus far is the sole reference document in this field;

e) Strengthen the mechanisms for recruiting and promoting women in professional and decision-making positions by expanding the PAHO Candidate Roster and by actively seeking out qualified women for high-level administrative and technical posts; also recommended is the identification of women in the countries to participate in PAHO Advisory Committees, as well as in high-level scientific and technical conferences and seminars.

 Considering the devastation to several small island countries in the Caribbean and several towns and cities in the United States of America and the immediate adverse effects on human health and welfare, as well as the destruction of crops, facilities, and infrastructure in these countries and the long-term consequences for their productive capacity and balance of payments: and

 Noting the decision of the Heads of Government of the Caribbean Community countries at their Tenth Meeting in July 1989 to institutionalize arrangements within the framework of their Community to enable quick responses to be made to their Member Countries in the event of natural disasters, according to their respective capacities,

1. To express deep sympathy to the Governments and people of those countries which have suffered damage, loss of life, and injury as a result of the recent Hurricane Hugo.

2. To commend the Director for his usual immediate and sensitive response on behalf of the Organization to the urgent needs in the afflicted countries, especially in the smaller countries, and to acknowledge the expression of appreciation for those efforts by the Representatives of those countries in this Meeting of the Directing Council.

3. To request that the Director:

a) Intensify the efforts of this Organization in assisting its members which are frequently affected by natural disasters in their activities geared to better preparedness, in emergency relief, and in long-term rehabilitation and reconstruction of their health and medical facilities and services where necessary;

b) Explore further possibilities, within the program and budget for the current and the next biennium, for increasing the support of the Organization in the relief and reconstruction efforts necessitated as a result of Hurricane Hugo.

 Having seen the Annual Report of the Chairman of the Executive Committee (Document CD34/12) on the work of the Committee from September 1988 to date, the period during which the 102nd and 103rd 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 CD34/12).

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

 Having seen the Annual Report of the Director of the Pan American Sanitary Bureau for 1988 (Official Document 228); 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 Director of the Pan American Sanitary Bureau for 1988.

2. To commend the Director for his continued efforts to transform the report into a dynamic working tool, which provides a better understanding of the work accomplished by PAHO during the period covered and assists in the evaluation of the programming of PAHO's activities.

3. To thank the Director for his leadership and for his support to the Member Governments in the technical cooperation activities conducted by PAHO during 1988.

 Having examined the Interim Financial Report of the Director for 1988 (Official Document 227 and Add. I);

 Expressing concern over the slow rate of quota payments toward 1988 quota assessments for the Organization;

 Noting that the Institute of Nutrition of Central America and Panama has received a qualified audit opinion from the Organization's external auditor on the completeness and accuracy of its financial statements and financial position at the end of 1988; and

 Recognizing that the Organization continues to maintain a sound financial position,

1. To take note of the Interim Financial Report of the Director for 1988 (Official Document 227 and Add. I).

2. To endorse the comments and concerns expressed by the 103rd Meeting of the Executive Committee in its report on the financial condition of the Organization as of 31 December 1988, 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 congratulate the Director on having maintained the Organization in a sound financial position.

 Having reviewed the report on acquired immunodeficiency syndrome (AIDS) in the Americas (Document CD34/13 and Add. I):

 Recalling Resolution CD33.R9 adopted by the XXXIII Meeting of the Directing Council (1988) dealing with AIDS in the Americas. and Resolutions WHA40.26,1 WHA41.24,2 and WHA42.343 of the World Health Assembly dealing, respectively, with the global strategy for the prevention and control of AIDS, the avoidance of discrimination in relation to persons infected with the human immunodeficiency virus (HIV) and those with AIDS, and the important role played by nongovernmental organizations in the prevention and control of AIDS;

 Considering that HIV continues to be transmitted throughout the Region of the Americas, requiring an intensified commitment by every country to strengthen its capacity to control the spread of HIV to mitigate the magnitude of the future impact of this disease on health services and national economies;

 Recognizing the importance of joint, coordinated international efforts to prevent and control this disease;

 Cognizant of the increased efforts against HIV/AIDS by the WHO Global Program on AIDS in the Americas, carried out by the Pan American Health Organization; and

 Considering the ever-increasing impact on national health services and health resources resulting from the need to care for an ever-increasing number of HIV/AIDS patients and the need for national HIV/AIDS programs and activities to be articulated with national plans to strengthen health systems and services,

1. To endorse the objectives, strategies, and future targets for the Global Program on AIDS in the Americas, as presented in Document CD34/13.

2. To urge that Member Countries:

a) Refrain from imposing discriminatory measures directed at AIDS patients or HIV-infected persons;

b) Strengthen and intensify the activities of their national HIV/AIDS prevention and control programs, taking special care to achieve improved articulation with national health systems and services.

3. To request the Director to establish, with extra-budgetary funds, a special program for HIV/AIDS research in the Americas which will be sufficiently flexible and responsive to the many research needs related to HIV and other retroviruses of public health importance, with priority being given to epidemiological, operational, and behavioral research.

 Having considered the progress report presented by the Director on the implementation of the Expanded Program on Immunization (EPI) and the Plan of Action for the Eradication of Indigenous Transmission of Wild Poliovirus from the Americas by 1990;

 Noting that all countries have adhered to the policies and strategies of the Program as outlined in previous Directing Council meetings on this subject, which translates the high priority accorded by Member Countries to this activity;

 Taking note with satisfaction that immunization coverage with all EPI antigens has steadily increased, reaching historical high levels in 1988 in most countries and in the Region as a whole;

 Considering that the English-speaking Caribbean countries, Canada, Cuba, and the United States of America have decided to eliminate measles;

 Recognizing with enthusiasm the tremendous progress made during the last year toward polio eradication, which indicates that this goal will be virtually achieved by the end of 1990;

 Acknowledging the contribution that these activities have made toward the strengthening of the health infrastructure; and

 Considering that in spite of all these successes there are still nearly 4 million children born every year in the Hemisphere that do not receive the full benefit of immunization,

1. To reiterate its thanks to the United States Agency for International Development, the Inter-American Development Bank, UNICEF, Canadian International Development Agency/Canadian Public Health Association, and Rotary International for the increased support to this program, and especially to Rotary International for its latest contribution, which helped intensify the "mop-up" operation.

2. To call to the attention of all Member Countries that the program has entered a critical phase and that increased political commitment and resources will be needed if the program is to succeed, that there is no room for complacency, and that, therefore, the policies and strategies set forth in Resolution CD33.R14 of the XXXIII Meeting of the Directing Council (1988)-that all polio-endemic countries should hold national immunization days at least twice a year as a complement to their national immunization program and institute aggressive disease surveillance-should be continued, and non-endemic countries should ensure that their high levels of immunization are maintained.

3. To request that Member Countries, polio-endemic and non-endemic, take steps to establish a weekly reporting network of flaccid paralysis, including negative reporting, to permit the prompt detection of any suspected case of the disease, so that aggressive investigation and control measures can be instituted.

4. To urge all Member Countries, particularly those still endemic for polio, to institute immediate "mop-up'' operations as soon as a probable case is identified, and in all those districts which are at risk of polio transmission.

5. To urge Member Countries to consider the progress already attained toward the goal of polio eradication and to build on this success by:

a) Intensifying those actions geared to the control of neonatal tetanus, particularly through vaccination of all women of child-bearing age in those areas already identified as at high risk;

b) Intensifying vaccination with measles and DPT vaccines;

c) Increasing further immunization coverage by routine health services, instituting measures to eliminate the missed opportunities for vaccination in all health facilities by offering to vaccinate any eligible children or women of child-bearing age that visit these services.

6. To request that Member Countries and participating agencies decentralize their financial resources to the district level, in order that health workers in the local health system have the required resources to implement promptly the measures necessary to improve coverage and interrupt the transmission of polio.

7. To congratulate and support the English-speaking Caribbean countries on their initiative aimed at the elimination of measles in their countries by 1995, and the similar initiatives of Canada, Cuba, and the United States of America.

8. To request that the Director:

a) Institute a reward of US$100 to the first person that reports in writing the first case of an outbreak (as defined in the Plan of Action) in a district for which subsequent laboratory tests confirm that the case was due to wild polio-virus;

b) Monitor the initiative of elimination of measles in the English-speaking Caribbean countries, Canada, Cuba, and the United States of America, since its success will be critical for the development of strategies for the elimination of measles from the whole of the Americas;

c) Maintain the same priority accorded so far to this program and to report to the XXIII Pan American Sanitary Conference in 1990 on the achievements of the targets that were established for this program.

 Having examined the "Regional Plan of Action for the Prevention and Control of the Use of Tobacco" (Document CD34/10);

 Seriously concerned about the growing trends in tobacco consumption in most of the countries of the Region, and about the scale of the promotion of cigarette sales, particularly among youth and women;

 Bearing in mind the existence of irrefutable scientific evidence that morbidity and mortality associated with the use of tobacco are presentable and avoidable; and

 Considering that up to the present few countries have adopted effective measures of prevention and control of the use of tobacco in spite of the fact that it has been shown that those measures are feasible and practicable,

1. To approve the Plan of Action proposed by the Director, with the amendments indicated by the Executive Committee.

2. To urge the Governments to take appropriate decisions and to adopt the necessary measures required by the laws of each Member Country in order to put effectively into practice the Plan of Action in their respective countries.

3. To request that the Director:

a) Mobilize extrabudgetary resources to carry out and finance the proposed Plan of Action;

b) Continue joint efforts and collaboration with national authorities, nongovernmental organizations, United Nations agencies, and all those institutions interested in collaborating, in order to carry out the Plan of Action in the broader context of prevention and control of the most prevalent noncommunicable diseases.

 Having examined Document CD34/7, "Malaria Control," and taking into account Resolution WHA42.301 adopted by the Forty-second World Health Assembly in relation to this topic; and

 Recognizing that several PAHO Member Countries have eradicated malaria, some more than 20 years ago, and have continued to carry out surveillance activities, thus preventing the reestablishment of malaria transmission in spite of the global increase of the disease,

1. To urge that Member Governments:

a) Assign political priority to the effective fight against malaria;

b) Promote collaboration and coordination regarding this topic among the different levels of public administration, between it and the private sector, and among those development sectors affected by this issue, such as housing, health, education, agriculture, and mining;

c) Ensure that planning and the application of preventive and control methodologies be based on sufficient epidemiological information to allow the stratification of the areas affected by malaria and the analysis of risk factors and groups, in order to make the necessary interventions to prevent, control, and monitor malaria infections and their implications for society at large;

d) Commit the necessary resources for the strengthening of the surveillance systems in order to prevent reestablishment of malaria transmission;

e) Incorporate malaria prevention and control activities into the local health systems, stimulating social participation and local programming so that related interventions are carried out in a comprehensive, synergic, and sustained manner, using all available human and financial resources (local and national) to address the local situation.

2. To request that the Director:

a) Promote the mobilization of institutional, human, and financial resources, internal and external, local, national and regional, in order to develop or use the necessary infrastructure for the execution of effective and consistent malaria control programs;

b) Encourage the establishment and adequate functioning of epidemiological services capable of: (i) organizing surveillance and information subsystems; (ii) analyzing causes and trends for transmission as well as risk factors; and (iii) maintaining the process of malaria stratification for planning interventions which decrease, inhibit, or nullify the risk factors;

c) Promote the technical cooperation for malaria surveillance systems development through joint efforts among the Member Countries in order to maintain malaria-free status in areas without transmission;

d) Formulate a human resources development plan to assist Governments in the organizational strengthening of basic health services, and ensure the development and retention of specialists in terms of various levels of training, professional education, supervision, management, administration, operations, and research;

e) Promote the interest of the scientific and financial community in the developed and developing countries to encourage and support research on alternative diagnostic, prevention, and control methodologies which are not only more efficient and effective, but also whose application is feasible in rural areas, as well as cheaper;

f) Encourage the process of decentralization/deconcentration, thus strengthening local health systems to develop permanent local programs to control vector-transmitted diseases such as malaria, and supporting the primary health care strategy;

g) Support the development of managerial and administrative capabilities at peripheral decision-making levels, in order to encourage local programming and the evaluation of prevention and control methods according to the local situations;

h) Carry out the necessary efforts to document and disseminate information on the experiences of countries in relation to their activities in training, research, management, evaluation, and finance.

 Having seen the resolution of the Special Meeting of Ministers of Health of the Andean Area;

 Considering Resolution XVIII of the XXXIII Meeting of the Directing Council in which the Member Countries are urged to support and cooperate in their strong enforcement measures against drug traffickers and to formulate and develop programs to prevent and control narcotics consumption;

 Considering, furthermore, recent events in Colombia related to this matter; and

 Aware of the serious consequences that drug addiction has on the health of communities,

1. To support in solidarity the people and Government of Colombia in their determined, brave struggle against drug trafficking.

2. To request that the Member Countries promote all activities leading to prevention, with emphasis on groups at risk and adolescents.

3. To ask the Member Countries to support activities to combat, control, and confiscate, implementing all necessary measures in the fight against drug trafficking.

 Having examined the study entitled "Health and Development: Repercussions of the Economic Crisis'' (Document CD34/21);

 Recalling Resolutions CD26.R34 and CD30.R2 on analysis of the relation between economic development and health, as well as Resolutions WHA40.30,1 WHA42.3,2 and WHA42.43 concerning monitoring the impact of economic trends and policies on health, support for countries facing economic constraints, and the rationalization of health care financing;

 Recognizing the relationship of this study to previous studies by the Secretariat concerning the negative impact of the current economic crisis on the health sector; and

 Expressing satisfaction with the advance of understanding of these repercussions embodied in this study, and observing the challenges for the Member Countries and the Organization which the study brings to light,.

1. To take note of the study.

2. To urge Member Countries to address the challenges described in the study, strengthen their information systems, and gather and analyze the pertinent data together with the Organization.

3. To request through the Director that the Organization continue to study with the Member Countries the relationship between health and development; the impact of the economic crisis on health and health services; financing and organization of health care and the administration of health services; and that he provide regular progress reports to the Directing Council.

4. To request the Director to continue to strengthen technical cooperation with Member Countries in order to better characterize and resolve the problems of the economic crisis and health, including more research projects, preferably multidisciplinary ones.

5. To thank the Director for his efforts to focus attention on the relationship between health and economic development through his support and encouragement of research in this area.

 Having examined Document CD34/9. "Blindness Prevention in the Americas," and Resolution CD26.R13 of the XXVI Meeting of the Directing Council (1979);

 Recognizing that a great part of the eye damage which causes so much human suffering and economic loss can be prevented, cured, or minimized through rehabilitation;

 Considering that many countries of Latin America and the Caribbean need technical cooperation and coordination in the introduction of local, national, or subregional programs on blindness prevention, primarily to identify populations at risk and in training personnel for the various levels of care; and

 Taking into account the growing interest and support on the part of the governmental and nongovernmental organizations to develop activities in this area,

1. To urge that Member Governments:

a) Maintain and strengthen their policies and programs for eye health and prevention of blindness integrated into general health services on the basis of the primary health care strategy and according to local needs;

b) Give special emphasis to the development of uncomplicated prevention, early diagnosis, treatment, and rehabilitative technologies related to the principal causes of blindness, enlisting ample participation from the community and from other sectors, especially the education sector.

2. To request that the Director:

a) Continue collaborating with the Governments of Member Countries and with nongovernmental organizations in the promotion of research, personnel training programs, and in the formulation, implementation, and evaluation of national programs of blindness prevention, including the promotion of eye health, and aimed at the major causes of preventable blindness, particularly cataracts, glaucoma, onchocerciasis, and vitamin A deficiency;

b) Take steps to obtain extrabudgetary funds and other resources from nongovernmental, bilateral, and multilateral organizations, and from any other source capable of assisting national and regional programs for blindness prevention.

3. To congratulate the nongovernmental organizations on their efforts in the prevention and control of blindness in the Americas.

 Taking into account the importance of developing human resources for the health sector and the role of the Fellowship Program of PAHO in attending to the academic training needs in specific fields which are more developed outside many of the Member Countries, and in ensuring a broad program of continuing education for existing personnel; and

 Considering that the Fellowship Program, as a technical cooperation instrument, must be utilized in the context of the health systems and programs being developed within the framework of the health sector's policies, and closely linked to the technical work being carried out by the countries and the Organization,

1. To urge that Member Governments:

a) Strengthen their activities in terms of development of policies and plans regarding human resources in health, including the use of fellowships;

b) Promote the use of academic fellowships in those cases in which the necessary opportunities do not exist at the national level;

c) Limit the award of short-term fellowships, both at the national and international levels, in accordance with the needs for advanced training in those fields that require formal education;

d) Apply the prescribed mechanisms for selection and approval of fellows, through the National Fellowships Committees, ensuring the participation of the technical levels of the health services in such Committees.

2. To request that the Director:

a) Maintain an up-to-date system for periodic review and acceptance of institutions which provide training to PAHO's fellows;

b) Enforce the rules regarding fellowship awards, production, collection, and analysis of fellows' reports and outcome evaluation, and assure that fellowship hosts are provided sufficient information regarding the fellows' past experience and the expected outcome of the training;

c) Continue promoting greater participation on the part of women in the fellowship program;

d) Send this analysis of the fellowship program of the Region of the Americas to the Director-General of the World Health Organization for presentation to the Executive Board.

 Having considered Document CD34/5 and Resolution XIII of the 103rd Meeting of the Executive Committee; and

 Believing it desirable to adopt a new seal of the Pan American Health Organization,

1. To adopt the distinctive design presented in Document CD34/5 as the official seal of the Pan American Health Organization.

2. To entrust the custody of such seal to the Director of the Bureau.