Expressing satisfaction with the services of the present External Auditor, holder of the Office of the Comptroller and Auditor General of the United Kingdom of Great Britain and Northern Ireland, and noting his expressed willingness to continue to serve as External Auditor of the Pan American Health Organization,

1. To appoint the holder of the Office of the 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 1996–1997 and 1998–1999, 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 John Bourn for the work he has performed for the Organization in his audit of the accounts for the financial periods 1992–1993 and 1994–1995.

 Having considered the report of the Director on the collection of quota contributions (Document CD38/19 and Add. I) and the concern expressed by the 116th Meeting of the Executive Committee1 with respect to the status of the collection of quota contributions;

 Noting from the report of the Working Party on the application of Article 6.B (Document CD38/19, Add. II (Rev. 1) that payment had been received from Bolivia in accordance with the deferred payment plan which had been accepted by the XXIV Pan American Sanitary Conference;2 and

 Further noting that Cuba, Haiti, Peru, Suriname, and Venezuela have outstanding quota amounts in excess of two full years of assessments and are subject to the application of Article 6.B of the Constitution,

1. To take note of the report of the Director on the collection of quota contributions (Document CD38/19 and Add. I).

2. To express appreciation to those Member Governments that have already made payments in 1995, and to urge all Member Governments in arrears to meet their financial obligations to the Organization in an expeditious manner.

3. To congratulate Bolivia and Haiti for their payment efforts to reduce quota arrearages for prior years.

4. To recognize the concern expressed at the meeting of the Working Party with respect to the future voting privileges of Cuba, Peru, and Suriname and to request the Director to advise the Governments of the views of the Council.

5. To request the Director to notify Venezuela that its voting privileges are conditionally suspended at this XXXVIII Meeting of the Directing Council until either payment of the arrearage or a specific and acceptable plan of payment is received and approved by the Secretariat, and that voting privileges will be restored by either of these actions.

6. 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 XXXIX Meeting of the Directing Council on the status of the collection of quota contributions for 1996 and prior years.

In establishing the contributions of Member Governments, Participating Governments, and Associate Members, their assessments shall be reduced further by the amount standing to their credit in the Tax Equalization Fund, except that credits of those 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 1996 to 31 December 1997, inclusive. Notwithstanding the provision of this paragraph, obligations during the financial period 1996–1997 shall be limited to the effective working budget, i.e., Parts I–VII.

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, exclusive of the provision made for transfers from the Director's Development Program in Part II. Except for the provision made for the Director's Development Program in Part II, 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. The Director is authorized to apply amounts not exceeding the provision for the Director's Development Program to those parts of the effective working budget under which the program obligation will be incurred. All transfers of budget credits shall be reported to the Directing Council or the Pan American Sanitary 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, adjusted to PAHO Membership, in compliance with Article 60 of the Pan American Sanitary Code; and

 Whereas, adjustments were made taking into account the assessments of Cuba, the Participating Governments, and Associate Members,

 To establish the assessments of the Member Governments, Participating Governments, and Associate Members of the Pan American Health Organization for the financial period 1996–1997 in accordance with the scale of quotas shown below and in the corresponding amounts.

 Recalling that the XIV Pan American Sanitary Conference, in Resolution CSP14.R28 (1954), set the criteria for establishing official relations between PAHO and inter-American nongovernmental organizations;

 Mindful of the provisions in Resolution CSP20.R20 (1978) of the XX Pan American Sanitary Conference defining the procedures for the establishment by the Pan American Health Organization of official relations with inter-American nongovernmental organizations;

 Recalling that the 113th Meeting of the Executive Committee adopted Resolution CE113.R18 recommending the updating of the criteria for the establishment and maintenance of official relations between PAHO and inter-American NGOs;

 Recognizing the important role of nongovernmental organizations and the complementarity of resources they represent in the network of governments, peoples, and PAHO/WHO striving for health development;

 Emphasizing the need to mobilize national, international, and inter-American nongovernmental organizations for accelerated implementation of health for all strategies;

 Taking into account that PAHO would benefit by having a written document containing the conceptual framework dealing with the development of informal working relations with nongovernmental organizations and with their admission into official relations similar to that of the World Health Organization (1987);1 and

 Having taken note of the recommendations of the Executive Committee (Resolution CE116.R6),

 To adopt the Principles Governing Relations between the Pan American Health Organization and Nongovernmental Organizations presented in Document CD38/10.

 Having reviewed and discussed Document CD38/15, containing the plan of action and a progress report on the national and regional efforts towards the elimination of measles from the Americas by the year 2000;

 Noting with satisfaction that nearly all countries have adopted the strategies outlined in the plan of action and have made considerable progress toward measles elimination;

 Observing that, in spite of the major efforts made with the implementation of national campaigns and improvements in routine vaccination programs, the number of susceptible children is accumulating every year in every country;

 Realizing that measles surveillance requires considerable resources, both financial and human, but cognizant that a surveillance system is essential to future developments of communicable disease surveillance, including emerging and re-emerging infections; and

 Bearing in mind the level of funding needed to implement the activities between now and the year 2000,

1. To approve the Plan of Action for Measles Elimination in the Americas by the year 2000 as presented in the progress report of the Director (Document CD38/15).

2. To urge all Member States to adopt the strategies outlined in the Plan of Action and allocate the resources needed for its smooth implementation.

3. To congratulate Governments for the efforts implemented thus far and the strides already made towards the elimination of measles from the Americas by the year 2000.

4. To request the Director to make every possible effort to secure the international resources needed to support the national efforts.

Elected the Bahamas, Chile, and Costa Rica to the Executive Committee upon termination of the periods of office of Argentina, Belize, and Mexico, and thanked the Governments of these countries for the services rendered to the Organization by their representatives on the Committee.

 Having reviewed and discussed Document CD38/14, containing the plan of action for elimination of congenital syphilis as a public health problem in the Americas;

 Noting with satisfaction that most countries have established practices of syphilis screening during pregnancy and that inexpensive yet effective treatments are available;

 Observing that, in spite of the efforts taking place at national and local levels, preventable cases of congenital syphilis continue to occur in every country;

 Realizing that congenital syphilis surveillance will serve to assess both the quality of prenatal care services and syphilis control in the community, and understanding that such a surveillance system is linked to the development of communicable disease surveillance;

 Recognizing that elimination of congenital syphilis must be done as an integrated component of programs for reproductive health and control of other sexually transmitted diseases; and

 Bearing in mind the level of funding needed to implement the plan between now and the year 2000,

1. To note the plan of action for elimination of congenital syphilis in the Americas (Document CD38/14).

2. To urge Member States to adopt the strategies outlined in the plan of action and allocate the resources needed for its implementation.

3. To congratulate governments for the efforts developed thus far and the strides already made towards the control and elimination of congenital syphilis.

 Considering that the publication Health Conditions in the Americas contains the most recent and reliable information on the progress in health achieved by the Member States of the Pan American Health Organization; and

 Having reviewed Document CD38/12, which contains the proposal to modify the mandate to submit a report every two years on the progress in workers' health,

 To reiterate Resolution CD36.R22 of the XXXVI Meeting of the Directing Council (1992), modifying operative paragraph 6(d) so that the publication Health Conditions in the Americas replaces the progress report requested in said paragraph.

 Having reviewed the report on acquired immunodeficiency syndrome (AIDS) in the Americas (Document CD38/16);

 Bearing in mind that each year more than 1,000 new infections per day continue to occur in Latin America and the Caribbean, many of which could be prevented with appropriate and timely interventions;

 Taking into account that in January 1996 the new Joint United Nations Program on AIDS will begin to carry out AIDS prevention activities at the global and country levels; and

 Taking note that PAHO possesses the functional structure and capacity to provide technical cooperation for the prevention of infection by HIV and other sexually transmitted pathogens and for the clinical management and the comprehensive care of diseases associated with such infections, and has the responsibility to do so,

1. To request the Director:

(a) To reiterate to the regional directors of agencies of the United Nations and inter-American systems, as well as other interested bilateral agencies, PAHO's commitment to collaborate fully with the new Joint Program;

(b) To continue to provide technical cooperation in the Organization's areas of technical expertise for the prevention and comprehensive care of HIV/AIDS and other sexually transmitted diseases in the Americas, within the framework of its constitutional mandate and the strategic and programmatic orientations and within the context of the new UN Program;

(c) To continue to intercede with the Member Governments of PAHO so that AIDS, understood fundamentally as a health problem but one that has implications for other sectors of society, is combated with multisectoral participation, efficient investment of national resources, strong governmental leadership, and the technical guidance of the health sector;

(d) To continue the necessary consultations with the other agencies that make up the Joint Program, the organizations of the inter-American system, and other agencies involved, in order to establish coordination mechanisms that will guarantee broad participation and have a demonstrable impact, reducing HIV infection and the social consequences of AIDS in the Region.

2. To maintain and strengthen PAHO's ability to provide technical cooperation with regard to HIV/AIDS and STDs in the Organization's areas of responsibility, in close collaboration with the Joint Program.

 Regretting the damage occasioned by recent hurricanes, particularly Hurricanes Luis and Marilyn in the islands of the Caribbean-especially in Anguilla, Antigua and Barbuda, the British and U.S. Virgin Islands, Dominica, the French and Netherlands Antilles, Montserrat, Puerto Rico, and Saint Kitts and Nevis-and Hurricane Ismael in Mexico;

 Taking note of the damage to the social, economic, and physical infrastructure, and in particular to the health facilities and water systems of these countries and territories, and of the assistance provided by PAHO;

 Bearing in mind that one of the functions of PAHO is to provide aid and technical assistance to the Member States in emergencies; and

 Considering that the General Assembly of the United Nations has designated the period 1990–1999 as the International Decade for Natural Disaster Reduction,

1. To request the Director to offer the condolences of the PAHO Member States to the governments and peoples of the affected countries and territories.

2. To congratulate the Director for having provided the Organization's assistance.

3. To urge the Member States:

(a) To provide assistance to the countries and territories affected by hurricanes Ismael, Luis, and Marilyn;

(b) To consider the adoption of measures to mitigate the physical damage to health facilities and water systems as a development priority, allocating national and international resources within the framework of the International Decade for Natural Disaster Reduction;

(c) To participate actively in the International Conference on Disaster Mitigation in Health Facilities, to be held in Mexico in February 1996.

4. To request the Director to continue to provide assistance to the countries and territories affected by the aforementioned hurricanes through an assessment of the damages suffered by the health sector and formulation and support of plans for the reconstruction and rehabilitation of the health systems, as well as the garnering of sources of assistance to realize such plans.

 Considering the situation in the Region of the Americas with regard to what have been termed emerging infectious diseases and/or the re-emergence of communicable diseases considered to have been under control or in the process of disappearing;

 Recognizing the magnitude and gravity of the threat that the risk of propagation of these diseases represents to public health and the economic development of the countries of the Region;

 Mindful of the emergency situation presented by dengue hemorrhagic fever in the Hemisphere; and

 Having seen the Director's report on these diseases,

1. To recommend to the Member Governments:

(a) That they strengthen the infrastructure that will permit better performance of the networks for surveillance of communicable diseases, reinforcing early-warning systems and providing for rapid response of prevention and control measures;

(b) That they promote the dissemination of information on the issue to health personnel and to the public at large as part of an enhanced social communication thrust;

(c) That they promote applied research on methods of rapid diagnosis, epidemiology, and prevention.

2. To request the Director:

(a) To promote and support the mobilization of national, subregional, regional, bilateral, and multilateral resources to address this issue;

(b) To promote the establishment of intergovernmental mechanisms to facilitate coordinated action among the countries of the Region;

(c) To encourage the implementation of a regional plan of action that supports the activities of the Member Governments, as resources permit, in the areas of early detection, surveillance, control, and information exchange.

(d) To establish immediately a technical task force to study the feasibility, timeliness, and appropriateness of drawing up a hemispheric plan for the eradication of Aedes aegypti as an effective means of controlling dengue and urban yellow fever in the Americas.

3.3. To thank the Director for having taken the initiative of presenting the issue of new, emerging, and re-emerging infectious diseases to the Directing Council.

 Considering the revision made to the base/floor salary scale for the professional and higher categories of staff in graded posts, effective 1 March 1995;

 Taking into account the decision by the Executive Committee at its 116th Meeting to adjust the salaries of the Deputy Director and Assistant Director (Resolution CE116.R11);

 Having noted the recommendation of the Executive Committee concerning the salary of the Director of the Pan American Sanitary Bureau (Resolution CE116.R11); and

 Bearing in mind the provisions of Staff Rule 330.3,

 To establish the annual net salary of the Director of the Pan American Sanitary Bureau at US$ 93,735 (dependency rate) and $84,232 (single rate), effective 1 March 1995.

 Mindful of the provisions of the Plan of Action approved by the Heads of State at the Summit of the Americas, held in Miami from 9 to 11 December 1994, which included a resolution on equitable access to basic health services; and

 Taking into account the reports presented by the Member Governments on health conditions and the status of their national processes of health sector reform, as well as the working document prepared by PAHO in consultation with the Economic Commission for Latin America and the Caribbean, the Inter-American Development Bank, the Organization of American States, the United Nations Children's Fund, the United Nations Population Fund, the United States Agency for International Development, and the World Bank, as well as the Government of Canada, which coordinated the organization of the Special Meeting on Health Sector Reform and the deliberations of this meeting,

1. To thank the governments and agencies for the activities that they carried out in preparation for the Special Meeting on Health Sector Reform.

2. To take note of the discussions at the Special Meeting on Health Sector Reform.

3. To request the Member Governments:

(a) To give priority attention to the health sector reform processes, with a view to achieving greater equity, efficiency, and effectiveness in sector activities;

(b) To facilitate the sharing of national experiences and to report periodically on the results of their national health sector reform projects and processes.

4. To urge the cooperating agencies to intensify the coordination of their activities and programs of work and to broaden their support for health sector reform processes, bearing in mind the particular characteristics of each country.

5. To request the Director:

(a) In accordance with the recommendations of the Summit of the Americas and taking into account the discussions at the Special Meeting on Health Sector Reform, to continue to work with the Member States and agencies in the design and development of a process for monitoring health sector reform in the Americas;

(b) To coordinate the implementation of an inter-American network with the governments and agencies, as a mechanism for facilitating information exchange on health sector reform;

(c) To transmit a report on this Meeting to the next Hemispheric Summit, to be held in Bolivia in 1996.