Considering the revision made to the base/floor salary scale for the professional and higher-graded categories of staff, effective 1 March 2000;

Taking into account the decision of the Executive Committee at its 126th Session to adjust the salaries of the Deputy Director and Assistant Director (Resolution CE126.R12);

Having noted the recommendation of the Executive Committee concerning the salary of the Director of the Pan American Sanitary Bureau (Resolution CE126.R12); 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 $108,242 (dependency rate) and $97,411 (single rate), effective 1 March 2000.

(Final Report, CD42, 8)

CD42.R2    The Directing Council,

Having considered Document CD42/5 and the tentative request to the World Health Organization for US$ 74,682,000 without cost increases for the Region of the Americas for the financial period 2002-2003; and

Noting the recommendation of the Executive Committee,

To request the Director to transmit to the Director-General of WHO the request for $74,682,000 without cost increases for the Region of the Americas for the financial period 2002-2003, for consideration by the WHO Executive Board and the World Health Assembly in 2001.

(Final Report, CD42, 8-9)

CD42.R3    The Directing Council,

Having analyzed the report on food protection in the Americas (Document CD42/10), which describes the current problems deriving from foodborne diseases and the action that the Pan American Health Organization is taking to assist the countries in solving these problems through technical cooperation to organize food protection programs;

Taking into account that the Fifty-third World Health Assembly adopted Resolution WHA53.15 on food safety, emphasizing the importance of this topic as an essential public health activity;

Considering that, according to the reports prepared by the Pan American Health Organization through the Pan American Institute for Food Protection and Zoonoses (INPPAZ), a significant number of outbreaks of foodborne disease have been observed, with a high number of cases and deaths from this cause; and

Bearing in mind that international trade poses a high risk for outbreaks of foodborne disease unless technical action is taken to prevent food contamination,

1. To urge Member States to:

(a) organize food protection programs as an essential public health function, promoting active coordination among the health and agriculture sectors and industry;

(b) update and modernize their food inspection and protection systems, taking into account the Codex Alimentarius standards and the sanitary measures contained in the Agreements on Sanitary and Phytosanitary Standards;

(c) consider, when implementing food safety measures, food for both domestic consumption and the export market, as well as medium and small enterprises;

(d) strengthen the surveillance systems for foodborne diseases so that the information obtained can be used to orient measures for the prevention and control of these diseases;

(e) encourage the active participation of producers, food processors, food handlers, and consumers through communication and health education programs;

(f) provide the necessary resources for the development of food protection programs;

(g) create, as soon as possible, national Codex Alimentarius committees in Member States where they do not exist.

2. To thank the Government of Argentina for its continued support for the maintenance and operation of INPPAZ, and to urge the rest of the countries to contribute to its financing.

3. To request that the Director:

(a) continue with the development and execution of the strategic plan on food protection;

(b) explore the need for a regional commission on food protection to deal with matters related to the development of regional policies in this area;

(c) establish mechanisms for coordination with other international technical cooperation agencies to offer the pertinent technical cooperation to the countries, avoid duplication of efforts, and make better use of resources;

(d) urge countries to establish a regional network of laboratories with a view to harmonizing methodologies and information exchange, which would result in improvements in quality.

(Final Report, CD42, 9-10)

CD42.R4    The Directing Council,

Having considered the report of the Director on the collection of quota contributions (Document CD42/21 and Add. I) and the concern expressed by the 126th Session of the Executive Committee with respect to the status of the collection of quota contributions; and

Noting that Argentina has proposed a deferred payment plan to address its arrears of contributions,

1. To take note of the report of the Director on the collection of quota contributions (Document CD42/21 and Add. I).

2. To express appreciation to those Member States that have already made payments in 2000, and to urge all Member States in arrears to meet their financial obligations to the Organization in an expeditious manner.

3. To congratulate the countries that have fully met their quota obligations through 2000.

4. To compliment the countries which have made payment efforts to reduce quota arrearages for prior years.

5. To request the President of the Directing Council to notify Argentina that it shall have the privilege of voting at this 42nd Directing Council.

6. To take note that all other countries are in compliance with their approved payment plans and, therefore, shall retain the right to vote.

7. To request that the Director:

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

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

(c) report to the 43rd Directing Council on the status of the collection of quota contributions for 2001 and prior years.

(Final Report, CD42, 11-12)

CD42.R5    The Directing Council,

Having analyzed The World Health Report 2000, published by the World Health Organization on 24 June 2000;

Considering the importance of health in the development and well-being of the population;

Bearing in mind the importance of health systems in improving health conditions and the quality of life;

Recognizing the important role of performance evaluations of health systems in improving the quality, equity, and other criteria relevant to these systems; and Recognizing that WHO has an historic and important role to play in conducting these evaluations and issuing recommendations on health policy,

1. To urge the Member States to:

(a) mobilize national intelligence, represented by their respective Ministers of Health, universities, research institutions, and similar organizations, to monitor and evaluate their own health systems;

(b) provide technical information to the World Health Organization to conduct comparative studies among countries.

2. To recommend that the Director of the Pan American Sanitary Bureau transmit to the Director General of the World Health Organization the request that WHO:

(a) promote, with the broad participation of the Member States of the World Health Organization, a review of the framework and methodologies utilized in the comparative performance study of health systems contained in The World Health Report, 2000;

(b) submit the technical and methodological bases of the next World Health Report for consideration of the WHO Executive Board, before its publication.

(Final Report, CD42, 12-13)

CD42.R6    The Directing Council,

Having reviewed the evaluation of the Regional Program on Bioethics (Document CD42/9), carried out in compliance with Resolution CD37.R9 (1993);

Expressing appreciation for the considerable technical and financial support provided by the Government of Chile and the University of Chile toward the establishment and continued operation of the Bioethics Program since its inception, as well as for their commitment to continue support for the Program; and

Emphasizing that bioethical analysis should become an integral part of policy formulation and decision-making in the health sector, particularly in processes involving improving quality of health care and research and increasing equity in access to health care services,

1. To encourage Member States to incorporate the development of the capacity for bioethical analysis within the normative and steering role functions of the ministries of health and to formulate public policies in health informed by bioethical principles, particularly with regard to research with human subjects.

2. To request that the Director:

(a) continue support of the Program, promoting the inclusion of bioethical analysis in technical cooperation activities and stimulating capacity building in bioethics in the Member States;

(b) assist the Member States in strengthening ethics oversight bodies-ethics commissions and committees of government or scientific institutions and civil society-especially through the formulation of training proposals for their members;

(c) unite efforts of the Member States for the common definition of international standards of ethics in research involving human subjects that will ensure the protection of vulnerable populations, especially in developing countries.

(Final Report, CD42, 13-14)

CD42.R7    The Directing Council,

Bearing in mind the provision of Articles 4.D and 15.A of the Constitution of the Pan American Health Organization; and

Considering that El Salvador, Jamaica, and Uruguay were elected to serve on the Executive Committee upon the expiration of the periods of office of Antigua and Barbuda, Ecuador, and Mexico,

1. To declare El Salvador, Jamaica, and Uruguay elected to membership on the Executive Committee for a period of three years.

2. To thank Antigua and Barbuda, Ecuador, and Mexico for the services rendered to the Organization during the past three years by their delegates on the Executive Committee.

(Final Report, CD42, 14)

CD42.R8    The Directing Council,

Having considered the report of the Director on vaccines and immunization (Document CD42/8) and taking note of the progress being made by all countries in the control of vaccine-preventable diseases;

Taking into account that there is still a considerable number of children who are not receiving the benefits of immunization;

Cognizant of the fact that major efforts are needed to achieve the goal of measles eradication by the end of the year 2000; and

Considering that the sustainability of immunization programs and control/eradication of vaccine-preventable diseases require a permanent effort by the health sector at all levels,

1. To urge Member States to:

(a) maintain a high degree of priority in the financing of their national immunization programs, including the costs related to the introduction of new vaccines;

(b) target a 95% vaccination coverage for all antigens in every district of the country as the national goal;

(c) ensure that all measures necessary to interrupt the transmission of measles are put in place, including those related to mop-up operations and strengthening of surveillance and complete case investigation;

(d) initiate activities related to the containment of any laboratory material that may harbor specimens of wild poliovirus, to ensure that global certification of eradication is eventually accomplished;

(e) implement periodic multidisciplinary evaluations of their national immunization programs to identify any constraints that may hamper the equitable access to measures aimed at the control of vaccine-preventable diseases;

(f) ensure that all vaccines used in national immunization programs comply with national and international standards.

2. Request the Director to:

(a) collaborate with Member States in the containment of biological material that may harbor the wild poliovirus;

(b) support the networks of national control authorities and national control laboratories to ensure that vaccines of reliable quality are used in all countries;

(c) support the national program evaluations in coordination with other collaborating partners;

(d) assist the relevant Member States in benefiting maximally from the Global Alliance for Vaccines and Immunization.

(Final Report, CD42, 14-16)

CD42.R9    The Directing Council,

Taking into account the information provided in document CD42/11 on cardiovascular disease, and especially hypertension;

Given the magnitude of cardiovascular problems, which are among the leading causes of death and disability in all the countries of the Americas;

Bearing in mind the cost-effectiveness of interventions for the prevention and control of these diseases, especially interventions to control hypertension; and

Recognizing the need to adopt measures for the prevention and control of cardiovascular disease in general and hypertension in particular,

1. To urge the Member States to:

(a) implement systems for surveillance of the risk factors for cardiovascular disease and noncommunicable diseases in general, including end-stage renal disease and its economic impact;

(b) update their health policies to strengthen and prioritize community and health service interventions, especially in primary care, that will lead to the prevention and control of cardiovascular disease and hypertension in particular;

(c) develop or strengthen national plans for the prevention and control of hypertension.

2. To request the Director to:

(a) establish the necessary measures for the mobilization of technical cooperation resources that will permit the creation or strengthening of national plans for the prevention and control of hypertension within the framework of an integrated strategy for the prevention and control of noncommunicable diseases;

(b) encourage partnerships with scientific and professional societies, community organizations, and bilateral and multilateral cooperation and development agencies so that they support the proposed approaches and conduct research to improve the prevention and control of hypertension.

(Final Report, CD42, 16-17)

CD42.R10    The Directing Council,

Having considered Document CD42/12 on medical devices;

Considering that, in the exercise of the steering role of the health sector, it is an essential function of the health authority to safeguard the efficacy, safety, and quality of the medical devices utilized by the health services and the population;

Recognizing that is necessary to establish a process for the planning, implementation, and management of technologies to guarantee the efficient operation of the health services network; and

Taking note of the recommendation of the Executive Committee,

1. To endorse the recommendations on medical devices contained in Document CD42/12 and to support the work of PAHO in this field.

2. To support the proposal to form an ad hoc group to promote and facilitate the medical devices harmonization processes in the Americas.

3. To urge the Member States to:

(a) develop and strengthen their programs for the regulation of medical devices;

(b) promote and support the participation of their regulatory authorities at the general meetings of the Global Harmonization Task Force (GHTF) and those of its four study groups, while promoting the use of GHTF documents in their programs for the regulation of medical devices.

4. To request the Director to continue his support to the governments for the development and implementation of programs to regulate medical devices and to support the search for sources of financing for the activities of the proposed program of work for the biennium 2000-2001.

(Final Report, CD42, 17-18)

CD42.R11    The Directing Council,

Having considered the Director's report (Document CD42/13) on drug regulatory harmonization in the Americas;

Taking into account that the drug regulatory harmonization processes are fundamental for guaranteeing the safety, efficacy, and quality of drugs;

Recognizing that other regions and subregional groups of countries in the Americas with different levels of development are making efforts at the global level to move forward with drug regulatory harmonization;

Aware that, through its plans of work, the Pan American Network for Drug Regulatory Harmonization will represent a concrete regional option for this process; and Observing that drug regulatory harmonization offers health, economic, and technical advantages for the countries committed to its implementation,

1. To urge the Member States to:

(a) review the current drug policies, with a view to adopting new policies that will ensure access to drugs that are safe, effective, and of acceptable quality;

(b) strengthen the infrastructure currently in place for regulating drugs to permit regulation that is expeditious but technically acceptable;

(c) support national implementation of the agreements and recommendations arising out of the Pan American Network for Drug Regulatory Harmonization.

2. To request the Director to:

(a) support the establishment of the Pan American Network for Drug Regulatory Harmonization and strengthen the role of PAHO as its Secretariat;

(b) promote progress toward technical agreements on drug regulation among the Member States, including multilateral, bilateral, and subregional agreements, with the participation of all sectors and interest groups;

(c) promote the search for sources of financing for this process and the plan of work.

(Final Report, CD42, 18-19)

CD42.R12    The Directing Council,

Having considered the report on child health (Document CD42/14); Recognizing the need to build a new, fuller concept of the importance of child health to a better future, based on the achievements of the past decade and the new knowledge and evidence contributed by various disciplines;

Taking into account that there are still unresolved issues related to children's' rights, equity in health, development opportunities, and solutions for basic health problems, as well as emerging issues affecting child health, yet aware of the importance of dealing with a broader public health agenda involving determinants and understanding that investment in child health is justified; and

Recognizing the moment as a critical one for the development of child health due to the global attention on the 10th anniversary evaluation of the World Summit for Children as well as the United Nations General Assembly special session planned for September 2001, when the agenda for children in the new millennium will be established,

1. To request the Member States to:

(a) institute national processes to review policies and legislation vis-à-vis their conformity with children's' rights, distribution of resources to achieve child and family friendliness, and community and environmental contributions to integral child health and development possibilities;

(b) maintain the topic of integral child health and development on the public agenda using, among other mechanisms, those available through the application of social communication methodologies, and joining in national and international efforts and networks promoting development in this area;

(c) include in the health sector reform processes a provision for the reorganization of health systems and services so that they reflect the urgent need to prioritize and invest in integral child health and development;

(d) contribute towards the improvement of child health through stimulating research activities, paying special attention to operationalizing integration at local levels, and developing monitoring and evaluation criteria.

2. To request the Director to:

(a) promote the mobilization of resources to enable adequate investment and advocate in national and international forums that priority attention be given to integral child health activities;

(b) support the development of a regional plan for action based on the framework suggested which would include multidisciplinary and multisectoral inputs and coordinated efforts with partner agencies;

(c) stimulate the development of a network of interested parties for the identification, testing, and evaluation of indicators that would reflect both process and achievements in monitoring child health programs whose focus is on the integration of health promotion with preventative and therapeutic efforts, i.e., criteria for evaluating health, and not just its absence;

(d) continue PAHO's leadership role in the Americas in child and adolescent health and nutrition within the various regional and global venues, including the United Nations Special session of the General Assembly in 2001 for follow-up to the World Summit for Children, the Ibero-American Summits, and the Fifth Ministerial Meeting on Children and Social Policy in the Americas.

(Final Report, CD42, 19-21)

CD42.R13    The Directing Council,

Having considered the report on acquired immunodeficiency syndrome (AIDS) in the Americas (Document CD42/7);

Acknowledging the strong relationship between the sexual and vertical transmission of HIV and the presence of other sexually transmitted infections (STI);

Cognizant of the evolution of the HIV/AIDS/STI epidemics in the Americas and of the challenges raised by the increasing numbers of people requiring comprehensive prevention and care services for HIV/AIDS/STI; and

Taking into account the technological developments and successful interventions and experiences in the Region and in the world to prevent and control the sexual, blood-borne, and mother-to-child transmission of HIV and other sexually transmitted infections,

1. To urge Member States to:

(a) consolidate national HIV/AIDS/STI efforts, foster horizontal technical cooperation, and maximize intercountry collaboration through regional, subregional, and national programs and initiatives;

(b) strengthen the surveillance capacity of the technical programs to better monitor the trends in the HIV/AIDS/STI epidemics and adjust national responses and strategies accordingly;

(c) continue to focus on prevention, especially the sexual and mother-to-child transmission of HIV and its transmission through the illegal use of injectable drugs, through voluntary counseling and testing, as well as appropriate measures, including universal access to inputs for prevention, drugs, and breast-feeding policies based on scientific advances;

(d) consider HIV prevention and the care of people living with HIV/AIDS as a continuum based on the principle of safeguarding human rights, which requires a comprehensive approach that responds to local needs and uses resources efficiently ("building blocks " approach);

(e) facilitate people living with AIDS and HIV-positive pregnant women and their children to have access to treatment, especially to antiretroviral drugs, health care, and other inputs necessary for maintaining their health;

(f) take the necessary action for the treatment of sexually transmitted infections;

(g) collaborate at the national level in the collection of pricing data for antiretroviral drugs and share this information with other countries, through PAHO.

2. To request the Director to:

(a) continue to facilitate a wider participation and collaboration with other institutions and agencies, particularly with UNAIDS, in the fight against HIV/AIDS/STI in the Americas;

(b) promote initiatives such as the horizontal technical cooperation group of Latin America and the Caribbean on HIV/AIDS and support efforts to develop studies and proposals to improve national responses to HIV/AIDS;

(c) strengthen regional capacity for technical cooperation, especially in the areas of science and technology development, communication and social marketing, the promotion of healthy sexuality, and comprehensive services for HIV prevention and care for people living with HIV/AIDS/STI;

(d) continue working toward the development of the Regional Revolving Fund for Strategic Public Health Supplies and mechanisms whereby Member States can access the Fund to obtain lower prices;

(e) promote, together with the Member States, infrastructure and technology development for the adoption of common strategies on drugs for AIDS-strategies that should include facilitating the sharing of information on databanks that have pricing information on antiretroviral drugs used in the treatment of AIDS.

(Final Report, CD42, 21-23)

CD42.R14    The Directing Council,

Having considered document CD42/15 on essential public health functions; Taking into account that the Pan American Health Organization has implemented the Public Health in the Americas initiative, aimed at the definition and measurement of the essential public health functions as the basis for improving public health practice and strengthening the steering role of the health authority at all levels of the State;

Considering the need for health sector reforms to pay greater attention to public health and to increase the social and institutional responsibility of the State in this regard; and Taking note of the recommendation of the 126th Session of the Executive Committee,

1. To urge the Member States to:

(a) participate in a regional exercise, sponsored by PAHO, to measure performance with regard to the essential public health functions to permit an analysis of the state of public health in the Americas;

(b) use performance measurement with regard to the essential public health functions to improve public health practice, develop the necessary infrastructure for this purpose, and strengthen the steering role of the health authority at all levels of the State.

2. To request the Director to:

(a) disseminate widely in the countries of the Region the conceptual and methodological documentation on the definition and measurement of the essential public health functions;

(b) carry out, in close coordination with the national authorities of each country, an exercise in performance measurement with respect to the essential public health functions, using the methodology referred to in Document CD42/15;

(c) conduct a regional analysis of the state of public health in the Americas, based on a performance measurement exercise targeting the essential public health functions in each country;

(d) promote the reorientation of public health education in the Region in line with the development of the essential public health functions;

(e) incorporate the line of work on the essential public health functions into cooperation activities linked with sectoral reform and the strengthening of the steering role of the health authority.

(Final Report, CD42, 23-24)

CD42.R15    The Directing Council,

Having considered Document CD42/16 which proposes that the Member States in which malaria continues to be a public health problem adopt the Roll Back Malaria initiative in their territory; and

Taking into account that this initiative, in addition to being consistent with the goal of promoting local health systems and services, encourages joint efforts to remove obstacles to the implementation of effective malaria control through the strategic lines of action of coordinated resource use, the establishment of a malaria drug policy, and the training of human resources to carry out the measures to control malaria transmission,

1. To urge the Member States to:

(a) formalize the adoption of the Roll Back Malaria initiative in territories where malaria still constitutes a public health problem;

(b) make a commitment to perform an annual evaluation of progress in the different areas of the initiative, until malaria is eliminated as a public health problem in the Region.

2. To request the Director to:

(a) continue to support the mechanisms for monitoring the progress of prevention and control programs;

(b) support the efforts aimed at mobilizing the necessary resources for the elimination of malaria in the Region.

(Final Report, CD42, 24-25)