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well as the entry of the former Soviet Union republics, are expected to keep demand for Fund resources at a high level in coming years.

The IMF adopted a series of modifications to its lending policies in November 1990 to respond to the financial effects of the Persian Gulf crisis. This included a temporary provision allowing members to draw on IMF resources to offset the effects of increased oil import costs. This provision disbursed over $3 billion in timely balance of payments assistance to 15 members during 1991.

Arrears to the Fund grew in the 1980s, totaling over $4 billion in late 1990. At its May 1990 session, the Interim Committee endorsed a strengthened arrears strategy to reward sound economic performance and discourage accumulation of arrears. Under the new approach, an existing arrears country was able to earn "rights," based on sustained economic performance under a Fund-monitored program, toward extraordinary financing to settle its arrears. Strengthened remedial measures included suspension of voting and representation rights of members who did not fulfill their Fund obligations. IMF arrears growth has slowed significantly since the initiation of this new strategy.

World Health Organization (WHO)

The World Health Organization (WHO), based in Geneva, was established in 1948 with the objective of "the attainment by all peoples of the highest possible level of health." Its membership increased in 1991 to 170 with the admission of the Marshall Islands, Micronesia, Lithuania and Latvia. Tokelau was admitted as WHO's only associate member.

During 1991 the U.S. Government continued its cooperation with WHO on numerous technical and administrative issues. There were more Americans than any other nationality in professional staff positions. Senior posts filled by Americans included those of Assistant Director General for Communicable Diseases, Director of the Global Program on AIDS and Legal Counsel. The United States provided the largest share of the WHO regular budget, and the largest amount of voluntary contributions.

U.S. Representatives participated in meetings of the World Health Assembly, the 31-member Executive Board, the Board's 12-member Program Committee (all in Geneva); regional committees for the Americas (in Washington), the Western Pacific (in Omiya, Japan), and Europe (in Lisbon); and the 16-member

Governing Council of the International Agency for Research on Cancer (in Lyon). U.S. officials also participated in meetings of the management committees of the major voluntarily funded programs, including the Global Program on AIDS.

World Health Assembly

The World Health Assembly (WHA) meets annually. The U.S. Delegation to the 44th WHA, held in Geneva on May 6-17, was headed by Dr. Louis W. Sullivan, Secretary of Health and Human Services. In a speech to the Assembly plenary, Secretary Sullivan gave strong emphasis to child health and survival, describing children as "the world's most precious resource." He urged delegates to help promote changes in personal behavior and life-style that can achieve the benefits of good health, citing his own efforts in the United States to eliminate tobacco use. In addition, the Secretary said the United States would be a full participant in the effort to advance the Children's Vaccine Initiative launched at the 1990 UN World Summit on Children.

Health Issues

Paradigm for Health. At meetings of both the Executive Board and the Assembly, WHO Director General Hiroshi Nakajima (Japan) reiterated his interest in development of a WHO "paradigm" for health. This would be a new philosophical rationale for WHO's work compatible with the established goal of promoting "health for all by the year 2000." Dr. Nakajima said progress toward that goal was being diverted by dramatically declining resources, political upheaval, war and civil strife, as well as the AIDS pandemic, outbreaks of cholera, and natural disasters such as earthquakes and floods. A number of delegates raised questions about the ultimate goal of Dr. Nakajima's proposal, and the Executive Board in May 1991 asked that the "paradigm" be fleshed out for consideration by the Board at a later time.

AIDS. WHO's Global Program on AIDS (GPA) received growing attention during 1991 as public and professional awareness of the vast dimensions of the pandemic became more apparent. Dr. Michael Merson (U.S.), the GPA director, said the most recent estimate was that by the year 2000, some 40 million men, women and children will be infected with the HIV virus, and about half of those will have developed AIDS. He said AIDS could not be viewed solely as a health problem, but required a multisectoral response from many sectors and organizations in each country.

The Global Management Committee, consisting of donors and others elected to determine policy for GPA, authorized an external review committee to make recommendations for improvements in its operations. The study focused on the need to increase the attention given the pandemic by individual governments, and the need for multisectoral collaboration, both at the country level and among intergovernmental agencies. After receiving an executive summary of the review, the GMC in November established its own working group to study the recommendations in more detail.

The UN General Assembly in December adopted a resolution (Resolution 46/203) which noted with appreciation the established leadership and coordinating role of WHO, as well as efforts of other agencies, in combating the spread of AIDS. The resolution urged member states give attention to many aspects of the AIDS problem, including safer sexual practices, blood supply, discrimination against those affected by AIDS and HIV, the need for a multisectoral response, and need for mobilization of additional resources to deal with the problem.

Tobacco. The WHA adopted by consensus a resolution (WHA44.26) proposed by the Board which urged member states ban smoking in public conveyances where protection against involuntary exposure to tobacco smoke could not be assured, and urged WHO collaborate with ICAO in developing guidelines for a "smoke-free travel environment in all types of public conveyances." The Assembly did not accept a resolution which asked for assistance to developing countries dependent on tobacco production as a major source of income. The United States, among others, felt that this draft resolution would have undercut WHO's antismoking efforts; when Director General Nakajima offered to present the views expressed in the debate to ECOSOC and the WHO Executive Board, the proposal was withdrawn.

Cholera. The cholera epidemic, especially in Latin America, was discussed by the Assembly at length. The U.S. Delegation said the breakdown of the basic sanitation infrastructure during economic difficulties of the 1980s may have facilitated spread of the disease. The consensus was that the cholera problem would continue until water supply and sanitation improvements were implemented in the affected countries.

A resolution (WHA44.6) cosponsored by 60 countries called for immediate reporting of cholera cases, continuation of the search for a cholera vaccine, and establishment of a "global task force on cholera control." The resolution also asked member

states not to impose restrictions on the import of products from affected countries when the restrictions could not be justified.

Tuberculosis. The Assembly discussed the relationship between tuberculosis and HIV infection, and expressed concern that there were three million tuberculosis deaths and eight million new cases annually throughout the world. Resolution WHA44.8 urged member states give high priority to tuberculosis control as an integral part of primary health care, especially in light of the HIV pandemic, and proposed global targets for detection and cure of tuberculosis cases.

Chernobyl Center. The Assembly approved by consensus a request by the Soviet Union that WHO establish a program, funded with voluntary contributions, to mitigate the health effects of the nuclear accident at Chernobyl, including an international center. (Resolution WHA44.36.) The U.S. Delegation noted general support for the study of the health effects of the accident, but expressed caution and concern about the budget for the center, its proposed location in Obninsk, and the need to keep any WHO commitment under continuing review in light of apparent political instability in the Soviet Union.

Other Topics. The Assembly also addressed nutrition, maternal and child health, acute respiratory infections, human organ transplants, traditional medicine, leprosy, guinea worm disease, the children's vaccine initiative, malaria, and health strategies in the face of rapid urbanization.

Administrative and Budgetary Issues

Adoption of the Budget. In its main topic of business, the Assembly adopted a new biennial program budget, covering 1992-1993, of $734,936,000, a nominal increase of 12.42 percent over the 1990-1991 budget of $653,740,000. Revisions in budget calculations during the Assembly, strongly promoted by the U.S. Delegation, reduced the nominal growth from 16.83 to 12.42 percent, and cut the increase in total assessments from 21.19 to 15.97 percent. The new budget contained no real growth; cost increases of 10.05 percent and exchange rate fluctuation accounted for all the nominal growth.

The main reason for the change in the budget level at the Assembly was the recalculation of the budget at a different exchange rate between the U.S. dollar and Swiss franc. The budget originally had been calculated at a rate of 1.30 Swiss francs to the U.S. dollar. Under prodding from the U.S. Delegation, the WHO Secretariat agreed to take advantage of improvements in the exchange rate and calculated the budget at 1.49 Swiss francs

to the U.S. dollar. The effect was to bring down the overall level of the budget by $28.8 million. WHO also recalculated the casual income (or miscellaneous income) available to help finance the budget. Rather than $22 million originally estimated, the amount available was $24,929,000, and this reduced assessments overall.

After 8 days of review of the proposed budget, the U.S. Delegation repeated efforts at reductions in very large programs dealing with publications and administration, including attempts to secure a commitment for WHO staff to use a more economical class of air travel. The Delegation said that even after the sizeable budget reduction resulting from the exchange rate recalculation, the overall budget level was still very high. The final vote in committee was 93 (U.S.) to 10, with 1 abstention. Dr. Nakajima said that he would take into account the fact that there had not been consensus on the budget, and that he continued to be concerned with budgetary and financial management issues. He observed that most interventions by delegations were laments that not enough money was in individual program lines of the budget, but virtually no one had proposed any places for cuts. In the end, the budget was approved in plenary by consensus. (Resolution WHA44.35.)

For the United States, the gross assessment established for 1992-1993 was $201,194,250. The United States received a credit of $12,750,000 for the tax equalization fund, and $137,560 from the incentive payment scheme. This left the net U.S. assessment at $188,306,690, or $94,153,345 in each year of the biennium.

Incentive Payment Scheme. In a related question, the U. S. Delegation proposed that the Assembly not apply the new incentive payment scheme to the new 1992–1993 budget. Under the scheme, interest earnings on assessments paid to WHO would be distributed to member states according to the timing of their payments. Those who paid early would receive a larger share of the interest earnings, while those who paid late would receive little or no interest earnings. The United States had argued against adoption of the scheme in 1988, saying it appeared to punish many countries which could not pay earlier, either because of legislative systems which prevented earlier payment (as in the United States) or because they were too poor to pay. The U.S. Delegation also argued that the WHO scheme improperly covered interest earnings on income not related to payment of assessments, and that this money legitimately belonged to all member states.

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