1. The Relationship of the Pan American Sanitary Bureau to the World Health Organization

Since the principal existing regional health organization is the Pan American Sanitary Bureau, originally established in 1902 by the First Pan American Sanitary Conference, primary attention was given to working out its relationship with the World Health Organization. Specific amendments were presented by the delegations of Brazil, Canada, France, Norway, the United Kingdom, the United States, the Soviet Republics, jointly, and Venezuela. The United States proposal, offered as a basis for discussion, consisted primarily of a constitutional provision to the effect that regional agencies should be integrated or brought into relationship with the Organization through special agreements providing either that the agency be transformed into a Regional Committee or Office, or that its facilities and services be utilized with a view to its progressive absorption through subsequent agreement, as circumstances might permit. The proposal also included a draft resolution which set forth the possible content of an initial agreement between the Pan American Sanitary Bureau and the Organization.

In the initial Committee discussions, the United States suggestions received warm support from most of the other American republics. At the same time, however, these governments expressed the view that the Pan American Sanitary Bureau should continue its separate existence. Amendments and suggestions submitted by Canada, China, Norway, and the United Kingdom laid greater emphasis than had the United States initial proposal on the necessity of ultimate integration of the Bureau with the Organization. The delegations of India, Liberia, Poland, the Soviet Republics, South Africa, and Yugoslavia, particularly, strongly supported the language of the first alternative of the Technical Preparatory Committee proposal, which was interpreted to require complete early transformation of the Bureau into a Regional Office of the Organization.

Egypt called attention to the existence of the Pan Arab Health Bureau of the League of Arab States and requested that it be given equal consideration with the Pan American Sanitary Bureau as an existing regional health agency.

Following Committee discussion, a "Harmonizing Subcommittee" of 16 members was appointed to prepare an acceptable text. The subcommittee was composed of delegates from Brazil, China, the Dominican Republic, El Salvador, France, India, Lebanon, Mexico, the Netherlands, Norway, Peru, the Union of Soviet Socialist Republics, the United Kingdom, the United States, Venezuela, and Yugoslavia.

The text worked out by the subcommittee provided that:

"The Pan American Sanitary Organization represented by the Pan American Sanitary Bureau and the Pan American Sanitary Conferences and all other intergovernmental regional health organizations in existence prior to the date of signature of this constitution should in due course be integrated with the (World Health) Organization. The integration should be effected as soon as practicable through common action based on mutual consent of the competent authorities expressed through the organizations concerned."

This text was unanimously approved by the Committee on Regional Arrangements and later by the Conference in plenary session. 2. The Participation in Regional Organizations of NonSelf-Governing Territories

A second major problem concerned the participation of non-selfgoverning territories in the Organization at both the regional and central levels. Several delegations, including those of the United Kingdom and France, expressed the view that while the participation of such territories in the central Organization should be limited they should be admitted to full membership in Regional Committees and Offices, with voting rights equal to those of members. The French Delegation suggested that the state responsible for such territories should determine the representation and participation.

The United States Delegation favored participation by these territories in regional organizations but took the position that they should not be given a status equal to that of members and that the Constitution should not seek to determine the details of participation.

Joint consideration of the problem by subcommittees of Committee III (Legal) and Committee V (Regional Arrangements) resulted in agreement on the following formula which was incorporated in the Constitution (Article 47) :

"Territories or groups of territories within the region, which are not responsible for the conduct of their international relations and which are not Associate Members, shall have the right to be represented and to participate in Regional Committees. The nature and extent of the rights and obligations of these territories or groups of territories in Regional Committees shall be determined by the Health Assembly in consultation with the Member or other authority having responsibility for the international relations of these territories and with the Member States in the region".

3. The Establishment and Organization of New Regional Committees and Offices

Formal amendments seeking to clarify and improve the Technical Preparatory Committee's text relating to the establishment, organization, and functions of new regional branches of the Organization were submitted by Canada, the several Soviet Republics, jointly, the Union of Soviet Socialist Republics, separately, the United Kingdom, and Venezuela. A special drafting subcommittee worked out a single text incorporating most of the substantive portions as well as the drafting suggestions contained in these proposals.

This text provides that the Health Assembly may, with the consent of a majority of the members situated within the regions concerned, establish regional organizations consisting of Regional Committees and Offices. The composition of Regional Committees is delineated. Their functions are described as including supervision of the activities of the Regional Offices, cooperation with regional branches of other organizations, and tendering advice on matters of broader than regional significance. It is specifically stated that, under the general authority of the Director-General, the Regional Offices are to be the administrative organs of the Regional Committees and are, in addition, to carry out within the region the decisions of the Health Assembly and the Executive Board.

4. The Appointment of Regional Directors and the Selection of the Staff of Regional Offices

Discussions arose concerning the method of appointing the Regional Director and of selecting his staff. In Committee a majority approved a provision to the effect that the Regional Director should be appointed by the Regional Committee subject to the approval of the Executive Board, and that the staff of the Regional Office should be appointed by the Regional Director in accordance with regulations to be approved by the Regional Committee and the Director-General. The United Kingdom and Canada, particularly, expressed the view that the appointment of the Regional Director should be made by the DirectorGeneral in consultation with the Executive Board and the Regional Committee.

The Conference, in plenary session, adopted a provision to the effect that the Regional Director should be "appointed by the Executive Board in agreement with the Regional Committee" and that the staff of the Regional Office should be "appointed in a manner to be deter

724741-47-3

mined by agreement between the Director-General and the Regional Director".

It was the opinion of the Conference, manifest in its unanimous approval of Chapter XI as a whole, that this chapter adequately preserves the centralized character of the Organization giving at the same time considerable freedom of action to the regional units in dealing with regional health matters. The provisions concerning the Pan American Sanitary Bureau and other existing regional health organizations assure their orderly integration, through mutual consent, as Regional Committees and Offices of the Organization. The regional agencies will bring to the Organization invaluable experience in international health work while the Organization will bring to bear upon the regional agencies the full impact of world-wide interest and participation in international health affairs. The existing regional agencies will become integral parts of the international system.

BUDGET AND EXPENSES (Chapter XII)

The Health Assembly is authorized to approve budget estimates prepared by the Director-General and submitted to the Health Assembly with the recommendations of the Executive Board. It is also given the authority to apportion the expenses among the members in accordance with a scale which it will fix, following as closely as practicable the scale of the United Nations. Authority in these matters was made subject to such agreement as might be reached between the Organization and the United Nations. Australia submitted an amendment which would have required the Organization to make an agreement whereby all expenses of the Organization would be met by the United Nations. This amendment, which would have made the Organization directly dependent on the United Nations, raising a question as to its status as a specialized agency as conceived in Article 57 of the Charter of the United Nations, was defeated in Committee.

The Constitution provides for the maintenance of a special fund, to be used at the discretion of the Executive Board, to meet emergencies and unforeseen contingencies.

VOTING (Chapter XIII)

The Technical Preparatory Committee recommended that decisions of any body of the Organization should be taken by a majority vote of the members present and voting except as otherwise provided in the Constitution. The Ukraine proposed that decisions should be

taken only on a majority vote of the members of any body. In the case of the Board, for instance, this would have meant that no decision could be taken without the concurrence of ten of the eighteen members. A compromise proposal was made that decisions be taken by a majority of members registered at any particular meeting.

Canada called attention to Article 18 of the Charter of the United Nations which provides that decisions on important questions, as listed in the Article, are to be made by a two-thirds majority of the members present and voting, whereas decisions on other questions, including the determination of additional categories of questions to be decided by a two-thirds majority, are to be made by a majority of those present and voting. The Conference accepted the principle incorporated in this Article and in drafting Chapter XIII followed its wording, making appropriate changes in the list of important decisions requiring a two-thirds majority.

REPORTS SUBMITTED BY STATES (Chapter XIV)

The Constitution provides that each member shall report annually to the Organization on the action taken and the progress achieved in improving the health of its people; and on the action taken with respect to recommendations made to it by the Organization and with respect to conventions, agreements, and regulations. Each member will also provide statistical and epidemiological reports in a manner to be determined by the Health Assembly. A provision that each member should communicate promptly to the Organization important laws, regulations, official reports, and statistics pertaining to health was amended, on the initiative of the Union of Soviet Socialist Republics, by the addition of the phrase "which have been published in the state concerned".

LEGAL CAPACITY, PRIVILEGES, AND IMMUNITIES

(Chapter XV)

The provisions relating to legal capacity, privileges, and immunities (Articles 66 and 67) are substantially similar to those of Articles 104 and 105 of the Charter of the United Nations as well as those recommended by the Technical Preparatory Committee. They recognize the general principle that the Organization and its personnel should enjoy such privileges and immunities as may be essential to the performance of their functions.

The only addition that the Conference made to the Technical Preparatory Committee's recommendation in this matter is a provision (Article 68) that the legal capacity, privileges, and immunities of