STRICTLY ONFIDENTIAL LMV INTERNATIONAL BANK FOR RECONSTRUCTION AND DEVELOPMENT INTERNATIONAL DEVELOPMENT ASSOCIATION Joint Meeting Washington, D.C. Tuesday, May 1, 1973 A joint meeting of the Executive Directors of the International Bank for Reconstruction and Development and the International Development Association was convened at 10:15 o'clock, a.m. in the Board Room, 1818 H Street, N.W., Mr. Robertg. McNamara presiding as Chairman. HOOVER REPORTING CO, INC. 320 Massachusetts Avenue, N.F Washington, D.C. 20002 (202) 546-6666 STRICTLY fONFIDENTIAL 2 C O N T E N T S page 5. Onchocerciasis in Western Africa 25 || HOOVER REPORTING CO, INC, 320 Massachusetts Avenue, N. Washington, 0 C. 20002 (202) 546-6666 STRICTLYIPONFIDENTIAL 25 We turn now to a subject we've discussed with the Board before, riverblindness and its effect on developmen in West Africa. I would like to ask Mr. Bazin to introduce HOOVER REPORTING CO, INC. 320 Massachusetts Avenue, NT Washington, D.C. 20002 (202) 546-6666 STRICTLY CONFIDENTIAL 26 this subject to us, and we'll then open the floor for discussion. Go right ahead, sir. MR. BAZIN: Mr. Chairman, Members of the Board. Thlproposal for the control of riverblindness in West- ern Africa has been developed over a period of years on the basis of intensive stuay and research carriedout under the auspices of the WHO, with the full support and active partici- pation of the WHO, the FAO, UNDP and other national and inter- national agencies. The French Government in particular has been very closely associated with this work through the OCCGE, I an organization of which six of the seven African Governments concerned are also members. The Government of the United StateS has likewise taken a special interest in the preparation for the campaign. The Bank's interest in the work on riverblindness dates back to the mid-1960s when exchanges took place with USAI and the African Development Bank on the economic effects of thel disease. Subsequently, in February 1969, the Heads of State of the Ivory Coast, Mali, Niger, and Upper Volta, and the President of Niger acting in his cpacity as President of the lConseil de l'Entente, grouping Dahomey, Ivory Coast, INiger, Togo and Upper Volta, addressed letters to the President of the World Bank emphasizing the importance they attached to the fight against riverblindness and inquiring about the HOOVER REPORTING CO, INC 320 Massachusetts Avenue, N.E Washington, DUC. 20002 (202) 546-6666 STRICTLY PONFIDENTIAL 27 possibility of the Bank making a contribution to the campaign. In reply Mr. McNamara expressed the Bank's sympathetic interest and concern over the problem and asked to be kep informed of the progress of various studies then underway, so that consideration could be given at the appropriate time to the action which might be taken by the World Bank Group. As indicated in the paper before you, the Bank was represented also at the meeting held in July 1970 in Geneva, to define the terms of reference for the PAG missiol and has been following the progress of this mission since. The report of the mission is now under preparation, and its prin- cipal findings should be available at the time of the meeting which we are considering should be held in Paris at the end of June. I would like to emphasize that the proposal as presently conceived is very much a joint enterprise to which the four United Nations agencies most directly concerned have been closely associated. That means the UNDP, the FAO, the 1WHO in addition to ourselves. The UNDP has played a major role in the financing of the preliminary studies and has also provided funds for the financing of tle interim pilot project to be undertaken later in the year in Upper Volta. WHO will be the agency directly responsible for executing the HOOVER REPORTING CO, INC. 320 Massachusetts Avenue, N I Washington, D.C. 20002 (202) 546-6666 STRICTLY PONFIDENTIAL 28 control campaign itself. The FAO will have special responsibil:ty lin the preparatory work on the agricultural side. The proposal made by the Steering Committee that the Bank should take the lead in mobilizing resources for the financing of the main campaign reflects a natural divi ion of labor between the agencies and responds to the interest expressed by the African Governments in the participation of the World Bank Group. The significance of controlling riverblindness in the area from the point of view of the economic development hardly needs emphasizing. If the campaign is successful, it will not only remove a wide source of human suffering; it will also open up extensive areas of good land to cultivation in the part of the world which is currently experiencing the devastat- ing effects of a prolonged drought, and where even in normal times agricultural and livestock production is barely sufficient to support the most meager standard of living. The combined populations of the countries that would be directly affected by the program is in the re -ion of 35 million, of which one-third live in the project area, and of this one-third, approximately 10 percent or just about one million people ar. suffering from riverblindness. It is too early of course to put figures .n the costs and benefits of the HOOVER REPORTING CO, INC. 320 Massachusetts Avenue, N. Washington, D,C. 20002 (202) 546-6666 STRICTLY ONFIDENTIAL 29 riverblindness campaign, but there is one estimate which might be mentioned here, and which is available from the preliminary version of the PAG Report; that is, that the gross potential output of the areas which are now being deserted mainly because of the disease, would be on the order of about $30 million per year. A clear distinction must of course be made between the program to control the disease through control of the vect r and the investments which will have to be undertaken in order to realize the full possibilities for agricultural development in he area. It is the first, and not the second, to which we are addre sing ourselves at present. The work of agricultural project identification and preparation in this field is now in its very early stage, and a major effort is going to be needed for the next two or three years if the necessary investments are to go forward at the proper time. We are waiting for the report of the PAG mission to define more precisely what are the tasks that will have to e undertaken, and the world Bank Group would be ready to assist with theproject preparation work as well as to consider requests which may be made later on by individul1 governments for financing specific agricltural and livestock da- velopment projects. HOOVER REPORTING CO, INC. 320 Massachusetts Avenue, N-L. Washington, D.C. 20002 (202) 546-6666 STRICTLY FONFIDENTIAL 30 The proposal before you is something of an experi- ment. The Bank has never been involved in anything quite like it before. There are considerable risks involved, but we believe tht they are acceptable risks. The campaign will be conducted over an extended period in the territories of seven countries, and the activities in each country, both for controlling the vector and dealing with the disease will have to be carefully and cautiously planned and coordinated. Nevertheless, for all the inevitable uncertainties, we believe that the campaign for control of riverblindness in this area presents a soundly conceived effort based on the best expert advice available, and it fully justifies the support of the World Bank at this time. If successful, it could as well serve s a model for other campaigns against riverblindness or other debilitating dis,ases elsewhere, and also help to improve the condition of life for some of the poorest people in the developing world. Thank you, Mr. Chairman. MR. McNAMARA: Thank you, Mr. Bazin, for an excellent introduction. Gentlemen, we are not asking for your approval expressed or implied, of any financial commitment by this institution this morning. We are bringing the matter to your attention and we really ask that you note the role we propose HOOVER REPORTING CO, INC. 320 Massachusetts Avenue, N E. Washington, D.C. 20002 (202) 546-6666 STRICTLYIFONFIDENTIAL 31 to play with the clear understanding that any financial commitment by the Bank would have to be brought back to the Board Eor your approval. If there were disapproval of the role we are proposing to play,by the Board, we would of course wish to know that before we proceed as has been suggested in my memorandum to you. Mr.Chaufournier and I together have discussed this problem with the heads of state in zveral of the countrieE involved. He much more than I has been close to it for several ears. Together he and I visited the territories of several of the states the areas infested by this, and the research center at Bobo-Dioulasso, which I reported upon a year or so ago, after our visit. There is no question in my mind this is a major problem retarding development in much of the area of the seven countries. It extends beyond those countries, by the way, as Mr. Bazin implied by his last remark, and if the campaign to control the vector and achieve expanded development of areas presently infested succeeds in this par- ticular area, it is possible that the same technique could be applied elsehwere in A rica. The disease affec'is much of Africa lying between the ninth and twelfth parallels, extending from East Africa and the Sudan clear across to West Africa and Senegal. HOOVER REPORTING CO, INC. 320 Massachusetts Avenue, NI. Washington, D.C. 20002 (202) 546-6666 STRICTLY pON Fl DENTIAL 32 But I want to emphasize, as I say, we are not asking for your approval expressed or implied in any financial participation by the institution this morning. First, Mr. Demeksa. MR. DEMEKSA: Mr. Chairman, I take the floor simply to express my approval of your general proposal today, and also to express my appreciation and the widespread appreciatiom of the governments I represent, to you and the staff, for the speed with which you have moved to reactivate an international effort to engage in the first major battle against an endemic disease, which has remained unchallenged for many centuries. Onchocerciasis has kept a large territory under- developed and uninhabited. I hope that all those who are concerned and have committed themselves to operate, will carry out their promises. I will look forward to the specific proposal you will soon make with great interest.I hope that pre-investment studies will closely follow the control effort which is forthcoming. Thank you. MR. McNAMARA: Thank you, Mr. Demeksa. Mr.Stedtfeld. MR. STEDTFE D: My Government welcomes warmly the initiative, Mr. President, and endorses fully the long-term HOOVER REPORTING CO, INC. 320 Massachusetts Avenue, N.I Washington, D.C. 20002 (202) 546-6666 STRICTLY PONFIDENTIAL program proposed by you for riverblindness control in the Volta River basin and adjoining areas, this all the more as my Government is already engaged in financing the pilot projec in the same area, in cooperation with WHO, its purpose being to explore feasible methods for conbaking riverblindness. A second project of the same kind is in preparation. Based on past experience, my Government also fully agrees tolbe leading role which the Bank should play in the administrative machinery envisaged. I can only express my sincere hope that your initiative and the subbequent combined efforts of all quarters concerned will bring about the results so much desired in the interest of the human beings suffering from the disease, and will create at the same time new and sound basis for economic revival and s cial welfare in the areas concerned, and hopefully later on, also in other areas suffering from the same disease. Thank you, Mr. Chairman. MR. McNAMARA: Thank you, Mr. Stedtfeld. Mr. Faure. MR. FAURE: Mr. Chairman, I would just like to say that I fully support this project and the general outlines of your proposals concerning control of riverblindness, in a study of which France is already involved, as was said before. HOOVER REPORTING CO, INC. 320 Massachusetts Avenue, NE. Washington, D.C. 20002 (202) 546-6666 STRICTLYIPONFIDENTIAL 34 I should just add that my authorities would like to devote more time, perhaps, to study more thoroughly that rather complex program and to define perhaps a more precise position, so I might, in this respect, if it is possible, inform the Board if .ecessary of any further preparations before the Paris meeting takes place. That's all, thank you, Mr. Chairman. MR. McNAMARA: Thank you, Mr.Faure. Mr. Reynolds. MR. REYNOLDS: Mr. Chairman, let me just briefly associate myself with the remarks of others in giving this ffort my full support. It seems to me a step of immense importance, from both humanitarian and economic development standpoints, and I think that the staff, and you in particular, H are deserving of our high praise for the leadership and imagine- tion exhibited in this initiative. I would say too that I very much hope that it will receive the broad donor support which it seems to me it richly deserves. Thank you. MR. McNAMARA: Thank you, Mr. Reynolds. Mr. Rinnooy Kan. MR. RINNOOY KAN: Mr.Chairman, I've had no opportunity HOOVER REPORTING CO, INC. 320 Massachusetts Avenue, NL, Washington, D.C. 20002 (202) 546-6666 STRICTLYIPONFIDENTIAL 35 yet to discuss this problem with my countries, but I would like to express I warmly welcome the Bank's role and the Bank's initiative in this whole fiu;ld. I would only liketto make one small remark, and that is that I think it would be very useful if the financing would take place mainly by the donors and that the contribution of the xank would be in that field rather small, Viecause after all, it would come from IDA funds;when ,4e have to take funds for this purpose, then we have to find it from other very commendable general ideas and purposes which otherwise we have available, and I think that is the general guiding line, maybe, which could be taken into account when you have discussions with the other governments. Thank you, Mr. Chairman. MR. McNAMARA: Thank you, Mr. Rinnooy Kan. Mr. Hattori. MR. HATTORI: Mr. Chairman, I have no objection, either, to the Bank's taking a lead in the meeting at Paris. I have just one cornment. In the background note it is said that current plans for controlling the disease rely mainly on interruptin- transmission by attacking the vector through peri dic introduction of insecticides into the rivers. Now, this may be all right, and it will certainly be HOOVER REPORTING CO, INC. 320 Massachusetts Avenue, N, Washington, D.C. 20002 (202) 546-6666 STRICTLY CONFIDENTIAL 36 much better than just doing nothing, but it is my feeling that in this particular field, more research will do a lot of good. It is said also in the same note, paragraph 3, that people started moving out of these black fly infested valleys si.ce the turn of the century. If so, I am wondering what caused these people to become riverblindness prone at the turn of the century to the extent that they had to move out? Was it because the flies, the black flies started migrating from somewhere else into these valleys or was there a sudden population explosion of the black flies and if so, wha was the incentive for the flies to migrate or multiply? Along a different line, was there some change in the nutritional balance in the diet of these people? Now, I am sure a lot of research has already been put into this subject, but I still think that these are matters that could benefit from further research and I think that we'd have little to lose in stressing the importance of further research, which could p'ssibly and hopefully lead to a discovery of more simple and efficient and hopefully a cheaper means ofc controlling riverblindness. Thank you, Mr.Chairman. MR. McNAMARA: Thank you, Mr. Hattori. HOOVER REPORTING CO, INC. 320 Massachusetts Avenue, N E. Washington, D.C. 20002 (202) 546-6666 STRICTLY CONFIDENTIAL 37 Mr. Bazin, would you add anything you can to what has been said about the movement of the people out of the fertile valleys at the turn of the century, and the cause of that, and then go on more broadly to the research program of WHO and their attitude to the questions that remain to be answered? MR. BAZIN: Thank you, Mr. Chairman. Regarding the movement of the population at the turn of the century, we do not have at the moment as many substantiated data as ,,ould have been desirable. From aerial photographs which have been carried out lately, and from oral history, it is more or less admitted now that by 1910 and the 1950s, thEre was a broad movement of population out of the area presently infested with riverblindness. It was not at all clear whether the people were moving because of the particula- difficult circumstances under which they were living, regarding both the agricultural production and the disease, but it's now more or less certain that there is a clear relationship I I should say a negative relationship between the amount of population living in these areas and the vector. The less people you have in the area, the more dangerous the vector is, and a survey was carried out about ten years ago by WHO in 1-=onwrd villages, HOOVER REPORTING CO, INC. 320 Massachusetts Avenue, N Washington, D.C. 20002 (202) 546-6666 STRICTLY11CONFIDENTIAL 38 to establish the relationship between the prevalence of oncho- cerciasis and the village size. The survey was carried out along three different patterns. Three groups of villages were surveyed: the first group with a population size going from zero to 199 persons, the second from 200 to 619, and the third exceeding 700. The results of the survey were that 20 percent of the small villages of the first category had 50 percent of prevalence; that 10 percent, it was the case for the medium size; and 2 percent for the big villages exceeding 700 perople. This striking association between the level of endemicity and size of the village may be an indication that ac the campaign progresses and people are convinced psychologically that the risk of becoming blind have been resolved by the campaign, as they come back to the area, they're going to restore by their very presence the balance in favor of men against the present situation where the vector is prevalent against man. Regarding the research program, Mr. Chairman, which is being undertaken by WHO, I think we have to agree with Mr. Hattori that there's a considerable amount of research which is needed. This is part of the project as conceived at present. Among the sectors which will be the subject of very HOOVER REPORTING CO, INC. 320 Massachusetts Avenue, NI. Washington, D.C. 20002 (202) 546-6666 STRICTLY CONFIDENTIAL 39 Iserious research, one is chemotherapy. As you have probably noted from the paper, there is at present no available drug 1which could be used in mass treatment. Three drugs are presently known as being more or less promising in individual Itreatments. One is suormine (2), the cther is ___c_ and the third one is M Experiments made by the FED, the European Development Fund, in 1966 in Mali, Ivory Coast and Upper Volta, to try to cure people presently infested with onchocerciasis, were carried out with Mel W, and it is certain now that some unfortunate accidents occurred with Mel W, at the rate of about three for 1,000 people treated. This was most unfortunate. This riverblindness doesn't kill people, and if the treatment is to lead to such a result, it has to be suspended. The two others which are now being carefully investi- gated, are understood to be quite efficient under very easy conditions where the patient has enough money to go to a doctor and to be followed closely for a number of weeks. But when it comes to treating a million people, they cannot provide useful and secure solution to the problem. This is one of the areas where research will be carried out. There are many others--epidemiology and also in techniques of refining how to spray insecticide to make sure that all the HOOVER REPORTING CO, INC. 320 Massachusetts Avenue, N, Washington, D.C. 20002 (202) 546-6666 STRICTLY1 CONFIDENTIAL 40 vectors of the area are killed, and also in the sector of finding out what type of collection should be organized to have the vectors analyzed, make a distinction between the males and the females, and see how old are the females which are collected, which would enable the people from WHO to make a clear judgment as to whether the campaign has been 100 percent or 90 percent successful. Thank you, Mr. Chairman. MR. McNAMARA: Thank you, Mr. Bazin. Mr. Bazin alluded to the difficulty of applying some of these potential remedies to the million people, given the scarcity of medical resources in the area. I visited as you know, perhaps 60 of our developing countries in the i last five years, and I don't think I can recall any that have as low a level of medical service as some of those we are talking about here. Particularly in the Upper Volta, I remember the ratio of doctors to population was estimated to be one to 70,000--one doctor to 70,000 people; put that in the perspective of the ratio in this country and in Scandinavia, for example, which is on the order of one per 700, so they have one percent as many doctors in relation to population a we do, and they have extremely complicated and widespread medical problems, of which this is only one. HOOVER REPORTING CO, INC. 320 Massachusetts Avenue, N.E. Washington, D.C. 20002 (202) 546-6666 STRICTLY CONFIDENTIAL 41 Mr. Gyasi-Twum. MR. GYASI-TWUM: Thank you, Mr. Chairman. Actually I wanted to be the last to speak. I notice that Mr. Kastoft has something to say. I merely want to take ithe floor, Mr. Chairman, to express the gratitude of the governments I represent, for the promptness with which iaction has been taken on this matter following the report which you made to the Board after your visit to West Africa in March of last year. Your involvement with such international organizations as WHO, FAO and UNDP in the project, and setting up a :Steering Committee, coupled with your willingness to lend 1the Bank's sponsorship to the mobilization of funds for control 1of disease has provided onenore demonstration of the deep concern for human suffering which has characterized your leader- ,ship of the B ank. My authorities in Ghana have asked me especially Ito convey their gratitude to you and the staff and to indicate their support for the project and their willingness to cooperatE ,1,fully with the Bank in setting up the proposed international fund and implementation of the program to include the developme t of the areas covered by the project. We are also gratified to note the indication given by some of the member governments of their willingness to suppo t HOOVER REPORTING CO, INC 320 Massachusetts Avenue, N. Washington, D.C. 20002 (202) 546-6666 STRICTLY1 CON FI DENTIAL 42 the program and we,hope that our joint efforts will result in early eradication of the disease and full utilization of resources in those areas which are now lying fallow on account of the existence of the disease. Thank you, Mr. Chairman. MR. McNAMARA: Thank you, Mr. Twum. Mr.Clarke. MR. CLARKE: Thank you, Mr. Chairman. I would just not wiart through silence merely to give my approval to this magnificent effort, and I certainly would like this opportunity to express my appreciation and associate myself with all the remarks that 11 Ve been made in welcoming and supporting the Bank's role. As far as Canada is concerned, I think I should record that Canada has been involved in this work for some time, through the International Development Research Center, and Canada, and my Canadian authorities are very much interested and thoroughly support the initiative which has been taken by the Bank. Thank you. MR. McNAMARA: Thank you, Mr. Clarke. Mr. Bull. MR. BULL: Mr. Chairman, my authorities need no convincing of the importance of this project nor of the HOOVER REPORTING CO, INC 320 Massachusetts Avenue, N Washington, D.C. 20002 (202) 546-6666 STRICTLYlCONFIDENTIAL 43 significance of your initiative, and I can give my full support. Thank you. MR.McNAMARA: Thank you very much, sir. Mr. Kastoft. MR. KASTOFT: Mr. Chairman, a campaign to control riverblindness is undoubtedly as worthy a cause as is the fight against any other of the major plagues which affect not only the health of millions of human beings but also their potential as fully productive members of their respective communities. Unfortunately, it is far from being the most important. May I just mention bilharziasis, which is affecting many more people, and which with the spread of irrigation may well increase in importance in spite of efforts to produce the opposite result. Unfortunately, in spite of all the sympathy and i compassion which your memo undoubtedly will provoke, it is unlikely that such sympathy can be converted into grants of the magnitude called for, which are not already av Alable for financial or technical assistance. Being fully aware of the attitude of the Nordic aid agencies to the proliferation of specialized funds for specific purposes in developing countries, this Chair has HOOVER REPORTING CO, INC 320 Massachusetts Avenue, N. Washington, D.C. 20002 (202) 546-6666 STRICTLY CON FI DENTIAL 44 drawn the attention of the national authorities to your memo and its outline for further action. The attitude of the Nordic aid agencies is not in all respects uniform, but they have all reiterated that in principle they are against the creation of new specialized funds. Their basic reason for this attitude is that further channeling of limited resources for development assistance into such funds will reduce the possibilities now and in the future of applying the resources in accordance with overall priorities. Some of the Nordic aid agencies have raised the question why the Bank has been called upon to take the lead in establishing the organizational framework for the efforts in this field. I realize that the proposal to this effect emanates from the Steering Committee mentioned in paragraph 1 of your memo, but at the same time I understand thit the contemplated financial role of the Bank would be quite limited. As UNDP has financed preparatory work and the World,health Organizatiln will carry the responsibility for the implementation, and as the project would rather be of a technical assistance nature, it might seem more natural if those two organizations took the lead in forming a consultative group for the purpose. HOOVER REPORTING CO, INC 320 Massachusetts Avenue, N.E Washington, D.C. 20002 '02) 546-6666 STRICTLYI ICON FI DENTIAL 45 However, Mr. Chairman, it is understandable that a program of this nature can be undertaken only on the basis of assurances regarding its financing over a period of years. Further, it is realized that the program has to be regional in character and that the region for which the program is proposed embraces some of the least developed and poorest countries in Africa. In view of such considerations, and if no other avenues for the program to be carried out are open, the authorities of the Noridc countries will not oppose the establishment under the leadership of the Bank of a consulta- tive group for the control of river blindness, but I think it is only fair to say already now, that none of the Nordic gov-1ernments will be represented at the proposed meeting in Paris in June, and some of them have already indicated that they willnot be in a position to contribute to the financing of the program. Thank you, Mr. Chairman. MR. McNAMARA: Thank you, Mr. Kastoft. I don't understand that attitude. Perhaps you can educate me. I don't want to take he time of the Board, but perhaps you can educate me later as tb what really lies behind it, because I don't look upon this as a special fund, I don't look upon it HOOVER REPORTING CO, INC 320 Massachusetts Avenue, N.E Washington, D.C. 20002 (202) 546-6666 STRICTLY11CONFIDENTIAL as ,to use your words, reducing the opportunity for applying assistance to the developing countries in relation to overall ,1priorities ;on the contrary, these countries have, which as you quite correctly emphasized, include many of those designated as least developed by the United Nations, these coun- tries have specifically and over the signature of their Chief Executives, asked that the Bank and the other agencies give this the highest priority in relation to their development program, and I think they'd simply say to all, not by any means only to the Bank, but to other donors as well, that if you are going to put money into our country, we ask that you pat it into this. So I don't really understand the Nordic problem. The Scandinavian countries have a magnificent record of assistance to the developing world, and if you'll explain their attitude to me, I can understand it better and perhaps deal with it more effectively. MR. KASTOFT: Excuse me, Mr. Chairman. MR. McNAMARA: Yes. MR. KASTOFT: May I try to do it very, very briefly. In all the Nordic countries the appropriations for development assistance, financial and technical, and humanitarian, are appropriated by the parliaments, and it's a question of limited amounts. It is not so that after the beginning of a HOOVER REPORTING CO, INC. 320 Massachusetts Avenue, N Washington, D.C. 20002 (202) 546-6666 STRICTLY CONFIDENTIAL 47 financial year, over a period of a year, the Government might go to the parliament and ask for more money for some specific purposes. We have one fixed sum per year, and that sum has to be divided among various purposes, so if we have to divert money, for example, for the campaign on riverblindness, that will be taken away from other purposes. That is what we understand by overall priorities in our local context but we are considering also the overall priorities in the global context. That is the reason why we think that specialized p funds, we have enough of them, and they will not add, they will not add generally speaking, as I think most countries have appropriations which are limited for these purposes, they will not add to the financial resources available. Therefore we think that there should be no new specialized funds, except if there are very, very strong Zreasons for it, as there was when we set up the UNFPA. MR. McNAMARA: Well, as I say, Mr. Kastoft, I don't look upon this as a specialized fund. If a nation were seeking to determine the most effective means of assisting Upper Volta with already appropriated funds, I would assume that nation would want to understand the problem of riverblindness in Upper Volta, since that is the problem that Upper Volta believes HOOVER REPORTING CO, INC. 320 Massachusetts Avenue, N F Washington, D.C. 20002 "02) 546-6666 STRICTLYf CONFIDENTIAL 48 is requiring most assistance from external sources, and it is this part that we'll have to discuss more privately, I think, i because I would not anticipate this effort would lead by itself to an increase in the concessionary aid available to the developing world. It is simply a vehicle by which that concessionary aid can be directed tow rd a pressing priority problem affecting seven nations and four international agencies, and a numbeof other participahts. - don't know any more effective way to organize that effort than that which has been suggested by the Steering Committee composed of UNDP, WHO, FAO and the Bank. But I don't want to take the time of the Board for this. We can discuss it privately later. Mr. Muhith. MR. MUHITH: Mr. Chairman, I take the floor now for two reasons. The first of the reasons is to take pride in the fact that this institution has taken a part in the initiative for controlling this disease. One of the purposes of this institution is to create or develop a better life style and I don't understand how a life style can be developed when we can't eliminate hunger and disease. The second reason for me to speak now is to express HOOVER REPORTING CO, INC. 320 Massachusetts Avenue, N.. Washington, D.C. 20002 (202) 546-6666 STRICTLY CONFIDENTIAL 49 a little bit of regret for the slow progress that we have made in controlling a disease which affects the quality of 11life. It is worse than death because it keeps people permanentl impaired. It has taken nearly three-quarters of a century to reach a stage where we are conv ening a neeting to consider the various ways of controlling it and the various ways of tackling the disease. The purpose really of bringing up this matter is to impress the urgency of the situation and the great necessity 11of giving more attention to this problem. Thank you, Mr. Chairman. MR. McNAMARA: Thank you, Mr. Muhith. Are there other comments or questions? We will proceed then. I think we understand the Iattitude of the majority of the Board and we will follow that. HOOVER REPORTING CO, INC 320 Massachusetts Avenue, N F 1 Washington, D.C. 20002 (202) 546-6666 STRICTLNl CONFIDENTIAL 50 meeting will record your previous approval of the items listed in the agenda unless I hear some objection to the contrary. This brings us then to other business, and before calling on any of you who wish to raise specific subjects for our consideration now, may I suggest tha we move into executive session, at which time I'll ask Mr. Rinnooy Kan I to make a statement on the subject of staff compensation. (Whereupon, at 11:35 o'clock, a.m. the IBRD-IDA meeting was adjourned, following immediately by an Executive Session.) HOOVER REPORTING CO, INC. 320 Massachusetts Avenue, N.E Washington, D.C. 20002 (202) 546-6666