APPENDIX "A"

WMA GENERAL ASSEMBLY AND POLICY DEVELOPMENT

A1.    General Assembly

A1.1    The WMA Bylaws establish the General Assembly as the most powerful body within the WMA. Its most important role is to adopt official and permanent WMA policy. The delegates should represent the views of their NMAs on these having reviewed materials before the meeting in order to form a consensus. The General Assembly also elects presidents, decides when and where future meetings should be held, reviews applications for membership, considers financial statements and instructs the Council on actions to be taken in pursuit of the objectives of the WMA.

General Assembly documents

A1.2    The most important documents guiding the work of the General Assembly are the General Assembly Agenda and the Report of the Council. Delegates should review the Council Report prior to the General Assembly in order to be able to participate in the decision-making process. Most documents have been in development for over a year and NMAs are given the opportunity to comment. If delegates have concerns about a document, they should seek out Council Members before the vote or ask the Secretariat.

General Assembly rules of procedure

A1.3    The General Assembly rules of proceedings are intended to ensure that all the work is accomplished while at the same time enabling all voices to be heard. If delegates become confused about what is going on they should ask the Chair to slow proceedings down. Open discussion is allowed on all topics on the agenda; however the Chair may sometimes have to limit time for individual comments in order to ensure that all agenda items are covered.

Voting in the General Assembly

A1.4    The voting process is outlined in the document "Overview of Parliamentary Procedures." Voting in WMA meetings is based on standard parliamentary procedure. Any delegate can make a motion, which must be seconded by another delegate (if a motion comes from another WMA body, e.g. the Council, it doesn’t need a second). After it has been seconded, the Chair will invite discussion of the motion. Following discussion, delegates will be invited to vote by raising voting cards showing the number of votes of their delegation. This depends on the number of the NMA’s declared members: 1 vote for every 10,000 declared members and part of it. After votes have been counted, it is declared whether the motion has been passed or defeated.

• Dr. Rudolf Henke (German Medical Association) pointed out that a rule that "any delegate can make a motion" implied that individuals could forward a motion contrary to the views of the rest of their delegation. Dr Kloiber explained that a delegation is seen as one body with the underlying assumption of harmony within a delegation. He strongly recommended that delegates should ensure that they reach consensus within their delegation prior to the meeting.
  
• Dr Ekwaro Oboku (Uganda Medical Association) asked for clarification on the number of votes for NMAs with less than 10,000 declared members. Dr Otmar Kloiber explained that NMAs with 1- 10,000 members would have one vote, 10,001-20,000 declared members two votes, and so on.

Secret ballots

A1.5    Dr Alvin Chan (Hong Kong Medical Association) asked whether there were any occasions when delegates could ask for a secret ballot apart from the presidential election. The Chair explained that a motion for a secret ballot could be forwarded at any point. This would not require a second but it would require a majority vote.

Delegate registration

A1.6    Dr Miguel Jorge (Brazilian Medical Association) pointed out that when registering for WMA meetings it is possible for people to register as a "delegate" without the knowledge of the NMA. Dr Otmar Kloiber emphasised that ticking delegate on the registration page would not mean the person would be considered an official member of the NMA delegation.

A2.    Policy Development

A2.1    Input from NMAs in the development of policy is at the core of the work of the WMA. NMAs have the opportunity to provide input on policy documents throughout the year. If they do not respond to requests for comments on policy documents then they will not be successful in efforts to influence WMA policy. The Secretary General reiterated the importance of NMA input and explained that the Secretariat is there to assist NMAs in how to provide this.

A2.2    The Chair went on to explain the policy development process. This was summarised in an abridged workflow diagram:

1. Submission of document to the Secretariat in one of three official WMA languages;

2. Secretariat translates document and assigns it to proper committee for initial consideration at next meeting;

3. Committee recommends document for circulation to the NMAs for comment;

4. Secretariat compiles and reviews comments and sends revised document to the committee for consideration;

5. Committee may recirculate the revised version to NMAs for further comments;

6. Once the considered document ready, the committee submits document to the Council with the recommendation that it be approved and forwarded to the General Assembly for adoption.

A2.3    This entire process may take 1-3 years to accomplish, depending on the number of times a document is recirculated or whether it is an emergency issue. NMAs must therefore realise when they submit a document that alterations will be made and the end product may not resemble the initial document. Once they submit a document it becomes the property of the WMA. In certain rare cases the General Assembly will be asked only to accept or reject a document that has been developed in cooperation with another organisation.

A2.4    The participation of constituent members in the policy process is requested and appropriate, for example when draft policies are sent out with calls for comments. However if NMAs feel overwhelmed by the volume of documents they are asked to comment on they may be selective and focus upon the issues of particular interest to them.

A2.5    Ms Anne Trimmer (Australian Medical Association) asked about the procedure for the calls for comments. Dr Otmar Kloiber explained that open documents are posted on the website and a call for comments is sent out by email followed by a reminder.

A2.6    Dr Otmar Kloiber introduced Prof. Vivienne Nathanson, Facilitator, and Ms Marie Colegrave-Juge, Legal Advisor. He explained that Ms Marie Colegrave-Juge advises the WMA on legal issues which arise in the work of the WMA, but also on parliamentary procedures during the meetings. She also ensures that policy documents are brought into the correct format before meetings. Prof. Vivienne Nathanson is seconded to the WMA on a part-time basis to assist with process, policy, ethics and public health questions that arise concerning matters of policy, for example when members wish to bring an issue to the WMA.

Submitting ideas for policy development

A2.7    Dr Otmar Kloiber invited NMAs with ideas for policy documents to contact the Secretariat well in advance of Council and General Assembly meetings for advice on how to submit these. He pointed out, however, that they may not be able to assist with last minute requests for advice after the deadline for the submission of new policies as they will be busy preparing for the meetings.

A2.8    The Chair called upon members to come to the meetings prepared and to take influence within their medical societies and their countries on behalf of their patients and colleagues. She encouraged delegates to attend Council Meetings and seek contact with Council Members to discuss issues of concern. She closed by thanking delegates for their attendance and told them not to hesitate to ask if they don’t understand anything in the future.

Accessing on-line WMA working documents, procedural guides, etc.

A2.9    Dr Wonchat Subhachaturas (Medical Association of Thailand) asked how to get a user name and password for the website. Dr Kloiber explained that NMAs should contact the Secretariat to ask for passwords for staff members in order to be able to access working documents, registrations for meetings, procedural guides and standing documents, which contain procedural details.

Joining committees

A2.10    Dr Margaret Mungherera (Uganda Medical Association) commented that communication with the NMAs is still a challenge, for example when officials change and the Secretariat is not informed of the new contact details. She asked how NMAs can join committees and working groups. Dr Otmar Kloiber asked NMAs to always inform the Secretariat of changes to contact details. Dr Ardis Hoven explained that Council Members are appointed to the three committees and the committee chairs are elected from the Council Members. Workgroups examining at defined issues generally have max. 5 members, which are assigned based on their declared willingness to participate. Workgroup members do not have to be Council Members.

A2.11    Dr Lincoln Lopes Ferreira (Brazilian Medical Association) asked if the presentation today could be incorporated into a written report for the NMAs. Dr Kloiber explained that this is already online in the form of a Delegates' Guide. There are also Council Members' Guides online.