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SIXTIETH WORLD HEALTH ASSEMBLY Provisional agenda item 11.4
A60/6 8 May 2007
Eleventh General Programme of Work: monitoring implementation Report by the Secretariat
INTRODUCTION 1. WHO’s Secretariat is committed to monitoring progress of the General Programme of Work.1 Certain principles to guide the monitoring have been finalized and a framework prepared.2 Monitoring will focus on trends in global health in order to assess the adequacy of international responses, and on WHO’s core functions in order to review the quality and balance of the Organization’s work and to define its role clearly.
Monitoring the global health agenda 2. The indicators linked to the strategic objectives of the Medium-term strategic plan 2008–2013, the targets and goals agreed at the Health Assembly, and key WHO statistics will be used to define the measures for monitoring the global health agenda. These trends will be reported on periodically until 2015. 3. The indicators to be used for this purpose were discussed with an external advisory group.3 Using this feedback, criteria were determined to assess the quality of available data covering measurability, availability, baseline trends, international alignment, peer review and resource implications. A core set of indicators was derived, including some from strategic objectives in the Medium-term strategic plan, together with a number of cross-cutting indicators, such as life expectancy, that will be available on an annual basis to the Health Assembly, as part of the report on world health statistics. The core set of indicators will cover progress in the area of health-system inputs, access and coverage, risk factors and health outcomes (see Table 1 below). 4. Other selected areas of the global health agenda will be analysed in detail each year. The areas will be chosen in line with the views of the governing bodies and those held within the United Nations system, and will aim to bring coherence and add value to existing initiatives.
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Document A59/25, Annex 2. See document A59/25 Add.2. Advisory Committee on Health Monitoring and Statistics (14–15 December 2006).
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Table 1. Available indicators for monitoring the global health agenda: summary1 INPUT/PROCESS Total health expenditure per capita Out-of-pocket spending on health and catastrophic expenditure Health worker density (doctors, nurses/ midwives) Availability and price of generic medicines ACCESS/COVERAGE Access to water and sanitation Immunization: coverage with three doses of diphtheria, tetanus and pertussis vaccine Maternal care: skilled birth attendance Family planning: contraceptive use HIV/AIDS: prevention of mother-to-child transmission of HIV and availability of antiretroviral therapy Tuberculosis: success rate of directly observed treatment with shortcourse chemotherapy Malaria: use of bed nets, intermittent preventive treatment, indoor spraying Treatment coverage for acute childhood and chronic diseases RISK FACTORS Child stunting/ underweight Adult obesity and overweight adolescents and children Use of solid fuels HEALTH STATUS Life expectancy Adult mortality and causes of death in adulthood Under-five mortality and causes of death in childhood Mortality in emergencies and crises HIV infection, tuberculosis, mental illnesses: incidence/prevalence/ consequences Burden of disease: healthy life expectancy, environmental risks, noncommunicable diseases, mental illness
Nutritional wasting in emergencies and crises Prevalence of tobacco use
Harmful use of alcohol
MONITORING THE CORE FUNCTIONS OF WHO 5. The purpose of monitoring WHO’s core functions is: • to ensure that WHO is constantly striving to improve the quality of its work, across the three levels of the Organization • to assess whether WHO’s resources are being used in a way that allows an appropriate balance of core functions to be conducted throughout the Organization
Equity dimensions to be used where appropriate: gender (wealth, social, special, age); socioeconomic (poverty, ethnicity, education, marginalization); age (children, adolescents, aged).
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• To assure that the Secretariat fulfils its obligations to Member States and plays its role within the United Nations system and with partners in general. 6. Work has progressed in two phases. (1) Key cross-cutting (i.e. across programme) “business processes” that need to be strengthened for WHO to be effective in delivering its core functions are being identified. They are summarized in Table 2, and some of the main issues are discussed below. Quality criteria will be defined for these processes so as to allow regular assessment and analysis, and ensure sustainable improvement. (2) Monitoring mechanisms for these business processes will be established in order to provide WHO senior management with up-to-date summary information. The Global Management System and other information systems and databases in WHO will be reviewed to consider how they can be adapted in order to provide key quality measures to managers, alongside other performance-related information. Table 2. Key cross-cutting actions requiring common quality standards and related information systems: summary Providing leadership on matters critical to health and engaging in partnerships where joint action is needed Shaping the research agenda and stimulating the generation, translation and dissemination of valuable knowledge
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Resolution-making in governing bodies and improved monitoring of their implementation Monitoring of WHO’s role in health partnerships Common reporting system for WHO activities in health research Standard procedures for the conduct of research and use of findings Development and dissemination of WHO technical guidance Monitoring and review of WHO publications Mechanisms for securing external advice Prequalification systems Access and use of national capacity-building plans Monitoring of quality of technical support to countries Databases of expertise across international health bodies and networks Centralized systems for monitoring the quality of health statistics Adherence to “four step” process (database, peer review of methods, external expertise and clearance) Consolidation of information on health trends at global and regional levels Performance information from the Secretariat Implementation and maintenance of a WHO riskmanagement strategy
Setting norms and standards, and promoting and monitoring their implementation
Providing technical support, catalysing change and building sustainable institutional capacity
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Monitoring the health situation and assessing health trends
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Strategic information for decision-making in WHO
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Summary of key cross-cutting actions by core function 1. Providing leadership on matters critical to health and engaging in partnerships where joint action is needed 7. Recent consultations suggest that WHO needs to develop a more structured system of feedback, in addition to the more formal governing body resolutions and strategic planning exercises. A review of the resolution-making process and consideration of governing mechanisms of other complex international organizations would help to make the work of the governing bodies more efficient.1 Ways will be explored to make collaboration with civil society and the corporate sector more effective. A policy on partnerships is being framed so that the Organization can proactively engage in shaping existing and new partnerships on behalf of Member States. Work under way to strengthen activities in country offices will be accelerated. The Organization will participate actively in the current reform of the United Nations system.
2. Shaping the research agenda and stimulating the generation, translation and dissemination of valuable knowledge 8. Guided by an external advisory group, a research strategy is being drawn up in order to strengthen the coordinating role of WHO in research, to make better use of research evidence for major policy decisions, and to improve the management and organization of research activities in the Secretariat.2 Knowledge management capacity has been built up so as to improve the flow of healthrelated knowledge in countries.3 ACHR will continue to provide external scrutiny and advice.
3. Setting norms and standards, and promoting and monitoring their implementation 9. A review mechanism has been set up in order to improve the preparation of normative guidance. Further work is required to ensure that the entire Secretariat benefits from this mechanism, and that the use of WHO’s guidance is better monitored. WHO’s expert advisory panels work well in some areas but need to be kept under review. Mechanisms will be set up in order to ensure transparency and quality in the selection and tenure of external experts and their awareness of WHO’s procedures and policies.
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Articulating ethical and evidence-based policy options
10. Member States need to be adequately provided with policy options to consider in different settings. This requires WHO to assess the feasibility of its guidance in different social and economic environments, taking into consideration cost-effectiveness, ethics and equity. This area requires further consultation within WHO and with partners.
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See also document EB121/5. See document A60/23. See also document EBPBAC5/3.
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5. Providing technical support, catalysing change, and building sustainable institutional capacity 11. WHO will focus on strengthening national institutions and systems by implementing its strategic agenda for strengthening health systems.1 It will take the lead in defining a common understanding of technical support by building cross-agency mechanisms for monitoring and evaluation and by encouraging the routine use of local expertise and national institutions in technical support programmes. WHO will strengthen its work with the main multilateral bodies working with governments in the health sector such as UNICEF, UNFPA, the World Bank, regional development Banks, and the European Commission in order to establish good practice, strengthen networks of expertise and harmonize approaches, building on existing alliances and regional initiatives.
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Monitoring the health situation and assessing health trends
12. WHO will continue to improve application of the highest standards for determining comparable estimates for core health statistics and obtaining country clearance through an interactive consultative process and capacity building. The external Advisory Committee on Health Monitoring and Statistics, which reports to the Director-General, will scrutinize work. WHO will build on existing networks to improve the volume and quality of mortality and health statistics and to address underinvestment in assessment of health systems’ performance.
BUILDING STRATEGIC INTELLIGENCE TO IMPROVE THE QUALITY OF WHO’S WORK 13. WHO’s information systems will be further developed so that managers not only have access to information on programme performance, as will be supplied in the Global Management System, but also are aware of the progress and quality of essential cross-cutting work under their responsibility.
ACTION BY HEALTH ASSEMBLY 14. The Health Assembly is invited to note the above report.
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Document EB120/38.
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