WHO-EM/WR/020/E
Report on the
Twentieth meeting of the Regional Director with WHO Representatives and Regional Office staff
Cairo, Egypt, 28 November – 2 December 2004
World Health Organization Regional Office for the Eastern Mediterranean
WHO-EM/WR/020/E
Report on the
Twentieth meeting of the Regional Director with WHO Representatives and Regional Office staff
Cairo, Egypt, 28 November – 2 December 2004
World Health Organization Regional Office for the Eastern Mediterranean Cairo 2005
© World Health Organization 2005 All rights reserved. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. The World Health Organization does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use. Publications of the World Health Organization can be obtained from Distribution and Sales, World Health Organization, Regional Office for the Eastern Mediterranean, PO Box 7608, Nasr City, Cairo 11371, Egypt (tel: +202 670 2535, fax: +202 670 2492; email: DSA@emro.who.int). Requests for permission to reproduce WHO EMRO publications, in part or in whole, or to translate them – whether for sale or for noncommercial distribution – should be addressed to the Regional Adviser, Health and Biomedical Information, at the above address (fax: +202 276 5400; email HBI@emro.who.int).
Document WHO-EM/WR/020/E/10.05/100
CONTENTS 1. 2. 3 4. 5. INTRODUCTION .............................................................................................................1 OPENING SESSION ........................................................................................................1 ELECTION OF OFFICERS..............................................................................................4 ADOPTION OF THE AGENDA AND PROGRAMME ..................................................4 TECHNICAL DISCUSSIONS..........................................................................................4 5.1 Follow-up on the recommendations of the nineteenth meeting held in 2003 ..........4 5.2 Staff development and learning: regional policy and plan of action, global leadership programme..............................................................................................5 5.3 Public health and health for all in the 21st century in Eastern Mediterranean Region: challenges and strategic directions .............................................................6 5.4 3 by 5 initiative and the Global Fund: progress and challenges ..............................8 5.5 Drug abuse ...............................................................................................................9 5.6 WHO Framework Convention of Tobacco Control ...............................................10 5.7 Millennium Development Goals: role of WHO in the Region and monitoring of achievement of MDG indicators ............................................................................10 5.8 Essential health technologies: briefing on the scope and challenges.....................12 5.9 Knowledge Management at the country office level: what does it mean and what to expect?................................................................................................12 5.10 11th General Programme of Work .........................................................................13 5.11 Renewal of results-based management framework, mid-term strategic plan and strategic resource allocation ............................................................................14 5.12 Monitoring and evaluation of implementation of workplans, reporting formats for mid-term review and end of biennium .............................................................17 5.13 Building partnership for health: reaching out to others, advocacy and resource mobilization ...........................................................................................................18 5.14 Health action in crisis.............................................................................................20 5.15 WHO presence in countries ..................................................................................22 5.16 Global management system: progress of the work ................................................25 5.17 Country activity management system, WR office database, operational workplans for WR offices and planning, monitoring and evaluation portal............................26 5.18 District team problem-solving................................................................................28 CONCLUDING SESSION .............................................................................................28 RECOMMENDATIONS .................................................................................................29
6. 7.
Annexes 1. AGENDA ...... ......................................................................................................................31 2. PROGRAMME ....................................................................................................................32 3. LIST OF PARTICIPANTS ...................................................................................................34
WHO-EM/WR/020/E 1. INTRODUCTION
The twentieth meeting of the Regional Director with WHO Representatives (WRs) and Regional Office staff was held in the WHO Regional Office for the Eastern Mediterranean (EMRO) from 28 November to 2 December 2004. During the first three days the meetings were held in plenary sessions. The fourth and the fifth days were devoted to individual and divisional meetings between the WHO Representatives and Regional Office staff. The fifth day was also allocated for final discussions and adoption of the report. The meeting enjoyed the participation of staff members from WHO headquarters. 2. OPENING SESSION
Dr Hussein A. Gezairy, Regional Director for the Eastern Mediterranean, welcomed participants to the 20th meeting of the Regional Director with WHO Representatives and Regional Office staff. Referring to the diversity of the Region in terms of social and economic development, he stated that support for some of the least developed countries in the world that lack the basic health infrastructure and resources to combat communicable diseases was essential. Many Member States of the Region faced complex emergency situations, which taxed resources and national energies and prevented countries from developing and prospering. He referred to the plight of the Palestinian people in the Occupied Territories where basic human rights, including the right to health, were denied to millions. Dr Gezairy spoke of the Darfur crisis in Sudan where it was estimated that 1 200 000 people had been displaced. In spite of all the difficulties, WHO had collaborated with the Sudan Ministry of Health and UN sister agencies to conduct major campaigns for polio, measles, and cholera and provide support for access to essential health services in the affected areas. He noted, however, that the health infrastructure throughout Sudan was in need of rehabilitation, not just that in Darfur. He also noted that such situations were regularly exploited by people to serve their own special interests. He referred also to the tragedy of the Bam earthquake in the Islamic Republic of Iran last December. WHO’s input had resulted in the mobilization of considerable external assistance to support the systematic rehabilitation of the health care delivery system and health-related services in Bam. He noted, however, that many of the complex emergencies in the Region had become chronic problems which ceased to attract attention and needed developmental solutions. Referring to the situation in Iraq, he said that WHO had supported the Ministry of Health in the reconstruction and rehabilitation of health infrastructure and services but that there was a huge challenge to be met in rebuilding the health system there. He thanked the national country staff inside Iraq for their selfless and courageous efforts, as well as the Iraq staff currently stationed in Amman, Jordan, for their tireless dedication. The people of Somalia and Afghanistan continued to live in chronic humanitarian crisis, which might worsen at any time. As the lead international agency for health, WHO had a heavy responsibility in both countries to assist in revitalization of the health care systems. The Director-General, Dr Lee, took an interest in the work of the emergency and humanitarian
WHO-EM/WR/020/E Page 2 action programme in the Region and had visited Darfur in Sudan and Bam in the Islamic Republic of Iran with the Regional Director. The Regional Director highlighted the key health challenges in the Region including tuberculosis, malaria and HIV/AIDS, which are among the major killers in the Region, as well as road safety, polio, malnutrition among children, mental health-related problems and substance abuse. With the shift towards injecting drug use and the rise of HIV/AIDS and hepatitis, particularly hepatitis C, 80% of the cases of which are caused by unsafe injections, the danger posed by substance abuse to public health was becoming more ominous. The ratification of the WHO Framework Convention on Tobacco Control presented both a challenge and an opportunity in the quest to overcome the risk factors contributing to poor health. The Regional Director stressed the increasing burden of health expenditure on people, as governments reduced their financial commitment to public health or were unable to meet it, assuming that health insurance could meet the gap. Up to 100 million citizens in the Region lacked regular access to essential medicines. The Fifty-first session of the Regional Committee, held in the Regional Office in October, had unanimously endorsed and expressed its deep appreciation for the efforts made by the Regional Office in helping the Member States. The strong endorsement of the Regional Committee naturally was a reflection of the hard work carried out by the country offices and the Regional Office. Dr Gezairy thanked everyone for their input. The Regional Committee noted the alarming increase in prevalence of HIV/AIDS and the lack of adequate reporting of cases, and expressed its concern that only 5% of people living with HIV/AIDS had access to anti-retroviral therapy. The Committee also noted the low detection rate of tuberculosis and incomplete expansion of DOTS, as well as the growing resistance to anti-malarial drugs. According to Dr Gezairy, unless local, regional and global responsibilities were shared now, achievement of the Millennium Development Goals would be close to impossible. The health sector must take the lead in influencing policies made by partner sectors which have impact on the health of communities. Partnership development is essential. Some of the current partnerships, in contrast, involved a great many actors, who often sought to influence WHO’s work. In spite of the remarkable success of WHO in negotiating with pharmaceutical industries and other stakeholders involved to lower the cost of drugs, more efforts were still needed. Unfortunately, the disbursement of funds so far from the Global Fund to Fight AIDS, tuberculosis and Malaria was far from the expected level; to date only 14 million dollars had been disbursed by the Fund. The Director-General had emphasized the redistribution of resources to the regional and country offices and there was now a good chance for decentralization to work. A number of important publications were issued in Arabic and in English in the past year and had been well received.
WHO-EM/WR/020/E Page 3 The eleventh General Programme of Work (GPW) would cover a ten-year period, providing a long-term strategic look at the world and the place of health in the social and economic development of nations. It would establish new global public health principles and revisit the roles the various players in global public health, including WHO, need to play. Since 2000 WHO had implemented a results-based management approach which had increased the accountability and transparency of programmes and their financial management. The Regional Director drew the attention of participants to the Regional Programme Budget Policy, a document that continued to be very relevant a number of years after it was first published. WHO’s new integrated Global Management System would improve the efficiency and effectiveness of operations at all levels. It would cover all the six administrative areas of programme management, finance, human resources, payroll, procurement, and travel. Overall implementation would engage the Organization until the end of 2007. Two country offices in each region were selected in the pilot phase of the project, in the case of the Eastern Mediterranean Region, Sudan and Pakistan. The Regional Director referred to the leadership development programme, developed by the Regional Office and now devolved to the subregional level. An important initiative of the Director-General was a fresh focus on staff development through the Global Leadership Programme, which aims to strengthen key leadership and managerial capacities of professional staff in the Organization. He also referred to the delegation of authority to the WRs, whereby he had delegated the full extent of what he was authorized. By the end of 2003, five Country Cooperation Strategy (CCS) documents were completed and published. Since the beginning of 2004, the CCS process had been undertaken in 12 countries and it was expected that 8 of them would be published before the end of 2004. The CCS in the remaining 5 countries were expected to be completed before the end of the first quarter of 2005. It was a good start and WHO should make full use of this activity. Governments should be actively involved in developing the national health plan, together with non governmental organizations. In the high and middle-income countries, in addition to the health system development reform, noncommunicable and lifestyle-related diseases ranked very high in terms of priority for WHO support. Campaigns to reduce obesity and smoking and promote exercise and healthy lifestyles, were complex to develop and implement but very necessary. The Regional Director had also written to the Director-General with regard to establishing a global drug facility for chronic diseases, which involved very high treatment costs. One of the most important problems of decentralization within WHO was how to move towards one country plan and budget which should also incorporate all the country-specific activities supported by the three levels of the Organization. Many Member States saw the WR’s office as a drain on the national budget, forgetting that it served the role of a permanent consultancy which would cost the government far more on a private basis. In this regard, WRs’ reports were important tools for advocacy and mobilization of resources. It was necessary also to emphasize the important contribution the WR made to the country.
WHO-EM/WR/020/E Page 4 The Regional Director touched on the recent global meeting of country strategy units, held in EMRO, and urged participants to refer to his comments in the opening of that meeting. He also drew attention to existing documents, in particular the WHO Constitution, the Health for All series, including Primary Health Care, and the WR’s post-description. All of these were valuable documents with which everyone should be familiar. 3 ELECTION OF OFFICERS
Dr Khalif Bile Mohamud, WHO Representative to Pakistan was elected as chairman. Dr Jihane Tawilah, WHO Representative to Djibouti was elected as Co-Chairman. Dr I. Abdel Rahim, WHO Representative to Tunisia, Dr Mohammad Assai, Regional Adviser, Community Based Initiatives and Mr Hatem El Khodari, Administrative Services Officer were elected as rapporteurs. 4. ADOPTION OF THE AGENDA AND PROGRAMME
The draft agenda and programme were adopted. The agenda, programme and list of participants are given in Annexes 1, 2 and 3, respectively. 5. 5.1 TECHNICAL DISCUSSIONS Follow-up on the recommendations of the nineteenth meeting held in 2003 (agenda item 2) Dr A. Assa’edi, Assistant Regional Director
The nineteenth meeting of the Regional Director with WHO Representatives (WRs) and a number of Regional Office staff was held in WHO headquarters in Geneva on 15 November 2003, immediately following the third global meeting of WHO Representatives in Geneva which took place from 10 to 14 November 2003. The one day meeting had six recommendations. On the subject of improving and strengthening communication systems for the WHO offices, many actions were taken. Five more country offices were connected to the GPN system. Networks and software were updated in 10 country offices. Five country offices built their websites and e-mail systems in seven country offices were standardized in accordance with WHO global standards. As for improvement of follow-up of recommendations, a proposal was developed and approved by the Regional Director early this year, however, the implementation was not completed. Regarding collaboration among countries, a number of technical cooperation initiatives have been undertaken, including joint work on malaria and vector control between Yemen and Saudi Arabia, human resource development between Afghanistan, Pakistan and Islamic Republic of Iran, as well as between Jordan and Iraq.
WHO-EM/WR/020/E Page 5 With respect to development of Country Cooperation Strategy Documents, five countries have published their CCS, eight countries are in the final technical review stage, and five countries will have their drafts before the end of the year. The remaining four countries are planned for 2005. The process of preparation has been modified to have only one mission fielded to finalize the document. It was made possible only through extensive preparation at the national level and involvement and active participation of national counterparts in the countries. Regarding the 3 by 5 Initiative, an inter-divisional task force was established and a regional workplan was developed. A medical officer at the Regional Office and two other medical officers, one for Sudan and one for Djibouti, Somalia and Yemen (based in Djibouti) are being recruited. A regional advocacy briefing was held in February 2004 and joint headquarters and the Regional Office missions were fielded to Sudan, Djibouti and Somalia. A training knowledge hub has been established in Sudan and two training courses were conducted there. With respect to development of a roster for CVs of public health experts, no specific action has yet been taken. 5.2 Staff development and learning: regional policy and plan of action, global leadership programme (agenda item 3) Dr B. Sabri, Director, Health Systems and Services Development and Ms Helen Robinson, Human Resources, WHO headquarters
As human resources are the main asset of WHO, staff development and learning (SDL) are among the priorities at various levels. Such commitment is expressed at the highest level of WHO and has been translated into a global staff development and learning policy which should be implemented, taking into consideration the specific needs of regional and country offices. The global policy, developed with the contribution of all regions, states that SDL should be systematic involving all levels of WHO, capturing the strategic agenda of WHO and sustainable in both financing as well as adjusting to specific needs. The global SDL policy was used as a framework to prepare regional programmes using the various training and learning opportunities globally, regionally, and locally. The regional SDL committee will prepare a regional programme, including training in generic skills, such as use of information technology or writing skills and in specific technical areas. The programme aims also to improve managerial and leadership attributes of WHO staff. The global training in leadership and management has been initiated and regional staff will benefit from various planned sessions. In order to better implement the regional SDL programme, a unit is being established under direct supervision of the Regional Personnel Officer. A professional staff will coordinate the unit, who will be a specialist in health personnel education and will liaise with all personnel at regional and country level to identify their training needs and to develop
WHO-EM/WR/020/E Page 6 appropriate programs. He/she will also be involved in monitoring and evaluation of training activities and will map the training opportunities at various levels, making use of progress in information technology and in e-learning and distance learning. Training activities that have been identified for the coming months include some generic skills such as writing and presentation, administrative and financial skills for staff working in country offices and training in health systems and health systems development for professional staff. All staff members are requested to provide their views and comments on better ways and means to improve staff development and learning activities regionally and globally. Staff are expected to provide input in the various SDL components, including needs identification, curriculum design, implementation and monitoring and evaluation. Discussion The meeting strongly endorsed the importance of country office staff development and learning and recommended a systemic approach for the planning and the implementation of the staff development. An enabling environment must be present to support staff development and training. Time constraints and connectivity issues often represent significant challenges for country offices and need to be taken into consideration in staff training plans. Involvement of country offices in the design of training plans would help in the development of strong teams at each individual country level. Staff needs assessments must be conducted in many country offices, and restructuring of offices may be necessary with respect to staffing. Many offices are staffed largely by personnel on temporary contracts, for example, and provisions must be made to ensure adequate training and development. In addition, there are strong arguments for training nationals as well as international staff. Funding for the leadership development programme comes from the terminal portion of staff salaries, which is already being deducted. In the Region, this figure amounts to US$ 400,000. For programme purposes, 5% of staff time translates into eight days a year. 5.3 Public health and health for all in the 21st century in Eastern Mediterranean Region: challenges and strategic directions (agenda item 4) Dr B. Sabri, Director, Health Systems and Services Development
All countries of the Region are committed to health for all. Such commitment was clearly expressed in the adoption of the policy document on health for all for the 21st century. However, the important changes and challenges in the political, economic, environmental, epidemiological, demographic and social fields have indicated the need to adjust policies and strategies aimed at better implementing health for all through primary health care. WHO has taken several initiatives to deal with these changes and their expected impact on health systems and on important health outcomes.
WHO-EM/WR/020/E Page 7 The report of the Commission on Macroeconomics and Health confirmed the need for investment in health and the important economic return of such investment. The report also developed scenarios for bridging the gap in health system financing through mobilization of both national and international sources. The report also stressed the importance of supporting poverty reduction strategies in order to mitigate the impact of the determinants of ill health. Countries with technical support from WHO are striving to operationalize the main recommendations of the report. In the meantime, world political leaders are committed to the achievement of the Millennium Development Goals (MDGs), which include improving main health determinants and health outcomes. Efforts are being made to improve monitoring and evaluation of the MDGs and to determine WHO’s contribution in achieving such important goals. WHO has established a global commission on the social determinants of health including experts from the WHO regions. The global commission will look at ways and means of improving the social determinants of health and of reducing health inequalities inside and between countries. The regional policy on achieving health for all through primary health care in the 21st century reaffirms the main health for all values, including social justice, equity in access to appropriate health care, as well as the protection of public health and bioethics. The Health for All policy highlights health as a human and constitutional right, and as an important element of human security. Strategic directions to achieve health for all focus on improving the social and economic determinants of health, strengthening public health through improved public health functions and strengthening health systems. The new directions of WHO’s work should impact on its main functions including technical cooperation with countries and the normative functions. The international community should adhere to the values of peace, cooperation and equity which should be translated into concrete solidarity mechanisms to improve health in the global world. Discussion Health for All still represents a valid goal. Unfortunately, the vehicle for achieving that goal, primary health care, has not been given adequate support. Budget allocations are insufficient, and the necessary levels of intersectoral collaboration, community involvement and use of appropriate technology have never really been reached. The Islamic Republic of Iran and Oman have had successful experiences in this area that might be shared with other countries. Regional initiatives such as community-based initiatives and the action-oriented school health programme are aimed at implementing primary health care principles. The Regional Office must continue to promote these initiatives actively and advocate with Member States to include them in their national plans.
WHO-EM/WR/020/E Page 8 5.4 3 by 5 initiative and the Global Fund: progress and challenges (agenda item 5) Dr Z. Hallaj, Director Communicable Disease Control
The 3 by 5 initiative is an interim target that aims at providing 3 million eligible people living with HIV/AIDS with antiretroviral therapy (ART) by the end of 2005 with a view to reaching universal access in the future. The initiative forms part of the Global Health Sector Strategy (GHSS) on HIV/AIDS where prevention remains the basis for all interventions. The cost of achieving the target of 3 by 5 is estimated to be around US$ 5.5 billion, of which the Eastern Mediterranean Region needs US$ 77 million. Thus, resource mobilization, in addition to reducing prices of ARV, developing normative tools and functions, strengthening health care systems and human and structural capacity-building are imperative inputs to achieve this target. WHO, as a leader in health has a key role in achieving this target, and thus strengthening its regional and country office capacities is also crucial So far, some achievements have been noted within the Regional Office and country offices. These include committing a total of US$ 8 045 000 to fight HIV/AIDS during the biennium 2004-2005; assisting the Member States in developing treatment-oriented GFATM proposals; and recruiting or initiating the recruitment of 3 by 5 officers to support countries as well as the Regional Office. Other achievements in capacity-building and technical support on drug supply and management are also marked. WHO has supported countries in drug price negotiation and has achieved remarkable decreases (range US$ 100–600 per patient per month). Weaknesses are most obviously visible in fund mobilization, and consequently affect other areas. Moreover, the drug prices achieved are still far higher than those achieved globally (US$ 484 per patient per year). The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) is one of the main sources of funds to fight the three diseases in the Region. Ten Eastern Mediterranean Region countries have 23 approved GFATM proposals amounting to US$ 304 579 166 over five years. Of these, 48% are for HIV/AIDS, 31% for malaria and 20% for tuberculosis. Disbursement of funds has not so far been as expected, with only US$ 5 372 772 disbursed to this date, while some countries have not signed the agreements for proposals approved since round two. Acknowledging the importance of this source of funding, WHO will always assist countries in developing proposals and implementing their activities, but only based on official requests from the national authorities, since WHO cannot be a principal recipient but can be sub-recipient, to provide this type of assistance. Discussion Although the targets of the 3×5 Initiative may not be achieved on time, the activities being undertaken remain valid. The goals of the initiative go beyond provision of antiretroviral therapy and represent a new direction in strategy to combat HIV/AIDS.
WHO-EM/WR/020/E Page 9 Although WHO is a member of the Board of the Global Fund, the Fund is not under the control of WHO. Moreover, because it is a member of the Board, WHO cannot be designated a primary recipient. Nevertheless, WHO has a key role to play in facilitating disbursement and absorption of Global Fund support at country level. It is important for WHO to remain a strong player in country coordination mechanisms. By identifying its strengths and focusing on them, WHO can maximize its contribution to country support. The major obstacle to achieving the targets of the 3×5 Initiative is the price of the drugs. Negotiations with drug companies are at the centre of the initiative, and countries have had varying degrees of success in such negotiations. Brazil is an example of a country that opted for producing generic drugs nationally. The availability of less expensive generics, such as from Brazil or India, provides another option for countries and hence a leverage point for negotiations with pharmaceutical companies. 5.5 Drug abuse (agenda item 6) Dr A. Mohit, Director Health Protection and Promotion
Substance abuse is on the rise throughout the Region. The pattern of this increase also has characteristics that are a cause for concern. The average age of drug users is decreasing; the number of women among drug users is increasing and drugs are finding their way to schools in an unprecedented way. There is also another major concern from a public health point of view and that is an increase in the number of people who use substances through injection – so-called injecting drug users (IDUs). It is also an increasingly more important transmission route for other blood-borne diseases like hepatitis. All of these facts call for new and innovative approaches. These approaches should continue to work at all levels of prevention, but should also be responsive to reducing the harms. Two years ago, the Regional Director agreed to form the Regional Advisory Panel on the Impact of Drug Abuse (RAPID) to advise on these issues. RAPID has reviewed drug abuse in the Region and drafted a strategic plan. WHO will provide technical support and WRs’ offices have a very important role in collaborating with the Member States in responding to the public health consequences and advocating newer approaches and means to deal with them. Discussion Chronic khat use has devastating effects on productivity and the economy in Djibouti, Somalia and Yemen. However, this issue differs qualitatively from other forms of substance abuse because khat use occurs within a context of social acceptance. Community participation and the involvement of nongovernmental organizations are crucial for addressing all behavioural issues. In this regard, a consultation was held earlier in the month to formulate a regional strategic framework for health promotion.
WHO-EM/WR/020/E Page 10 5.6 WHO Framework Convention of Tobacco Control (agenda item 7) Dr F. Al Awa, Regional Adviser, Tobacco Free Initiative
The FCTC was adopted by the WHA in 2003. The three years of negotiations resulted in a very promising development in favour of tobacco control at national level, legislation was adopted, plans of actions were developed and in each Member State a focal point was appointed for tobacco control. Unexpectedly, since the adoption, the process of ratification is moving very slowly in the Region compared with the active role played by the Member States during the negotiations. So far the Region has only 3 ratifications and 18 signatures. The delay in ratifying the FCTC will have a high price for our region. Since most of our tobacco control activities are covered by extrabudgetary funds, donors will be less likely to continue supporting regional and national tobacco control activities. Additionally, if none of its Member States become parties to the Convention, the Region will be excluded both from the benefits of the FCTC, and from participation in the ongoing development of the FCTC. The delay is attributed to lack of understanding of the legal process, the involvement of many national parties in the process which complicates it and finally to lack of political commitment in some cases. Discussion The major problem in the process of ratification of (or accession to) the FCTC is lack of coordination between all concerned national authorities, especially the Ministry of Foreign Affairs. The critical role of WHO, including the WRs, during this process is to sustain the awareness and commitment of national stakeholders and clarify any technical questions about the ratification process. Nongovernmental organizations were very important in the development of the Convention, and are continuing to play a key role in enhancing public knowledge and supporting tobacco control efforts at national level. 5.7 Millennium Development Goals: role of WHO in the Region and monitoring of achievement of MDG indicators (agenda item 8) Dr M. A. Jama, Deputy Regional Director
Almost half of the Millennium Development Goals (MDGs) are directly related to health. Achievement of the other targets, such as poverty, education and gender, will also have absolute positive impact on the state of the world’s health. The target date 2015 might seem a long way off still, but unless more concerted action is taken soon, the goals cannot be met. This is a shared global responsibility and we all must do our part, globally, regionally, nationally and locally in achieving these goals as committed to by the Member States. The MDGs are not freestanding, but are mutually synergistic with poverty reduction strategies. The implication is that achievement of the over-arching goal of poverty reduction will not occur unless the supporting goals are also met. It is therefore a challenge to all health authorities, national and international, to deliver the gains, which will support poverty reduction and human development. The health sector can take on the leadership role. Building
WHO-EM/WR/020/E Page 11 on its cross-sectoral aspect, ministries of health are also called upon to play a more proactive role in influencing policies made outside the health sector related to the MDGs. This not only requires health ministries to become advocates for good health outside their domains but also places an onus on them to support their arguments with evidence and information. WHO should assist the ministries of health to play their role as desired. It is necessary to capitalize on the existing interventions and resources. Intersectoral partnership can be facilitated through a coherent process involving the development of Poverty Reduction Strategy Papers (PRSPs), the Global Fund to Fight AIDS, Tuberculosis and Malaria, the UN Development Assistance Framework (UNDAF), the Global Alliance for Vaccines and Immunization (GAVI), and the follow-up to the report of the Commission on Macroeconomics and Health (CMH). In order to achieve the MDGs the Regional Office has established a Task Force comprised of directors and regional advisers with clear tasks and responsibilities. The Task Force is assigned to review existing regional strategies that are in conformity with the MDGs, develop monitoring and evaluation tools, advocate and promote country strategies and policies, ensure mobilization of resources, forge alliances with potential partners and develop networks between countries and with other regions. The countries of the Region were ranked according to selected MDG indicators, such as child mortality, EPI coverage, maternal mortality, tuberculosis prevalence, and access to water and sanitation. Ten countries (Afghanistan, Djibouti, Egypt, Iraq, Morocco, Pakistan, Palestine, Somalia, Sudan, and Yemen) were selected as priority countries requiring additional support to achieve the MDGs. The countries will be assisted to develop their own national plan and strategic directions, in addition to capacity-building, resource generation, monitoring and evaluation. Weak monitoring and evaluation capacity are among the major challenges that need to be addressed by the country and regional offices. Fostering broad-based partnerships and linkages; linking health and poverty; resource constraints; weak political commitment and instability; political, economic, demographic, epidemiological and environmental constraints in the least developed countries; lack of national statistical base and capacity and not using information in planning and management. Discussion Despite apparent variation in commitment to the MDGs by countries, they themselves set the goals at the UN in 2000 and they are the owners. It is WHO’s role to help them achieve the health goals by giving support in its areas of technical expertise. This may be needs assessment, development of the health component of the national plan, strategic planning over 5–10 years, mobilization of resources, setting indicators, monitoring and evaluation. The 11th General Programme of Work is aligned with achievement of the MDGs and all the country planning elements must be consistent in this regard so that conflicting messages are not given. WHO is somewhat late in setting operational strategies at the various levels and needs to catch up. There is a problem with available data at the country level. Data is often unreliable and not borne out by evidence from other agencies and actors. Water and sanitation is a case in point. If the baseline data is not accurate then the indicators and targets will be unrealistic.
WHO-EM/WR/020/E Page 12 There is a need also for disaggregated data to identify the most disadvantaged areas and target support to where it is most needed. Quality indicators are essential and additional indicators need to be developed. Advocacy and partnership with other UN agencies and sectors, governmental and nongovernmental, are crucial to ensure coordinated planning and effective outcomes. This applies to the non-health goals, such as goal eight, as well as the health goals. WHO should be proactive at country, regional and global level in promoting partnership. The MDGs present an opportunity as well as a challenge, to mobilize resources and strengthen national capacity. The MDGs are an opportunity to make life better for millions. Long-term improvements in national health status are sustainable only through poverty reduction and vice versa. With commitment from WHO and the countries to the key targets and indicators, much can be achieved. 5.8 Essential health technologies: briefing on the scope and challenges (agenda item 9) Dr N. Metwalli, Regional Adviser, Blood Safety, Laboratory and Imaging
In 2002, the management team in charge of blood safety and clinical technology in headquarters changed. The new team found that WHO needed to cover more technologies than the three basic areas of blood safety, laboratory and imaging. A regional retreat was held in 2003, and the six regional advisers concerned with these areas of work were invited to headquarters, for their inputs. An agreement was reached that other technologies were urgently needed by the Member States worldwide. Also regional advisers should be strongly involved in the decision-making of the division. Lastly some of the focal points should be moved to the regions, in support of national programmes. The budget for Essential Health Technologies (EHT) was to include two regional projects, involving two Member States (US$ 50,000) annually. Health technologies now include: laboratory services, blood transfusion safety, imaging, medical devices and biomedical equipment, biological standardization, emergency and surgical clinical procedures, transplantation, prevention of health care-associated HIV/AIDS, and e-health, the latter being taken care of in the Regional Office by the Health Information Management and Telecommunications Support unit. 5.9 Knowledge management at the country office level: what does it mean and what to expect? (agenda item 10) Dr N. Al Shorbaji, Regional Adviser, Health Information Management and Telecommunication Support
Dr Al-Shorbaji introduced the concept of “knowledge management” as a new discipline that promotes an integrated approach to the capture, search and use of the Organization’s information assets, including databases and documents, as well as the un-captured tacit expertise and experience of individual staff. He presented analysis of the importance of
WHO-EM/WR/020/E Page 13 communication and sharing of high quality data, information, knowledge and experience which leads to development of a learning organization. The link between information technology and knowledge management was discussed. The various knowledge assets were presented including: a) explicit knowledge (information that has been recorded) such as electronic (databases, websites, CD-ROMs, etc); printed (Documents, reports, books, articles, etc); published (journals, books, reports); semi-published (documents, reports); unpublished; and b) tacit knowledge (not yet captured in written format) such as expertise and experience of individual staff. The second part of the presentation was an analysis of a survey that was conducted on knowledge management and assets at country offices. The results revealed that the majority of these offices have the basic information, and communication technology infrastructure is available in most country offices. Connectivity is still a major issue for many of the countries. Only six countries are connected to the Global Private Network. (GPN). More than half of the countries do not have library services. The majority have not established e-mail services according to WHO standards. Many of the countries do not have access to the GIFT and the headquarters intranet. Collaboration and networking with colleagues is still lacking. New technology based on the SharePoint was presented as a tool to assist in the management of both explicit and tacit knowledge. The potential of this technology has not been realized either by the Regional Office or by country offices. The tool has a number of features that can be applied either in full or in pilot manner. 5.10 11th General Programme of Work (agenda item 11) Mrs P. Brudon, Planning, Resource Coordination and Performance Monitoring, WHO headquarters The presentation reviewed the development of the 11th General Programme of Work (GPW) and the use of the concept of scenarios. It was followed by a discussion on the GPW and on the future of health in WHO. The 11th GPW will cover a 10-year period, and will assist all actors (Member States, other partners, WHO secretariat) in understanding the changes which may take place throughout the world in the future, identifying appropriate responses to these changes and reviewing the strategic directions, roles and functions of WHO. In order to understand the larger context and its possible experiences in health, the GPW makes use of scenarios. The presentation outlined the role of scenarios in the GPW and described the four scenarios which have been developed: a “best guess” extrapolation of current conditions, a “hard time” scenario with deep challenges and two visionary scenarios in which there is an improvement of health either through market-driven approaches or through shared values and international cooperation. The presentation also reviewed the steps in the consultation which will take place during 2005.
WHO-EM/WR/020/E Page 14 Discussion The GPW is a framework for cooperation between WHO and Member States, mandated by the WHO Constitution, that will guide the action of WHO, countries and partners. In this regard it is not a strategy or a plan of action but an agenda for collaboration. It is developed and owned at and by all levels of the Organization as well as by Member States. The Region is involved in the task force and there has been, and will continue to be consultation, although this may not have been extensive up to now. The final document will not be finalized until May 2006, so there is still a long way to go. The scenarios outlined in the draft framework are just one of several tools to develop the GPW and will be used to analyse future challenges, look at past lessons learnt and focus on WHO’s functions and leadership roles. The GPW will take into account other processes such as the MDGs, country cooperation strategies, poverty reduction strategy papers etc., in order to achieve consistency. There will be further consultation including involvement of assistant directors-general and regional directors. The concept of scenarios is well known, useful and often practised at country level but more consultation at country and regional levels is desirable to ensure applicability and appropriateness. Water, for example, should be a key component of any scenario for the region, and globally. Governments and stakeholders should also be involved to ensure ownership and relevance. WHO has a unique position as a specialized agency and should make use of this to influence partners and lead the way in health. Once the GPW is finalized, corresponding strategies will need to be developed. 5.11 Renewal of results-based management framework, mid-term strategic plan and strategic resource allocation (agenda item 12) Dr H. Feirman, Planning, Resource Coordination and Performance Monitoring, WHO headquarters Despite the various improvements over the past bienniums, the current results-based management framework (RBMF) has a number of shortcomings: (i) It is too vertical and does not facilitate working collaboratively across the Organization; (ii) the 2-year time horizon limits its value as a strategic document and does not adequately reflect the more strategic nature of what many programmes are doing; (iii) the way the programme budget is currently organized around areas of work provides a poor fit at the country and regional levels; finally (iv) it is a burdensome framework due to the short timeframe and ensuing concurrent processes. The proposed renewed WHO results-based management framework takes into consideration the above mentioned limitations. It represents both continuity and change from current practices. Some of the key processes and instruments, such as a change in a 2-year budget or the governing body approval process, were not considered because of statutory requirements. A number of innovations and improvements are being proposed.
WHO-EM/WR/020/E Page 15 Overall, the critical added value of the renewed RBMF is that it provides a true strategic perspective for the Organization and links the biennial budget and operational planning to this perspective. Strategic planning is being freed from the constraints of a 2-year budget. The current programme budget by default serves as a strategic plan for the Organization. Recognizing this shortcoming, the new framework in effect separates a medium-term strategic plan (6 years) and a simplified 2-year budget that supports the strategic plan. By emphasizing strategic objectives rather than areas of work as the means to organize our work, the proposed framework avoids the verticality of the current programme structure. At the country level, the proposed changes do not lead to increased workload. The strategic plan, developed through a thorough “bottom-up/top down” consultative process and endorsed by the governing bodies, will provide direction to the Organization over three bienniums. A limited number of international health development goals, derived from the General Programme of Work, MDGs, and other sources will constitute the starting point of the plan. Strategic objectives, commitments of the Member States and the WHO Secretariat, would then be developed to contribute to the attainment of these goals. It is these strategic objectives that will serve to guide our work at all levels of the Organization over a 6year horizon, thus providing the parameters within which biennial budgets are then developed. The strategic objectives will be informed by country and regional level needs through the CCSs and other mandates. The strategic plan will cover a period of six calendar years, beginning in 2008. While the options of 4 or 5 years were explored, there was consensus that a 6-year plan provides the greatest advantage. It synchronises with the biennial budgeting period, thereby rationalizing the projection of targets and resources and ensuring greater accountability. It allows for 3 "light" biennia within one strategic cycle; and it better reflects the planning cycles of many technical programmes. The biennial budget will cover a period of 2 calendar years. This periodicity is a constitutional requirement. It is also in line with the budgeting cycles of most other UN agencies. The process for the development of the biennial budget for the first biennium of the strategic planning period will begin once the draft strategic plan is ready. Drawing on the Organization-wide strategic objectives, each office will develop office-specific expected results, in consultation with each other. This bottom-up process will culminate in the formulation of regional expected results and then organization-wide expected results for the 6 years with targets for 2 years. A qualitative indication will also be provided on the resource outlook for the 6 year period. An organization-wide peer review would serve to validate the organization-wide expected results as well as their indicators, target and resource requirements. The two subsequent bienniums will have a much "lighter" development phase since the expected results for the six years will already have been defined. They will need to be revisited to ensure their continued relevance. New targets will be set for the two-year period; and these targets will be costed.
WHO-EM/WR/020/E Page 16 Discussion The initiative arose out of WHA51.31 which had the effect of cutting the budgets of four regions over three biennia by 3% every bienniem, in favour of the other two regions. For the Eastern Mediterranean Region this meant an ultimate loss of US$20 million from the regular budget. With the moves towards decentralization of WHO funds to the regional and country levels, using a results-based management approach and a single integrated budget that includes both regular and other sources of income, and in the interests of solidarity within the Organization, it was felt that more strategic resource allocation would be both fairer and less devisive, at all levels. By WHA51.31, some countries lost out and this approach should restore some balance. Other countries received massive amounts of support from other sources because of emergency situations but this is not sustainable and diverts resources from other countries according to the current method of distribution. Currently 94% of extrabudgetary resources in the Region go to Iraq, polio eradication and emergency and humanitarian action. Had WHA51.31 included the extrabudgetary resources in its formula for reallocation, the Region would not have lost out to the extent it did. Four countries had their entire (small) budget cut, while two countries in need had their budgets reduced despite dire circumstances. Now that all sources of funds are to be pooled in a single budget there is good hope that a greater degree of fairness in resource distribution will be achieved. The renewed results-based management framework (RBMF) provides an approach that allows WHO to develop a single integrated country plan and budget. There is a need for more risk analysis in the planning process. A training module on this is provided by the resultsbased management training package. Monitoring and evaluation need greater emphasis. The CCS will provide the basis for development of strategic objectives, and the programme budget will provide the basis for resource mobilization, especially for unspecified funds. Better resource mobilization from within the Region is necessary and this should be studied. Strategic planning has long been needed in WHO and a 6-year planning cycle will meet this need. However all other UN agencies work on a 5-year cycle, and the first 6-year cycle will also not synchronize with the GPW. A 5-year cycle may therefore be worth considering, with a mid-term review at 2.5 years. A common planning approach is now needed in regard to the 6-year and 2-year plans, with regular (6-monthly) revision of implementation to determine which funds have been received, what has been implemented etc. Planning for substantive WHO support in those countries with relatively little budget is entirely dependent on funds from other sources. Better access to those sources should be considered and planning for their allocation based, perhaps, on a pro rata approach. The guidelines on strategic resource allocation were distributed to WRs and these should be shared with Member States. The health needs of the country should be assessed as well as the national capacity to meet those needs.
WHO-EM/WR/020/E Page 17 5.12 Monitoring and evaluation of implementation of workplans, reporting formats for mid-term review and end of biennium (agenda item 13) Dr S. Bassiri, Regional Adviser, Planning Monitoring and Evaluation and Dr Harry Feirman, Planning, Resource Coordination and Performance Monitoring, WHO headquarters In WHO, performance monitoring and assessment are conducted in relation to two key instruments within the WHO RBMF: the workplans and the Programme Budget. Workplan monitoring is an ongoing process, allowing for the detailed review of the delivery of products and services. Workplan monitoring is considered a decentralized function. The organization-wide requirement for six-monthly reporting has been abolished, and there are no longer standard questions nor a common format to guide workplan monitoring. Regional offices and headquarters’ clusters are responsible for determining the process, focus, content, tools and periodicity of monitoring at the workplan level and the development of specific guidance on the conduct of workplan monitoring. Monitoring and assessment of the programme budget is conducted at the mid-term period (mid-term review) and upon completion of the biennium (programme budget performance assessment). The mid-term review serves to track and appraise progress towards the achievement of expected results and enable corrective actions, re-programming and reallocation of resources during implementation. It is purposefully designed to be light and simple, relying on minimal data collection and the use of 'stoplight ratings' to communicate findings and providing managers with easily digestible information without imposing major data collection or reporting requirements. In a change from previous biennium, there will be a consolidation of regional and headquarters reports into an organization-wide report. Previously, country and regional office reports were consolidated at the regional office level for submission to the Regional Director. The purpose of the programme budget performance assessment, undertaken at the end of the Biennium, is to assess the actual achievements of each organizational level and the whole Organization against the expected results described in the programme budget. The assessment is designed to provide a more comprehensive appraisal of achievements than is required at the mid-term period. As such, it involves a thorough assessment of performance in the achievement of the expected results expressed in the programme budget, for which the Organization as a whole is accountable. Findings at each organizational level (country, regional, headquarters) are rolled up and synthesized into the programme budget performance assessment. In the consolidated report, each area of work is expected to provide a brief narrative to illustrate country level achievements. The illustration should be demonstrative of the impact of WHO interventions for the area of work in one or more selected countries. The main body of the consolidated programme budget performance assessment report is on performance in relation to indicator achievement values, baselines and targets established in the programme
WHO-EM/WR/020/E Page 18 budget. Finally, information on success factors and impediments, lessons learnt and how these might be applied in the coming biennium will be provided. Discussion Evaluation of programme implementation and reporting by WRs has several purposes: 1) to meet WHO’s needs, and in this regard appropriate indicators should be established to enable WR reports to feed into the annual report of the Regional Director; 2) to meet the needs of donors; 3) to meet the needs of the country and provide advocacy for WHO’s work. These separate aims should be very clearly distinguished. Reporting on activity implementation needs a very clear structure. Advocacy reporting should be up to each office to develop and structure. There is a constitutional requirement on WHO to report back to Member States on performance of the health sector and on health development status. At the same time, WHO needs to be able to evaluate its input and effectiveness. The problem continues to be in formulation of expected results, which needs more work. Those programmes that are properly planned, monitored and evaluated are also those that attract the funds. Currently monitoring and evaluation is not part of the JPRM process and this should be a joint activity with the countries, not just a WHO activity, since it concerns the countries’ programmes. Some activities are implemented over several biennia and this should be taken into consideration. Reports need to be technically valid and work still needs to be done on format and structure. Evaluation should also reflect all the other functions the WR performs that do not form part of the JPRM process. WRs should therefore be involved in developing the tool further. Some activities are difficult to evaluate since WHO is not always the only player involved and often not the major player. RAMS currently does not meet all the needs for country reporting, since it does not reflect the resources available on a daily basis and implementation, or track changes and deviations from the JPRM. Effective reporting is a difficult balance to achieve, in that both the financial and the technical requirements need to be satisfied. A simple summary report may be developed to satisfy the majority of needs with provision for detailed annexes for those that may need them. 5.13 Building partnership for health: reaching out to others, advocacy and resource mobilization (agenda item 14) Dr G. Popal, Regional Adviser, External Coordination The Eastern Mediterranean Region is diverse in many aspects but shares vulnerabilities at the global, regional and country levels. Climate change and desertification, water scarcity, massive population growth, rapid urbanization, high demand for agriculture/food products, more exposure to natural hazards, migration, and increase in communicable and noncommunicable diseases are a few examples in this respect. Moreover, catastrophic
WHO-EM/WR/020/E Page 19 conflicts have been increasing in the Region. These situations call for effective partnership to mobilize new resources for responding to the increasing health needs of population, particularly in the poor countries of the Region. Recent years have seen a dramatic expansion in the number and diversity of external partners, both traditional and new, working with WHO at country, regional and global levels. It has been increasingly evident that such a multiplicity of partnerships requires improved analysis and information sharing between the country offices, Regional Office and headquarters, and better coordination among and between them and partners including the donor community, United Nations agencies, civil society and private sector. As the regular budget of the Regional Office has been declining over recent biennia, there has been a shift to voluntary contributions to fund the development and implementation of WHO programmes. This has created new challenges and obligations and emphasized the need for new and innovative ways of mobilization of resources in the Region and for enhancing the Regional and country offices’ capacities to effectively build partnership with others, mobilize and manage the external resources, and ensure the sustainability of funding health programmes. There are unique opportunities within the Region for enhancing partnership and mobilizing extrabudgetary funds. There are highly spiritual, religious and cultural values, principles and practices among the population in this Region, based on sharing of resources with the poor (zakat, etc.), sympathy, generosity and care that can be approached for mobilizing extrabudgetary resources for health actions in the Region. Moreover, there are several wealthy countries and philanthropic wealthy individual figures, foundations and charity organizations who have the potential to support health actions in the Region. In addition, the Region is changing rapidly. It is becoming not only an important consumer market but also a centre of business, with multinationals establishing their offices and production in the Region. There are many international and regional entities, such as OPEC, that can be approached for partnership and mobilization of resources. There are unprecedented opportunities for WHO/EMRO to explore greater engagement of the private sector. We need to move towards social investment by strengthening partnership with the private sector. We need to transform our traditional sporadic interaction into longer-term collaborative partnerships that build the health and well-being of the population in the Region. To enhance partnership for health, one option is to establish a Regional Fund for Health (RFH). As a partnership between governments, civil society and the private sector, the Regional Fund for Health (RFH) will represent a new approach to regional health financing. The RFH will work in close collaboration with other bilateral and regional organizations, supporting their work through substantially increased funding. Governments in the Region, members of royal families, charitable foundations, potential philanthropic individuals, private sector, technical institutions, celebrities, prominent businessmen, regional institutions and firms and others will be partners for the regional fund and will contribute to the funding of health actions in the Region. The Regional Fund will not be an independent entity, and will be governed by WHO rules and regulations including financial accountability. Contributing
WHO-EM/WR/020/E Page 20 partners will be governments, civil society organizations (CSOs), the private sector (including business and philanthropic foundations and individuals), and regional international organizations and financial institutions. The Regional Fund will rely on local and national ownership and planning to ensure that new resources are directed to programmes on the field. The Regional Fund will be a mechanism aimed at raising new resources for health actions and swiftly channel them to developing country health systems in the Region. Discussion Resource mobilization is clearly a growing requirement, given the increasing reliance on extrabudgetary funds. A task force could help explore innovative ways to advocate for resources, such as using goodwill ambassadors and region-specific channels such as zakat. Infrastructure must be put in place for resource mobilization. Resource mobilization should be a core part of every programme. Administrative requirements of both donors and WHO often present a challenge. Greater flexibility is needed from donors and countries, ongoing dialogue must be maintained. In come cases, WHO has successfully negotiated with donors to remove bureaucratic obstacles. A number of lessons have been learned from the extensive fundraising experience of the poliomyelitis eradication initiative: emphasize involvement (use the term “partner” rather than “donor”); ask only for what you need, ask each potential donor only for what it can provide; use the funds for the original planned activities; report regularly and on time; respect deadlines; and involve all partners at country level. 5.14 Health action in crisis 5.14.1 Overall Emergency and Humanitarian Action regional strategies for the future, lessons learned (agenda item 15) Mr A. Musani, Regional Adviser, Emergency and Humanitarian Action The objective of this forum was to discuss the impact on health of various disasters experienced in the Region and, more importantly, WHO’s engagement as a lead health agency before, during and after a disaster. A presentation on the epidemiology of disasters in the Region gave a detailed analysis of the frequency and impacts of disasters both a global and regional level. The number of disasters occurring globally is evidently on the increase. More importantly, the impact of various disasters (both man-made and naturally occurring) have had a tremendous impact on human lives and national infrastructure. The overall trend over time clearly illustrates that the populations affected (killed, injured or displaced) by disasters in the Region is on the increase. UN reports estimate that in the past 20 years over 3 million deaths have occurred as a result of, and some 800 million people have been affected by, natural disasters. Furthermore, damage to the infrastructure in countries affected is estimated at over US$ 50 billion. The disaster trends illustrate that this region has been significantly affected by both natural and man-made disasters. Approximately 90 million persons have been categorized as living in risk, over 13 million persons have been displaced from their
WHO-EM/WR/020/E Page 21 country of origin (58% of refugees + 36% of IDPs worldwide), and every country in this region over the past 10 years has experienced a catastrophic event leading to adverse health outcomes. In light of all these challenges in this region, which is highly vulnerable to a number of natural hazards and man-made disasters, WHO has recently embarked on a strategic approach to address the health impact of such events in order to ensure fundamental human survival in the event of a major crisis. This regional strategy is based on a multi-hazard approach which focuses on reducing the risks to health and mitigating the impact of such events through preparedness and mitigation activities. The importance of investing more in disaster preparedness and mitigation activities is a fundamental element of this strategy which is incorporated in a developmental framework and not merely a humanitarian response. A number of tools have been developed to ensure that health partners have the necessary guidance and technical know-how to better prepare for, respond to and recover from disasters. Important messages stressed during this presentation were: • • • • investing more efforts in disaster preparedness and mitigation and building national capacity; ensuring WHO’s unique role in times of emergency; ensuring that all risks and threats to health of affected communities are addressed in a systematic manner based on best practices and lessons learned; investing in partners at local and national level to ensure harmony in disaster reduction programmes.
5.14.2 Country experience in emergencies: Sudan (agenda item 16) Dr G. Sabatinelli, WHO Representative, Sudan WHO’s role in UNDG reform at country level: experience of WR office for Iraq (agenda item 17) Dr N. Al Gasseer, WHO Representative, Iraq Discussion Preparedness is key to mitigating the impact of disasters. Unfortunately, it is a behindthe-scenes activity that is unappealing to donors and largely sidelined by national authorities. Despite ongoing advocacy by the Regional Office, and disaster simulation exercises in some countries, most countries in the Region have not yet developed preparedness plans, allocated budget lines or established units/focal points in ministries of health. A culture of preparedness needs to be fostered at country level, with wide intersectoral involvement. Coordination is among the most important aspects of disaster response and recovery. In a disaster, various agencies come together with common objectives but different approaches and strategies. Coordination is needed to synergize efforts and prevent depletion of human resources and fragmentation of information. Coordination efforts, particularly in countries
WHO-EM/WR/020/E Page 22 with complex emergencies, must also ensure that the health development agenda remains focused on building the ministry of health. The Eastern Mediterranean is a particularly disaster-prone region. Emergency preparedness and management capacity should be strengthened at regional as well as country level. Coordination mechanisms are needed to make use of regional expertise for emergency situations. Experiences and lessons learnt in dealing with disasters in the Region, including less severe disasters, need to be documented and shared with other countries. Mental health interventions are needed for emergency situations, especially for children, and can help reduce long-term morbidity resulting from disasters. Community involvement during disaster response and recovery is important, both in terms of real assistance provided and in terms of mental health benefits for the community. Training materials are needed in this regard, as well as the incorporation of emergency preparedness and response components into community-based initiatives such as basic development needs. 5.15 WHO presence in countries
5.15.1 WHO presence in countries and decentralization policy (agenda item 18) Dr A. Assa’edi, Assistant Regional Director Discussion The CCS is the mid-term strategic vision for cooperation between WHO and the country. It should capture what all sectors are doing in relation to health, not just the Ministry of Health. It should capture the situation and needs at country level so as to inform the regional and global budgeting and planning process. The JPRM is the complementary workplan for implementation over two years. The consistent message from all CCS is that more needs to be done at country level on health systems in terms of planning, human resources, financing, delivery, infrastructure, essential drugs, hospitals, laboratory services, etc. The CCS documents vary tremendously in quality between countries, which is unsurprising for a first time exercise. More training is needed at country level in strategic analysis and planning. However, there is scope to revise the documents during the period concerned. The CCS should be signed off by the Minister of Health. The CCS process is still not well understood throughout WHO. Headquarters needs to distribute the guidelines to all staff and do more in terms of advocacy within WHO. Consideration should be given to allowing more time for the CCS process at country level. WRs and all technical staff should be familiar and refer to essential WHO documents (Constitution, global and regional programme budgets, policy documents, GPW, rules and regulations) as these legitimize and facilitate WHO’s work in the long run. Regional Office staff as well as WRs should be familiar with the terms of the delegation of authority to WRs.
WHO-EM/WR/020/E Page 23 Once the CCS and JPRM are in agreement with the government, it is collectively binding. While there is scope for revision, this needs to be done systematically, perhaps sixmonthly, and in consultation. In general, agreed plans should be adhered to. While legitimate requests for funding unplanned activities are considered, most funds are planned in advance and there is not much scope for replanning or reallocation. If the CCS is revisited and revised in July then the planning for the JPRM should fall into line and discrepancies be avoided. The WHO system is cumbersome compared with other UN agencies since permission for some actions still needs action at regional level, e.g. emergencies. The Africa region has special CCS for countries in crisis. Response at country level needs to be faster. The delegation of authority is a great help but the ability to respond quickly is still hindered in some areas, for example in the area of financial reporting to donors. The global management system should alleviate this situation once developed and implemented. A common planning cycle would help in planning joint activities with other UN agencies. It is essential to define a minimum core presence for all country offices, to determine basic technical needs for fixed term staff. Even small offices need more than one professional staff as the WR has many functions other than technical. The small offices have difficulty demonstrating WHO’s technical support function. Large offices need professional staff in specific technical areas. More staff training is needed at country level. The process of classification of country offices should take account of all the normative functions of all offices, however small, as well as the technical needs. Development of a model structure may assist the process of classification. WRs might also look at developing a blueprint of their needs to share with the Regional Office. Once the criteria for classification have been developed they will be shared with WRs for comment. Nevertheless the scope for recruitment at country level is limited to the availability of funds. The regions are involved in the interregional working group to define core presence. A position paper will be finalized by March 2005. It remains unclear what the decentralization split of 70:30 percent means in practical terms for the country offices, whether it will translate into more funds at the WR’s disposal and how the WR will be involved in decision-making with regard to the “one-country budget”. The shortfall of US$ 86 million in distribution of funds to the Region from other sources has hindered the ability of the Regional Office to provide additional funds to the countries. The Regional Office is working with headquarters to rectify this. The situation with regard to the SSAs needs to be regularized to the extent possible. SSAs should be used for defined tasks of limited duration and planned activities. Once the activities are completed the SSA is not necessarily renewable. WHO needs to study this problem on a wider level. WRs may look at converting SSAs to national professional officers where feasible and may be able to make better use of cooperation with ministries of health to implement activities through use of ministry staff. Funds planned for STCs may be more costeffectively planned for a fulltime technical office. UN volunteers might also be used if the necessary skills are available. Use of the JPRM to fund country office staff is acceptable provided it is jointly identified with the government and properly planned. Other UN agencies and donors may also fund staff.
WHO-EM/WR/020/E Page 24 Greater flexibility is needed in JPRM planning so that, for example: 10% can be planned at the WR’s discretion, whether for activities involving other sectors and agencies or for contingencies and activities arising during the biennium. Country offices need greater visibility and better communications skills to facilitate WHO advocacy and image. Other UN agencies are perceived to have a higher profile at country level. The field training manual developed by WR Lebanon needs to be adapted by each country office to its own circumstances. The French-speaking countries in the Region need greater consideration in access to documents in French, both from the Regional Office and headquarters. More consideration should also be given to provision of interpretation at key meetings to enhance understanding and participation. Greater attention is being given to provision of official documents and publications in all the official languages at global level and the Director-General has appointed a coordinator to study the issue. 5.15.2 Development of a country cooperation strategy document: progress of work and lessons learned (agenda item 19) Dr Marie-Andree Diouf, Department of Country Focus, WHO headquarters The Director of the Department of Country Focus presented the Country Cooperation Strategy (CCS) which reflects a medium term strategic framework (4–6 years) for WHO technical cooperation in and with a Member State for achieving the MDGs, as milestones on the road towards Health for All. It was the first of the six elements of the Country Focus Initiative that was lauched in 2000. In 2003 the Director-General turned this initiative into a Country Focus policy and set of strategies. The coverage of CCS as of November 30, 2004 is of 119 out of the 143 countries with permanent WHO country presence. In the Eastern Mediterranean Region it has been decided in 2003 to accelerate the process and a special investment has been made in this regard. Already 18 CCS have been completed or are close to completion and all countries of the Region will be covered by mid 2005. The CCS is a flexible and live process now institutionalized and acknowledged as the main basis for one country strategy, plan and budget involving the three levels of the organization, and reflecting the regular budget as well as the voluntary contributions (OS funds). The following are lessons that have been learned from those 119 CCS across the six WHO Regions. There is an universal need for strengthening Country Offices with regard to i) the WR's role of policy adviser and neutral broker; ii) the technical capacity of strengthening national health system, including health system financing; iii) and the capacity to support the coordination role of the Ministry of Health with regard to national processes such as national health plans, poverty reduction strategies, sector-wide approaches, and UN processes such as Common Country Assessment (CCA) and UN Development Assistance Framework (UNDAF).
WHO-EM/WR/020/E Page 25 New guidelines for the CCS have been prepared through a very participatory interregional process and will be issued in January 2005. It confirms that the CCS is endorsed by the Regional Director. It specifies the link with the global, regional and country managerial processes at the level of strategic objectives and approaches. They are the basis for the biennial budget and its expected results. The new guidelines put the emphasis on health systems. The debate confirmed the strong commitment of WRs to the CCS process. Still some questions need to be clarified. 5.16 Global management system: progress of the work (agenda item 21) Ms E. Mandel, Global Management System, WHO headquarters The Global Management System (GSM) will provide significant benefits to WHO and particularly to regions and countries. These benefits will include faster and more streamlined processing, improved transparency and information sharing, support to decentralization and delegation of authority, better accountability, harmonized and simplified tools and processes, and better support for working collaboratively. GSM will be a single integrated database and management system in countries, regions and headquarters, covering processes in planning and programme management, budget and finance, human resources, payroll, travel and procurement. The system will be rolled out in phases beginning in January 2006 and finishing by December 2007. The first stage of the project is being completed now. This stage covered project initiation, establishing governance and the project Board (Chaired by the Deputy Regional Director of EMRO), analysing our current processes, and selecting the software vendor. Vendor selection is being finalized now and a public announcement is expected in mid-December 2004. The second stage, beginning after vendor selection, includes detailing our requirements, and working with the vendor to identify how to meet these requirements. It also covers identifying what will be in each phase of the roll-out and where each phase will be rolled out. The third stage, which is system roll-out, will be repeated for the number of phases needed to roll out the whole system. This stage includes designing and building the system, testing it, training, deployment and support. The Regional Office involvement in the project has been very strong, with presence on the project Board, two pilot countries (Pakistan and Sudan), and strong involvement in analysis and in vendor selection. The project’s success will be enhanced by continuing strong involvement from regions and countries, particularly from the pilot countries whose active involvement is essential, in defining requirements, and in helping to manage the change involved in streamlining and harmonization. This investment is expected to pay important dividends in efficiency once the project is fully implemented.
WHO-EM/WR/020/E Page 26 Discussion The Global Management System is one of a number of global initiatives currently being undertaken to improve WHO management. Others include the global management framework, strategic resource allocation and global staff development and learning initiatives. All are region-led and respond to the needs of countries. They also build on previous experiences of WHO offices and other UN agencies that have adopted similar systems. The Global Management System is intended to transform and lighten administrative processes in WHO, which will be reflected in changes to WHO rules and regulations. Staff should make use of the opportunity to contribute to shaping the new system. The issue of multilingualism in the new system is one of many high-level requirements still being explored. Labels for fields are likely to be available in many languages, but the language of data entry may be more restricted, depending on the policy decided for information that must be consolidate across regions. Timelines are still tentative; information on availability of various components will be clearer early in 2005 and may help guide decisions about updating existing systems. The new system will ensure confidentiality where appropriate, but one of its goals is also increased transparency. The new system is being framed by the needs of technical areas rather than by information technology issues. However, the system will not work without completion of the GPN, which is expected at the end of 2005. An ITT budget line of US$ 6.7 million has been allocated by headquarters for site surveys and installation costs in each country. Recurring costs and costs for preparation of local infrastructure in countries must be borne by the Regional Office. To date the biggest obstacle to establishing the network is securing the necessary government permission. Obtaining the VSAT licence can be a lengthy process, and ongoing advocacy by WRs and negotiation with national authorities is needed in some countries. Fellowship management is outside the scope of GSM. The EMRO fellowship system could be used by all regions, and integration of the system with GSM was proposed by meeting for reporting and other purposes. This and other options for meeting the requirements should be considered by the project implementation team. 5.17 Country activity management system, WR office database, operational workplans for WR offices and planning, monitoring and evaluation portal (agenda item 22) Dr A. Assa’edi, Assistant Regional Director and Dr S. Bassiri, Regional Adviser, Planning, Monitoring and Evaluation Planning, monitoring and evaluation (PME) is keen to introduce the Country Activity Management System (CAMs), which is an advanced web-based application using Web Services technology. It aims to assist country offices in the administration and management of their work and monitor the implementation of WHO collaborative programmes through access to data in various information systems running at the Regional Office (RAMS for planning and monitoring data, ROAFI for financial data, SMIS for supplies requests, FEL for
WHO-EM/WR/020/E Page 27 Fellowship requests, PER for human resources, etc) from a single integrated user-friendly environment. A daily schedule running at the country office connects to the Regional Office servers through Web Services and downloads updated data which is reflected back into the CAMS database. The system in its primary version is very promising, further development is envisaged to enhance its functionalities at the Regional Office level. In order to improve WHO performance at country level and strengthen the technical and managerial role of WR Offices, it was crucial to assess their technical capacity, administrative capacity, work environment and internet connectivity. In this regard, a web-enabled database, interactive and online through the Internet has been designed. The results derived from the database are being used to develop plans of action for supporting country offices. It is important to note that access to the WRO Assessment Database is given according to predefined permissions, while internal and external users are authenticated by their standard usernames and passwords assigned to them by the LAN administrator in the Regional Office. The database is equipped with flexible tools for data reporting and analysis. Reports are customizable (dynamic), and can be exported to Excel files. The PME portal is innovative, modern and uses the SharePoint Portal Server 2003, a top-technology in the knowledge management era. It presents the operations and services of PME to all units/divisions and Eastern Mediterranean Region country offices, and is considered a team-orientated channel of communication and dialogue between PME and technical units on several activities, including mid-term reviews, end of biennium reports, and pair reviews. The portal is managed and built to enable a thorough user-focused, user-friendly interface, convenient to access accurate information. The portal incorporates global, regional, and country focused aspects of WHO’s work, including the Regional Activity Management System (RAMS), Country Activity Management System (CAMS), and the WR Office Assessment database. The Country Cooperation Strategy (CCS) documents, their background documents and progress of missions along with elaborate country profile document libraries that include useful links are also available. JPRM is another central feature within the PME portal that provides access to guidelines, deadlines, team members, templates for country and programme profiles, and both general and country specific briefings. Also, the Global Management System (GSM) latest news, development and bulletins in different languages are posted on the portal. The portal is an important link for key WHO references including the General Programme of Work and Programme Budget, in addition to a comprehensive list of useful links related to health and development, including Ministry of Health websites, useful UN websites, and websites of bilateral agencies for international development. Finally, the portal is equipped with a powerful Search Engine, where one can search for any document and web site included in PME portal by typing the appropriate query in the search box.
WHO-EM/WR/020/E Page 28 5.18 District team problem-solving (agenda item 23) Dr Amr Mahgoub, Regional Adviser, Health Management Support Discussion The district team problem-solving (DPTS) methodology is powerful and can be used in a variety of contexts. Once institutionalized in the planning culture, the approach can be used at every level of the health system, as in the successful experience of Oman. Community participation is key for the DTPS approach, which is a natural partner to community-based initiatives. A new tool has been introduced to link with the community. DTPS experiences and materials need to be made widely available. 6. CONCLUDING SESSION
The Regional Office will intensify its technical and financial support through WR Offices to the Member States in the development of national health policies, strategies and plans as well as decentralization of health systems, primary health care and promotion of the strategy of health for all (HFA) in the 21st century. In this regard the importance of making use of WHO documents in daily work is highlighted. All staff at regional and country level are encouraged to make full use of essential WHO documents including the Constitution, Regional Programme Budget Policy and other strategic documents such as regional and global programme budget documents, CCS, and programmatic strategies. It was also agreed that the country and regional offices should use all managerial and monitoring tools (PME portal, RAMS, CAMS and the WR office assessment database), which will be further enhanced to meet the changing needs. Many countries of the Region are facing man-made or natural emergencies. To improve their capacity in mitigation, preparedness and response, the Regional Office will continue its technical support to the development and implementation of national plans for emergency preparedness and response. Concerted efforts should be made to mobilize resources for national preparedness and response, particularly for countries in chronic crisis. Special focus should be given to inclusion of community-based disaster preparedness and response in in the Region. In view of the multifaceted nature of some programmes like HIV/AIDS, substance abuse and Tobacco Free Initiative, and the fact that many other sectors are involved in addressing the problems, WRs should further strengthen their partnerships with civil society (including nongovernmental organizations), relevant other health-related sectors and the community in awareness creation activities, prevention and management of these problems. WRs may also ensure that the roles of partners are well defined in a complementary way and supported by appropriate action.
WHO-EM/WR/020/E Page 29 The participants commended the quality of the meeting with respect to the programmes, planned individual meetings and practical, action-oriented and friendly environment in all the discussions. 7. 1. RECOMMENDATIONS A comprehensive plan of action for staff development and learning should be developed at regional and country levels. The required financial resources should subsequently be allocated to ensure its operationalization and sustainability. (PER, SDL Committee, WRs,) 2. A position paper should be developed to present the public health challenges of the 21st century alongside the strategies to address them through primary health care at the country level. The position paper should be discussed and adopted in a regional consultation along with its framework for action (ARD, PDs, WRs) 3. The Regional Advisory Panel on the Impact of Drug Abuse (RAPID) should take a proactive role in providing technical advice to country offices for mobilization of national activities to combat the health hazards of substance abuse, including relevant actions within HIV/AIDS proposals for the Global Fund. (MNH, ASD, WRs) 4. The WRs should continue to encourage Member States to expedite ratification of the Framework Convention on Tobacco Control and its subsequent enforcement. (WRs, TFI) 5. The Regional Office should intensify its technical and financial support to the 10 MDGpriority countries of the Region, in development of mid-term action plans and monitoring progress towards achievement of goals, building on the strategy of Health for all (HFA) in the 21st century along with various other national strategies aimed at poverty reduction (PRSPs, HPIC, Sector-Wide Approach, GFATM funded projects, etc). (DRD, PDs, WRs) 6. The preparation of the General Programme of Work should ensure the use of other tools for strategic planning and epidemic forecasting in addition to the scenarios approach. Country and regional offices should be fully engaged to ensure that national development plans and CCS documents are used in the process. (PME, PRP/HQ, WRs) 7. A regional task force should be established on resource mobilization to support development of a regional strategy on resource mobilization and partnership. (COR, ARD)
WHO-EM/WR/020/E Page 30 8. The Regional Office should ensure that French-speaking countries receive critical and policy-related publications and documents in French. The Regional Office also should facilitate, when possible, simultaneous translation in all official meetings for French speaking member states. (HBI, technical units) 9. The Regional Office should take necessary action to accelerate re-profiling of country offices in close collaboration with the WRs, ensuring core staffing needs are met. High priority should be given to regularizing the status of key technical staff for programme support. (ARD, DAF, WRs) 10. The CCS documents should be used to guide development of the JPRMs and intercountry programmes. The Regional Office and headquarters should use the CCS in development of programme budget as well as in support of the country programmes. (WR, Programme Directors, ARD, PME, CCO/HQ) 11. In line with decentralization, the Director General should consider increasing the delegation of authority to the Regional Director, to facilitate the work of WRs and improve performance at country level. (RDO, DGO) 12. The Regional Office and WRs should be involved in the process of developing the global management system to ensure its responsiveness to regional and country specifications. The fellowship system should be integrated with the GSM. (WRs, PME, GSM/PRP/HQ) 13. The experience of community participation in the GFTAM-funded projects on prevention and care of these diseases in the BDN areas in Pakistan should be shared across the Organization and with other Member States. DTPS and similar managerial tools (e.g. TQM, MEP, etc.) should be integrated into national health systems development especially through involving the community in development planning through BDN. (CBI, HMS, DCD, WRs) 14. WHO representatives should support a comprehensive approach to the new areas of work in Essential Health Technologies, considering related workplans in their next JPRM. The Regional Office will provide technical support to enhance this area of work in the Member States. (LAB, WRs)
WHO-EM/WR/020/E Page 31 Annex 1 AGENDA 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. Opening remarks Follow-up of the recommendations of the last meetings Staff development and learning: regional policy and plan of action, global leadership programme Public health and health for all in the 21st century in the Eastern Mediterranean Region: challenges and strategic directions 3 by 5 Initiative and the Global Fund: progress and challenges Drug abuse WHO Framework Convention on Tobacco Control Millennium Development Goals and role of WHO in the Region, monitoring of achievement of MDG indicators in the Eastern Mediterranean Region Essential health technologies: briefing on the scope and challenges Knowledge management at the country office level: what does it mean and what to expect? 11th General Programme of Work Renewal of results-based management framework, mid term strategic plan and strategic resource allocation Monitoring and evaluation of implementation of workplans, reporting formats for midterm review and end of biennium Building partnership for health: reaching out others, advocacy and resource mobilization Overall emergency humanitarian action regional strategies for the future, lessons learned Country experience in emergencies: Sudan WHO’s role in UNDG reform at country level, WR Iraq’s experience WHO presence in countries and decentralization policy Development of country cooperation strategy document: progress of work and lessens learned Delegation of Authority Global management system: progress of the work Country activity management system, WR office database, operational workplans for WR Offices and PME portal District Team Problem-Solving Individual meetings of WRs with divisions Review of the draft report of the meeting and recommendations Closing Session
WHO-EM/WR/020/E Page 32 Annex 2 PROGRAMME Sunday, 28 November 08.30 – 9.30 Opening remarks Dr Hussein A. Gezairy, Regional Director Follow-up of the recommendations of the last meeting 09.30 – 11.00 Dr Abdullah Assa’edi, Assistant Regional Director Staff development and learning: regional policy and plan of action, global leadership programme Dr Belgacem Sabri, Director, Health Systems and Services Development Ms Jutta Nopper, Regional Personnel Officer Ms Helen Robinson, Planning, Resource Coordination and Performance Monitoring, WHO headquarters 11.30 – 13.00 Public Health and HFA in the 21st century in EMR: challenges and strategic directions – a discussion paper Dr B. Sabri, Director, Health Systems and Services Development 3 by 5 initiative and the global fund: progress and challenges Dr Zoheir Hallaj, Director, Communicable Disease Control Drug Abuse Dr Ahmed Mohit, Director, Health Protection and Promotion WHO Framework Convention of Tobacco Control Dr Fatimah El Awa, Regional Adviser, Tobacco Free Initiative Millennium Development Goals and role of WHO in the region, monitoring of achievement of MDG indicators in the Eastern Mediterranean Region Dr Mohamed A. Jama, Deputy Regional Director Essential health technologies: briefing on the scope and challenges Dr Nabila Metwalli, Regional Adviser, Blood Safety, Laboratory and Imaging Knowledge management at the country office level: what does it mean and what to expect? Dr Najeeb Al Shorbaji, Regional Adviser, Health Information Management and Telecommunications Support
14.30 – 15.30
15.45 – 17.15
Monday, 29 November 08.00 – 10.00 11th General Programme of Work Mrs Pascale Brudon, Planning, Resource Coordination and Performance Monitoring, WHO headquarters Renewal of results-based management framework, mid term strategic plan and strategic resource allocation Dr Harry Feirman, Planning, Resource Coordination and Performance Monitoring, WHO headquarters
WHO-EM/WR/020/E Page 33 10.30 – 12.00 Monitoring and evaluation of implementation of workplans, reporting formats for midterm review and end of biennium Dr Sussan Bassiri, Regional Adviser, Programme Planning, Monitorin and Evaluation Dr Harry Feirman, Planning, Resource Coordination and Performance Monitoring, WHO headquarters Building partnership for health: reaching out others, advocacy and resource mobilization Dr Ghulam Popal, Regional Adviser, External Coordination Dr Mubashar Sheikh, WR/Islamic Republic of Iran Dr Fouad Mujalled, WR/Syrian Arab Republic Health action in crisis Overall emergency humanitarian action regional strategies for the future, lessons learned Mr Altaf Musani, Regional Adviser, Emergency and Humanitarian Action Country experience in emergencies: Sudan Dr Guido Sabatinelli, WR/Sudan WHO’s role in UNDG reform at country level, WR Iraq’s experience Dr Naeema Al Gasseer, WR/Iraq
14.00 – 16.30
Tuesday, 30 November 8.00 – 10.00 WHO presence in countries WHO presence in countries and decentralization policy Dr Abdullah Assa’edi, Assistant Regional Director Development of country cooperation strategy document: progress of work and lessens learned Dr Marie-Andree Diouf, Department of Country Focus, WHO headquarters Delegation of Authority Dr Hichem Lafif, Director, General Management Global management system: progress of the work Ms Eva Mandel, Global Management System, WHO headquarters Country activity management system and WR Office database Dr Abdullah Assa’edi, Assistant Regional Director and Dr Sussan Bassiri, Regional Adviser, Programme Planning, Monitoring and Evaluation Operational workplans for WR Offices and PME portal Dr Abdullah Assa’edi, ARD and Dr Sussan Bassiri, Regional Adviser, Programme Planning, Monitoring and Evaluation District team problem-solving (including 20 minutes film) Dr Amr Mahgoub, Regional Adviser, Health Management Support
10.30 – 12.00
13.30 – 16.00
Wednesday, 1 December 8.30 – 10.45 Individual meetings of WRs with divisions 11.15 – 13.30 Individual meetings of WRs with divisions 15.00 – 17.15 Individual meetings of WRs with divisions Thursday, 2 December 8.30 – 10.30 Individual meetings of WRs with divisions 11.15 – 14.15 Individual meetings of WRs with divisions 15.00 – 16.00 Review of the draft report of the meeting and recommendations closing session
WHO-EM/WR/020/E Page 34 Annex 3
LIST OF PARTICIPANTS WHO REPRESENTATIVES Dr Riyad Musa Ahmed A/WHO Representative AFGHANISTAN Dr Jihane Tawilah WHO Representative DJIBOUTI Dr Zuhair Hallaj A/WHO Representative EGYPT Dr Mubashar Riaz Sheikh WHO Representative ISLAMIC REPUBLIC OF IRAN Dr Naeema Al-Gasseer WHO Representative IRAQ Dr Muhammed Z. A. Khan A/WHO Representative and Director CEHA JORDAN Dr Habib M. Latiri WHO Representative LEBANON Dr Ibrahim Al Hadi Sherif National WHO Representative LIBYAN ARAB JAMAHIRIYA Dr Raouf Ben Ammar WHO Representative MOROCCO
WHO-EM/WR/020/E Page 35 Dr El Fatih El Samani WHO Representative OMAN Dr Khalif Bile Mohamud WHO Representative PAKISTAN Dr Ambrogio Manenti Head of Office PALESTINE Dr Awad Abuzaid Mukhtar WHO Representative SAUDI ARABIA Dr Ibrahim Betelmal WHO Representative SOMALIA Dr Guido Sabatinelli WHO Representative SUDAN Dr Abdullahi Mohamed Ahmed WHO Technical Officer Public Health Coordinator for South Sudan SUB-OFFICE IN SOUTH SUDAN Dr Fouad H. Mujalled WHO Representative SYRIAN ARAB REPUBLIC Dr Ibrahim Abdel Rahim WHO Representative TUNISIA Dr Hashim Ali El-Zein El-Mousaad WHO Representative REPUBLIC OF YEMEN
WHO-EM/WR/020/E Page 36 COUNTRY DESK OFFICERS Dr Fariba A. Al-Darazi Desk Officer/BAHRAIN Dr O. Khatib Desk Officer/KUWAIT Dr Hoda Atta Desk Officer/PALESTINE Dr A. Abdul Latif Desk Officer/QATAR Dr Said Arnaout Desk Officer/UNITED ARAB EMIRATES
UNITED NATIONS RELIEF AND WORKS AGENCY FOR PALESTINE REFUGEES IN THE NEAR EAST (UNRWA) Dr Fathi Moussa Special Representative and Director of Health UNRWA Headquarters Branch JORDAN WHO headquarters Dr Marie-Andree Diouf, Director, Sustainable Development and Healthy Environments Ms Eva Mandel, Global Management System Dr Harry Feirman, Planning, Resource Coordination and Performance Monitoring Mrs Pascal Brudon, Planning, Resource Coordination and Performance Monitoring Dr Peilong Liu, Director-General Office WHO Regional Office for the Eastern Mediterranean Regional Director Deputy Regional Director Senior Policy Adviser to the Regional Director Special Advisers to Regional Director Programme Directors All Regional Advisers All technical and professional staff Senior Administrative Assistants