Financial and administrative implications for the Secretariat of resolutions proposed for adoption by the Regional Committee: a call for action to enhance and scale up the health workforce in the Eastern Mediterranean Region

Regional Committee for the Eastern Mediterranean Seventieth session Provisional agenda item 3(c) EM/RC70/R.4 Add.1 October 2023 Financial and administrative implications for the Secretariat of resolutions proposed for adoption by the Regional Committee Resolution: EM/RC70/R.4 A call for action to enhance and scale up the health workforce in the Eastern Mediterranean Region A. Link to the approved Programme budget 2022–2023 1. Output(s) in the approved Programme budget 2022–2023 under which this draft resolution would be implemented if adopted: Strategic priority 1: One billion more people benefiting from universal health coverage Outcome 1.1: Improved access to quality essential health services irrespective of gender, age or disability status Output 1.1.5: Countries enabled to strengthen their health and care workforce 2. Short justification for considering the draft resolution, if there is no link to the results as indicated in the approved Programme budget 2022–2023: N/A 3. Any additional Secretariat work during the biennium 2022–2023 that cannot be accommodated within the approved Programme budget 2022–2023: N/A 4. Estimated time frame (in years or months) to implement the resolution: 2024 to 2030 B. Resource implications of the implementation of the resolution for the Secretariat 1. Total resource levels required to be budgeted to implement the resolution: US$ 30.75 million 2.a. Estimated budget levels required which can be accommodated within the approved Programme budget 2022–2023: N/A 2.b. Estimated budget levels required in addition to the amount already planned in the approved Programme Budget 2022–2023: N/A 3. Estimated resource requirements to be budgeted for in the proposed Programme Budget 2024–2025: US$ 7.67 million EM/RC70/R.4 Add.1 2 4. Estimated resource requirements to be budgeted for in the proposed programme budgets of future biennia: US$ 23.08 million 5. Level of resources already available to fund the implementation of the resolution in the current biennium: – Resources available to fund the resolution in the current biennium: N/A – Remaining financing gap in the current biennium: N/A – Estimated resources, not yet available, if any, which would help to close the financing gap in the current biennium, if any: N/A Annex. Breakdown of estimated resource requirements (in US$ millions)a Biennium Costs Country offices Regional Office Total B.2.a: Already planned for in approved Programme Budget: 2022–2023 Staff Activity costs Total 0.00 0.00 0.00 B.2.b: 2022–2023 additional resources Staff Activity costs Total 0.00 0.00 0.00 B.3: Programme Budget 2024–2025 to be planned Staff 1.50 2.75 4.25 Activity costs 2.77 0.65 3.42 Total 4.27 3.40 7.67 B.4: Future biennia (Programme Budget 2026–27 to be planned Staff 3.89 7.16 11.05 Activity costs 9.78 2.25 12.03 Total 13.67 9.41 23.08 Overall total 17.94 12.81 30.75 a The row and column totals may not always add up, due to rounding (note to be deleted if totals do add up). The total resources required for the implementation of the Resolution from 2024 to 2030 amount to US$ 30.75 million, of which the planned allocations for staff and activity costs are at a 50/50 ratio. Overall, the majority (58%) of the resources is planned to be allocated at the country level, especially for the six priority countries in the WHO Support and Safeguard List in the Region, Afghanistan, Djibouti, Pakistan, Somalia, Sudan and Yemen, where dedicated technical staff will be positioned to take the lead and carry out the planned interventions to accelerate actions to enhance and scale-up a fit- for-purpose health workforce. It is worthwhile to highlight that the proposed Resolution covers comprehensive actions to scale up the health workforce in the Region. Thus, the resource requirement covers overall investment in output 1.1.5. The increase is commensurate with the current allocation. = = = EM/RC70/R.4 Add.1 3 Guidelines for completion of the template Section A: Link to the approved Programme Budget 2022–2023 A.1: Output(s) in the approved Programme Budget 2022–2023 under which this draft resolution would be implemented if adopted Please list the programmatic output or outputs under which the work to deliver the resolution would be budgeted and implemented. In most instances, this should not include more than three outputs unless considered necessary. In the rare instances where there is no link to the approved Programme budget, this should be completed with N/A (see Section A.2). A.2: Short justification for considering the draft resolution, if there is no link to the results as indicated in the approved Programme Budget 2022–2023: Please only fill out this section if the answer to A.1 was N/A. The most common answer to this section will be N/A, since there are very few resolutions or decisions which are not related to a result already planned for in the approved Programme Budget. A.3: Any additional Secretariat work during the biennium 2022–2023 that cannot be accommodated within the approved Programme Budget 2022–2023: This section has to be completed if section A.2 has been filled out, but as noted above, this will be rare. Otherwise, this section should be used very sparingly since it constitutes an effective request for a raise in a budget ceiling, which should only be made when the following criteria are met: • the work required to deliver the resolution has not been planned for to any extent in existing workplans; • the ceiling as approved for the outcome(s) under which the work will be budgeted is highly likely to be 100% implemented by the end of the biennium and will not leave any space which could realistically be allocated to the delivery of the resolution through reprogramming within or between outputs and/or budget centres; • it is highly probable that there will be sufficient capacity (both human and financial) for the resolution to be implemented, assuming adequate budget space; • the total amount to be costed is at least US$ 10 million. A.4: Estimated time frame (in years or months) to implement the resolution: This refers to the entirety of the time frame over which the resolution will be implemented and should be derived from the text of the proposed resolution. If there is no obvious endpoint in a technical sense, the end date can be taken as the last date at which the Regional Director is called upon to report back to the Regional Committee. This will determine the levels of costing across different biennia which are required in section B. Section B: Resource implications of the implementation of the resolution for the Secretariat In general terms, resource requirements are the planned expenses that the WHO Secretariat will incur in delivering the work called for under the resolution if it is adopted. This work is defined in the operating paragraphs of the draft resolution. This does not refer to actual funding per se, only to the necessary cost to deliver this work. Whatever is costed will then have to be funded through WHO’s standard practices of resource mobilization and allocation. The logic for costing a resolution is the same as that applied for planning the programme budget. It should be a bottom-up process which is designed to determine the level of resources required across the Region to deliver the results specified in the operating paragraphs. These should be broken down in the Annex (see below) by staff and activity costs. Unless the costing is extremely low, these can be high level estimates and will not be enforced in a detailed manner (e.g. a 50/50 split between staff and activity envelopes will be able to be implemented as a 40/60 split if required when the resolution is operationalized). The precise levels may also be adjusted in later biennia. EM/RC70/R.4 Add.1 4 The costings of the resolution for biennia after the present should be considered when planning the programme budgets for those biennia. Future programme budgets should include whatever work Member States have required from the Secretariat through the approval of resolutions and decisions and this should be borne in mind when determining the costing levels. B.1: Total resource levels required to be budgeted to implement the resolution, in US$ millions: This is the total resource levels which will be required to deliver the resolution to its endpoint as defined in A.4. It is equivalent to the sum of Sections B.2 to B.4 which break resource levels down by biennium, and to the total of the table included in the Annex. The work to be costed is only what the operating paragraphs of the draft resolution actually call for the Secretariat (referred to as the Regional Director) to do. For example, costing a resolution which calls upon the Secretariat to develop a 10-year strategy for consideration by the Regional Committee in a year’s time should not include the investment which will be needed to implement that strategy. It should only include what WHO will have to budget to develop that strategy over the next year. If, in a year’s time, the Regional Committee then approves the strategy, a new costing will be prepared for the implementation costs over 10 years, as called for by the now-approved resolution. Note that the costing only includes costs which should be borne by the Secretariat. Therefore, additional investments which may be called for from Member States or other partners are not included. Costings given in this section and in the rest of section B should be global totals only, displayed in the format US$ x.xx million, referring to US$ millions. For example, a resolution costed at four million dollars would be displayed as US$ 4.00 million. The breakdowns by Regional and Country Office levels and salary/activity will be entered in the Annex table (see below). B.2.a: Estimated budget levels required which can be accommodated within the approved Programme Budget 2022–2023, in US$ millions: This is the cost of the work required which is already planned as part of the approved programme budget. It is expected that for most mandates the work required to deliver the resolution will be programmatically and budgetarily aligned with the programme budget and with its accompanying work already planned, hence no change to the ceiling already approved will be required. It is strongly recommended that unless exceptional and significant ceiling increases are justified, the cost of delivering the resolution in the current biennium be entered here. B.2.b: Estimated budget levels required in addition to those already planned in the approved Programme Budget 2022–2023, in US$ millions: It is expected that most resolutions can be accommodated within the current scope and/or budget or the current Programme Budget (Section B.2.a). Therefore, this section must be used as infrequently as possible if any work has been detailed under section A.3. Here is where additional ceiling requirements in the current biennium should be entered. The main reason for avoiding use of section B.2.b if possible is that it constitutes a direct request to Member States to approve an increase in the existing ceiling. This is something to which Member States are highly sensitive and for which they require a very strong justification. If one cannot be provided, they are quite likely to withhold approval, pending the resubmission of the costing with all costs for the present biennium moved from section B.2.b to section B.2.a. Therefore, before entering anything into section B.2.b, serious consideration should be applied as to whether it is absolutely necessary. B.3: Estimated resource requirements to be budgeted for in the proposed Programme Budget for 2024– 2025, in US$ millions: As stated above, the planned cost levels for the next biennium should be summarized here, following the same logic as above. EM/RC70/R.4 Add.1 5 Where costings are extrapolations from one biennium to the next, it is recommended to include a 4% cumulative increase as standard adjustment for inflation : i.e. 104% of the last biennium’s planned amounts whether actual or extrapolated. B.4: Estimated resource requirements to be budgeted for in the proposed programme budgets of future biennia, in US$ millions: • As in Section B.3, this is an extension of the costing prepared according to the same logic but for the remainder of the implementation period as defined in Section A.4. Individual biennia do not have to be broken down, but it should be considered whether the same level of work will need to be carried out in each biennium or whether scaling up or scaling down may be necessary. This can be taken into account in devising the overall total. B.5: Level of resources already available to fund the implementation of the resolution in the current biennium, in US$ millions • Resources available to fund the resolution in the current biennium: • Remaining financing gap in the current biennium: • Estimated resources not yet available which would help to close the financing gap in the current biennium, if any: The purpose of this section is for reference only. Although a costing is not driven by actual resources, it may still be informative for Member States asked to approve a resolution costed, for example, at US$ 25 million over one year, where only US$ 25k are available with no realistic prospects for resource mobilization. This may then lead Member States to question whether the costing, or even the resolution itself, is actually realistic. On this basis, the section should thus indicate, under the three points: • Actual funds presently available, if any • The funding gap (i.e. the total of costing in B.1 less whatever is available) • Resources projected to be mobilized soon, if any All figures should be displayed as US$ x.xx million. It is worth noting that a properly costed resolution can serve as a valuable tool for resource mobilization with donors subsequent to its approval by the Regional Committee. Annex: Breakdown of estimated resource requirements (in US$ millions) The table here comprises the breakdown of the total costs in Sections B.2, B.3 and B.4 by Regional Office and Country Office levels and the type of expenditure planned. The totals should match those in the respective sections. As above, the totals should be given as US$ x.xx million unless the costing total is less than US$ 1 million, in which case it can be prepared in US$ thousands. Costings are not presented by individual Country Offices. They are presented simply as an aggregate of all costs estimated at those levels. This gives more managerial flexibility for reprogramming at later dates, depending on how precise circumstances develop. The best practice, however, is to estimate the costs by country offline and then present these as the aggregate. The presenter will be able to refer to the details used if specifically questioned but the costing itself does not have to be approved by individual budget centre. Precise costings for staff in Country Offices should be calculated according to the Post Cost Averages (PCA) which are available to WHO workforce at https://intranet.who.int/homes/prp/budget/costaverages/index.shtml.